If you’re in your 30s or 40s, you might not be thinking about menopause just yet, but now is the perfect time to start the conversation. Understanding what’s ahead can help you feel more prepared, confident and in control of your health.

In this episode, Dr. Renee White chats with Dr. Cheryl Phua, a highly respected fertility specialist at IVF Australia, to break down what every woman should know about perimenopause and menopause. Dr. Phua has extensive expertise in reproductive medicine, holding a Masters of Reproductive Medicine from the University of NSW, along with a BSE and Masters in Biotechnology from the University of Pennsylvania. She is passionate about helping women navigate all stages of reproductive health, from pre-pregnancy through to menopause and beyond.

You’ll hear about:

✔️ What perimenopause actually is – and why it’s not just “menopause lite”

✔️ Common (and surprising) symptoms – beyond the classic hot flushes

✔️ Treatment options – including the truth about hormone therapy

✔️ How menopause affects long-term health – and why you need to advocate for yourself

✔️ The biggest menopause myths debunked – so you don’t fall for outdated advice

Whether you’re starting to notice changes, supporting a loved one, or just want to be prepared for the future, this conversation is a must-listen. Menopause doesn’t have to be a mystery—or something we just “put up with.” You deserve to feel informed, supported, and in control of your health every step of the way.

Resources and Links:

📲 Want to chat more about this? Connect with Renee on Instagram: @fillyourcup_

🌐 Want to learn more about Dr Renee White and explore Fill Your Cup Doula services

🍪If you want to gobble up our famous Chocolate + Goji lactation cookies, look no further!

📲 Want to connect with Dr. Cheryl Phua? Follow her on Instagram: @drcherylphua or visit her website: drcherylphua.com

💡 Looking for more menopause info? Check out the Australian Menopause Society for evidence-based resources: www.menopause.org.au

🎧 If this episode gave you clarity or confidence, share it with a friend who might need it too. And if you haven’t already, hit subscribe so you never miss an episode.

Disclaimer: The information on this podcast presented by the Fill Your Cup is not a substitute for independent professional advice.

Nothing contained in this podcast is intended to be used as medical advice and it is not intended to be used to diagnose, treat, cure or prevent any disease, nor should it be used for therapeutic purposes or as a substitute for your own health professional's advice.

[00:00:27] I'm Dr Renee White and this is The Science of Motherhood. Hello and welcome to episode 164 of the Science of Motherhood I am your host, Dr. Renee White. Hello everyone. This is a, this is a cool episode. Um, this is if you haven't already worked out from our social media and lots of other things, I'm very keen to learn more and more and more about perimenopause and menopause, because I think these are discussions that we need to start having in our thirties and forties.

[00:01:29] I would jump back into that episode. Today's episode, we're going to be talking with a fertility specialist about, you know, what you need to know. But before we dive into that particular episode, I just wanted to remind everyone about Fill Your Cup, which is an amazing doula village that I run here out of Hobart, but we have doulas all across the east coast of Australia.

[00:02:38] And we have those lovely people in our doula village. Um, we also have wonderful postpartum doulas as well. So if you're one of those people who maybe you've got a toddler, maybe you're thinking, Oh my goodness, it was hard enough with one. How are we going to juggle multiple kids, you might be feeling a little bit guilty about not, you know, giving older kids enough attention.

[00:03:39] There may be a postpartum dollars for you and as I said, we have lots of those people who can help you with in-home care. We come in, pop into your house for three hours a week. Generally it can be more, can be less, but generally it's weekly. You get to pick, um, some beautiful meals and snacks from our menu.

[00:04:53] All right, let's jump into today's episode. As I said, it is the second episode in our little mini series on perimenopause and menopause. And we have got the wonderful Dr. Cheryl Phua with us today, and she is the a distinguished fertility specialist at IVF Australia. Um, if you haven't caught her on our previous episodes, she holds a master's of reproductive medicine from the University of New South Wales.

[00:05:49] We're going to talk about real definitions of perimenopause, menopause. We're going to be talking about treatments. We're going to be talking about, you know, with perimenopause and fertility, is it all doom and gloom? And we're going to debunk some myths along the way, because there is a lot of misinformation in this area for many, many reasons.

