Webinar | The Second Spring: Navigating Perimenopause and Menopause

To mark World Menopause Day on Friday 18 October, the Victorian Women’s Trust proudly presented an expert panel on perimenopause and menopause.

Messages around perimenopause and menopause are often in conflict. With fear mongering in the media, alarming statistics about a woman’s earning capacity during this time, and a lack of adequate support from some in the medical profession, it’s easy to see perimenopause and menopause as “the beginning of the end.” In other quarters, this pivotal season of life — sometimes called the ‘second spring’— is framed as an opportunity for self-reflection, growth, and renewal.

How essential is reproductive leave during this life stage? Is it possible to break the societal taboo and prioritise wellbeing? And what role does our mindset play?

Speakers:

• Jane Bennett (Menopause Educator and Facilitator, WorkCycle)
• Prof Jayashri Kulkarni (Professor of Psychiatry, The Alfred and Monash University)
• Moderated by Gina Rushton (journalist, reporter, author of The Parenthood Dilemma and host of The Dilemma podcast)

Transcript:

Gina Rushton: I’d like to begin by acknowledging the Traditional Owners of the lands in which I’m coming to you, from which is the Gadigal land of the Aurora nation. I pay my respects to Elders past and present. Sovereignty was never ceded. This always was, and always will be, Aboriginal land.

Gina Rushton: So my name is Gina Rushton. Once upon a time I was a reproductive health and rights reporter, but now I’m the editor of Crikey, author of The Most Important Job in the World, and the host of The Dilemma Podcast, which is brought to you by the Victorian Women’s Trust.

Gina Rushton: Today I am delighted to be joined by two incredible experts to facilitate a conversation proudly presented by the Victorian Women’s Trust on World Menopause Day. Happy World Menopause Day, everyone.

Gina Rushton: So we’re here to discuss the complexity and contradictions in all of the conversations about perimenopause and menopause.

Gina Rushton: We are going to have a short Q&A towards the end. So you can pop your questions in the chat.

So it’s not in the actual chat function on this webinar, it’s in the Q&A function. So if you click on ‘more’, you should be able to find the Q&A spot and put those questions there. You can also vote for people’s questions. If there’s a question that you really really want asked, make sure you make that clear, so we can bump it to the top of the list.

And of course everyone’s story is important. But for the purposes of this forum it isn’t a place for sharing personal experiences. It’s just a spot for questions, and the wonderful Victorian Women’s Trust team will pop recommended support services in the chat.

Gina Rushton: I am going to introduce our speakers. I understand one’s just dropped off because of bad internet. But we’ll proceed anyway, and hope that she gets back on soon. So Prof Jayashri Kulkarni is an academic and clinical psychiatrist running a women’s mental health and second opinion clinic in a metropolitan public hospital.She’s been caring for women with early menopause and related mental health concerns for years in both public and private settings. Her research focuses on perimenopausal depression, women’s mental health and the relationship between gonadal hormones.

I hope I’m saying that right? I’m sure you’ll correct me if I’m not. And mental health. Prof Kulkarni’s dedication to improving women’s wellbeing has been central to her career.

Gina Rushton: We are also joined, or will be again when she joins back up with her internet, joined by Jane Bennett, who is a social worker, researcher, writer, and educator, with nearly years of experience. She is the founder of the Chalice Foundation, a facilitator with WorkCycle, and has dedicated much of her career to natural fertility management, co-authoring, several resources, including the natural fertility management kits,
About Bloody Time: The Menstrual Revolution We Have to Have, and The Pill: Are You Sure It’s For You?

Gina Rushton: Jane also launched programs like Celebration Day for Girls and Mense-Ed, focusing on empowering women and girls through education. Her work continues to foster healthy curiosity and best practice self-care.

Gina Rushton: So much like, I guess, everything to do with reproductive health. There is simultaneously minimising and fear mongering when it comes to this stuff, when it comes to perimenopause and menopause. So let’s sort of get clear on the basics.

Gina Rushton: Prof Jayashri, how would you define perimenopause? And how does it differ from menopause?

Prof Jayashri Kulkarni: So, as per usual with anything medical, let’s introduce the most confusing terminology possible. So in the simplest of terms the whole menopausal process takes about to years. So unfortunately, it’s a long ride, and the beginning of it — ‘peri’ — is called perimenopause. So peri being around menopause, but it’s actually in the intro to menopause. And people talk about this period of time, which commonly starts at about somewhere about there, that there are symptoms

Prof Jayashri Kulkarni: that I say, you know, it starts in the brain and and the brain symptoms. The first lot of symptoms that women may or may not notice. So that’s the difficulty, because this is all going on before the end product is the stopping off period and hot flushes. So the actual menopause is one day in a woman’s life, at which point in time the periods stop and she doesn’t get any more.

