You've had a history of depression, very high likelihood that you will experience depression again in the menopausal transition. And then the other side is if you've never had depression, anxiety, let's just take those 2, you're at twice to 4 times the risk during the menopausal transition.

Welcome to Fempower Health. This is Georgie. I'm so excited to share this episode with Dr. Allie Sharma with you. She is a clinical psychiatrist specializing in women's mental health. And if you can believe it, one of the top search terms on Google is how to deal with a menopausal wife. So we cannot underestimate the importance of covering this topic. We've got so many hormone changes happening in perimenopause and then the ultimate shift once you're postmenopausal. So today, we're going to dive deep into the often ignored mental health impacts and discuss practical strategies for navigating this stage of life.

And we're going to talk about how you can advocate for your health and how your family members can best support you through these changes. So if you're really looking to understand and have better clarity on this journey, tune in and take a listen. So doctor Sharma, before we dive into this fascinating and important topic, why don't you give us your introduction and, and then we'll go ahead and just dive right in.

Sure. So I'm Dr. Allie Sharma. I'm a clinical psychiatrist and currently co-founder and Chief Medical Officer of Being Health, which is an integrated care model. I can explain it to you in a little bit. And then also, I'm an advisor for EverNow, which is a digital menopause care company. And just briefly about my background, you know, I trained at Cornell as a psychiatrist. And in the 1st 10 years of my career, I was an attending psychiatrist at Columbia. I worked for the homeless population, supported student mental health, worked in global mental Health, and then I really switched a couple of years ago when I had my second child and everything was too much to working in tech, and then becoming advisors for certain organizations and cofounding Being Health and really thinking about best practices and a new model of care.

And throughout my career, I've supported women in all phases of their life, you know, from early adulthood to pregnancy, post partum, and now perimenopause and menopause and beyond. So it's really a passion of mine.

That's awesome. So tell me what makes, perimenopause and menopause such a passion of yours.

Well, first of all, I'm 48, so I am in that age bracket where all of it is happening to me and all of my friends around me. So that's one thing. And also having been through motherhood, we see all these shifts in our hormones. And second, so many, my my practice skews towards women.

Okay.

And as I've grown up and people have, like, followed me in my practice, we're all kind of aging into this together. And it's interesting because of the deficit of training, and we know all the reasons why. But in my medical training, we've sort of had to figure this out on our own. Like, we learn as providers from the people we treat. And so we see what happens. And the question is, what do you do about it? Right? How do you get the knowledge and then the tools to help people? So and then I, you know, I came across ever now, and it was just a beautiful marriage of women's health and this really underserviced area of women's health.

Why don't we talk about why menopause impacts mental health? And one thing I do wanna clarify is, because I'll be interviewing doctor Jeri Lynn Pryor, and she's been studying women's health since the seventies. And she she and I are actually going to discuss, guys, it's not menopause as a blanket. There's perimenopause and then there's postmenopause, and they're very different. So as we have this conversation, I just wanna at least put that out there. And then perhaps as relevant, we discuss the differences. But can I make a guesstimate that most of this is gonna be related to perimenopause? Is that a fair A lot of the risk is related to perimenopause. Absolutely. And I can tell you, like, how it how

it sort of travels through the cycle of time.

Okay. Let's do that then. Let's start there.

Okay. Great. So I think what a lot of people don't know first is that perimenopause, generally are the years leading up to menopause. So I always learned in medical school, average age of menopause is 51, you know, and hot flashes. That was sort of all we were given. Right? And and then if you look at the science, it's like, on average, 4 years leading up to menopause, so let's say 47 to 51, that's perimenopause. However, we know in clinical practice and in reality, perimenopause can actually start in your late thirties or Georgie, or if you have your ovaries removed, for example, surgical menopause. And so it's really a longer span of time, and that's how we actually witness clinical symptoms in our practices.

