Demystifying Menopause with Nurse Practitioner Shiree Walker

Shiree Walker demystifies menopause and perimenopause, helps you find your pelvic floor and explains why this life change may feel as though you’ve turned into a crime scene and puffer fish over night!  

She brings the science to ‘the change’ in the second of our three-part special on ‘Women’s Wellness’. 

 A Nurse Practitioner, Shiree’s expertise stretches across 21 years of emergency care nursing and specialist skills in continence and uro-gynaecology, and further post graduate training to become an advanced cosmetic injector. 

“The one we always hear about is the night-time sweats … but there’s urinary incontinence, pelvic floor, vaginal dryness, lack of libido – that fun stuff that’s all to do with menopause and perimenopause.” – Shiree Walker, Nurse Practitioner.

You’ll hear:

• Fertility, menopause and evolution explained (2:05)
• Personal training – hormones, cycles and wellbeing (4:00)
• Perimenopause (5:00)
• Anxiety (5:30)
• Flooding bleeding (6:30)
• Weight gain, metabolism slows down (7:30)
• Get tested – tests don’t guess (8:00)
• Vaginal dryness (11:40)
• Urinary incontinence (16:45)
• Pelvic floor (17:30)
• Night sweats (22:20)
• How long does menopause last? (27:30)
• Supplements, hormones, diet and next level testing (28:00)
• Keeping a symptom tracker (32:00)

Duration: 34 minutes.

Mentioned in this episode:

Find out more and book a timeslot with Shiree Walker (Glow Aesthetics Perth) via Instagram:  https://www.instagram.com/glowaestheticsperth/?hl=en

Shiree's website: http://glowaesthetics.com.au/

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Transcript

Shiree Walker: 0:05

The one we always hear about is the nighttime sweats. But for my background my former former life doing incontinence in uro-gynaecology is to do with urinary incontinence, pelvic floor, vaginal dryness, lack of libido, that line of things, that fun stuff that comes along with perimenopause and menopause, which is all to do with those hormonal changes as well.

Sonia Nolan: 0:29

Yes, menopause. It's a topic we don't talk about enough. Nurse Practitioner Shiree Walker is my guest today, in Part Two of our women's health special. Last time we covered cosmetic enhancements. It's another area of specialty for Shiree. But this week, we're talking crime scenes and puffer fish. Well, they're actually my own descriptions for the unexpected heavy bleeding and weight gain we experienced during perimenopause and menopause. Shiree puts the science around this today, and outlines some of the surprises we can expect during these years. But also, thankfully, some ideas how we can make it a smoother ride. I'm talking with Shiree Walker again, which is just such a privilege. Hello, Shiree. And welcome back to My Warm Table.

Shiree Walker: 1:12

Thank you. Thanks for having me again,

Sonia Nolan: 1:14

Shiree. Today, I want to talk about menopause. It's just something that all of my friends want to know more about. And not just my friends, who want to know more about what this mysterious stage in life actually is from a physical hormonal, body changing point of view. And it just seems to be something we don't talk about enough. It's something that people talk about in hushed voices or when you do hear someone talk about menopause, you can absolutely always hear the sentence. Menopause sucks. Yeah. So that's pretty much you know what, what we're exposed to. So I'd love you as a Nurse Practitioner to tell us some of the science and the medical activity that's going on in our bodies at this stage in life.

Shiree Walker: 1:58

So I guess from a very basic point of view. If we look at ovulation in women, we are constantly going through this hormonal cycle. So two main players in our body and women are oestrogen and progesterone, and they will peak and trough at certain levels depending on where you are on your ovulation cycle. So you know, oestrogen kind of begins to rise up before ovulation. And then when we ovulate, that kind of begins to come down. And then our progesterone begins to rise in preparation for implantation of an embryo. And then if that doesn't happen, if you don't get pregnant, then progesterone will drop, we'll get our period. And we just keep going through this cycle again, and again, until we go through menopause or we go on a contraception or we have surgery or hysterectomies or to stop periods. So I guess, at a very basic level, it's it's evolution, it's what's happening within our bodies, until we get to the point where we are no longer going to reproduce. I guess that's survival as well, because as a woman gets older, are they going to be fit enough to then carry a child and live long enough to look after the child to get to adulthood? So it's an evolutionary process as well.