Prof Jayashri Kulkarni: So it’s a very strange terminology, and you know, as usual, it’s probably made up by men to confuse women, and to, you know again obfuscate all of the difficulties that can happen over a long period of time. So let’s get that straight. This is a transition between reproductive and non-reproductive, but in that there are fluctuations in the hormones that have many, many different effects in brain and body.

Prof Jayashri Kulkarni: and it goes from about to about would be the average age in the Australian population.

Gina Rushton: Great. Thank you.

That was very succinct as well, considering it’s such a big —

Prof Jayashri Kulkarni: And I got to have my little dig at, y’know, who made up this crazy terminology.

Gina Rushton: Yes, it is really confusing.

Gina Rushton: so I want to talk about the common symptoms of perimenopause and menopause. Can you take us through some of those?

Prof Jayashri Kulkarni: Sure.

Prof Jayashri Kulkarni: So, as I said, it’s you know, the beginning of the process sometimes can go unnoticed, but it is beginning in the brain with symptoms that are of mental health concern. So this is, and it can happen in both groups of women, that is one group of women who’ve had mental health problems in the past and have had complete control over it. They’ve been happy. And then, all of a sudden, bang!

Everything just starts to go haywire again, and they can have a relapse of their depression.

Prof Jayashri Kulkarni: Or the second group is where the mental health problems are brand new. They’ve never had anything before. And then suddenly, at about they can start to experience severe anxiety with panic attacks, and then, followed by a whole raft of symptoms that are not traditionally sort of the usual major depressive symptoms.

By that I mean — Sleep goes off, and this is well before there’s hot flushes, so the sleep can be really difficult, you know, as in getting up having  hours of sleep and then ruminating about everything, So sleep goes off. Energy can go, you know, just not have no energy. And I’ve had patients describe things like, “I couldn’t even have the energy to pick up a hairbrush to brush my hair. That’s how tired I was, but I couldn’t sleep.”

Prof Jayashri Kulkarni: And so that can happen. The mood can be sometimes sad, but it’s not the sort of sustained, depressive mood that we see in major depression. This is a mood that fluctuates as well as that. There can be rage. There can be this incredible hostility and just snapping people’s heads off, and being really enraged about something that normally wouldn’t bother her. So this is out of character.

Prof Jayashri Kulkarni: And of course, you know, I believe women are allowed to be angry about so many different things. But this is something that is out of character rage.

Prof Jayashri Kulkarni: There’s also weight gain, which is often the opposite to major depression where there’s weight loss. So this is weight gain, and we do know that the menopausal physical process involves weight gain, for most women, between and kilos. And it’s because of all the hormone changes, in terms of hormone metabolism of fats and other carbohydrates, and so on. So this is weight gain.

Prof Jayashri Kulkarni: There’s also a loss of self-esteem. So many times, the person is…sort of self denigratory in her thoughts. “I’m big, I’m fat, I’m ugly. I’m old.”

“No one would want to stay with me”— that kind of self denigration. And then, there can be, added to that, a sense of paranoia, which is not paranoid schizophrenia type thinking.

Prof Jayashri Kulkarni: But it goes along the lines of, “they had a new computer program at work. We had to go to the tutorial, and I know that everybody thinks I’m useless, because I couldn’t pick it up as fast as the others in the group. They’re probably thinking, I’m old and you can’t teach an old dog new tricks.” That sort of paranoia. That other people are talking about the person, the woman.

Prof Jayashri Kulkarni: There’s dissociation or disconnection, which is this terrible feeling that people have when they’re very anxious, that they can sort of go, “Oh, the rooms tilting,” or “I feel out of my body,” or they’ll look at the family that are enjoying the meal that she’s cooked, and saying things like, “I don’t feel connected to them. They’re all talking about something, and I feel like I’m in a bubble. I’m not communicating with them.”

Prof Jayashri Kulkarni: Libido can disappear altogether or be very diminished, and if that goes along with vaginal dryness, then sex can be painful, and that sets up a terrible cycle of fear of pain. Pain occurs, then there’s more fear, and on that goes, and then there can be the sense of, “I have to have sex to keep him happy”, if it’s a heterosexual relationship, or “keep her happy.” And that can lead to unwanted sex and resentment and all sorts of things there as well.

Prof Jayashri Kulkarni: So the symptoms can come on, and the mood disturbance is there. As I mentioned, it can be a full on sadness with tears, but it can also very much, sort of, subside in a couple of days. So the fluctuations are what throws people, because sometimes women have really bad time, and they’re really, really unable to function either in work or at home, or in any kind of pleasurable activities that she normally would love.