[00:06:39] Um, yeah,

[00:07:02] We're talking about perimenopause and menopause today. I am on a little bit of a rant about all of this because I'm about to turn 40 and my friends, most of them are older than me, so they're kind of well into the perimenopausal kind of sphere um, and so I want to get a leg up on all the information in this area.

[00:07:42] Dr Cheryl Phua: Yeah, in Melbourne just recently.

[00:07:53] They're fabulous. Cheryl, do you want to talk to the listeners and let them know who you are and what you do on the daily?

[00:08:05] Dr Renee White: No, I love your energy. I keep telling the team, I'm just like, oh my god, this woman is amazing.

[00:08:33] And let's not forget our women who've contributed so much to society, menopause, because that area is even more taboo sometimes I think than infertility because lots of women get to late 40s or mid 40s, some even earlier that see me for period troubles and then we find out they've gone through early or premature ovarian insufficiency.

[00:09:30] Dr Renee White: Absolutely. And I think this is, I, I'm, I'm assuming it's probably because I'm in this, you know, sphere of women's health and things like that. But, um, and I don't think she's going to get cross at me for saying this, but my mum, my mum is the one who's also kind of spurred me on in this area, being the scientist in the family.

[00:10:16] You're at that stage of your life. You just suck eggs. That's where you're at. And you just like, that is, this is it. Like you can't change it. And my mum is just like. Nah, I'm not doing that.

[00:10:30] Dr Renee White: It doesn't sound right to me. Is there anything we can do?

[00:10:42] Symptoms can start in perimenopause. Peri just means around the time of menopause because, annoyingly, And I always think that the reason why definitions are so weird is because it's probably made by a bunch of male doctors back in the day. Then.

[00:11:04] Dr Cheryl Phua: It's basically retrospective. So we look backwards. So when you haven't had your period for 12 months. Say you're 52 now, you haven't had a bleed for 12 months, we can throw the pads or tampons or menstrual cups and the period undies out, then that's the definition of menopause 12 months after your last period.

[00:12:13] It'll stop eventually. Just leave it. Nothing's going to happen. And I think that this is because back in the day, in the 90s, there was this big study that came out that got a lot of media attention then that said, Oh, you can't go on hormones for menopause because any hormone therapy, HRT at the time was what it was.

[00:12:42] Dr Renee White: God,

[00:12:54] A lot of people aren't comfortable with prescribing it because they haven't caught up with the latest evidence and the latest. forms of treatment that's available. And so these poor women come and see me sort of three or four years later, having been suffering through things. And then when we talk about what's available for treatment, they're like, Oh my gosh, that's, you know, so good.

[00:13:32] Dr Renee White: Absolutely. And I think, you know, on top of that, the complexity of the mental health status of those women through that three, four, five years time of just grinning and bearing it, it's just deplorable, like, We have a, you know, I, I, we spoke offline about this, um, the fact that there was a, a menopause kind of webinar, um, workshop thing here in Hobart and one of the GPs was kind of mapped on a timeline in terms of the rate of suicide in specific age groups.

[00:14:32] I'm out.

[00:14:57] Dr Renee White: Mm hmm. Absolutely okay, so we've kind of defined, you know, what perimenopause is in comparison to menopause. Let's talk about the treatments. Let's talk about the positive sides of what women can actually do. What are some of the options available?

[00:15:44] Some people experience brain fog, irritability and more and more anxiety going back to what you said about mental health. A lot of people say, look, I'm just feeling really anxious. I get these palpitations out of nowhere. All of these is due to sort of the menopause changes in our brain hormones and the lack of estrogen primarily being released by our ovaries because they've now gone to the stage where they've got not enough capacity to release any more hormones, leading to these symptoms.

[00:16:50] If certain foods and things trigger flushes, we try to avoid them and sort of eating healthy things with a lot of high antioxidants or phytoestrogens may be helpful in someone with mild symptoms. If that doesn't sort of quite improve things, then there's hormone therapy, which is the first line for troublesome symptoms.

[00:17:31] Even people who see me with like an eight or nine hot flush severity, if it gets down to a four, they're very, very happy because that means that instead of having a hot flush every hour, if they just have one once or twice a day, they can go about doing the other stuff that they need to do and be able to sort of, you know, enjoy other aspects of their life.

