Episode Transcript
Speaker 0
I haven't mentioned this to you yet, but that whole waking up at two AM like I'm plugged into an electrical socket is happening again.
Speaker 1
No. Fuck off.
Speaker 0
Yeah. I at first, I and I I was panicked, and I'm like, oh
Speaker 2
my god. It's back. What do I do?
Speaker 0
I need sleep. And then I remembered that based on my nurse practitioner's advice, I started taking a a higher dose of estrogen patch about six weeks ago. So I've got an appointment booked to see her because I think, you know, I've got a lot of stress going on, but I think maybe that increased dose has triggered that estrogen dance again.
Speaker 3
Oh, interesting.
Speaker 1
And I don't even think I would have clued into that. Good on you.
Speaker 0
Yeah. Might not be, but I'm gonna check it out.
Speaker 1
Yeah. You may as well. Well and, like, let me know what she says because my anxiety is I like, even sitting here right now, like, the anxiety coursing through my veins is insane. And I think a lot of for me, it's because Ben just started university, and he's off, and he's on his own. And, you know, I don't know if he's gonna make any friends, and I don't know if he's gonna have any fun, and I don't know. Like, I it could like, what if he
Speaker 0
plays Yes. He is. But I totally get where it come from.
Speaker 1
I I yeah. I hope so. It's just like it's terrifying. I don't know. Anyway, I know it's gonna be good, but, I don't know. Maybe hearing you say that, though, I'm postmenopause now, and it never even dawned on me. And I I know that I do also, this is stressful, but maybe there is something there. Maybe there's maybe I need to start tracking my symptoms and go in and talk
Speaker 0
to you. You need a new prescription. Yeah.
Speaker 1
I haven't even thought about that. You're right. It's, it's tricky. Like, is this hormones? Is this stress? Is this depression?
Speaker 0
Yeah. Exactly. And, you know, whatever is causing how you're feeling, the point is it impacts everything. And I don't know about you, but some days I'm struggling to keep it together.
Speaker 1
Some days. I struggle every day, I feel like, lately. It's like I don't know. It's it's not as bad as when we started this is perimenopause. Do you remember I almost, like, threw in the towel right at the beginning? Because my That was terrible. My depression, and I was so it was so dark. It was scary. I'd never felt like that before. And looking back, now I wonder, like, how much of that was hormones? How much of that was COVID? Maybe it was just my life. I I don't know, but it was really confusing. It was really isolating and overwhelming, and it was really hard to figure out what was going on. How do you even start?
Speaker 0
Well, that's why I'm so glad we're talking to doctor Ariel Dolphin today. Psychiatrist, cofounder of a virtual clinic called Bria, where they actually understand the complex intersection of mental health and reproductive life stages and all that that can bring up for women.
Speaker 1
Intersection or Bermuda Triangle, Mick?
Speaker 0
Well, let's ask doctor Ariel. Ladies, this is perimenopause.
Speaker 2
Doctor Ariel, welcome. So great to see you again.
Speaker 1
Thank you. Welcome. Great to be here.
Speaker 2
Please excuse the very sexy voice. I know the weather, but I did not wanna miss this conversation. So everyone's just gonna have to listen to the
Speaker 1
The sexiness. No. I like the sexiness. The sexy.
Speaker 2
The sexy. Well, thanks. Thanks. Let's dive in, doctor Ariel. So you are the CEO and cofounder of Bria, which is a virtual, clinic offering mental health comprehensive mental health options and hormone assessments. So maybe you could tell us a little bit about how that came to be and how your background helped to create what sounds like an amazing offering.
Speaker 3
Well, thanks. I'm always happy to talk to Bree about Bree, and I'm very happy to be here talking with you both today. So thank you for this opportunity.
Speaker 0
Of course.
Speaker 3
I have been a psychiatrist caring for women with mental health concerns for over twenty years. And, me and one of my cofounders worked side by side, at a big academic hospital in downtown Toronto. Her name's doctor Bev Young. And we had offices beside each other. We worked running the women's mental health program at this big hospital one after the other. And we always had a dream of creating a one stop shop where women could come at different life stages and get all the health care services that they need. And so this dream started many, many years ago. And then we right before and during COVID, we turned fifty. We, had been doing virtual care around the whole province of Ontario starting in about twenty fourteen. And so everything came together at some point in early COVID, and we said, it's now or never. Let's jump. Let's create our dream. And that's how Bria was born.