Prof Jayashri Kulkarni: So she can’t do any of it, and then, that can go on, for you know weeks, and then all of a sudden, one day she wakes up and goes, “I’m back. I feel fine.” And then that feeling fine can go on for a little bit, and then suddenly crash again. And so people from the outside are looking at this going, what the hell is going on here? And that’s where, unfortunately, many mental health clinicians do not think about the menopause at all.

Prof Jayashri Kulkarni: So then you get the diagnoses of bipolar disorder, or all kinds of other kinds of psychiatric disorders or treatment resistant depression. And so then the person gets treated with antidepressants, and that doesn’t particularly hit the spot, and then she gets another antidepressant or a bigger dose.

Prof Jayashri Kulkarni: Then comes the mood stabiliser or the antipsychotic and you know, it just is awful. Worst thing is when somebody is struggling with their cognitive function, which is also another symptom. They can have memory loss. So very commonly people go, “I walked into the room for something, and I can’t remember what it was”, or “I’m in the shopping centre trying to buy something. And what was it?”

And all of a sudden, you know, the first thing is, people say, “I can’t possibly remember a mobile phone number, because that’s digits.” Mind you, very rarely do we try and remember something like a mobile phone number. It’s plugged in. But those memory kind of changes are also typical.

And so it becomes a thing that if this person has the mood, then the memory, and it’s up and down that sometimes the diagnosis of bipolar disorder or treatment resistant depression, ends up with her getting ECT or shock treatment, and that makes her memory worse.

Prof Jayashri Kulkarni: So there are a few pitfalls that we’ve got. But I wanted to also say, I am not into medicalising menopause. Millions and squillions of women go through menopause very happily, and that’s fabulous. Leave them alone. We can give them information about their physical health and looking after their physical health, and maybe their mental health, if a little bit is disturbed. But she’s on top of it. She’s fine.

Prof Jayashri Kulkarni: Let’s leave her alone. I have no intention to interfere there, and great, and I know many women who have had a really nice time of not having periods anymore. And then, you know, not worrying about their body shape and all that. So that’s brilliant.

Prof Jayashri Kulkarni: But from my perspective, I’m in a tertiary hospital clinic, and I see the most despairing of situations where women have, you know, again attempted suicide, and suicidality is a thing that can happen when the depression is really significant and severe. So that’s the group that I’m very much working for, working with.

Prof Jayashri Kulkarni: I think no matter if you’re a woman who’s had an easy time of it. You know, your sisters are not. Some of your sisters are not, so. That’s why I get annoyed when people go, “Oh, leave it alone.” Okay, I’ll leave them alone. I’m already got a year waiting list, so I don’t need any more people, but it’s the sort of sense that we mustn’t leave anybody behind. We must not leave any woman behind who could reach her potential or has reached her potential, and then is losing her potential because of something that we can sort with her.

Gina Rushton: Yes, so on that note, and I’m sure there was so much there, and I’m sure it’s bringing up a lot of questions for people. So please do put them in the Q&A function, if there’s something there that you want to dig a bit deeper into.

Jane, now that you’re back, I’d love to come to you on this, now that we’ve sort of talked through some of those symptoms — What can women do to cope with these changes in both personal but also professional context? Because this affects all parts of your life, really.

Jane Bennett: Sure, sure, and sorry everyone that I missed out the the very beginning. It’s all of a sudden, the storm arrived and my internet went out. But lovely to be here. I think one of the things I’d like to say to start with, just to really, you know.

Jane Bennett: add to what you were saying, Prof Kulkarni, is that when we did the 3,500 odd women research with the Victorian Women’s Trust,
that then led into the book, About Bloody Time, we had categories of women: and over, having gone through menopause, and the other and over, having not yet gone through menopause. There were thousands of women in that category. And one of the things that struck me, and struck us as a team, was how extraordinarily diverse their experiences were.

Jane Bennett: And it wasn’t that we got, I mean, some people did mention their symptoms, but to a large extent was, how was this for you?

You know what was this like for you?

And that was incredibly diverse, and some of it was based on what they were experiencing, you know, physically and emotionally.

Jane Bennett: But other things were, was their attitude to it, or their fear about going through menopause, and what the what the repercussions would be. So whether they, you know the extreme of being, you know, extraordinarily happy about heading through that, or being out the other side to, you know, extraordinary fear and anxiety about the whole process, as well as all the ups and downs of the various symptoms.

So how this affects people in the workplace and in their everyday life is also incredibly diverse.

Jane Bennett: And I think what’s really fantastic about this upwelling of more conversation and more understanding, and more learning and more research around perimenopause and menopause, is that we’re starting to appreciate that this is a very important and very specific time, and there’s going to be a whole range of experiences and a whole range of needs. So when we’re talking about the workplace, for some it might be just some simple adjustments to conditions in the workplace might make all the difference.