Sonia Nolan: 3:13

It's actually quite, quite basic as that, isn't it? And I know, this colleague that you mentioned, you know, she said to me, that there's only two species on the planet that actually go through menopause, which I found interesting, because once a species ends its fertile life, then they're of no use to the species anymore. So they normally die or get killed off, which is really quite tragic. So you know, I'm very thankful that women are allowed to continue even when they are not reproductive anymore, because, believe it or not, we're actually quite useful. But apparently, it's only the human species and I think it was killer whales. That are the only two species on the planet that go through menopause. I found that staggering, came home and told my husband I said, Did you know and his first response to me was, Oh, my God, I'd never want to meet a killer whale going through menopause. So yeah, good point. Yeah, rude.

Shiree Walker: 4:08

Yeah. And, you know, when I speak to my female clients, even when we're not, they're not going through menopause, but maybe just looking at changes in periods and fertility. It's really that hormone that cycle, that's one's going up, one's coming down, one's going up, one's coming down. And you know, there's a lot of information now about there, you'll see a lot of personal trainers are talking about when they train a woman how it's different from a man because our function of our hormones, like I think pre ovulation we're at our peak, and that's where we're driven and we're getting everything done. And then after that, why I could have lifted like 100 kilos, those two weeks, but then come post ovulation across my period. Game over. So it's this whole process of not just what's happening with our hormones from a, you know, period perspective, but just all our well being and then getting towards the menopause stage of perimenopause, which can start 10 years prior to stopping of ovulation and then your hormones changing is that you can get these changes in the body. depending on you know what's happening with your oestrogen and progesterone. So there is a lot of changes as well in the body in regards to stress levels, adrenal issues just generally and fatigue and women. So there is this big play between the oestrogen and progesterone. We talk about progesterone in women is pretty much being relaxation and chill pill. And you will find in a lot of women who have adrenal issues or fatigue, I say when your body has been in this fight or flight response, when we do testing their progesterone levels are actually quite low. And then you might give them some progesterone and they just begin to feel amazing. Like their anxiety goes, they're sleeping better. They're just feeling chill and relaxed. I actually do have a nursing friend who's in her 50s, who actually I've known for many, many years, we did all her hormone testing, and she did have some anxiety and got on some progesterone and I asked her a couple of months after how you're going on and she said You know what? I'm so chill at work. I'm not stressed. The patient doesn't want to do that. Okay. Yeah, yeah.

Sonia Nolan: 6:11

And that is interesting, because I know friends who've never suffered from anxiety never had anything remotely like anxiety, but leading into menopause. This anxiety has just come out of nowhere. So it's just that Peri menopause time is something again, we don't talk enough about. So I do want to explore some of that. The other thing that women report is this flooding their period flooding. Now I call that crime scene, because it's like a crime scene. And, and I've got my, my name for perimenopause is crime scene and puffer fish. Because you, you know, out of the blue, you're flooding with your bleeding totally unexpectedly, and then you'll have nothing for four months. And then again, you'll you might have a little bit and then you'll, you'll flood again. And it's actually quite debilitating and terrible from a professional point of view, because you never know. And so, there are women that I know who who are terrified of flooding in the workplace. So it's, you know, it is something that again, you know, the reason I want to record this today is to reassure women that you're not alone in this that we are probably not talking about it enough and if you've experienced that crime scene experience, yes then there is someone else who absolutely has been there as well. And then there's the puffer fish like Okay, so you know, all of a sudden, my metabolism just decided one night, that I'm just not going to play anymore. Yeah. And I swear to God, I woke up 10 kilos heavier the next morning. It just seemed to come out of the blue had nothing to do with the chocolate Shiree!. But no, seriously, that metabolism, just totally just shut down. And and yet, so it's it, there's so many changes that seem to just slap you in the face out of nowhere. And they all come at once. But the good news about you know, sort of progesterone and the chill pill, the anxiety, you know, these things can be managed?