We see these symptoms starting earlier on than what we've been told or what we would expect. Perimenopause, late thirties, forties, or if you have removal surgical removal of your ovaries. And here's the Being. Our ovaries produce and secrete progesterone and estrogen. And as we age, let's say late thirties, forties, and there's variability for everyone, the ovarian follicles start to deplete. And, therefore, the hormones that are produced start to become irregular. So, here's what happens. In perimenopause, late thirties, forties.

If you have estrogen and progesterone, which cycles around your menstrual cycle, they start to fluctuate. And then there's a downward slope as we reach menopause. And menopause is actually when the levels decline. So if we're talking about perimenopause, so think about fluctuation, and a lot of people Being, okay, should I get my hormones checked in perimenopause? And what I've learned from my expert colleagues like Mary Claire Haver, Heather Hirsch, and others is that actually you shouldn't get your hormone levels checked because one day you could be Sharma, and the next day you could be low because there's variability. So that's really important for us to know. So if you're in your forties and you feel mood swings, irregularities, you have irregular menstrual cycles, that's because the hormones are fluctuating, but there's a downward slope. So, as we reach menopause, which is clinically defined as the cessation of periods for 1 year, then there's a precipitous drop in estrogen and progesterone. And then, melatonin is also declining in the background, which is responsible for our sleep wake cycle.

And that's something that happens in midlife to all of us. So, you can imagine all of the effects on our health and mental health. And I know we're going to get into that. But that's the general cycle. And then postmenopause is, you know, the years after that precipitous decline in the hormones and the cessation of our periods. And I have to quote one of my colleagues because I learned, you know, as a doctor, you're constantly learning from colleagues and from patients. So Heather Hirsch had a post the other day, and she said, you know, you know how you know when you're in perimenopause? It's when you actually start to go to the doctor, but there's nothing wrong. There's no, like, actual, like, disease or pathology or basis for your symptoms.

It's probably perimenopause. And I was, like, actually, that's a brilliant way to think about it. Right? Because we so a lot of the symptoms that we might experience are nonspecific. You know, a little bit of insomnia, a little bit of hot flesh or warmth or nausea or acid reflux. Right? A lot of palpitations, you know, and but yet there's no physiological basis or nothing wrong for your doctor. You might be in perimenopause.

What are the the mental health aspects of this, and and what is happening to like, how does the type of mental health impact we have tied to the hormone changes? So, because so many times it's around depression and anxiety. It's like this this is what women have, depression, anxiety, and it comes in different forms. And, you know, I think it's so much more than that.

The first thing to know, let's talk about the 2 hormones, estrogen. We know that the estrogen decline is responsible for a lot of the symptoms of the menopausal transition. And the interesting thing is when I dug into the literature and the science of it, although this is not something I learned in medical school or my residency training in psychiatry, is that estrogen is involved in the metabolism of the neurotransmitters that are responsible and related to mood. So for example, serotonin, norepinephrine, even dopamine. Estrogen also exerts a complex influence on sleep and the sleep wake cycles. So if your estrogen is fluctuating and it is responsible for those relationships, then your mood is going to fluctuate, meaning decrease or not feel so good. And also, your sleep is going to change. There's a lot of sleep issues.

Now, the other piece is the progesterone. So progesterone is actually an anxiolytic, so antianxiety hormone, and a sedative. So, it works on the GABA pathway, and that's the same pathway that alcohol or the Benzodiazepine medications like Xanax, Valium, that we might be familiar with, work on. And so if your estrogen is depleting, then you may be likely to have more anxiety or not be as sedated in a good way as usual. So, there is an interaction between those hormone levels that are fluctuating and dropping and mood, anxiety, and sleep. So we know that. The thing is, though, we need more research to understand it. And I think we're just starting to get more funding and more advocacy in terms of more research.

Now, there's also an impact on the brain. I don't know if you know, we talked about Doctor. Lisa Moscone. So, there are changes in the brain pre- and postmenopause. It's probably much more complicated. And there are known effects on our cognition, like pre- and postmenopause. So let's backtrack a little bit. So me as a psychiatrist, what I do and how we're trained is we think of certain vulnerable groups, vulnerabilities, or people in certain stages of their life having specific risks associated to their health and mental health.