Jane Bennett: Or if there’s flexibility about being able to work from home, or a certain amount of flexibility with time that can allow for paying attention to the needs for rest, or needs for slowing down and just self-care during those kind of times, and all the way through to someone who may need to really take time off, take some leave to really rest and take care of the symptoms they’re receiving, and get the treatment that they need.

Jane Bennett: And, you know, just to come back to a more even keel. So it does vary enormously, and it’s been great to see more and more organisations really start, to make the effort to to learn about, and to make the adaptions they can, and to develop the policies that have that adaptability. It’s not a one case fits all.

Jane Bennett: But if there’s if there’s the capacity to vary that, and to be open to the conversation, and see what people need, that really, from many women, and other people going through perimenopause and menopause that I’ve spoken to, it really makes a difference that there is a channel to have the conversation, and very often they may say, well, I just need a different kind of uniform, or I need to be near a window, if possible, or whatever else it might be.

Gina Rushton: Prof Jayashri, is there anything in particular that —

Prof Jayashri Kulkarni: Let’s just call me Jayashri, please. We’re amongst friends, so I’m Jayashri.

Gina Rushton: The notes said Professor, and I thought, okay, must be important to you.

Gina Rushton: Great. I’m wondering as well, if you have any, I guess, any insights into what people can do to to cope with some of these changes?

Prof Jayashri Kulkarni: Look, I mean, I love Jane’s work, and her book is fantastic, and I think you know we’re in lockstep with the whole sort of view is that of a spectrum.

Prof Jayashri Kulkarni: So you know, in a spectrum, because, first of all, every woman’s going to go — person assigned female at birth — is going to go through some form of menopause. It just is inevitable. So that means you’re talking half a population which means you’ve got huge variation. So the key to this is to have the flexibility to be able to understand that, things could be rocky for a bit, but then they could be fabulous for another bit, and so on

Prof Jayashri Kulkarni: So I think in terms of what can we do for perimenopause is to actually get that message out there, which is — it’s not all gloom, doom, and despair, but nor is it all roses, and you know, beautiful chocolates, and whatever else it can be, everything.

Prof Jayashri Kulkarni: And that’s why I find it difficult when the argument goes from one zealot to another. So you know you have the zealots who go, “We mustn’t talk about menopause at all”, and I’ve had that conversation where people have said, “Shush! We don’t want people saying all women are at the women mercy of their hormones.” And so if we start saying there are mental health issues around menopause, and then they are never going to make President of the United States, or, you know, hold other big offices that are important. You know, a CEO of a company, or whatever.

That’s a very diehard feminist of the 70s and 80s, who I’m very grateful to, by the way, because otherwise I wouldn’t have the job that I have. But I think we have to move from that. Then we have the zealots in the other direction who go, “Oh, it’s all natural. It’s all good, you know. We should embrace the the end of reproductive life. It frees women up to be themselves, they can speak out, they they feel empowered to do this, this and this.”

Prof Jayashri Kulkarni: And that’s also, it’s great, if you fall into that capacity of that category, but that sometimes invalidates the women who are not having a great time, and then, not having a great time, divides into those, who Jane mentioned can cope with it by having like not having night shift at the time that the sleep is really, you know, absolutely awful, because that just throws out the diurnal variation as well, and having, you know, a uniform that isn’t awful, and I do feel for our colleagues in surgery who have to wear all infectious diseases, had to wear full PPE, you know, during the height of the pandemic, that was awful for them.

Prof Jayashri Kulkarni: So you know those sorts of things that can modify, and again empower her to tell us what she wants. But then there’s this other group, who I work with, and who other clinicians work with, who are really suffering, and who are completely lost in terms of — “Hey! I was the CEO of this successful company. And now I can’t even remember you know how to turn my computer on” — because the hormones that are creating havoc in her brain are real, and the havoc is real.

Prof Jayashri Kulkarni: So that’s the group that we then have to make sure she gets the appropriate care and attention, and doesn’t feel invalidated or doesn’t feel lesser than her sisters that are dancing around, you know, having a good time being freed up from a whole range of things.

Prof Jayashri Kulkarni: So that’s where I think we need to, you know, not do a one size fits all in any of it, because we’re not going to be able to win for the women who are struggling. The other thing is a lot of the work is based on community surveys of percentages, like people often ask me, what percentage of women do have significant menopausal depression? Vary from like 8% through to 60%. And I keep looking at these data and thinking, why do we have such a big variance? Well, it’s because what constitutes menopausal depression? It’s not in any classification system.

So it’s almost in the eye of the beholder, as in, what do we classify as menopausal depression? And plus, you’ve got fluctuation in this condition over years.

Prof Jayashri Kulkarni: So it’s also hard to grasp. You know, those times when the depression is particularly bad for some women, and then you’ve got the fact that, many of the surveys use the standard depression questionnaires that are not going to pick up this type of depression. I mentioned the symptoms, you know, anxiety, energy, loss, libido, loss, weight, gain. These things are not typical of depression.

