But that didn't always need to be the first conversation. So, you have to walk into your doctor's office armed with information. And I'm sorry that the onus has to be on us, but right now it does. If you're looking for more, my book How to Menopause covers all of it. It's on right now.It's linked in the show notes. I also made a free downloadable. It's a hormone therapy 101 sheets. You can track your symptoms. It includes questions to ask your doctor.So many of you have told me you've brought this sheet into your appointments. It's super simple. Your doctor finally took you seriously. And thousands and thousands of you have also downloaded it. It's a resource I wish I had earlier.
It's why I put it together and it's free. Quick disclaimer before we dive into all this. I'm not a doctor. I'm a journalist who has lived through this. This is the book I wrote on it.
I took everything that I studied and research and interviews I did and I put them all in here. In this book Had a Menopause, take what I share to your own doctor because your body and your history are yours. And know going into it, women have been dramatically understudied in medicine, especially around this time in our lives. So when you hear someone say the research is still building, that is true. But it's true because the system never bothered to study us in the first place.
So let me explain what's actually going on inside your body when this hits. There are two hormones doing most of work on your mood. And when they start to drop, things get wonky. First is estrogen. Simplest way to think about estrogen in your brain, estrogen is basically fuel.
We'll call it fuel for your brain. When you have a lot of it, your brain runs smoothly. You remember things. You don't walk into a room not remembering why the hell you're there. You know what's going on.
You don't lose your confidence cuz you can't remember things. When it starts to drop, your brain has less to run on. And that's when things that used to be easy feel hard. Estrogen's also closely tied to serotonin, which is your brain's kind of feel-good chemical they call it. So when estrogen drops, the feel-good chemical serotonin drops, too.
And you start feeling lower and less resilient and more easily knocked sideways by things that wouldn't have bothered you a year ago, like jumping into the car and driving somewhere without thinking about it. For me, I think the best way I can describe it, and I've heard from a lot of you, too, is like the little things feel very heavy. Maybe you're kind of weepy and cry at things you don't usually cry with. You feel like this low background dread for no reason. It's kind of like the Sunday scaries or like Monday through Friday, too, every day of the week.
The second is a progesterone, which I've covered in detail in another one of the episodes that's also down in the show notes. Everything's in the show notes that I'm talking about. Progesterone is your body's calming hormone. And it binds to your same receptors in your brain as anti-anxiety meds. So, when it drops, that calming effect goes with it.
You feel anxious. You wake up at 3:00 in the morning with your heart racing, and you can't settle your nervous system. Here's the part no one tells you about. This often starts years before your hot flashes do. So, you have those like symptoms going on there, and might not even be aware of it.
And before your periods get noticeably weird. The first thing that happens in perimenopause, our body produces less progesterone. And so, our calming hormone disappears before any of those obvious symptoms show up, and we start feeling like don't feel like myself anymore, a different version of myself, and we have no idea why. There was actually a study about don't feel like myself anymore, because that is something we have all said. And there's one stat I always mention because it floors me.
Women are twice as likely as men to suffer from a panic disorder. And a huge chunk of that gap shows up in those perimenopause years specifically. And that could last for a long time. That could be like late 30s all through your 40s, depending Everybody's different, but that can happen there. Years ago, I had a panic attack combined with a hot flash and a heart palpitations on a news set during a broadcast.
It was 2019. I'll never forget it. I had to leave in the middle of the newscast. That moment is what started me down this entire path for, I don't know, 40-plus years. I'd never said the word menopause or perimenopause.
And it's a dramatic version of what we're talking about today. But anxiety in perimenopause doesn't have to look like a panic attack to be real. Sometimes it's like a quiet voice in your head telling you, "Hey, you can't drive anymore. You don't know how. You suck.
It's scary." Or you don't want to go to that event, or I don't know, you just [clears throat] don't feel like yourself anymore. You're not yourself anymore. Let's talk about what that actually looks like, because I think a lot of you are going through this and may not even realize it's happening. I would didn't realize it was happening. I didn't even realize it was happening recently with this whole driving thing.
You stop doing things you used to do. You cancel plans. You take the long way around. And you're convincing yourself that you're either just busy, or just can't do it, or it's You're not thinking anything else has changed. The truth is your nervous system is telling you something doesn't feel safe.
Even though logically nothing's changed. For some of us, it shows up as rage, what people like to call the factor. I've heard women describe it as I could chew through steel, patience evaporates, things that wouldn't have bothered you before set you off right away. You snap at people you love, and then you feel like crap about it afterwards, which makes you feel worse. I spent a lot of times last few years saying, "I'm sorry," because I've not felt like me.
And I feel terrible when I'm snapping at somebody. There's also the morning dread, that's another one, where you wake up before your your feet even hit the floor, and there's like something feels like wrong, but you can't name it. And then it could show up as crying for no reason. Suddenly you're sobbing in a song you've heard a hundred times, or like you're in a spiral with cute dog videos on Instagram. It can show up as panic attacks.