Speaker 1
Oh, I love it.
Speaker 3
Yeah. It was a time of obviously great stress, great distress, a lot of pain and suffering for many people, but also a time for us to say, okay. This is our one life. This is our one career. Let's dream big, and let's jump and make this happen.
Speaker 1
Oh my god. I love this. So tell so tell us a little bit about Brienne and the services that you're providing.
Speaker 3
So we provide services for women and their partners and families across reproductive life stages. We see people going through the fertility process in pregnancy, postpartum, early parenthood, and then, of course, in the menopause transition and menopause. And what we offer are a range of services from different types of therapies, talk therapies, to hormone assessments, hormone treatments, more in-depth mental health treatments and assessments, including ADHD assessments, including assessments for hormone therapy, including support for people who have sleep issues and insomnia. Like, who doesn't at all these different stages. Right?
Speaker 2
Okay.
Speaker 3
And dietitian, nutritional help. So, really, everything that someone needs to feel better, to get better at these different stages, we brought them together under the Bria umbrella to get the kind of help they need.
Speaker 1
This is awesome. I need this.
Speaker 2
Amazing. Sign up. Yeah. I need it moved back to Ontario.
Speaker 3
We're open in Alberta too. We're open all over Ontario and over all over Alberta. Oh, amazing.
Speaker 1
Oh, perfect. Oh, that's fantastic.
Speaker 2
So maybe you could take us through what, someone who is like us, perimenopausal, can expect, when they sign up for your offering. How does, you know, how does it work?
Speaker 3
So they can go to our website, which is w w w dot betterbria, b e t t e r b r I a, dot com. And on it, they will see a little button where it says or several buttons on it to say book a call. So they can book a call, and they will be greeted by one of our amazing care coordinators. Well, they will learn about Rhea services. They will learn about what we have that can help people in perimenopause, and I'll get into that in a second. So they book a call. And then, generally, the best way for people to start is to sign up after that for what we call our mini health assessment. So that's a that's a thirty minute intake assessment that will go through their health history, their physical health, their mental health, their hormone health, and then the care coordinator who does that service too will develop a plan for them. So very commonly for people in perimenopause, that might entail, a hormone assessment, which we call our medi health assessment. Then they'll meet with one of our providers. They'll do a very comprehensive preventative physical health, mental health, and hormone health assessment. And the outcome from that may be a prescription for hormone therapy, menopause hormone therapy, or, nonhormonal therapies that can help with symptoms they're having, like hot flashes or night sweats or something really suitable to help with the symptoms that they may be dealing with in perimenopause. So that would be for people who are really struggling with physical symptoms of perimenopause. And sorry. What what kind of practitioner
Speaker 1
are they seeing? Is it an MD that they're an a registered nurse?
Speaker 3
They're not seeing an MD for that. They're seeing a nurse practitioner who's trained in women's health. If someone also has mental health concerns in perimenopause, they may start with one of our mental health assessments, which is a it which is done by a non MD first. Okay. An OT, a registered psychotherapist, a social worker for the first part, and then they'll see an MD psychiatrist for the second part. And and where where they start in perimenopause really is determined by the symptoms they're dealing with, what's the most concerning thing. Is it physical health that's more bothersome? Is it mental health that's more bothersome? And then they'll be, suggested to one direction or the other. And then after that, they can do the other service as well if need be.
Speaker 1
Can I ask you, like, are there is it more mental or physical, or is it, like, fifty fifty? Like, when the women come to you, is there a greater proportion of the population coming for mental health or physical? Or
Speaker 3
Well, I'd say it's both. It's a lot of both. And people often don't know. They come in and they're like, I'm feeling like crap. Help me. I don't know what's going on. I don't know what why it's going on. That's why our intake assessment is so helpful Mhmm. Because we don't expect people to come to us with a diagnosis. Yes. This is physical symptoms. Yes. This is mental. That's where we do the work. That's where we want people to rely on our expertise and our knowledge. So that's why we have this very wide open door of our mini health assessment. We say to people, come try this, and we will tell you what we think you need to start with.