So I know if someone is pregnant or postpartum, they have a specific risk profile. I also know now with time and education and understanding that if someone is in their late thirties, forties, or let's say fifties, we've got to think about the menopausal transition as a risk factor. So, here's what we know. You know, I think if someone has a history of mental health issues, you have a history of anxiety, history of depression, history of ADHD, history of psychosis, trauma, etcetera, You're more vulnerable during this menopausal transition. There was one study that I saw, the Pennovarian study, that shows the risk is manyfold. If you had a history of depression, very high likelihood that you will experience depression again in the menopausal transition. And then the other side is, if you've never had depression, anxiety, let's just take those 2, you're at twice to 4 times the risk, during the menopausal transition. What? Yes.

And there's the recent CNN headline was that, you know, there's an increased risk of 40% for mental health conditions, in perimenopause compared to before. So the risk of depression is pretty high in perimenopause and the menopausal transition. If you've had it, it's very high, and if you haven't had it, it's it's pretty high. So I think if we just look at that and start there, for me, as a public health person, that just speaks to education as key. We need to educate and prepare people for this phase of life. And I think, like, knowledge is power. If you know that this could happen, then you're not going to be so confused or disoriented if it does happen, and you can be prepared that it's coming. And I think that can really sort of set the stage for getting the right help and care in place.

Now how do I, as a provider, think about those 2 types? So I think for new onset symptoms in this decade ish of life, we gotta think about HRT or going to a provider who can take care of the menopausal transition symptoms first. Okay. Right? And I know a lot of people might present. If you have mental health symptoms, you present to me or to your therapist, and that's fine. But I think as a, you know, medical, as medical providers, we need to move in that direction. Like, we need to think, alright. What's the root cause of what's going on? And, of course, it still could be a primary mental health condition, and it's often complicated how to tease out what it is. But we got to think, alright, is this premenopause? And let's treat that.

Right? However, if people have had the experience of mental health episode or condition before, then the approach might be a little bit different, multifaceted. So that's, like, the first way I would, answer your question. I'm sure there's much more to dive into.

Yeah. So I guess the way the standard is right now is typically, let's assume you have a mental health professional that you're already working with. You see them every week, every month, every quarter, whatever the schedule is, multiple times a week, whatever. Your OB GYN, you see once a year if you're a good patient, and we already know the data shows that that's not even happening. Right? So my presumption is that the person closest is going to be the mental health provider. Actually, beyond that is going to be family members. Because if someone isn't already going to a mental health provider and they're amongst the majority of the population that's not seeing the OB GYN, the first people to notice are going to be the friends and family members. Correct?

I could not agree more. And what you're speaking to is who do we sensitize? Who do we prepare? You know, where do we put our educational efforts? And I really do think this is a population wide movement. Right? We have to educate everyone. It affects everyone in our society, and it really is important for the person who might go through it to understand the symptoms as well as loved ones around them to understand the symptoms. And I do agree with you. It's all providers. Right? It's primary care providers, general practitioners, internists. It's not just OBGYNs.

Right? They are doing what's in their scope. But I think it's all of our responsibility, psychiatrists included, to really think about this and understand, you know, that these years are a vulnerability for mental health conditions.

By the way, when I did research on top keywords, do you know for menopause what the most common one is outside of symptoms? How do I deal with my menopausal wife? Not kidding you. Oh my goodness. So I guess, why don't we talk first about, like, this whole awareness piece, and then we can talk about navigating the health care system with it. So from a a the person going through it and then the person observing, what what do we need to to think about? And I don't know if it's one answer or if there's an answer for each stakeholder. Can you tell I'm a consultant? Each stakeholder.

Yeah. No. Absolutely. Allie me just talk about it from the point of view of a patient. You know? And just I'm thinking of, like, an aggregate of all the people I've seen in my practice, and including friends. I think what starts to happen, if we're just talking about, like, with a mental health lens, you know, you this is a time of life where, generally speaking, you have more responsibility. So you might be taking care of children. You might have more responsibility in your work.