So unless you use a specific menopause depression tool, which is not used, you will get odd results. So we’ve got a whole lot of confounders, as well as the, “Shush. Don’t talk about this. Minimise this because it’s bad for the female race” sort of thing going on as well. It’s a politicised area. So you know, there’s a lot that’s going on.

We had our Inquiry recently, with lots of — recommendations. I met with Larissa Waters last Friday, and so, you know, we’re full throttle on what’s going to happen in this country, which I think we’re going to be talking about in a little while as well.

Prof Jayashri Kulkarni: But I would put a plea in for — Please let’s not leave behind our sisters that are in the despair group as well, because I think it’s about 20% of the population of menopausal women is from my understanding of what we’re seeing. And yes, unfortunately, there is a predisposition for some women who’ve had PMDD. Or sorry, premenstrual depression or postnatal depression. They’ve got a hormone, sensitive brain.

Prof Jayashri Kulkarni: So that we would, you know, think that we have to. You know, look a bit more carefully, for with them when they get to …I put a lot in there. I love talking about this, so just shut me up when you need to.

Gina Rushton: No, I was just gonna say so, I mean, you sort of touched on there, I mean, like many reproductive health issues, they affect huge parts of the population, and there’s minimal supports available. So I guess you know, there’s something that affects half the population, as you said. And then within that population there’s a big chunk of people who have really complicated mental health experiences.

Gina Rushton: Jane, why do you think people often feel unprepared for menopause or perimenopause? Have we just not come far enough in providing information, or what’s going on?

Jane Bennett: Well, I think that’s what you just said is absolutely correct. For so long there has been virtually no education available and, you know, no nuanced widely available education and conversation. And also this is really across the board, because in my understanding this is true also within, say health, professional education as well, that I do know. But I know very recently there was only one medical school in Australia that had a unit on menopause, that was tested.

Jane Bennett: So given that this is an experience that half the population or thereabouts has, it wasn’t seen important enough to really make that a testable. You know, you need to pass this to move on. So there has been a dearth of understanding and knowledge across the board.

Jane Bennett: Now this is starting to change, and there’s starting to be some really good resources and some great practitioners doing terrific work. But for those of us going through perimenopause and menopause, one of the important things is to really, you know, be proactive and look for ourselves, whether we’re in that % having the most difficult symptoms or or anywhere else on that spectrum. I think, you know, really looking around for to find information about health issues, but also understanding what this process is, having conversations about what this, what this is, and exploring.

What does this mean to me? What does this mean to my sisters?

Jane Bennett: And really finding your place in that, because truly this is, you know, a huge transition, and a huge time, which, as we know, if we’re counting the years of perimenopause, we could be looking at -years, or it might be a short number of years that are really pivotal for any individual.

Jane Bennett: But I think it really presents, without over overly romanticising it, but it does present an opportunity, you know, if we’re experiencing the changes, and these hormonal shifts — It’s not like one simple shift, either.

Jane Bennett: It’s changing a lot, it can be can be for years compared, to say, a regular cyclic experience in the twenties or thirties. Not that that’s true of everybody during those times, either necessarily, but generally so. These huge changes can impact us in many ways and differently. So where the hormonal profile might be similar, how that impacts individuals can change enormously. But through all of that and through our experience of this change, and transition is a fantastic opportunity to explore how we’re changing, where, where we are in our life, whether there are changes in the conditions of our lives that we want to make.

Jane Bennett: And who are we? Who are we becoming through this process? And there’s no one simple, you know, as you say, Jayashri, that you know menopause absolutely is one day. But there’s many days of thinking. Is this it? Is this it now, or is it then? Or, Oh, okay, here’s another bleed.

So we’ll start waiting another year to see. So it’s one of those crazy, retrospective things which is somewhat the nature of perimenopause and menopause, isn’t it, that it’s…diverse. And it does, I think you know, depending on our personalities and our life changes. It’s worth some reflection. It’s worth some contemplation and worth to the extent that we’re able.

And you know all, all understanding and sympathy, sympathy for busy lives. But it’s worth, if we can create some space, to really spend some quiet time with ourselves during that process, to really explore what this is for us, what this is personally.

Gina Rushton: You’ve sort of started to touch on it there, and we’ve spoken about it in different ways throughout this conversation, is particularly between those camps of like, talking and not talking about it as well, and I wanted to come to my last question, and then I’ll definitely get into the Q&A questions. Please put a thumbs up in the Q&A, for which questions you like the most by the way, for everyone listening so that we can prioritise the ones that people definitely want, really, really want answered.