Speaker 1
Are women sometime like, do you find that a a number of women come in and they just think, I just don't feel great. I just don't feel like myself. I'm whatever it is. And then you say, oh, okay. You do your assessment, and then you're like, oh, this is potential. This is perimenopause. Are they gobsmacked? Do they know that this is coming? Is that why they think they're there, or are they surprised by that diagnosis? I guess it depends on the age, but
Speaker 3
I'd say it depends on the age and it really depends on the person. You know, I feel like people are getting more and more well educated about perimenopause. They're more and more aware of, the fact that menopause hormone therapy can be suitable for people. They're more and more aware that if they can't take hormone therapy, there are other options. So I'm finding we've been in business for almost three years that I'm finding more and more people coming, and they have a sense of what's going on and what they're looking for as time progresses. And as people like you guys and so many other people out there are doing really good work educating people, they're coming with more knowledge. But we still we don't want people to have to bear the burden and come to us and saying, you know, I think this is my diagnosis. I think this is what they need. Like, we want people to come to us and rely on our knowledge that we can help them regardless. So we wanna take where they can come and they can be like, oh, finally a place where I'm understood. Is this mental health? Is this long COVID? Is this am I drinking too much? Do I have perimenopause? Am I depressed? Like, we pull it all those strands and we say, yes. Maybe you're anxious. Maybe you're, you know, going through perimenopause. So we wanna do that work for everybody.
Speaker 2
And what you're speaking to is, you know, most people would probably tick most of those boxes. And that's exactly the point is that there is no one solution here. There are a lot of, you know, factors that, come together at this pivotal time in a woman's life. Right? And it's Exactly. Not just the symptoms. It's Exactly. The crush of midlife as we like to to call it. And Yeah. How amazing is it to have a team of experts who get that and then can help someone, not just parse out what is going on, but figure out the best way forward.
Speaker 3
You know, I really like the term the crush of midlife that you're using because I don't wanna reduce everything to our hormones and medications and pills. Like, as we've talked about, as you know, both of you know, like, there is so much else going on too. It's relationships. It's our parents. It's our kids. It's our, you know, our work, our the world we're living in these days. Like, we're crushed on all these different sides. So that's why we also offer all kinds of therapies for people to be able to parse out. How do I deal with this? Okay. Maybe I am on medication or I'm on menopause hormone therapy, but I also need to figure out, like, do I still like my partner? We're left alone. Is my kid leaving home? That really hurts. Or, oh, they're not leaving home, and I wish they were leaving home. It's like, we need to figure all this out. Right? And that takes more than just a medication. So we come at mental health, physical health very comprehensively.
Speaker 2
Amazing. Question for you on the mental health piece. And and maybe this is you can't generalize, but I wonder if you see a reluctance in some patients or the majority of your patients to actually start peeling back the onion on, you know, should I be married or should I you know, that's that's a pretty scary place to go, I would think, for most people. And and I'm just wondering what you see in your practice.
Speaker 3
Oh, we see that all the time, and we see that's why we're in it for the long relationship that especially that our therapists have with people because on day one, nobody's making a recommendation. Oh, you should leave your marriage. Like, that would freak people out. I mean, you know, people would run for the hills. These are things, like you said, we take we have to very gently approach and build up a relationship and build up trust and get to know who is coming to see us. Like Absolutely.
Speaker 1
Mhmm.
Speaker 3
You know, we do we take our jobs with great humility and say, we don't know what's best for you, especially not on day one. And let's sort of let's poke around and see what's leading you to feel really super anxious. What's leading you to feel
Speaker 2
Right.
Speaker 3
Really down. What's leading you to drink too much? Why are you, like, you know
Speaker 1
Angry all the time.
Speaker 3
Angry all the time. What's going on there? So we wanna poke around at all the different parts of people's lives together with someone else and say, This could be something that you're not aware of, you're not dealing with, you don't wanna talk about.
Speaker 0
Right.
Speaker 3
Let's slowly start to peel back the layers and talk.