You might be taking care of elders or parents. Family members are passing away, having health issues. You might be a caregiver in many respects. So there's a lot of stress. And then on top of that, our hormones are changing. And so you're managing the stress as well as you might be starting to manage these physical symptoms that are starting to interfere or impact your functioning, and then maybe your sleep starts to get disrupted. Right? And if sleep gets disrupted, it can actually increase the risk of anxiety and reduce your ability to concentrate and also increases the risk of depression. And all of it is this, like, vicious cycle that really renders people feeling very vulnerable and not themselves.

Right? And I think people who are in this state recognize that something is is not manageable and not okay. Right, and and are just trying to get by in their life, managing all the stresses, and having these hormone fluctuations. And so the people that I encounter, of course, they come to my practice with symptoms, but they really know they that something is wrong. Now the challenge is it might show up as irritability. Right? Because when we don't feel good, whether it's mentally or physically, we're gonna be irritable. And and we know that we've heard the term menopausal rage. I mean, that's not a a clinical symptom. However, rage, you know, anger, irritability is, and so a lot of people present that way.

And, also, it causes so much strife with partners, loved ones, children, etcetera. And I think, you know, I think people try to really hold it together in the workplace, but it might come out more with family. Right? That's often what happens, the projection onto family. And and it just is is a it's like a a boiling, pot with a lid on its top that's about to explode. You know? And so I think people feel really bad. You know? And the problem is we haven't had these interventions in the last 30 years because of that study. And so it's there there's been this attitude of, like, this is what you go through. You gotta toughen up.

And I think you're right about relationships. I spoke with a divorce lawyer at Mary Claire Havers retreat at the end of January, and she was saying that, like, divorce rates are high in this period of life. And I want you know, there should be more studies on the impact of the menopausal transition on relationships and falling outs and and divorce rates. And I think, you know, from a prevention standpoint, if we could tackle this and, you know, empower people with knowledge, loved ones, family members, children, you know, and we start teaching people from from from menarche, from their cycle starting that, okay, the cycle starts now, but here's how it's also gonna end, and here's what happens, and there is life beyond that. If we can teach people that and prepare the spouses for what could happen and to treat you know, people who go through menopause with a kinder, gentler, and more compassionate approach, I think we could really prevent a lot of the relationship conflict that's happening. You know, but, ideally, we have a way where we have a mental health provider who collaborates potentially with an OBGYN provider, who collaborates with your GP or your PCP. And there's that triad Allie in one system of care. But if it's 3 people that can collaborate and work together, that's probably gonna lead to the best outcomes.

So how does one in this crazy, you know, siloed health care system figure this out? Because, one, the answer is not always hormone therapy. I think people aren't discussing the role of progesterone enough. I feel like there's too much public attention on estrogen only. So how does someone navigate this to, like, help guide their own clinicians? Because you kinda have to, unfortunately.

Just to to really think about it very simply, let's think about what your baseline is. Like, how were you starting at age 18 through your twenties, through maybe your early thirties in terms of sleep, cognition, mood, physical body, symptomatology, etcetera, right, outside outside of the normal process of aging and what that means. You know? And then is there a shift? You know? Has there been a shift, and are you of that age? Right? Are you late forties, early fifties, or in your forties? And now is your cognition different? And Allie is taking a look at, like, what else is playing into this? Are your stress levels different? You know, what's different about your life? What's not supportive? What is protective? And you got to trust yourself, right? If you feel like this is like a significant shift, and this does not feel like the me I've known for 20 years, then it's worthwhile to fight for that and try and understand what that is and fix it. And and I think you're right. So, like, let's go over the symptoms again. Obviously, we always hear about hot flashes or vasomotor symptoms, but let's talk about all the other things. So feeling increased levels of stress, which can be anxiety, increased anxiety, worsening mood or irritability or feeling depressed, sexual health changes, so vaginal dryness, decreased libido, are common ones. And then there's lots of other symptoms, headaches, nausea, acid reflux, hair and skin changes, usually dryness.

