# 6 - Managing menopause
In this week's episode:
A talk with Teresa Isabel Dias
Teresa Isabel Dias is a pharmacist with 25 years of professional experience. She’s in post menopause now but during her perimenopause her mood swings were so intense her son asked her if she was bipolar. She became a Menopause Practitioner (NCMP) certified by the North American Menopause Society and founded MenopausED, a virtual women’s health practice, to help women navigate the stages of menopause and live a vibrant and productive life. Teresa is breaking the last health taboo in the work place- menopause, and she’s delivered education and training to the Universities of Waterloo, Toronto, and Brock, Maple Leaf Foods, Stantec, and other major employers. She also has written and presented to several pharmacy associations.
Episode 6 Audio Sun, 6/13 2:06PM 35:17 SUMMARY KEYWORDS menopause, women, perimenopause, hormones, hormone therapy, estrogen, support, hrt, life, talk, risk, feel, doctor, symptoms, age, whi, trial, helping, increase, last menstrual period 00:09 Hey everyone and welcome to the Age Sister podcast. Today I'm talking to Teresa Isabel Diaz. Teresa is a pharmacist with 25 years of professional experience. She's in post menopause now, but during her perimenopause, her mood swings were so intense her son asked her if she was bipolar. So she went on to become a menopause practitioner certified by the North American menopause society, and she founded menopause add a virtual women's health practice to help women navigate the stages of menopause and live a vibrant and productive life. Theresa is breaking the last health taboo in the workplace menopause, and she's delivered education and training to universities, to large corporations and to other major employers. She's also written and presented to several pharmacy associations. So welcome, Teresa. 01:09 Thank you, pleasure to be with you here. So happy to have you. You know, I I'm so interested in the work that you do. And I think it's so important that you're helping women at this time in life, maybe you can just tell me a little bit about how you came to do the work that you're doing today. How did you get here in terms of your journey? 01:30 It's usually with a personal story that we get into these things, isn't it? So my mind was one day my oldest son, he was in his late teens. And I was in my late 40s. He asked me if I was bipolar. Because apparently my mood swings were so extreme that the whole family was walking on eggshells around me because I never knew if I was happy and nice, or if I was in a dark mood and just complaining and being nasty to them. So since I was the health care provider of the house, why don't I look into that? So I did. In those days, this was more than 10 years ago, maybe 10 years Episode 6 Audio Page 1 of 13 Transcribed by https://otter.aiago, there was not a whole lot of good information on the internet. There was actually a lot of misinformation, even this information. So it took me a while to figure out what was going on. And then I realized I was in perimenopause. So and I know this happened to many other health care providers. I'm not alone on this. If I as a professional in health did not know what was going on in menopause, and perimenopause. And I didn't know that mood swings, for example, could be part of the journey, then a whole lot of other women probably did not. So I decided to write the exam through the North American menopause society and I became a certified menopause practitioner. I learned a lot for myself. And then I figure if I already know this, and I passed the exam after studying a whole year for it because perimenopause concentration, and memory are not 100%. So I got my certification. And I started helping women in a pharmacy. I used to work in community pharmacy, but I soon realized it was not the best place because there was not enough. 03:24 There was not enough time and there was not enough quiet space and private space for us to talk about such personal things. So I changed my business model. And I 03:38 found at menopause that and I do all my services online. And that's how it started. It started with me having mood swings that were affecting the family. 03:53 Raising. 03:56 I guess I just like to know from you, what are some of the common myths around menopause? What I find with the women that I work with is they're kind of surprised by some of the things that have come up for them during perimenopause and during the menopausal transition. So maybe you can just tell me a little bit about that what you come across. So the most common symptom symptoms, and I don't like calling them symptoms because it's not a disease, but I can't I haven't been able to find a better word so symptoms challenges, I'm going to change them. So the most common and affects 80% of women are hot flashes and night sweats. night sweats are hot flashes that happened during the night. And together we call them vasomotor symptoms or VMAs. So those are affecting 80% of women. And those seem to be the ones that everybody knows about. But then other things like sleep difficulties, memory and concentration issues. body shape change, a lot of women change shape, even if they don't put on weight Episode 6 Audio Page 2 of 13 Transcribed by https://otter.ai05:00 They tend to accumulate fat around the middle because that's just what happens when estrogen starts going fat composition and fat distribution changes. 