Gina Rushton: So there was a really popular book that came out this year that was hailed as the first great perimenopause novel, All Fours by Miranda July. It’s really fantastic, if you haven’t read it. But the reason I think, that it was so popular, for that reason at least, was that it was celebrated for depicting perimenopause as certainly a period of change. But you know, with lots of uncomfortable symptoms and everything, but not a stage in which someone loses their relevance or desire or sex appeal, and at risk of romanticising it, I do kind of just want to ask the question about you know, what do you think — is there positivity in the stage of life, and through this process? Are there opportunities, like? Is it all doom and gloom?

Gina Rushton: Or are there things that you kind of think are worth reflecting on, potentially? So maybe, Jayashri I’ll start with you.

Prof Jayashri Kulkarni: Sure. Look, I definitely don’t think there’s all gloom and doom and despair by any means. So if I can go to a neurobiological perspective on this. It’s really interesting what happens to the brain in perimenopause and then beyond, post-menopause.

Prof Jayashri Kulkarni: So there’s another term to throw in here. The brain in a lot of ways is a plastic malleable, you know. It changes, depending on environmental cues depending on physical cues. And then there’s the circuits and the chemistry that changes with the hormones. The hormones are the potent drivers of the brain chemistry which drives the brain circuits.

Prof Jayashri Kulkarni: So you know, hormones are really potent in how you behave, how you think, how you feel all of those things and the cognitive functioning as well. What happens in this fluctuating menopause state is this massive up, down, or hormone, oestrogen and progesterone and testosterone as well. So they all have just, you know, like, instead of being relatively steady with the menstrual cycle blips, you suddenly go to these big drops and these big uphill. But the soretooth pattern is that generally the estradiol is coming right down, and so is the progesterone.

Prof Jayashri Kulkarni: In that with the fluctuations there can be shifts in the brain chemistry, which then results in, in the vulnerable brain, there can be this terrible depression that can start and maybe not finish for a long time. However, the circuitry is another interesting part of all of this, because what happens is, some parts of the brain circuits are actually impacted adversely. So that’s where the short term memory can be a problem.

You can have word finding difficulties. That horrible — Oh, what was that? What was that name? What was that name? That kind of tip of the tongue, sort of problem with name finding. But then over time, what happens is, as I said, the brain is plastic. So you then see that in the resolving menopause fluctuations, you get the development of different brain circuitry that actually is enabling a top of the mountain strategic thinking, enhancing that. So you see this in practice, don’t you, in the real world that many times women get better and better and better at the sort of strategic thinking. It might be like, ‘I haven’t got a bloody clue, what that person’s name or that paper was that I wanted to quote, but I can see where we can solve this major problem.

So it’s a really interesting thing that has been written about in a number of different ways about the brain circuitry and the change. And we can call that wisdom. We can call it experience experiential knowledge. We can call it a freeing up of inhibitions of youth.

Prof Jayashri Kulkarni: I mean, call it whatever you want. But the neurobiology is there.  And I think it’s really interesting and important neurobiology. So as women get older, they get better at some things, maybe not so great at some of the other things. But you can work your way around the tip of the tongue stuff. Get somebody else to tell you what the name of that paper was, or you know, and not be embarrassed about it and go, ‘Oh, I don’t remember the minor stuff. But, boy, get me on the major stuff, and we’ll get there.’

Gina Rushton: Jane, do you have any reflections on that?

Jane Bennett: Could you tell me the question again, please?

[Laughs] [Cross talk]

Gina Rushton: You sort of you sort of began speaking about it earlier, when you were saying, you know, it’s a time that you can kind of reflect on, you know, a period of transition. I guess we were just saying, you know — is it, is it all bad, really? That was the initial question.

Jane Bennett: Yeah. Well, well, a couple of answers there one is that I’m ever the optimist. So I would say, absolutely not. And I know through my own experience, and through the experience of so many women and others who do go through this time of life, their experience at this time is that it can be revelatory, you know, it can be if we welcome that and it really can be true of people who have minor symptoms or no observable symptoms,
all the way through to those who have heaps. So it’s not really. It’s not really to do with the extent of whether it’s a hard journey, you know.

Jane Bennett: Symptom, wise or not, it’s whether it…partly attitude, partly what I would sort of call, you know, as a pedagogy, that is, in all our schools these days, which is growth mindset. Are we seeing something as inevitably bad? Or are we seeing it as, how can I meet this time?

You know, what are the qualities of this time? I’m certainly experiencing changes, and there’s changes in my life. And, as you say, Jayshri, there’s things I’m doing better. There’s things I’m not doing so well. But also what’s important to me in my life is changing.

Jane Bennett: And what does that massive hormonal shifts? And I love the term you use the soretooth graph of hormones that’s changing, which is different to the also majorly fluctuating, regular menstrual cycle. These hormones have powerful effects on us. They’re powerful biochemistry.