Frozen shoulder is one that I've understood that happens to a lot of people. The musculoskeletal syndrome, aphasia is just aching, joints aching, pain. You know, so and again, if you've gone to your doctor for a checkup and there's nothing else wrong, it's probably perimenopause or menopause. So I would say at that point, my advice is to engage with a provider who has experience with and is willing to prescribe HRT. It doesn't mean you need HRT, but you have the possibility of having Allie evaluation with someone who's comfortable with it. And, unfortunately, that's not every OB GYN. It's not every family medicine doc. It's not every internist.

However, it really is important to find that person if you're starting to have this surge of symptoms. And if you have any of the mental health symptoms, including increased stress, anxiety, depression, changes in sleep, then think about engaging with a mental health provider or at least a primary care provider who can help guide you where to go. Okay. I think those are my two pieces of advice. And I think finding that person who can prescribe HRT, I think that's been the challenge. You know, even for me, I will send a lot of my patients back to their OBGYN for HRT, and they come back on the pill, the birth control pill, which is not HRT, which is a massively high dose. Yes. That is, like, in New York City.

And and they're like, you don't you're not in menopause. Therefore, I'm just gonna give you the pill. Well, that's contraception that suppresses your cycles. And it's not bioidentical estrogen, right? So it's a different receptor in the brain, what I've understood from my colleagues. And so, yeah. So it's, you know, so it's but there are providers out there who are willing to provide HRT. And that's wonderful. Now the other thing is about estrogen and progesterone.

You know, as I mentioned, it's like about both. Right? Both of those are the both of those hormones are involved in our menstrual cycle. Both of those hormones fluctuate and decline Being up to the menopause transition. And you can't have unopposed estrogen if you have a uterus because of endometrial proliferation. So progesterone piece is really important. But, of course, the prescribing of HRT, that is a very specific discipline. It's not something that I do yet. And, you know, it really takes a seasoned provider to help someone through it.

My understanding before things got really loud with hormone therapy is a lot of women in this stage of life were being given, like, you know, all these different mental health medications. So how how do we know I guess, 1, do you see that that is the case? And then, 2, how can we help advocate for ourselves to know when that's right versus hormone therapy. Because I this is it's not like there's a diagnostic where you could just say, you know, oh, based on this blood draw, blah blah blah, this is the root cause. This is the medication you get. So I'm supposing there's way too much of the non hormone therapy prescriptions out there, but how do we know which is right?

Yeah. So, apparently, in the last 30 years, like, the the number of prescriptions for SNRIs and SSRIs, so antidepressants among perimenopausal women skyrocketed. I don't I can try to get you the study. Someone presented this at one of the conferences I went to. And because you don't have anything Health. Right? So if you haven't had if we haven't had this knowledge that perimenopause can increase risk of anxiety and depression and we have HRT for new onset anxiety and depression and perimenopause. We haven't had that as a prescribing practice in the last, like, say, 20 or 30 years. What else are you gonna do? You're gonna try to treat as a provider, you try to treat the symptoms of anxiety and depression with what we think works.

Right? And I think, you know, mental health is often complicated. So, it's usually a confluence of things that bring out depression or anxiety, you know. So in part, I imagine having psychotherapy, having some medication, you know, can alleviate a lot of the symptoms. But I think where we're going to, especially for a psychiatrist, is if it's new onset anxiety or depression and someone is in the perimenopausal years, think hormones as a root cause first, but also continue to clinically monitor and watch because they may very well benefit from, let's say, CBT and a SNRI or SSRI. That may be what someone responds to. So it's complicated. And I think this has to be done on a case by case basis. Care has to be very individualized.

And, you know, often in psychiatry, we have to try a few treatment options before we see good effects. Right? It's not often that you give someone a pill, and every single time, there's a good result. Right? So it really is about finding the right medication and the right treatment program for that person.

How much of psychiatrists not prescribing hormone therapy is it based on how reimbursement models work and that it's more tied to OBGYNs, and how much of it is training? Is it both? Is it we're not sure yet because everything is evolving too fast? Like, can you help us understand that? Because I think by those listening, understanding that dynamic, they can also help figure this out. Because, for example, let's assume a psychiatrist does happen to prescribe it and they don't get reimbursed. They can call the health plan, have a discussion about it, and then maybe just say, dear OB GYN, can you just prescribe this for me? So can you walk us through that?