It can happen alongside hot flashes at night. Whatever it is, the world that you used to know feels very far away. Some women experience mood swings that feel like the worst PMS they've ever had, except they don't tie to a cycle anymore. And then, of course, brain fog. Let's talk about that real fast.
It can feed that anxiety where you forget a word in a meeting, instead of laughing it off, your whole nervous system spikes and you break out in a sweat. If any of this sounds familiar, what you're experiencing is real and there are options and I want to get into them because you could be getting dismissed and you don't even realize it. And that part makes me really angry. If you have ever brought any of this up to a doctor or your doctor, it doesn't have to be your OB/GYN, it could be your GP, it could be an endocrinologist, it could be whoever. And you were told it's stress or it's just depression or it's just your life right now or you should try to meditate, you're not alone.
You are part of a much bigger pattern. 29% of women between 18 and 64 report being dismissed by their doctors. And almost half of all women who go in looking for help for what they think are hormone-related symptoms, report having a negative experience. This happened to me. I went to my doctor. I was not feeling right, not feeling like myself.
I was told it was stress. I was put on antidepressants, never asked about hormones. Same thing years before during my divorce, hadn't been sleeping for weeks. I never heard about hormones. My doctor never said anything like that.
I I actually found my notes from that one of those appointments and it was like, "Patient complaining of weight gain and anxiety." And that was it. I didn't get hormone checked. I didn't get asked any of the right questions. I got a prescription and got sent on the way. And I'm not telling you this to scare you about doctors.
I'm telling you this so that when or if it happens to you, you recognize it. And so, when someone tells you it's just stress, you know how to ask the next question. And the next question is, "Could it be my hormones? Could it be perimenopause? Could it be menopause?
I haven't had my period for 14 months." No one is going to advocate for you in that office except you. And there are reasons it happens. A lot of doctors fully admit they were not trained on menopause. The symptoms of hormonal anxiety overlap with symptoms of depression and anxiety. So it's really easy for to be confusing or for a doctor to say, "Hey, maybe this is what you need." and move on then dig deeper.
Women's symptoms have been historically minimized in medicine. For years and years and years, none of it should be your fault, but it is a reality that that is what you are walking into. So I want to make sure it's as easy as possible for you to walk in informed. Okay, so the part you've been waiting for. So let's talk about what actually helps Samson.
Like let's get to it. I want to say something before I get into any of the medical options. And again, not a doctor. This is data. This is science.
This is expert advice from doctors. I'm going to talk to you about hormones first and not because they're the only answer, but because they are the option that keeps getting skipped over the most. So we're going to lead with that one. Body identical progesterone. Bioidentical is often the missing piece for the anxiety side of this.
Because of the calming effect it has on the brain and the way it lets you actually fall asleep without your brain spinning and spiraling. I have an entire episode on progesterone because that's how important I think that is. If anxiety is your biggest symptom, I beg you to go listen to it. Estrogen helps the mood side, the serotonin piece. And that is where you start to feel the lower dread and the resilience coming back.
For a lot of women, that estrogen and progesterone are really going to help, which is why that is the combo that most menopause specialists prescribe. There are also non-hormonal options. SSRIs absolutely have a place. They're not the wrong answer. They're often the wrong first answer if your hormones haven't been part of the conversation.
Look, sometimes getting hormone therapy alone is enough. And then sometimes you need both hormones and an SSRI. The point is is that the conversation about your hormones has to happen and usually it doesn't. There's no baseline for that conversation. There's no like we you know to get a colonoscopy or to go get your mammogram.
We know kind of the ages for all those things. We don't have that for this, for hormones. Therapy is also huge, especially with someone who actually understands hormones in midlife and I think more and more therapists are doing that more and more disciplines are getting into that. I'm so excited about that. I think it's so important.
There are two kinds that I want to specifically pull out and mention because they have a lot of evidence behind them and they work in really different ways and I'm seeing them repeated over and over again. And so the first is CBT, which is cognitive behavioral therapy. And the simplest way to explain it is that CBT teaches you how to catch the anxious thoughts running on a loop in your head. Look at them honestly and then figure out which ones are actually true and which ones are your brain in panic mode. Then it gives you those tools to talk back to those thoughts and to shift your behavior.
So if you're spiraling at 3:00 in the morning convinced something terrible is happening, CBT gives you that muscle to stop the spiral and ground yourself. It's practical. It's skills-based and there's a ton of research behind it for this type of anxiety that we're talking [clears throat] about today. This is another one that I wasn't as familiar with and had to do more research on. It's EMDR, which stands for eye movement desensitization and reprocessing.
I know it's a mouthful. Here's what it actually is. Sometimes there are old experiences even ones you thought you had moved past that are still living in your nervous system and hormonal changes can pull them right back to the surface. I did this with a therapist for a short amount of time because we were dealing with my mother's death. Years later.