Shiree Walker: 8:05

Yes, definitely. So I think the important thing is getting tested and not guesswork. So we know exactly what's happening with your hormones. You know, there's lots of natural supplements out there and different things you could do or my friend did that and I Googled this. But I always say you know tests don't guess because it could be counterproductive with what you're taking. And you know, we're in this age where you can order something online from overseas that might not necessarily be approved here in Australia, but you can get from overseas, but isn't necessarily the best thing for you.

Sonia Nolan: 8:36

So getting tested, so you can actually see, where's your oestrogen at? Where's your progesterone at? Where's your testosterone at? So that's the other one. Yeah.

Shiree Walker: 8:43

So there are different tests available. And this is something I've had to learn, you know, coming out of, I guess, hospital system where, you know, we would do a hormone panel which is very much just like your oestrogen or progesterone, or like your follicle stimulating hormone luteinizing hormone can do testosterone. But then there are different tests, I guess we call it in integrative functional medicine that are available. So there is a saliva test that you can do, which does test your adrenal gland as well as your hormones or there is one called the DUTCH Test, which is the Dried Urine Total Comprehensive Hormone Test. And that one actually gives you a massive breakdown of your oestrogen metabolites. The saliva one does as well that gives less your E1, E2, E3 metabolites of your oestrogen and that will so it depends on them. They have different cost factors, but they that break down off your metabolites actually then tells us what's happening with your oestrogen pathways, as well as your progesterone and testosterone and then what we need to adjust so that that flooding that you talked off, usually is to do with your oestrogen levels. And I guess coming into a state where we might call it oestrogen dominance. So there are different health issues for women where we call oestrogen dominance like endometriosis, fibroids might be one as well. And so that can be from a more oestrogen dominant state. And there's things that we need to do to maybe look at how your body is actually detoxifying oestrogen through the body. And then that might help those pathways and then make periods less of a crime scene. But then we can also counterbalance with progesterone, which actually helps to decrease the amount of bleeding or I want to say thin, I guess to a degree kind of thinning the lining of the uterus, but also Yeah, it helps with that as well. And so it's getting that testing to know what's happening.

Sonia Nolan: 10:31

And is that testing sort of perimenopause is a good time to go and get that testing done?

Shiree Walker: 10:37

mums or young women who either pre fertility want to know where things are at, or things haven't been right since having kids and they're not getting any answers. So then we look at, yeah, testing their hormones and seeing where everything is in the balance are not in the balance

Sonia Nolan: 11:01

or not in balance anymore to the point exactly. And menopause is defined as it's been 12 months since your last period.

Shiree Walker: 11:09

Yeah. So that's then where they say okay, menopause is now you're officially in menopause.

Sonia Nolan: 11:13

Yeah, yeah. And so what sort of other surprises await the woman in menopause?

Shiree Walker: 11:19

So I guess the one we always hear about is the nighttime sweats. But from I guess, my background, my former former life, doing continents and urogynecology is to do with urinary incontinence, pelvic floor, vaginal dryness, lack of libido, that line of things that fun stuff that comes along with perimenopause, and menopause, which is all to do with those hormonal changes as well.

Sonia Nolan: 11:43

So tell us about, you know, those, can we unpack those? So let's start with vaginal dryness.

Shiree Walker: 11:48

Yeah, so that is to do with oestrogen levels dropping off and potentially could be with your progesterone dropping as well. And, it's to do with cervical mucus, because you one way you can track your fertility naturally is to track your cycle. So you can do like your temperature, but then also your cervical mucus discharge.