Speaker 1
If I come to you and I'm I'm seeing a therapist and a dietitian and I'm now on HRT, like, are you guys coming together to Mhmm. Interesting. And and is that, like, a regular ongoing
Speaker 3
Absolutely. That's one of the beauties of our model is that we all work together. And in particular, we have amazing well trained therapists. We have regular meetings, and we'll put our heads together and say, okay. What's going on here? And we'll bring sort of the collective hive mind to say, okay. Have you considered this? Have you considered that? Wow. And that's one of the beauties of our of our model and working on our team is that we have people with so much different types of training and different expertise. What I did wanna say is one of the things we're super excited about it, Bria, is we are now doing training for health care providers to become menopause mental health certified. So we've developed our own program, our own training, and accreditation for health care providers of all kinds. They can learn about being a mental health provider for people in midlife and going through menopause. And we're so excited about this. We've trained over a hundred, and I think we're now at a hundred and twenty clinicians over the past twelve months. Wow. This is super exciting. So we've trained all our own providers. They've attended our training. Plus we're training people from all over the world to get our certification to learn how to offer better care for people at midlife. So that's something we're super excited at Priya of doing now too.
Speaker 2
And if someone is listening and is interested, is it do they come to find you through your website?
Speaker 3
They can come to our website. They can email us at hello at better bria dot com for more information.
Speaker 1
And is the crux of this certification, like, is it recognizing the menopause symptoms, or is it like, are they dealing with clients in perimenopause and menopause differently than they would a teenager who's going through, you know, puberty or?
Speaker 3
A hundred percent. So we we it's a four week training program, and we look at we teach people about the physical symptoms of perimenopause. We teach them a little bit about menopause hormone therapy. We teach them about the mental health changes and challenges and interpersonal changes and relationships and perimenopause. We teach them some specific therapeutic tools. We also teach them about sleep issues, nutrition issues at this stage, about sex therapy, sexual health, and relationship changes. And then we we review cases so to get people to put all these things together. So it's essentially to give people the knowledge and information to help them support their own clients and their own practices to be able to say, yeah. That sounds like perimenopause. Those recurrent UTIs you're having that the doctor saying, you know, couldn't definitely not be related to perimenopause, they probably are. And that's causing you a lot of pain and discomfort and taking multiple courses of antibiotics. Like, have you thought about doing this?
Speaker 2
Scheduling more sex is not gonna work.
Speaker 3
Exactly. Exactly. Exactly. So it's helping all these providers have a wider lens and the right tools to support the people who they're seeing in their own practices. So we're trying to make a real ripple effect for women at midlife to get good care and informed care.
Speaker 1
Wow. This is so cool. I didn't even know you were doing this. I love this. Thank you.
Speaker 2
One thing, doctor Arrell that I that struck me on your your website, and I think this is also really important as, you know, menopause is now a movement. It's beyond a moment, and this is an amazing thing. But there can also be the downside, which is someone will then blame everything that's happening in their life too, perimenopause or menopause depending on Right. What age and stage they're at. And that's problematic and be
Speaker 1
Right.
Speaker 2
Dangerous in fact in some instances. So I read on your site that you help patients distinguish menopause related symptoms from other conditions. I was wondering if you could give us an example of, you know, it it seems like perimenopause or menopause, but it's actually you know? And and and how you parse out what it actually is.
Speaker 3
Great question. So let's say since I'm a psychiatrist and a big focus of what we do is mental health, you know, if we look at depression and anxiety, those are very common things or feelings of rage that someone is having. So hands up for everybody on that. Right?
Speaker 1
Yeah. Yeah.
Speaker 3
So that's where our intake assessment is so helpful to be able to say, yes. You are you know, based on your age, based on your menstrual cycle patterns, you are in perimenopause. But let's look a little bit deeper and saying, okay. You know, you've just lost your job because they want to hire someone a lot younger than you, and, you know, your kids are really struggling in university, and, you know, you meet all the criteria for depression. You have a really untreated depression. Depression can often manifest as anger or sadness or rage. So let's try and treat your depression and see if that reduces some of the symptoms that you're having. And the same with things like if someone has really bad premenstrual dysphoric disorder, that can get worse in perimenopause. But maybe someone doesn't know that they're hormonally sensitive and that their moods and their anger and their irritability fluctuate along their their cycles. And, you know, it's not just about being in perimenopause, but let's look closely at your background. Oh, you've had postpartum depression and anxiety. Oh, throughout your life, like, maybe since your twenties, you've noticed that you've had this pattern in the month in the weeks leading up to getting your period where you have a lot more irritability and you're supercharged angry. Okay. Well, maybe we need to treat this like premenstrual dysphoric disorder, which can get worse in perimenopause. So we don't wanna just say, okay. Take HRT or MHT or something like that. Like, let's treat what is happening. And you are someone with hormone sensitivity that your brain, under the influence of wildly fluctuating estrogen progesterone, that's kicking off serotonin, norepinephrine, dopamine that's responsible for your mood, for your anxiety, for your anger. Let's look take another approach, and maybe you have PMDD, premenstrual dysphoric disorder. Let's get a hold of that first and foremost, and that will probably get you a long way towards feeling better, perimenopause or not.