05:10 Women get very fatigued. 48% of women are very fatigued during perimenopause. And for two years after menopause, they have 05:20 mood swings, they take they tear up for no reason at all, or they get very moody for no reason at all, irritability, anger, all of these things seem to catch women by surprise. And they're not really symptoms of a disease. But many times these things can be misdiagnosed as mental health. 05:44 dysfunction. So when women go to the doctor, when there's tearfulness, and fatigue and lack of stamina and lack of interest, just flat many, many times erroneously, they are diagnosed as depressed. Or if they're irritable, and they 06:03 moody and very anxious, they get a diagnosis of anxiety. And sometimes it's not related to neurotransmitters and hormones in the brain is to do with sexual hormones like estrogen. So it's, 06:19 as I say, awareness goes a long way to, for women to understand what goes on is a natural change, because there's so many places in our body where estrogen works, when estrogen starts going up and down and then goes down. In postmenopause, it's natural for our body to feel different. So if we are aware that these changes could happen to us, and most 20% of women breeze right through menopause, and they don't complain up anything, and those are the ones everybody else envies, but good for them. 20% here severes challenges that, have them quit their jobs, quit the career and not so impactful that with our support, they seem to 07:05 have a quality of life greatly affected. So 60% of us are in the middle of getting mild to moderate Episode 6 Audio Page 3 of 13 Transcribed by https://otter.aisymptoms. If you don't know about these things, you get a lot of fear. And you get scared and you get worried. Why am I feeling this way? And of course, we know that as soon as we have something showing up in our health, we imagine the worst. So many women come to me and say, I'm having breast pain. Does that mean I have breast cancer? 07:33 So there's a lot of fear, because there's a lot of 07:38 ignorance, and it's nobody's fault. It's just because this is such a secret thing. Even though every woman goes through menopause that affects 50% of the population directly. And the 50%. indirectly, like it affected my family, right? It doesn't affect just a woman, it affects all of those who live with us. But because there's no talk about this, and women are not aware and prepared, they suffer a lot more and worry a lot more than I think we should. That's why I do what I do. My first thing is raise awareness about menopause. So women know it's a thing. It's normal, it's natural. Every woman goes through it, because most of them say, Oh, just hearing you say that. I'm not the only one going through this already makes me feel better. Exactly. You are not the only one but so many feel isolated in this journey. 08:31 Absolutely. Why do you think there's such a taboo around talking about menopause? Why is it something that you know, when when teenagers are going through puberty, there's still discussion around it, even though they might be uncomfortable, but there's something about menopause that nobody wants to? It's interesting that you mentioned that because menopause seems to be the reverse of puberty. And when a girl gets into puberty, we celebrate the first period, we have so much hope and an expectation of what this girl is turning into a woman and how is she gonna look like because the body is changing, her mind is changing. All of that is changing because of the influence of the new secreted sexual hormones. The estrogen, progesterone and testosterone while in menopause is the reverse. But it has such a negative connotation. It's like menopause is the end of life. Well, yeah, it used to be 100 years ago, women were dying at the end of their lives when they were becoming menopausal in the 50s. But now menopause happens to them to most of us halfway through our lives or even two thirds in when so much else is happening. So it's one more thing for us to put up with, in the sense that it's one more change. So if we are raising kids or looking after elderly parents, we have a job or a career or a business. Now there's this other thing on top of Episode 6 Audio Page 4 of 13 Transcribed by https://otter.ai10:00 They can be very hard to manage and to and to cope with. But I don't know, I think there's more than one reason why we don't talk about it. It's because it is media and everything around us as as, as made. It's such a negative event in a woman's life. It's the end of fertility. Okay, I understand that some women feel terrible because they haven't had a chance to reproduce before menopause and now that they are faced with reality that they won't be able to again. But for so many of us, that is a liberation of having to cope with our hormones telling us every month what to do, because not every day is different. Our hormones go up and down in a predictable way. Then in perimenopause, when the ovaries start aging, things are less predictable. So they are more worrisome, they are more annoying. And then in perimenopause, the ovaries just start producing eggs and estrogen, and