Sonia Nolan: 12:08

I think the Billings Method was a big one on that.

Shiree Walker: 12:10

Yeah, the Billings Method. And so basically, you're and this is the thing as well, you know, it surprises me sometimes women who don't they think that that discharge is not normal, not realising it actually is normal. And it's part of that fertile mucus, if you want to call it that. So as you're about to come to ovulation that mucus might increase might get me a bit more like slippery, because obviously, the sperm can then pass through that slippery mucus. If you're intending pregnancy, and then it marks off. But then if we're getting into menopause, and we're not cycling, then that's likely mucus is not happening, which then leads to vaginal dryness, vaginal dryness, then, you know, on penetration can then be quite uncomfortable can cause bleeding. So then becomes like a really uncomfortable process, especially if you've been in a relationship or whether it's male or female, whether you know, whatever, whatever your relationship, and then it becomes uncomfortable. And so then it affects the relationship as well. But there are things that we can do and try and play around with to try and help that process as well.

Sonia Nolan: 13:12

So what sort of stuff can you do to help counter that?

Shiree Walker: 13:15

So I guess simple things, though, before we get into medications is looking at foreplay, use of lubrication. Those are really important things to look at, and I guess, changes in conversation with your partner.

Sonia Nolan: 13:27

Yeah, look, I honestly think that menopause is a male issue.

Shiree Walker: 13:31

manopause,

Sonia Nolan: 13:32

manopause, definitely, let's go the manopause because, you know, my long suffering husband, you know, he's learned. He's learning a lot about women's health, or has done so since the very beginning of our marriage. So I just don't think we can not talk about it with our partners.

Shiree Walker: 13:48

Yeah definitely. And I think it's a thing. I've had conversations with my husband. I think as you evolve in your relationship, and I think for women as well, because we're maybe sexually not taught what, where we're at, like, I went to a Catholic high school, I think we got one session on sex, and the rest is like Dolly magazines,

Sonia Nolan: 14:10

We got all the Billings Method and we certainly got told to keep our legs closed.

Shiree Walker: 14:17

Yeah. And that's, you know, that's pretty much the sex talk. Yeah.

Sonia Nolan: 14:20

And we also were asked to feel our ovaries at one point, the girls we had very intense sexual training, sexual health training in our class, obviously.

Shiree Walker: 14:31

So I think it's that thing as well, just from a sex perspective, where where we have these discussions and where women, you know, we have that thing where I guess that whole Cougar, women do is come into their sexual prime as they get a little bit older, and maybe enjoy sex more as well. But then then, it goes on to this, whether that is surge of hormones, whether that's getting to know your body a bit better what you like what you dislike, or just, you know, bossing up and being like, this is what I want. And then we get to that perimenopause, menopause state where things begin to change. So I think it's that conversation around sex using yeah, for having a lot of foreplay lubrication. And then it goes potentially down the line of medications for vaginal dryness to make the experience not as unpleasant if you have, you know, friction happening when you're having penetrative sex. So you can there are different oestrogen formulations available on the market. I'm not going to go into trade names, but they are prescriptive. I know there are probably natural ones on the market, but I'm not going to go into that. But the prescription ones are effectively oestrogen creams that are inserted into the vagina just on the inside, it's not a lot that's used. But normally what it is, is you take it every night for two weeks, you insert it and what that is, is if you kind of think of like not like a bell curve, but like a graph, you're starting low because your oestrogen is depleted. And it's kind of coming up over the two weeks. And then you go to a maintenance dose of twice a week and then it just kind of maintains So yeah, that's that's where things so you know, nurse practitioners, GPS, doctors can prescribe that. There was a little bit of controversy because oestrogen in regards to breast cancer or family of breast cancer. So it kind of for some people, they got freaked out and didn't want to go on it or it fell out of favour. But you know, having gone back and worked in a female hospital just last year just went back for three months ended up staying for 12 in urogynecology that is kind of come back full circle and they are kind of going back to that or if we're saying if you are concerned if you have had breast cancer to see your oncologist get the all clear and then you can move forward with using your cream like that.