[00:18:11] Another one is, oh, let me show you. Another one is in a pump gel form. Oh, yeah. Yeah. And that's just like a facial cleanser type thing. And it pumps out from the pump and people just rub it on their skin till it dissolves and wash your hands afterwards. So the estrogen is what's important to relieve the symptoms, but having estrogen only, Renee, it's not very good in women who still have a womb.

[00:18:39] Dr Cheryl Phua: Because having unopposed estrogen by itself can lead to overgrowth of the cells in the lining of the womb. And it's some women that might lead to things like pre cancer changes. So in the little patch sticker patch, we've got both estrogen and progesterone, which is the molecule that helps shed the lining or keep the lining thin to prevent the overgrowth from the estrogen, which helps women's symptoms.

[00:19:06] Dr Cheryl Phua: If people are on the gel form, they just take a tablet. So there's two medic, two bits of medication and the gel is slightly more expensive versus a patch, which is a lot more affordable. Because again, women who are needing treatment for their hot flashes and things might find it hard to be paying lots of tens of dollars every month. until they need to stop the treatment. So that's the other consideration that's really important to discuss with my patients.

[00:19:38] Dr Cheryl Phua: Always, always. Menopause treatment is not sexy, it's not like, you know,

[00:19:45] Dr Cheryl Phua: Again, it's my conspiracy. I love it. It's not sexy. They know that people will always buy it. Yeah. Men are not needing it.

[00:19:58] Dr Cheryl Phua: There's how is that? How do we, we every year, there is always a time where they run out of the patches, which is why things like more expensive options come on the market because they know that people are that desperate for treatment that sometimes when the patches run out, that they've got no choice.

[00:20:19] Dr Renee White: And from a, okay, so let's just say someone has to do that. Is that okay to switch between the two?

[00:20:45] Dr Renee White: Yeah. Okay.

[00:20:58] Dr Renee White: That's what I told my mum to do.

[00:21:08] Dr Renee White: Oh yeah, 100%.

[00:21:13] Dr Renee White: The other underground thing that I've heard is that, say, say the, the patch that they require is 50 milligrams or whatever it is, is that if they can't get the 50, just get a 100 and cut it in half. Is that okay to do or are you compromising the patch?

[00:21:40] Dr Renee White: Wow because my mum suggests she said oh you know so and so said so and so said I should do this and I panicked and I said don't do that mum because I don't know because like being the scientist I'm like you could compromise the integrity of the patch something could come out of it I was like don't do it so she was like okay not gonna do it um so yeah okay okay all right Okay, so we can cut the patch. I think I need to text her now and tell her to cut the patch, mum. Just cut the patch.

[00:22:19] Dr Renee White: Yes. And she went through that as well. She was like, I can't do it. I'll die.

[00:22:54] The later you start it though, so in older women, so in their 60s or 70s, if you are starting hormones, then that's when it's risky, because that's when people have had more time to develop that's in their like heart vessels, more disease in their arteries of the heart and the brain leading to those complications of stroke and heart attacks.

[00:23:16] Dr Cheryl Phua: Whereas if you have it early, it actually protects you from heart disease, colorectal cancer. It protects people's bone strength. So it reduces the chance of osteoporosis. and also treats people's hot flushes. Back to what you were saying about the International Menopause Conference. Interesting, endocrinologists or hormone doctors are now using hormone replacement as one of the therapies to help women who are at risk of developing osteoporosis.

[00:23:43] Dr Cheryl Phua: I know, I was like, oh, that's interesting. So that was a really sort of good takeaway and that that's actually an add on treatment for women who say have a head of fracture or something to try and help maintain their bone strength because as we get older, the bones start to get more brittle. And it's not like there are injections that people can use, but from what I was listening to them speak, there seemed to be some side effects.

[00:24:11] Dr Renee White: Yeah. And so estrogen plays into that loop.

[00:24:20] Dr Renee White: Wow. Okay. That's fascinating. Um, I'm curious to know, apart from like that crazy study in the 90s, are there any other kind of big myths or misconceptions that you would love to debunk like right here and right now? Like, what are the things that you hear from people?

[00:24:55] Dr Renee White: Oh my goodness.