Jane Bennett: Yes. I would just would invite everyone to just take, you know, take the time to reflect on where you are in your life, who you are what’s important, what your values are now, where you want to go, and how you know, whatever the circumstances, how best to care for yourself, given the realities of your life.

Jane Bennett: And have have as many conversations as you can, and look for — maybe it might be health practitioners, or books, or resources, or workshops that really support and speak to you.

Jane Bennett: You know, what’s going to help you to feel supported through this particular process. I will mention a book that I’m mentioning everywhere. It’s been out, I think, a couple of years. It’s Lara Briden’s book, Hormone Repair Manual, which I’m going to show you because I’ve got it sitting right here. She’s a naturopathic doctor trained in the US, which means that she started medical training, and then a pathway through that is naturopathy.

Jane Bennett: So she does a great job of, a foot in both camps, and understanding what’s available with allopathic medicine, and also what’s available with naturopathic medicine and lifestyle, as well for all those different symptoms and processes that go through perimenopause, menopause and post-menopause.

Jane Bennett: Yeah, I think that’s a fairly long answer to your question.

Gina Rushton: That’s fantastic, and I’ve just seen Rachael’s put the link in the chat, so if everyone wants to find that book. I’m going to go over to audience questions now, and I’m kind of going to give you one each so we can get through a few of them. I’m going to start…I might give you this one, Jayashri — If someone’s had a hysterectomy, how do you quantify when menopause occurs?

Gina Rushton: And are there any other markers besides, you know, your period stopping.

Prof Jayashri Kulkarni: It’s a toughie, because to come back to it, the only marker that there is the follicle stimulating hormone level, which goes up to about or international units per litre, and that actually is at the end of the whole transition process. So it’s really tough because we don’t have markers, and this is often what happens for women who go to their GPs, or other doctors and say, ‘I think my mental health is terrible’ or not good or whatever she’s experiencing and ‘I want some help with that. And I think it’s my menopause.’

And yet, when a blood test is done, and there’s no point doing this blood test, it comes back normal. Of course, it’s normal. There’s nothing pathological happening, and there are no markers until the whole process is finished. This is where it’s important that the co-collaboration model with the woman is, to get her to tell you what she wants, because she’s living in her own body, and she knows what it’s like, and what she’s usually like, and what she wants.

Prof Jayashri Kulkarni: So again, it’s a clinical, good, old fashioned clinical work, but with the very important empowerment of the woman to tell you what’s going on for her, and I think that’s probably the best way to go forward because we don’t have a marker. We are trying to work on some things, but it’s it’s an interesting observation that hysterectomy will mean you haven’t got anything to hang the last period at all.

And, as people have said, it’s even yes, that’s the technical definition. The last period that stops on one day, but which day? As Jane said, and as others have said, it can be a stuttering process.

Prof Jayashri Kulkarni: So it’s all very, very vague. You know this is not an exact thing, but my clinic operates on the principle that someone has come to us for help because she’s experiencing something bad for her. So she’s asking us for help. We’re not going out there trying to, you know, drum up business or make out that this is all about, you know, that “menopause is an illness” or anything like that.

This is about the people who come having had a diagnosis of depression. Now we have to help her to get back to her usual functioning. That’s a different group.

Gina Rushton: I’m going to go to the next question, which has lots of thumbs up, and as soon as I say, you’ll understand why, from Sonia — Jane, I might throw this one to you. So the question is: I’m wondering if some such many of the symptoms described are also part of our systematic, patriarchal conditioning, where finally women wake up from the stupor of socialisation, through the patriarchal lens of where we are taught to people-please take care of others before our own needs, and hold down emotions to keep things peaceful in the family environment. Any reflections on that?

Jane Bennett: Oh, yeah. Well, I have some personal theories, and I don’t know. I haven’t seen the research on this. So I’m going to share this out on the limb, but I noticed as I was, you know, I was in the stage late stage perimenopause, with a lot of space between very light periods. So in my estimation, there’d be no ovulation going on at that time, and I noticed over a period of just a few months.

Jane Bennett: What I diagnosed for myself was a major dip in oestrogen, and I how I felt it was, one of the ways that I felt it was, a huge drop in feeling a need to please others. You know it wasn’t that I didn’t still care for the people, the close people around me. But I also wasn’t as caught up in that. I wasn’t as, “I can’t be happy until they’re happy and comfortable”, and so my my estimation, when I reflect back from how that, you know, was a very strong feeling.

Jane Bennett: That, you know, how I was with being very entwined with the happiness and well-being of my family, particularly, at earlier years. It’s particularly an oestrogenic quality.