Sonia Nolan: 16:34

Great. So okay, so there's so there is help. There are some tricks up the sleeve for vaginal dryness.

Shiree Walker: 16:39

Yep.

Sonia Nolan: 16:40

So some of the other surprises in menopause. What else are there that we need to be aware of and let's talk about them?

Shiree Walker: 16:46

So could be urinary incontinence. So urinary incontinence, there are different types. So there is stress incontinence. So that's usually when there's a weakness of the pelvic floor. There's urge incontinence, which is where you get, but at the time we get this sensation in the bladder to go to the toilet, you've got the urge, and then you've leaked, whether that's full bladder is emptied, or just a small amount. But then those are probably the main you can get a mixed picture with stress and urge depending on your anatomy and what's happening in your health history.

Sonia Nolan: 17:18

Does it make a difference, sorry to interrupt, in regards to your birth story?

Shiree Walker: 17:22

Yes. So we go back to the pelvic floor. So basically, the way that I explain it to my clients is the pelvic floor is like a sling. It attaches at the front of your pubic bone, it comes all the way back and attaches to your tailbone. Now for women, we have three holes that go through your pelvic floor, where men only have two, because we have the urethral opening where we empty the bladder from, the vagina and the rectum. So depending on yes, birth history, traumatic births use of instrumentations or maybe not necessarily for all women, a birth story but if they've had complicated gynaecology background or surgeries or Gynaecological Cancers, all those type of surgeries can affect your pelvic floor as well. Your bowel habits straining to have your bowels open because even though the pelvic floor that's around your rectum, it can actually is like I said, it's that that sling effect as well. So can have different actions depending on your birth stories, surgical trauma, gynaecological history, and bowel habits as well.

Sonia Nolan: 18:20

So can the birth a traumatic birth experience actually break the pelvic floor? Like does it does it rip, tear, break, sag? What what's, what does it do?

Shiree Walker: 18:30

I guess, essentially,

Sonia Nolan: 18:32

because I'm picturing a hammock, right?

Shiree Walker: 18:33

Yes, yes, swollen and tear. But then it's also that if you don't use it, you lose it like any muscle in the body. So it's that rehabilitation aspect, up until a certain point, there are some people who will then do their pelvic floor, everything goes back to normal. Once you've you know, you've given birth, all that information and trauma has gone back to baseline and that you know, that length of time, I can't tell you that's very variable in different women, because it's also you know, was it a single birth was it a multiples, birth, or, like, all this stuff stuff, and then doing your pelvic floor exercises, and then you do have like, specific pelvic floor, physios as well, that you can go and see who are very experienced and can rehab a pelvic floor as well before you would then potentially need to go down the line of surgery or using devices using vaginal pessaries. So that was something that you can do. So that is, if you got I guess what we call pelvic organ prolapse where uteruses and vaginas are just the volt is beginning to descend down, which can be from vaginal atrophy, which is your drop in oestrogen as well as a bit of your your pelvic floor structure not being strong enough, doing your pelvic floor exercises would definitely be one of those things that can help that side of things.

Sonia Nolan: 19:47

I just was reading sorry, again to interrupt you there Shiree, that I was reading somewhere that some schools are encouraging young girls from the age of about 12 to start doing pelvic floor exercises just as part of their routine.

Shiree Walker: 20:02

Yeah. And I think about two or three, maybe it's about two years ago, one of the Endometriosis Foundations, they actually got funding for I think a physio or nurse to go out to schools to do education about periods and, you know, like about painful periods, what's normal, what's not normal, and part of pelvic floor is part of the education that's going out there. So that's really great as well, that we're, they're getting that education at a young age.