Speaker 1
So then so if I come to you and it and we wanna treat the depression first and see if that's if we can get to the heart of that. What kind of treatments are we doing? What what does that look like?
Speaker 3
So the gold standards for treating depression most effectively are often therapy, talk therapy, Especially if someone has mild or moderate depression, talk therapy has the most data and is the place to start. If it's in the more moderate to severe category, we'll often add in medication and antidepressant medication. And, often, the combination is what is best. And there's a lot of women on social media saying, I went to my doctor, and they just gave me an antidepressant, blew me off. I feel like we've gotten sometimes that is necessary. It's not enough for many people, but sometimes that is necessary. And there are safe and effective medications that people can and should take to really treat the symptoms they are experiencing. And so it's important to start with that.
Speaker 2
Right.
Speaker 1
It's funny because that was my experience. I went to my doctor in my mid forties and was like, hey. I've got this, this, this, and this. And he's like, okay. Well, we can put you on an antidepressant. And I was like, wait. What? Yeah. No. Like, I I didn't I didn't, my goodness. I've got perimenopause brain today. I can't think words, but I didn't I didn't see myself as someone that needed that type of treatment. I was like, woah. And I didn't I didn't even have the word perimenopause at the time. Right? So it was it was really kinda strange. Anyway, maybe he knew maybe he was better than I thought.
Speaker 3
Well, maybe not. Like, maybe he just didn't know, and I don't know how long ago that was for you. But
Speaker 1
A while.
Speaker 3
Many health care providers, when they see someone in midlife, they're like, oh, they're not feeling like themselves. Let's treat them like they're depressed. They didn't have the language. They often still don't have the language Sure. To say this person is in perimenopause. This sounds like perimenopause or to dig deep and take a proper history to try and find out, is this perimenopause? Is this depression? Like, there are ways that we take a history, and as mental health care providers and psychiatrists, we can distinguish that.
Speaker 1
Mhmm.
Speaker 3
And that's why going to a health care provider who's informed and trained is so, so important. So you don't just go down the wrong road and get inappropriately treated for the wrong thing.
Speaker 1
And well and and fairness to him as well, I probably didn't go to the appointment with you know, I now know that I need to come with some really structured, here are my symptoms, here's when they're happening. Like, I I know a lot more now than other than I'm just I just don't feel my like myself is probably what I said. So Right. Fair to him.
Speaker 3
Well, you're very generous. You're very generous in your in your assumption. But yeah.
Speaker 2
I think too, would it be safe to say, doctor Errol, that there are times then where you would see someone who would come in with mild depressive symptoms who didn't have a history where you would say, okay. Let's start with hormone therapy.
Speaker 3
Yes. Absolutely. If they didn't and, you know, there aren't major life stressors, I would say there is and there is good evidence to show that menopause hormone therapy can be helpful for people without a history who have mild depression or anxiety in perimenopause. Absolutely.
Speaker 2
But that's that's akin as well. I think this is we were talking about this with, doctor Jennifer Zelovitsky recently and the fact that, you know, Oprah Winfrey regularly talks about having heart palpitations as a symptom of perimenopause, which is great in terms of of awareness. But doctor Jen pointed out she had recently diagnosed two women presenting similarly with arrhythmia. So I guess the the point being, you really wanna make sure you're getting some strong expertise because you don't want to be diagnosed dismissing, right, significant depression as perimenopause similar to heart palpitations as perimenopause when you've got something serious going on with your heart.