Jane Bennett: So for everybody, maybe it’s not…maybe it’s just me. I don’t know, but that’s what I have observed that over time, and as that changes, and as oestrogen diminishes, and sometimes quite dramatically, it can really make a difference. And I think this is a quality that’s often attributed to women post menopause, that they’re, you know, “they’re more ballsy”, in that, you know— I’m just going to try and not swear here —

[Laughs]

Jane Bennett: But really, really, just you know, seeing it how it is, saying it how it is, not getting so caught up, not feeling so emotionally entwined with the people around you, and it doesn’t stop caring, but it’s a different kind of caring. That’s a very sort of personal experience of that. But I do think, I observe that. And as I’m just seeing Tammy in the chat, saying, oestrogen is dubbed as the hormone of service and accommodation’, so and I do think that’s I observe that widely. Yeah.

Gina Rushton: Great, so much to look forward to.

Gina Rushton: I’m going to ask you this one, Jayashri, you mentioned before kind of people who are perhaps more sensitive to hormones, and there’s a question about it. So if you have a history of PMDD, what should you be expecting when it comes to perimenopause?

Prof Jayashri Kulkarni: So look unfortunately there are a group of women who do struggle with hormone related mental health issues, and PMDD premenstrual depression is one of those conditions, as is postnatal depression, as is perimenopausal depression.

So I’m talking now about a group of people who have got depression related to hormones. We’re not talking general community here, and in these patients or these women who are patients because they’ve identified that they feel unwell with all of this, we have been working on — why? Why do some women have a greater sensitivity to the fluctuations? Because it does flow through the life cycle, the sensitivity to the fluctuations in the gonadal hormones.

Prof Jayashri Kulkarni: And what we’ve actually done is now, I mean, I work a lot in the area also of trauma and women. And so in a lot of these cases of women we are, we find that there is a horrible story of early life trauma that’s emotional trauma, which includes emotional invalidation, emotional neglect, sort of the harsh critical — “what would you know?” That kind of stuff, and physical abuse and trauma as well as sexual abuse.

Prof Jayashri Kulkarni: So, you know, that kind of early life history can create a disturbance in the cortisol system, which is the stress system. So this is a girl who is growing up in a stressed situation, and that then has downstream effects on the other hormone systems, because cortisol is the big mama of hormones. So the downstream effect is on the gonadal hormones, and then you get this increased sensitivity to the fluctuations.

So that’s where the PMDD comes from.We think.

Prof Jayashri Kulkarni: So, it is important to understand the whole person, and the context of what the early life has brought for her where she is now, what traumas and stresses she’s in currently, and then to work with all of that as well. So in the clinical work, it’s very much a holistic approach, because you’ve got to look at trauma environment with psychology, with biology, and often people who have not seen or experienced major depressive disorder themselves, will put all of it down to environmental factors and the societal factors. But what’s missing? There is an understanding that it’s a combination.

Prof Jayashri Kulkarni: And this is what goes on in the environment affects the biology and vice versa. It’s an ever…circle system. So that’s important that we understand more of that. And we work more in that, because that way we provide a holistic approach. But yes, the short answer is hormone sensitivity can happen throughout the life cycle. But that doesn’t mean it’s inevitable, and it doesn’t mean that there are no solutions either.

Gina Rushton: Fantastic. I’m going to throw the final question to Jane, and sort of finish this wonderful session. Looking forward I guess, the question is, Jane — thank you for your wonderful book — What is your sense of the recent Senate Inquiry into perimenopause and menopause?Were the important things covered, and is Australia on the right path towards policy and laws?

Jane Bennett: Big question, how long have we got!

[Laughs]

[Cross talk]

But the short? For a few minutes? The short answer is, thank goodness for the Inquiry.

Jane Bennett: Certainly timely, great to see it. There were some amazing contributions, and, you know, really welcome the recommendations. We’re yet to hear the response, as to what exactly is going to happen, and what sort of resources are going to be involved. We’re sort of waiting for that part of the of the puzzle, but I do think the spirit of the Inquiry and the seriousness with which it was undertaken is, was exemplary, and I was out of the country at the time, but my hearing of what happened in the in-person sessions with the panel were also fantastic.

Jane Bennett: And every voice that that came to that was really welcomed and honoured. So it may not be the end of this story and the end of what we’re doing in this process, but I certainly think it’s a great part of the process of really bringing the issues of perimenopause and menopause, and how we live with that time of our life and the supports we need. I think we’ve really, you know, in the process of taking some big steps forward with the Inquiry, and other things happening around the place, as well.

Gina Rushton: Fantastic. I think that’s a great place to leave it, and almost all we’ve got time for. So I’d just like to thank our incredible speakers, our highly highly engaged audience, and all of the people at the Victorian Women’s Trust, who obviously made this happen, and have shared some great things in the chat, so check that out before you log off. There will be a recording of the event that VWT will share in the coming days.

Gina Rushton: But in the meantime, Happy Menopause Day and have a beautiful weekend. Thank you so much.