[00:25:14] So some people are like, oh, you know, but like, you know, I'm still having these problems with my, what we call genital urinary or down the bottom bits. All of those things can still be quite severe and people are like, Oh, I just keep giving, just give me antibiotics for my UTI, not realising that it's a lack of estrogen around the vaginal tissues that makes everything dry, painful, more susceptible to UTIs and incontinence sometimes.

[00:26:00] In some of these women, after close discussion with their treating team or their oncologist, we can give some form of vaginal creams of estrogen that's relatively safe because it doesn't get converted back in the body. Whereas a lot of these women, even the skin preparations of hormones is not quite safe because of the theoretical risk of bringing back the breast cancer.

[00:26:38] The knowledges and the, we can keep a close eye on these women, but there are options for treatment for these women even after, and if they're suffering from menopausal symptoms.

[00:27:34] Dr Cheryl Phua: And also really don't forget, women live longer than men. That's been proven. Australian statistics and worldwide, we know that we live longer. One of the reasons is because of our periods and our estrogen levels staying high to usually about 50 ish on average. That's what protects us.

[00:27:59] So we always thought that as women, we've got estrogen to about 50 something. We'll kind of protect it from heart disease.

[00:28:33] So that was quite an eye opener.

[00:28:43] Dr Cheryl Phua: They think that it's got action on the lining cells within the vessel walls of the blood vessels and that's why they're protective until we stop having them. That's one of the theories and it's sort of oxidation and stuff within the blood vessels seems to be better in younger women.

[00:28:58] Dr Cheryl Phua: That's it though, Renee. Sadly, last take from the international conference, women who present with chest pain to emergency are less likely to be adequately diagnosed with a heart attack because that's not what they think women get.

[00:29:16] Dr Cheryl Phua: I know it's quite interesting. So this cardiologist gave a talk, she was really good. She actually set up this research foundation with a patient of hers that had a heart attack in her 30s, which is unheard of. But because in emergency, when you come into emergency, you get triaged based on your symptoms, how severe they think it is.

[00:29:59] Dr Renee White: Wow, I feel like I need to dive into that, because isn't, like, have you said this already, but maybe it's just been in my head, but like cardiac disease and cardiac arrest is the leading cause of death for women, is it not?

[00:30:19] Dr Renee White: Okay, all right.

[00:30:23] Dr Renee White: Oh my goodness. I know. So we don't have, we don't have our patches and then when we turn up to emergency, we're not being taken seriously.

[00:30:37] But because you're 45 year old female, they might say, Oh, did you hit your chest? Was it like, you know, which was quite interesting to me from that perspective that even when they looked at the long term health after someone presented with an incident event. Yeah.

[00:30:58] Dr Renee White: Okay, that's fascinating.

[00:31:02] Dr Renee White: Yeah.

[00:31:16] That's all normal. Oh, it's PCOS or your polycystic ovary is causing those things. There's been quite a significant number of women that seen me with irregular periods. They might not have been bothered by hot flushes quite yet, but it's actually not their polycystic ovarian syndrome, but they've actually gone to, so I would always say if your periods have become funny after you've stopped your pill, or if, you know, things have just changed in terms of periods and how they are, how often they come, don't worry at all, just see your GP because sometimes it's as easy as doing a blood test for the diagnosis.

[00:32:06] So I've got patients who see me at 29, having gone through premature ovarian insufficiency, which is the new term now. And they're looking down the barrel of at least another 20 years of having, bugger all estrogen if no one were to treat them.

[00:32:33] Dr Cheryl Phua: Yeah, it depends on certain what their numbers are and how high their hormone levels are.

[00:33:02] So if my patient can't produce an egg anymore because she's run out of her own, then she, you're looking down maybe potentially using an egg donor, either someone you know, a family member, for example, or egg banks that all IVF clinics will work with. We can implant the egg with partner sperm, donor sperm, and then help my patient carry the pregnancy. So they're still the mother.

[00:33:29] Dr Cheryl Phua: And they're still falling pregnant. They still carry it to nine months and then everything else just happens.

[00:33:40] Dr Cheryl Phua: Not all aspects of it, so it can be quite costly depending on where the eggs come from.