Yeah. Okay. So let's let's go back. So first, I definitely think it's about what your scope of practice is as a provider. We are not in psychiatry trained in prescribing HRT. That's not part of our discipline, and, traditionally, it's sort of been it falls in the camp of the OBGYN, let's say, before that study came out, like, prior to 30 years ago, or it can be the family medicine doc or the internist. Right? And so, that's not been in our scope of practice. However, I think it is completely feasible, given that there's mental health effects, you know, of these changes in hormones, that that could be something that could be incorporated into our training.

In fact, I'm looking into it to become a prescriber. However, there's complications, meaning, you know, prescribing hormones can result in bleeding like vaginally or other side effects that really falls under the scope of work of an internist, a family medicine doctor, or an OB GYN. So there are certain complications, I think, because of the way we practice. So that's just something to know about psychiatry. In terms of reimbursements, so just from a psychiatry point of view, you know, the medications that are difficult to prescribe often are the ones that are newer, right, and aren't yet on the formulary of the payers and the insurance plans. So the ones have been that have been around a long, they're off patent, that are covered by most plans, those are the ones we often will prescribe, and we know the ones that are newer and on the market usually will get rejected or you have to have a prior authorization. And and to be honest, I don't know how that would work for HRT because I don't prescribe it. I don't know if there would be a reimbursement issue there, but I imagine it's the same.

If it's like a newer medication, more expensive, that's gonna be not likely to be covered by plans as quickly, and so it's probably the same pattern.

Birth control piece that you brought up was fascinating. So I'm glad you you mentioned that because I did not notice that that sometimes OB GYNs were doing that. But for dosing and titrating, how how would it work? Should hormone therapy be what is going to help women? Because I've heard stories that there's different levels of the dosing and titrating. And I know it's start low and go slow, but maybe you can give us a picture based on the data you have on what that would look like should hormone therapy be the path to go? Sure. So, again, the disclaimer

is that I'm not a prescriber. I'm not, trained to prescribe HRT. However, from what I understand from my colleagues in the research is that, you know, it really is about your symptoms and if the medication or the hormone, the HRT, is alleviating your symptoms and if there are any side effects. And that's the nuance that health care providers have to closely manage until it feels smooth. The other thing is because of the slope I I told you about that's downward that it goes downward, there might need to be adjustments along the way, especially in the perimenopausal years until there's, like, a steady state or, like, the decline where there's a more steady state. So the adjustments might be needed based on what's going on in the level of hormone. So I've understood from my colleagues who do this that there is a bit of nuance. And so you as a person or anyone who's listening just needs to know that it's not like a one shot deal.

You know, it probably is something you might have to go back to your provider who's prescribing the HRT, tweak it a bit, and really give constant feedback so that you feel good. And I think you'll know when you don't feel good, whether it's your symptoms because of hormone fluctuation or whether it's side effects of the medications, and that's really a personal discussion with your health care provider.

Okay. Based on your vantage point, what else do we need to discuss and and qualify or or or share that maybe I haven't asked or hasn't come up yet in this conversation?

So I wanted to talk about, like, sexual health and functioning in relationships. I think the whole sexual health piece is something that people carry a lot of shame with regard to, and maybe it's something that's more hidden. And I think maybe when we're younger with our girlfriends, we would be more open about this and talk about this. But I find just very anecdotally or sociologically, people don't talk about it as much at this stage in life, especially if you've been in a marriage and, you know, nothing's changed and you're not dating and things like that. But I think there are a lot of significant changes in our sexual health, our ability to function. Also, if you have kids, maybe you're not having health, our ability to function. Also, if you have kids, maybe you're not you're not having relations as much, not as intimate. But that and and just because things maybe there's vaginal dryness or decrease in libido.