Speaker 3
Exactly. We see so much. Like, everyone should be on menopause hormone therapy. Everyone no. Not everyone. And to your point, Mikael, it's about individualized assessments and cares for your specific symptoms based on your physical health history, based on your mental health history, history, and based on what you want and based on what you can tolerate, based on what you can afford, etcetera. Like, we need individualized care just like at every other stage, just like men get all the time. And now, luckily, we know it's not unsafe for most people to take menopause hormone therapy. So great. We have another thing in our toolkit as health care providers. But, certainly, we don't wanna just brush it off and say, oh, yeah. It's perimenopause. That is such an essential point you make.
Speaker 1
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Speaker 0
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Speaker 2
Everybody's journey is unique. Absolutely. And what works for me does not necessarily work for Michelle. And despite us having similar, scenarios. Right? Like, we really we really do need an individual approach, different solutions depending on our health history and what we're going through in particular. But when it comes to supporting mental health in perimenopause, in this, you know, the the crush of midlife, are there some nonnegotiables that everyone needs to participate in?
Speaker 3
I think there are several. I think, first of all, so often in midlife, we are pulled in a million directions. And it's important to just stop and pause and think about our own health and take that really seriously. And the same goes for mental health. A lot of women are very either ashamed, they're embarrassed, they're too busy, they don't wanna believe it, they brush it off. So that to me is a nonnegotiable. And, you know, stopping to think and reflect, like, who am I right now also? Like, I've been living my life this way. I've had all these responsibilities, all these obligations. How do I wanna live the rest of my life? Like, I I really encourage people to stop and pause and think about, you know, not only making their life not sick, but making their life really great and good enough and happy and contented. So I think taking the time to pause and think and question and then do the same about the people in our lives, the relationships in our lives, our careers, and those are it's hard to make these changes, and it's hard to talk about them, but it's so important. So those are all, like, sort of the psychological interpersonal things that I think everybody should ask themselves. And some of the major factors that I think are nonnegotiable for people are to get on top of their sleep. Sleep is so important. Women in midlife and perimenopause need to think about what's happening with my sleep. Why is it so bad? Mhmm. And how can I get it better? It's a huge risk factor for becoming depressed, becoming more anxious, becoming enraged really easily. None of us needs more of that. So so the sleep, and then, obviously, the really important things we always talk about as pillars of good health and mental health too are, you know, eating well, not obsessively, but eating enough to keep our muscles and our joints and our bones healthy, being active, being physically active, I say this day in day out to patients who I see is one of the best prescriptions for depression and anxiety, and so, so important. It doesn't have to be like you're running around in a weighted vest doing a marathon. Like, but it could be, you know, get up, go outside half an hour a day, get out there, walk. If you can do weight bearing exercises that you're gonna like and stick to, amazing. Do that too, and do that. That's all so good for our mental health. And then, of course, we see a lot of women who are drinking more than they should. And now that we have cannabis stores on every corner, you know, people think weed cannabis products are benign. Unfortunately, they're not at all. They are big both alcohol and weed and other drugs are significant contributors to depression, anxiety, feeling like shit in general, and it's so it's so underspoken about, and shameful. That's a big, big problem as well that I think has to be addressed by people. And we have a great we have great therapists at Bria who can help people with that. And even if they're not ready to quit or make changes to connect and to start to look at that ever so gently and get ready to make those changes because that is so important because we our bodies, our brains react differently to substances when we're going through perimenopause and can be really detrimental to our mental health.
Speaker 2
Right.
Speaker 1
Can I ask you a quick question? Circle backing to circle backing? Circle backing.
Speaker 3
I know what you're talking it is.