[00:33:52] Dr Cheryl Phua: I think those were my main ones and it was just interesting to see all these experts speak about these things and also lots of women, back to the early menopause population, lots of women come and ask me, hey, can we find out why? I said, yep, we've got these little basic tests we can do to check if there's a genetic reason for why you've got the menopause early, if there's any autoimmune condition that's associated with it.

[00:34:48] Dr Renee White: Mm. I think that would be really useful because my understanding is also that if you're in that kind of perimenopausal, uh, zone, there's not a clear definitive blood test because your hormones could be all over the shop and like, it's a single time point. So.

[00:35:29] Dr Renee White: Okay, that makes sense. That is all the questions I have before we jump into our rapid fire. Was there anything else you wanted to add before we did that?

[00:35:47] Dr Renee White: Yes, Dr. Hannah Chapman.

[00:36:05] It's important to reach out, look online for people who are, who have a special interest in menopause and currently now, like I said, we're expanding our public clinics, so hopefully people will be able to get in. The problem is like, you know, in the public sector, sometimes wait time is an issue.

[00:36:47] Dr Cheryl Phua: And that's a, that's a, that was one of the positives that COVID, the pandemic came out. Is that we now can do telehealth for most things, unless there's something we need to examine or you're worried about a lump or bump. Yeah. Telehealth is quite good most of the time for most of these management issues.

[00:37:21] Dr Cheryl Phua: Reach out to your friends, reach out to your family as well as your GP. Have a chat to them. There's a lot of good online resources.

[00:38:00] Dr Renee White: Um, do you have a go to resource? You've just mentioned that website. Um, was there anything else that would be available for people who are wanting to know more information?

[00:38:22] It breaks it down into extra five women in 10, 000 will have breast cancer if you're on hormones from 60 to 69. So you can see how sort of that number is actually not quite as bad as what the other studies suggested that to be.

[00:38:45] Dr Cheryl Phua: Already now, eye drops. New thing that's happened on my bedside table.

[00:38:50] Dr Cheryl Phua: Hay fever related. I think it's just springtime in Sydney, so I should have eye drops at night time. I might have to start on my own hormone soon, Renee.

[00:39:24] And we were, we were doing our last kind of quick shop before we headed to the airport. We ended up going to the airport four hours early. Cause I was like, I can't, I was like, I don't have any Zyrtec. What am I, what am I doing? I was like, that's it. We're out of here. Goodbye.

[00:39:43] Dr Renee White: That's a good question. I have a lamp, I have my Kindle always. I've got this beautiful flag. It's like, um, it's the shape of a kind of a long flag, but I got it in Japan. Last year or the year before, and I still haven't framed it. It's still in its packet. And I've got, um, There's always one of my daughter's books. You'll just always have like a book there that she'll come in. If I'm sitting on the bed, she'll read. And I don't know why I always have this, but I have the book, The Alchemist. Um, yeah, I just, it's one of those books that is. I just always have it. I just like to pick it up and read it. It's so short and like, I don't know. I absolutely love it. And always my, um, my Frank Green water bottle. So, yeah, that's what I have on my bedside table for all those playing at home. I've never actually told anyone that thank you Cheryl.

[00:41:03] Dr Renee White: Exactly. Exactly. So everyone, please feel free to share this episode and get talking about it because this is the only way that we're going to start squashing this suffering in silence because Totally done with it. Not interested.

[00:41:27] Yeah. And that's just the thing. People just normalise it so much that people don't go finding reasons for why they have debilitating period pain.

[00:41:40] Dr Cheryl Phua: Thanks so much Renee, have a good holiday season.

[00:41:48] Dr Cheryl Phua: See you soon, bye

[00:41:50] If you loved this episode, please hit the subscribe button and leave a review. If you know someone out there who would also love to listen to this episode, please hit the share button so that you can benefit from it as well. You've just listened to another episode of the Science of Motherhood proudly presented by Fill Your Cup, Australia's first doula village, head to our website ifillyourcup.com to learn more about our birth and postpartum doula offerings where every mother we pledge to be the steady hand that guides you back to yourself. Ensuring you feel nurtured, informed and empowered so you can fully embrace the joy of motherhood with confidence. Until next time, bye!