Sonia Nolan: 20:30

Oh, absolutely. No, that's really good. And great.

Shiree Walker: 20:33

The only thing I didn't mention was yeah, with the urge incontinence. So the best way that I kind of describe to women about urge incontinence is if you think of the your urethra, so female urethra is five to seven centimetres. Think of it like a balloon. So you've got a balloon and then you know, the little bit that you hold that we blow air into. So if you keep that pinched that what that's what happens, you know, when we're not menopausal or peri menopausal and it stays nice and tight and closed, which means it doesn't leak urine. When you get to perimenopause, menopause and your oestrogen levels drop off, if you unpinch your fingers it kind of gapes a little which means air or quote unquote urine can leak out. So that's why urge incontinence might get worse with age and women. So that's when also going on vaginal oestrogen cream can actually help to just bump that back up and keep that closed. And so some women will find that they actually get they get more urinary tract infections, perimenopause, menopause, where they've never had really any issues. And that's because that your urethra opening is slightly more open than what it has been their entire life. And like I said, you know, female urethra is five to seven centimetres, male ureter, it's 15 to 20 centimetres. So it's a lot easier for bacteria and even if it's just a normal bacteria on our skin, not necessarily like a bad bacteria, but the bacteria to transcend and go up into the bladder and cause an infection. It's a lot easier in in women for that to happen.

Sonia Nolan: 22:01

Definitely, it sounds that way. So we've we've covered vaginal dryness, we're covering incontinence and pelvic floor. Other surprises

Shiree Walker: 22:13

I think the one you'll probably find is the night sweats, night sweats, which has to do with your oestrogen levels dropping and tanking. So and this is again, I guess the controversial part and is whether you go on some type of hormone replacement therapy, to just kind of maintain and keep that oestrogen in there, getting it at the right balance to counterbalance things like the night sweats. And that's Yeah, and that's, I guess, a conversation some people are very for it, some are against it, some will look at natural therapies. And this is where like going back to, yes, testing, but also symptomatic symptom control. So when we're looking at like, hormones, I guess we talk about, if we do prescribe them starting low and going slow, so we don't just want to, as much as terrible as somebody is feeling, you don't want to give them this whole whack of hormones, and then we you know, they feel worse. So we would look at setting them on a low amount. And then probably repeat testing, whether it be blood test or symptom management usually won't do both like blood tests and symptoms in about eight weeks, and then see whether we need to go up from there, or whether we maintain them or whether we need to add in something else, you know, to just help them symptom wise.

Sonia Nolan: 23:26

And there's things now called Bio identical hormones that the whole HRT situation has changed significantly from perhaps the time of my mother going through menopause, where HRT was a really bad word like you just don't talk about it. You didn't you know, you just you know, you just have to persevere and get through menopause without actually taking anything. And when you did take something, there was always these huge risks associated with it. And there's been reports, actually debunking some of the studies that were done in those times is that right, Shiree that the fear that was caused about some of the HRT causing breast cancer.

Shiree Walker: 24:03

Yeah, and I think potentially that might go back to what we were talking about the oestrogen as well with the risk of breast cancer, and even though it's vaginal oestrogen versus breast cancer, so just, yeah, there definitely have been some articles where it debunks it. But I always tell people, if they're concerned, check, check, go go back to your oncologist. If especially if you do have a history, just get that letter of approval or have that chat. And then you kind of know where things are at because they are the specialists in that area. Yeah, so there is I guess, HRT which is synthetic hormones, and then there's bioidentical. So the other name you might hear is body identical. So they're the closest type of hormone to our bodies. And that is another way that's going to help relieve symptoms. It's one of those areas it depends on who you speak with from a health professional perspective as to whether they're for or against it. So this is where I think patients can get is a bit stuck, because they're getting pulled or it's, I guess I call I kind of call it like the the girlfriend effect. It's because my friend had this. Now I want to look after it, or they've never heard of it because they Yeah, it's because someone's told them rather than it's at that.