Speaker 1
Circling back. Oh my god. Oh my god. It's a day. Circling back to sleep. So for our listeners or maybe me who, laying in bed in the anxiety spiral in the middle of the night and can't get back to sleep. Do you have any tips on, like, how to shut that brain down? And I know this isn't I don't know if this is if this isn't your expertise or something you
Speaker 3
It's it's sort of in my I am not the foremost sleep expert. And, you know, as physicians, we like to stay in our lanes nicely. We have an amazing sleep person called Jess White Apria who is all around wonderful, incredible person, therapist, sleep expert. So I'm gonna, you know, tout her as an expert of all experts. But what I have learned from her and through my years is yes. So there are some things we can do. First of all, you wanna go to bed when you're tired, and you wanna be tired enough that, Jess uses this analogy of, like, a a a big balloon. So in the morning when we're waking up, our balloon needs to be like you know, when you blow up a balloon and it's tight and it's full, and you want the balloon to sort of get smaller and smaller till it's kinda squishy at the end of the day, and you can put your head on the pillow like a squishy balloon, not like that very buoyant, like, hard Yes. Balloon because that's when all the worries and stuff come in. So you wanna do things throughout the day to deflate that balloon, whether that's, you know, be active in the day. Do things that are gonna be relaxing, throughout the day to relax. Limit caffeine, and have a good unwinding bedtime routine. Not work out right before bed. Not eat a huge meal right before bed. Learn to associate your bed with, just sleep and sex and keep so everything that you can do to be as tired as possible and have those associations at bedtime. So your brain's not gonna pop up and be, you know, at bedtime. Perfect. And then doing things in bed, like mindfulness meditation has good data to help people. It's very, very hard to do. I know it's hard to do, and it's easy for me to just say, oh, listen to do a meditation and but there is good data. The more you practice mindfulness and even relaxation exercises, that can be helpful for people. So so there are a lot of different things based on an individual, and you kinda wanna look at what you're doing during the day in terms of caffeine and other medications you may be on and when you're eating, when you're exercising, and rejig some of that stuff in order to get to a point where at bedtime, you're ready for sleep and calm and the worries can go away.
Speaker 1
Thank you. I'll try that tonight. I you know what? I I do sleep generally, I do sleep really well, but just recently, there's been, you know, where lots of stuff on my mind, and I just Mhmm. And then the next day, as you said earlier, like, I'm just not functioning the same way. Like, today today, I I can't remember words. I can't get my words out. Right. Yeah. Exactly.
Speaker 3
Exactly. And it's a big and then you lie there at night thinking, oh, no. And tomorrow I have to do this, and I have to do that. And then tomorrow night I have to go to this. And when am I ever gonna be able to sleep again? And how am I gonna ever function again? And then it becomes catastrophic.
Speaker 1
Right. Yes. This is it. This is it. Ugh. Ruminating. I ruminate in the middle of the night. Doctor Ariel, I don't know if you're gonna have the data on this from Bria's perspective because I don't know if it's been, established long enough, but maybe from your other clinical experience. You're seeing patients through all the stages from, trying to conceive, pregnancy, postpartum, perimenopause, and menopause. Are you is there anything that you have seen over the years if you've been working with women for that course? Are there any flags that come up earlier in their in their journey that might, help them to identify and and help them to navigate perimenopause a little bit better?
Speaker 3
Absolutely. Absolutely. So the main the main thing to identify is one of the things we always do when patients come and see us is we take a bit of a hormone and mental health history. So this is where we wanna know, are you someone whose brain is sensitive to hormonal changes in terms of mental health symptoms? And what that would look like is we ask, are you someone who before your period, do you have a worsening of your mental health, depression, anxiety? Are you super sensitive? Are you really angry?
Speaker 1
Mhmm.
Speaker 3
Okay. How long have you had that? That's point number one of reference. Did you if you went through fertility, did you find it really tough on your mental health to be taking the medications that you need to prepare your body for the fertility procedures or or whatnot that you may have gone through. If you said yes, okay. Point number two of data. Did you have problems during pregnancy or the postpartum period? Again, very important information for us because we know when p the there is a subset of people who are hormonally sensitive have hormonally sensitive mediated, that's what we call it, mental health symptoms. So these in all people who've had these experiences, we know their brains are very sensitive to hormone fluctuations and that their brains they're manifest as depression and anxiety. So we know that this person who's had this, when we look through their life cycle and their reproductive stages that they've gone through, is likely going to struggle during perimenopause because, of course, as we know, the characteristic hormonal transitions of perimenopause, it's not a smooth gentle line. It's like a very jagged, sawtooth decline that we're experiencing, an up and down, and every hour is changing. So that person is also gonna be very sensitive throughout the menopause transition. And so people then, if they know this about themselves, the first thing we tell people is track. Track. Track. Track your cycles. Track your cycles and your mental health symptoms against your cycles as much as you possibly can because that gives your health care providers so much data. There's a lot of ways we can help people be successful and not suffer as much in perimenopause if we have this data about their about their background.