then we get leveled. And I think, if we spend menopause around and think of it as puberty is expecting time as a time of exploration of ourselves of what are we going to do for the next 30 years? Who do we want to be for the next 30 years? How do I want to behave? Move? Think, what do I want to do when I'm 70 8090 100? Some of us are going to make it to 100, we're gonna spend 30 years or more in post menopause, how could menopause be the end of it when there's so much to lift still. And then there's shame, their secrecy because it just goes around, if women don't talk about it, nobody else is gonna talk about it. Because it's a sense, it's supposed to be a woman's problem. And it just feeds itself. So I think it starts with us owning that, that is a normal, natural change of life, we can't do anything about it, there's not no amount of hormones in the world that you can take that you're gonna stop going through menopause, and then spin it around and celebrate your last menstrual period, when you look back 12 months and you confirm, you haven't bled for 12 months, you are in menopause, throw a party, oh, help you. Just like we throw a party for our girls first period, right? And then enjoy and then take time for yourself, be more aware of yourself love self care, because when estrogen goes down, you are going to be at risk for diseases that are related to lower levels of estrogen. So cardiovascular risk risk, heart attacks are gonna increase for you and it's going to be as high as it is for men. Because estrogen helped us all along the risk of osteoporosis because estrogen back of estrogen is gonna make your bones Leach more calcium out. So you need to know this much better than I do. You need to keep moving to keep your muscles and your bones strong to prevent osteoporosis and eventually fracture because a fracture is gonna change our quality of life. A big deal negatively. So I think midlife is a time in a woman's life to accept our body to be aware of our bodies to accept change, to go with the flow instead of fighting it. This anti aging thing is just making women spend money. We can't stop aging, but we can choose how we age and eat well sleep well move. Think the right things. I know it's hard. But with practice and with the right attitude towards this being a positive change in our life. A p a u s e pause ative change in our lives, I think we will do ourselves a big favor and society too. 13:56 Just that piece around anti aging I agree so much. And I'm wondering, because I'm really Episode 6 Audio Page 5 of 13 Transcribed by https://otter.aiinterested in women in the workplace at this age, because I think previously, women had very big pauses for more, or they didn't continue with work, but women are now working in well into retirement age, and really pursuing their careers, you know, pretty vigorously. But this is an issue for a lot of women in midlife where they come into some of these changes in their in their bodies and also in their mental health as a result of perimenopause and the menopausal transition. And this makes it kind of challenging at work and I know that you've spent some time at workplaces I'm just wondering if you have any suggestions for women who are going through this while trying to carry on a you know, a really yeah, it can be very difficult and unfortunately I personally know women who have given up their jobs. 15:00 their careers because they just did not have support. 15:04 I have examples of women having problems with concentration feeling anxious, not being able to perform as well as they were, let's face it, we also aging is not just menopause is aging men and women age and our brain function gets slower, we are just as smart, we just need to find out whether we put the information and takes more time to bring it up to the front. But all that can be managed, if you understand what's going on. And many women that I have few women that I've encountered in my counseling is they were diagnosed with depression, they are given antidepressants, which in themselves, if it's not the right medication could make your life worse, they're gonna cause drowsiness, that kind of, they're going to decrease your sexual 15:55 interest. So it's going to add a few more things to your life, some of them are going to impair your sleep. So antidepressants are not the the option or the right treatment for a woman going through perimenopause issues. So after two years of going through medical offices and being given this diagnosis, and these medications, that just put their hands up and they don't feel any better. They don't feel supported. And they say the only thing I can control is giving up my job because Mike, I can't get my kids out of the house. I don't want to divorce my husband, I don't want to kill my elderly parents, the only thing I can say no to is my work. And that's so unfortunate, because once they stop working, they realize nothing else has got better because the root of the cause has not been addressed. They are not getting support. So I tell women do not. So this is a topic that I talk in, in workplaces and my I do lunch and learns and I call it menopause is the glass ceiling no one is talking about. Because women are not aware that all these changes they're going through are related to hormones that can be