Just because that is, happening doesn't mean it shouldn't be addressed. You know, and I think sexual health really needs to be elevated a bit and focused on because that part of life can also lead to conflict, right, if there's an absence of it, and marriages falling apart or relationships falling apart. And, you know, even for, for example, breast cancer survivors, I've I follow doctor Corinne Men from my alloy, and she is a breast cancer survivor herself and talks about hormone replacement therapy for breast cancer survivors. Like, what's okay? What's not? And there is, like, vaginal estrogen, for example, that can be put on topically instead of something that you take by patch or, you know, by gel or another way that may be safe depending on your profile and your Health condition. And so I feel like, you know, there are a lot of nuances and a lot of different groups that have been historically, like, not part of the conversation that need to be a part of the conversation. Also, what about surgical menopause? You know, so if you have an emergency hysterectomy after birth, and you're unprepared for what happens because of the decline in hormones, let's say, you know, and how does that hospital system where you have that emergency surgery and your ovaries and, you know, everything's taken out, how do they prepare you? I don't think there is any preparedness, Right? It's something that just happens, and then you realize, oh, my gosh, what? I'm postpartum, and, you know, and I don't have these hormones, and I'm going into menopause. Like, what's happening? Right? So there's all these other vulnerable groups, and then there's also people who go into menopause very early, like, early, you know, like thirties. And that can be disconcerting.

Let's say you haven't had children yet, and you want to, and then you're going into menopause. So I feel like it's like, who are the different groups that we need to talk to and bring in to as part of this conversation?

Yeah, no, absolutely. And, it Allie impacts our mental health too. It's not even just the hormone changes, but it's almost like a a yin yang. You're right. There's so many ways to to slice and dice and cover women's health. And at the root of it is we have these hormones, and as they're changing, things happen to us. And we're just not told what that is.

Exactly. And I just think that has to be that conversation. I don't know if this happened to you in 3rd grade, but where you get, you know, the boys and girls in a binary way get, you know, broken apart, and then we go into a room with the shades going down, and then we're taught about our periods and how we have a baby. But what about, yeah, talking about menopause then, you know, and just starting the conversation then and and also mental health. And also the boys should just be in the room, or everyone should be in the room.

Is there anything else that we should discuss?

Yeah. So I'd love to share an anecdote with you that I have told people before. And so when I was probably in high school, teenage years, there was a period of time where I had more conflict with my mother than usual, and and my brother did with her too. And I think she was more irritable, maybe moody, or there's just more conflict at at home. And I remember, in some order, my dad sitting both my brother and I down and explaining to us with tenderness and care that our mother was going through a very special time in her life, that her years to have a child were Being. But with that came a lot of changes in her mind and her body, and that we should be extra caring around her. And we were like, no. But she's so difficult and all this.

You know? But my dad was like, No, this is just part of what a woman goes through. And I didn't even know the significance of that conversation back then. But now that I'm doing this work with EverNow and supporting women, I'm like, why that's the conversation that all, let's say, people in that position in their household should be having with their family members and their loved ones to protect that person who's going through the menopausal transition. And I should actually talk to him about it, but it was such a significant thing. And for me, it set the stage for knowing that this was a part of life that was gonna be difficult for me and that other people should understand this. So that's probably why I do what I do, and I've been, like, sensitized to it. But if everyone could have that experience of being treated with treated in terms of their perimenopause, menopause, and years with such, sorry, years with such care and tenderness, I think that could go a long way. And that's why everyone needs to be involved in this conversation.

No. Absolutely. I I completely agree. And I I think empathy and awareness and just a gentle reminder, we're not crazy. It's just a stage of life. It's hormone changes, and there's lots of resources. And I so appreciate how much the clinicians who are such experts in this space are advocating on social media. I think it's so important.

And so I really appreciate your contribution to this conversation because it's one that, we can't get enough of. I think we just need women to hear over and over again, We're not crazy.

Exactly. That's absolutely right. Oh, I've loved this conversation with you, Georgie. Thank you so much for having me on.

Thank you. Thank you. It's always wonderful to connect. Thank you so much for making time.