Sonia Nolan: 25:16

Okay, so there's been huge advances in that area. So. And there are practitioners who can actually work with us to alleviate any of the fears or concerns and actually work through what is actually going to be right for our own experiences of menopause. And also, what we want to achieve through menopause because it could be that you're actually okay with the night sweats, the anxiety that you just don't want to deal with. Or it's the, you know, it's the dryness or the incontinence, like they're, you know, so many so many things you could sort out

Shiree Walker: 25:45

And there's potential things like with the heaviness of the period. So the one thing that you can do is potentially with progesterone, you can go on it all cycle. So

Sonia Nolan: 25:51

Is that what the Mirena does or some of those like I was saying, before, your progesterone kind of peaks after ovulation, in the process of getting ready for implantation of an embryo. If I have a client who's like Shiree. I just want my periods to stop, you can actually trial putting them on progesterone, their entire period, their entire cycle, because your body is thinking to a degree that you're pregnant. So then you don't shed the lining of your uterus and it stops your period. other artificial contraception?

Shiree Walker: 26:24

Yeah, the Mirena has, like a so you've got like, I guess, I guess the copper, copper IUD doesn't have hormones, it just is a sort of maze that sperm aren't meant to be able to get through it.

Sonia Nolan: 26:36

It's too confusing for the boys.

Shiree Walker: 26:40

Exactly. And then your your Mirena will have different hormones in there. But you know, for some women, they can still get through breakthrough, bleeding with the Mirena. So it doesn't completely eradicate that at least, you know, I get some women who have no issues, and others who are like, I still know, when I'm ovulating, I'm bleeding or I've like bled the entire time. I've had it in or just makes me feel like crap. And I'm not to say that it's not for it's not not to be used for some people, it has great affects, you know, in some way with adenomyosis, which is like a sister disease to endometriosis. You know, the definitive surgery for that is a hysterectomy, which someone might not be wanting to go down that line. But they do talk about putting in a Mirena might be a good way to go to just help with that symptomatic control of the heavy periods and the clotting and bleeding that comes with that.

Sonia Nolan: 27:29

It's just rich with issues, isn't it? The whole female body is quite a miracle. Yes, quite the miracle and it creates beautiful miracles too. So you know, it's an extraordinary, extraordinary machine, the female body. How long does menopause normally last?

Shiree Walker: 27:45

That's another kind of variable depending on I guess if you take into effect the perimenopause to menopause state, I guess it could be like 10 to 15 years, depending on symptom wise, some women can get away with it, you know, I speak to them, and they kind of go, no issues, just sailed through it. And others were like, just dragged on and on and on. So it is always variable. But that's I think getting that symptom control and seeking out health soon, sooner rather than later can kind of bridge that gap for you and get make the experience not as unpleasant.

Sonia Nolan: 28:17

And look, you know, with modern medicine, and with compassionate and caring practitioners around us as well. There are so many tricks up their sleeve to to actually you know, help manage the symptoms in the situation as it is and, and also suit the busy lives of women in their 50s or 40s and 50s. Because you know we are living in a modern society where we do lots and lots of things at the same time and need some sort of understanding of how we can manage our menopause during that.

Shiree Walker: 28:46

Definitely. And I didn't really touch on natural supplements as well because, you know, I there are other things that can be used out there to help counterbalance part of the perimenopause, menopause state as well. So it's not necessarily always medications, but there are other things like natural supplements that people can use as well to help relieve some of those symptoms as well, depending on which way somebody wants to go. So you know, you have a lot of people who push back with the hormones and if that's not their jam, that's fine. We can potentially work on these other supplements which which might help depending on what's happening with your oestrogen and progesterone. And it might help them get them to a point where they feel okay, and then they in turn, they might want to progress to hormones, or they might just be like, I just want natural, natural natural and this is where they stay. So it is that balance as well as of of what a client wants.