Speaker 1
Do you know? I wish I could turn back time and go back fifteen years and do this all over again because they are so much wiser, these twenty, thirty something year old. They know to track. They know so much more. And so then I could be going to you to talk about this stuff, and you could prepare me and say, hey. By the way, in the next five to ten years, you might start noticing some of this stuff,
Speaker 3
and maybe this is what, like Exactly.
Speaker 1
Oh my gosh. I love this. I need a time I need a time machine.
Speaker 3
Yeah. Absolutely. And what we love now is people are coming to us. Like, we we people are coming to us at shows or at talks. They're showing up, and they're in their twenties and thirties. And at first, we're like, oh, hi. You know? Are you here for your mom? Are you they're like, no. I wanna get informed. I hear this is gonna be happening. And so now we just expect that when we're giving talks and at shows or That's
Speaker 1
so good.
Speaker 3
Wonderful. Like, the earlier, the better. I just really am so determined that people do not suffer in silence on their own. I'm determined that people have the words to take to their own health care providers to ask for good evidence based care and, to take their own health and their own health concerns really, really seriously and to feel better because we have so much of our lives still left to live. With respect to mental health in particular, I would say to people, don't be afraid to speak up about it. I think people are getting a little more comfortable speaking up, but I still see far too many people who come and see me, and they said, I've been dealing with this for over a year now. And, you know, I've had to take time off work. I can't function well. My relationship is so rocky. I'm thinking about leaving. I can't be the person I wanna be for my kids or my friends. So that is totally unacceptable. And I know it's hard to speak up, and I know it's hard to talk to health care providers if you have one. I know it's often hard for people to even find a good health care provider, but my wish is that you don't feel stigmatized or self stigmatized before you even get out your door and that you talk. And talk to your friends and talk Online, there are great resources. There are also bad ones, but there are also good ones. So you feel less alone and know where to go and know how to how to navigate.
Speaker 1
Why do you think that it's is it just women don't have the language for it? We're not used to asking for it. Why do so many people suffer for so long before they raise their hand?
Speaker 3
I think when it came comes to anything related to women and women's health, there's stigma. And I think with mental health, there's also stigma. So it's that double stigma of women feel like they should be perfect. They should have it all together. They can't speak up. And then when you add in brain health problems like menopause that feels shameful, like depression and anxiety, anger feels so shameful for people that that all of that together leads to self silencing and a lot of issues for people.
Speaker 1
Well, luckily, we've got not only the team at Bria, but also now, menopause mental health certified. Is that what it is? Menopause mental health certified practitioners. How do they find these practitioners? Are they designated? Are are you keeping a log like the National Menopause Society does?
Speaker 3
We publish lists with each of our cohorts that graduate. So if people follow us on Instagram, our Instagram handle is at bria dot health at b r I a dot health on Instagram. They can follow us on LinkedIn. They can follow me. They can follow Bria. They can follow my partner, Bev, Bev Young. We're all on LinkedIn as well, and we publish names of these providers who come through our training and get our certification on their own LinkedIn profiles. A lot of these providers have that. So when people are looking or they post on their Instagram handles, so we're trying to get the word out there.
Speaker 1
Yeah. Well, we will definitely be helping you. We'll have to do a post about that. This is great. Thank you. I'm very needed. Thank you.
Speaker 3
Thank you both.
Speaker 1
Ariel, that was fantastic. I know that this is such, an important topic for everyone, but also specifically women in perimenopause. It's something that a lot of women are struggling with. So this has been really wonderful to have, such, an important and honest conversation with you. Thank you for all that you're doing. And, Yeah. We appreciate it. Thank you.
Speaker 3
Thank you both. It's great to chat. I feel like we were just out for coffee chatting. So thank you.
Speaker 1
That's what this is all about. Yeah.
Speaker 0
Thanks so much for listening to the show. If you like what you hear, please subscribe and write a review
Speaker 1
so more women can find us and get a better understanding of what to expect in perimenopause.
Speaker 0
This information is not intended as medical advice. The intent of this information is to provide the listener with knowledge to support more efficient and effective communication with their medical provider.