managed. It's stress. It's not enough sleep, it's too much work at home. It's my parents. It's it's work. Yeah, it is. But it's also Episode 6 Audio Page 6 of 13 Transcribed by https://otter.aiyour hormones. So again, being aware that this is a natural thing that is happening to you and finding education and support to go through it. It's the key because we can't blame all medical conditions on menopause. So you should keep your checkups with your doctor. I know it's hard now to COVID. But keep seeing your doctor and keep if something is changing, address it, monitor what's going on find out if it is a medical condition, instead of being just the menopause. And if possible, if you own an organization, if you are the HR officer in the place of work if you have a leadership role, a real leadership role. 18:03 take that opportunity to bring menopause awareness and education to your workplace because you are doing yourself on all the women in your organization a favor and the men as well because men live with women who will go through menopause already, or will go through menopause in a few years. If there's more awareness about this, women who are having a hard time will not quit their jobs because they get the support they need organizations will understand that I have a 50 year old woman with a ton of experience and knowledge. If I lose this woman, I lose my company loses it's a lose lose for everyone. 18:44 What does she need. So a woman should be able to tell her manager, a boss, a CEO, an HR, I'm going through this, I need 18:56 one of my challenges not sleeping enough. So I need to sleep in and start work late. I will finish work later. Or I wake up very early. I rather wake up start working at five o'clock in the morning and then I can take a nap or three and be done for the day. Or I need now your home I need a fan I'm having hot flashes galore. And I feel very uncomfortable with it. Give me a desk fan. Or I feel self conscious. When I feel red and sweaty in a person in a person meeting or in a zoom meeting. I want to turn my camera off. I feel more comfortable if people don't see me going through that because if a woman feels herself hot and sweaty, she thinks nobody's gonna notice for the most part, but she thinks or now I feel nervous and sweat and it just feeds itself. And they're gonna think I'm not comfortable with what I'm saying. I'm not sure what I'm saying. I'm not gonna look professional. I'm not gonna be. So there's a lot of this going on. So the culture has to change. We have the mess. 20:00 To find pregnancy, pregnancy was just as secretive as secrets a secret as menopause is years Episode 6 Audio Page 7 of 13 Transcribed by https://otter.aiback, our previous sisters took care of that. We are addressing mental health now. And menopause seems to be the last health taboo in the workplace. And I talked to women, workplace. And I, it was funny because in one talk, I had a woman who said, I am not going to mention to anyone that I'm in perimenopause, because I'm already the oldest person in my team. If they find one more reason to get rid of me, they're going to so I'm not gonna say anything. So that there's that fear, which I understand and I respect but then someone else was there, another woman was there says, I brought my manager because I want her to know what I'm going through. And when I say, I need support with ABC, she understands where I'm coming from, and she'll be more likely to support me. That's my belief. If we don't talk about things, we'll never fix them. We don't need to fix menopause. But we need to fix the culture around it and understand that it is a thing and some women not all, so we can make it a one size fits all. It's not a work policy. It's like an awareness and education. Everyone who needs to know about this knows about it. Those who need support, know that there's someone in your organization who's going to listen to you understand what you're talking about, and then offer reasonable support. 21:33 I think that would work. 21:37 That's such great advice, Teresa, I just think that's excellent. I'm going to switch gears a little and ask you that that sensitive or tough question that I think there's a lot of struggle and misunderstanding around and I'm asking you this question because I know you're an expert in medication. As a pharmacist, you have a good understanding of some of the medications that can help women during this time. But one of the things that I hear quite often is women saying my doctor doesn't want to give me HRT, or I'm scared of taking HRT. So I'm wondering, I could talk about that for five hours, because it is that important, but it is unfortunately, so the whole thing started when the whi Hei trial results came out in 2002, and three, and the results were given 22:31 in relative risks instead of absolute risks. So for example, one of the biggest fears for hormones, we don't call it HRT anymore, because we are not replaced hormone replacement therapy, we're not replacing the hormones we had in our reproductive years. We're just calling it now menopause, hormone therapy, or MHD, because we adding a little bit of hormones, to those women who are having a hard time and need to get over these five to 10 years of discomfort to have a better quality of life of relationships and work. So