Sonia Nolan: 29:34

Is there any dietary changes that women need to make in that in that time as well?

Shiree Walker: 29:39

I guess for me because I guess it is that thing about the weight gain seems to be the issue. So I always kind of think about and then initially- I do not have a nutrition background. So I'm going to just you know, declare that share that and I'll be honest, I don't know enough about the to say this is a definitive but I do know some clients have gone on to keto and have had good results. I think this is where we need to potentially look at other testing as well. Because diet I think is definitely 80% of where we go with weight loss. I always think going like gluten free, dairy free, sugar free if we are getting the weight issues is probably the way to go. But this is where I think checking other tests in the body like checking your thyroid function, checking your blood sugar and insulin level for insulin resistance, because those are things that can definitely affect weight gain, if that's a concern for women during menopause or perimenopause state, and that's things that kind of get shoved under the table or forgotten unless, especially for thyroid, unless you have some type of definitive thyroid symptoms or family history. There's certain thyroid testing that, that it's not necessarily always done. And same with the insulin resistance, you know, certain practitioners are like, I don't bother to do the insulin and then you know, we might do insulin resistance and find it sky high. So they actually might be pre diabetic. And, you know, insulin resistance is very much where they hold that weight around their tummy. So sometimes you can actually just have a conversation and be like, where is where on the body is the weight gain, and they go, it's all on my tummy and then go right yep these flags, right, this is a next step of testing that we need to look at. So yeah, so though, and then that if they're pre diabetic, then we go into like a, there's lots of different ones around, we're probably like your low sugar, low carb type of diets, once again, I'm not a nutritionist, not an dietician, not a diabetes educator. But, you know, you can, you can delve a lot further into that, but you can just start the basics and beginning to that, based on what those results come back with.

Sonia Nolan: 31:29

Look, there's just so many forensics you can do at that point aren't there? And it really is that case of every woman is different, everybody's different, every menopause is going to be different, but there certainly are some gateways there of of what you can start having a discussion about. So it's finding I guess for for some of the women listening, finding a practitioner that you're happy to have those conversations with you as a starting point, and then starting to uncover what the diagnostics are telling us and and finding the way forward from there.

Shiree Walker: 31:59

Yep. And I also think for women you know, there are a lot of GPs and Nurse Practitioners that are quite open to having discussions so I always think I do tell people to keep like a period tracker or a diary and symptoms because then you are the best one by far to know exactly what's what's happening with your body and what the timeline is and then you can go to your practitioner going this is what's this is what's been happening and you know period trackers are great because they can chart everything out for you and tell you you know if you did you have random spotting was your bleeding heavy were you flooding pads symptom wise so there they are, give you some really great data to be like, This is what's happening with me and we need to action and work on this

Sonia Nolan: 32:40

Shiree thank you again, you're a font of information so much that is relevant to us today. As as women just try to try to get through the day. I really appreciate your time again today talking with us on My Warm Table.

Shiree Walker: 32:55

No worries. Thank you. Thanks, Sonia.

Sonia Nolan: 33:00

You've been listening to My Warm Table with Sonia Nolan in Italian a 'tavola calda' is a warm and welcoming table where you can share big ideas, friendship, laughter and life. So much happens around the kitchen table and I wanted to amplify it here in this podcast. My aim is to feed your mind and soul through smart conversations with heart. No topic is off limits, but good table manners rule. I hope you'll join us each week as we set the table for my extraordinary guests who will let you feast on their deep knowledge, life experiences and wise insights. Let's keep the conversation flowing. Please subscribe to the My Warm Table podcast and share it with your friends and networks. Perhaps if they are new to podcasting, take a moment to show them how to download and subscribe so they don't miss an episode either. I'd also love you to join our community on Facebook. You'll find the group at My Warm Table Podcast. Your support is very much appreciated.