HRT now is called MH T, Episode 6 Audio Page 8 of 13 Transcribed by https://otter.ai23:09 when the results of the whi trial, which was trying to see if HRT in those days, was good at preventing diseases, such as cardiovascular disease and osteoporosis, they found out that it wasn't. And the reason was they they used in the study women from 50 to 79. In, in fact, only 20% of something like that of women were at the age between 50 and 60, where we mostly feel all those challenges that we need to control. So most of the women who are older, and as I said before, as we age, our risk for diseases increases, so and those women adhan menopause more than 15 years ago, so all of a sudden they're given estrogen, and the body feels like this doesn't belong to me. So there were cardiovascular effects, there are stroke risk, this increases cardio, if you're older, you shouldn't take a hormone therapy because you don't need it anymore. 24:08 So when they when they gave the results, for example, the media said, Oh, hormone therapy, increased risk of breast cancer risk by 28%. So what do you and I think, now, we think that 2018 100 women are gonna develop breast cancer, right? That's what I thought. That's what the doctors thought. That's what everybody thought until I dig into this, and it says, increases the risk by 28%. So, to tell you the real numbers in the study, they use 5000 women in each study or 8000. New as a big study over 20,000 women in the study, some took estrogen and progesterone, and project teams and some took on the astral journey if they didn't have a uterus, and then there was a placebo when they meant that the risk increased by 28%. what they meant was 25:00 The normal the base rate for most of us for breast cancer is 12%. 25:06 When the that 12% risk increases by 28%. In 1000 women, 25:15 they, they found that eight more women were diagnosed with breast cancer in the hormone trial than the placebo trial. So it was only 8% in in 1000 women per 10 years. So the the increase in numbers was actually from zero to eight more, not 20% increase, it's almost like a lottery, if you buy a ticket, you have 100% chance of you have a ticket for lowering your chances of winning the lottery are still very small. If I give you another ticket, it increases your chances by 100%. But I bet you you're not gonna win the lottery is still right. So the risk increase, but because the risk was already small, that small increase in the risk was not that big. But how are we going to explain this Episode 6 Audio Page 9 of 13 Transcribed by https://otter.aito women after media says the risk increased by 28%. And nobody explained to women what it is. So that's how this confusion came. 26:14 So women became afraid of it, the doctors became aware of it, they looked into the whi trial by age group, again, the age where women need more support and could use hormone therapy to to to manage challenges. From the 50 to 60. Many, many people have studied those results. And the conclusion that all experts agree now is if you are a healthy woman, so you're not suffering from any cardiovascular diseases, you don't have breast cancer if you are a healthy woman under the age of 60, or within 10 years of menopause, so within 10 years of your last menstrual period, 26:57 the benefits of hormone therapy are higher than the risks of hormone therapy. And if you don't have a uterus, you don't need a progestin your risk of breast cancer is almost as much as if you weren't taking any hormone therapy. So they say that if you have a uterus and you need to take estrogen and progestin 27:18 for five years, your risk should not increase. If you have no uterus, your risk should not increase for seven years. For some woman three or five years is enough to get him over that time when all the symptoms are so challenging. And then you can stop, you can lower the dose, you can change the route of administration. And again, the whi trial only study one route of administration, which was oral pills, one type of estrogen, which was conjugated equine estrogens, none of them produced by the human body, and a progestin which is a synthetic progesterone, which would don't produce either. So we will never have a study as big, but maybe giving an extra diet, which is similar to what we produce and giving a progesterone which is similar to what we produce will not increase the risk as much other trials have been done. But that hasn't been proven yet. But it seems to so far, that there's less risk with those body identical hormones. 28:30 That's such important information. I think there's a lot of misunderstanding around taking hormones at this stage in life. Are there any other things that you would recommend just putting your pharmacist hat on? Think about take this, there's there are a lot of things that women take and 50% of what we take is placebo effect. So you take something and you believe it helps you fine, I'm fine with that as long as it doesn't cause any other harm. As long as it doesn't have any adverse effects as long as it is a good product, I usually recommend buying something with an Episode 6 Audio Page 10 of 13 Transcribed by https://otter.aiNPN. So it's a natural product number that means Health Canada looked into this problem into this product and it's accepted by our regulations. If it is black cohosh, sage whatever it is, we have to remember that the trials are studies to find if these things are safe and effective or not as robust as trials necessary for prescription drugs. So take it carefully. If it helps you fine if it stops helping probably was placebo effect. Try something else. If you take it and it gives you a stomachache causes nausea gives you a headache, stop taking it try something else. 29:48 It's normal for women to take several things before they find one that works for them. But as I said, try it if it doesn't work, try something else. Nothing is as effective for 30:00 hormones for menopausal symptoms as hormone therapy. If you are a good candidate for it, there's no reason why you should not take it. If you go to the doctor and the doctor says, Now it's bad for you ask, why is it bad for me the man explanation you have the right to ask the doctor Why not? The same, the same, right? You have to ask when someone gives you a prescription, why should I take this? What happens if I don't take it? 30:30 And then the doctor if the doctor is not in a metal applause 30:35 area like I am and some others are, you may not know enough about these other details about the whi results and how is not as dangerous as we all think it is. So you may have to change doctors talk to me, I did discovery calls. I love to helping women in discovery calls because as I said, not everything is related to menopause. If it is, I can help you deal with that. But if it's not, I know enough to know what to say. This does not seem very related to menopause. Let's investigate it a little further. Maybe you should talk to a gynecologist. Maybe you should talk to a rheumatologist because aches and pains is a symptom that many women feel. And it's not very commonly associated with with a transition. So I can do that for women. But what I want them to do because I cannot talk to everyone is go to the doctor when the doctor says no ask why if you don't like the answer, if in your gut, you feel like this is not right. I want to do something about this and I'm not having support, get a second opinion get a third opinion. And then ultimately it is your choice to take or not to take a medication but you should only make a choice after you've been educated. Episode 6 Audio Page 11 of 13 Transcribed by https://otter.ai31:59 So there's lots of good websites on online you don't have to talk to me. But I would love to the names the North American menopause society has amazing information so does the Australasian menopause society and the International menopause society the Canadian menopause society. Jean ales in Australia has an amazing website for everything to do with women's health. So go to those reliable 32:26 website if you've got to go on Google and I love to show my mug. 32:34 If you gotta go on Google, go on a good reputable site. Like I said nams IMS, Australasian menopause, this is sigma for Canada, because you can get lots of good, up to date, reliable science based information there and stop spending money on Jade eggs and all that stuff, because it's not gonna help you. It's gonna help you waste your money, but it's not going to help you with your menopause. So make get educated so you can make an educated an informed decision regarding your treatment about this and everything else. 33:14 So I'm guessing that a lot of women listening to you today would love to find out more information about the work that you do. So my website is menopause. and.org. My, my website has 33:29 a way to book a discovery call. I do one on one consultations online because I don't want to be well now I everything has to be online, but I don't want to be geographically stuck to Toronto. So I want to help women across Canada. can book a discovery call. I do we haven't talked about this. But that's another issue of your podcast. virginal on sexual health is even a biggest, biggest taboo. And the bigger the secret than menopause itself is, and it affects quality of relationships. I always tell women do not allow your vagina to ruin your marriage because it's a very common thing. So I do a vaginal and sexual health 34:11 consultation. I do initial consultations, I do drug adjustments. I do a four week start your journey Episode 6 Audio Page 12 of 13 Transcribed by https://otter.aiprogram. And then for those women who are really having a hard time and I've tried a lot of things and nothing helped and they really need support. For a longer term, I do a 12 weeks a positive your positive journey. So I do a lot of things because as I said, there's no one size fits all. Every woman goes through her own menopause. And all treatment or support should be done individualized because we are all different and even what's good for your system may not help for you and may not be safe for you. So everything has to be done for each of us. 35:00 That's fantastic. Well, thank you so much for joining me today. I just love talking to you and keep spreading. Thank you for helping me spread it, Kate. 35:10 My pleasure. Thank you. Bye. Take care. Bye bye
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The Age Sister Podcast is where Kate talks with an eclectic mix of guests about issues related to being a woman in midlife.
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