EMDR is a technique where a trained therapist guides you through those memories while having you do something with your eyes like following their finger back and forth, sometimes tapping on your knee. It sounds strange, I know, but the science behind it is that this back and forth movement actually helps your brain process and file the memory differently. So it doesn't keep hijacking you. It was not This was not easy for me, I'll be honest. It is incredibly effective for trauma and for anxiety that has roots in something old.
The right therapist here is gold. If you can find someone who understands both midlife and hormones, even better. I also want to talk specifically about exposure therapy because of what happened with me in the car. The science behind it's pretty simple. When you avoid something that scares you, your brain takes that as confirmation it's dangerous.
So the avoidance gets stronger. When you face it bit by bit and gradually, your body, your nervous system, your brain starts to learn that it's actually okay and that's how that loop starts to break. So what I did with the car and driving was actually a little bit a lot accidental. I made a plan like the night before. I'm getting into the car, I'm turning my phone off, I'm turning the the GPS off.
I'm just going to drive. I don't know where I'm going to go, but I'm going to drive to be comfortable. Cuz I didn't want to do it like having to go to a place and then be nervous about what time I was going to get there, if I was going to get lost, like whatever it was. I drove for such a long time. The longer I drove, the more comfortable I got and now I am driving in LA again.
Not all the time, but I'm back to doing it and not freaking out about it. I I want to be really careful with this one because clinical exposure therapy is structured and done with a professional, not done with me telling you my experience, it is graded over time. If your anxiety is severe, or if you're having panic attacks, or if avoiding something is starting to really shape your life and impacting it, I would really encourage you not to go through this alone. Get a therapist that understands this because what worked for me was like a self-experiment with driving, but that is not going to work for everything or everyone. And one more time again, I'm not a doctor.
Then, there are lifestyle pieces because they actually do matter. Exercise, I will say, is one of the most underrated tools for anxiety. I feel it when I don't do it, I feel it when I do do it. It moves the anxiety out of your body in a way I don't think anything else does. And that doesn't have to be like crush it at the gym.
Like, I need an hour to like go lift weights. I'm talking about going for a walk. I'm talking about getting out in the sun. I'm talking about getting outside and moving. Then there's magnesium.
Another super simple one, specifically magnesium glycinate. That's the one to focus on. Or at least the one I'm talking about here. A lot of people find that it helps with sleep and with that low-grade hum of anxiety. And you can talk to your doctor and make sure that's right for you.
Then we have talked about cutting back on alcohol. I know caffeine is a part of that. For me, that's a tough one. But, so you know, because I have to, you know, just tell you, both spike anxiety more than we realize, especially alcohol after the age of 40. Because it doesn't metabolize the same way it used to.
It just doesn't. That's why you feel different after the one drink, you know, before bed. Sleep, I always say is the number one thing if anybody asked me in an interview, "What's the first thing you If you only had one thing to pick?" It's sleep. None of it works without sleep. If your sleep is a mess, that's where you have to start.
You're not going to go to the gym if your sleep's a mess. You're not going to want to go for a walk. You're not even going to remember your magnesium glycinate. You're just not going to You're not going to want to cook something in the kitchen with high protein. It's just not going to work.
Here's something I really want you to know that's more important than anything else for me, bigger than any pill or any therapy, was knowing what was happening. And when I finally understood this was hormones, that there was actually a reason I wasn't alone, it wasn't my fault, they didn't cause it, that I wasn't feeling crazy and failing, I think something just released. Like I lost a lot of that shame, the fear went down, not all of it but some of it. And then I can actually start working on it to gain my confidence back. So, if there's anything at all you take from this episode, I hope it's that recognition that this actually has a name, you're not making it up, you're not alone.
All those things are really huge. And you should be able to lean on a community. I don't care if you start a a text thread on your phone and call it like whatever, you know, girl community and menopause, whatever it is, and get some of your friends on it that are going through the same things you can lean on them. When you start opening up about your mental health and where you are, you will realize there are so many other people that feel the same way. I've lost count on the times a friend said to me, "Oh my gosh, me too." The minute I started talking about what I was going through.
Please find the people and have a conversation. You're not alone, and you do not have to suffer in silence with this. Finally, I like everything to be a sprint, but this is a marathon. You're not going to be able to do it all in one moment. The first thing you try might not be the right thing.
So, don't give up if it doesn't click immediately. Keep going, keep advocating for what you need because you are the most important thing right now. Before we get into how to talk to your doctor, I want to give you some of the questions that you've hit me with, just so we can in just in case you have them right now. One of the big ones that I get a lot is it me or is it my hormones? I get this more probably than any other topic, and the honest answer is it's probably both, and that's okay.
Real life stress is real life stress. Hormonal shifts amplify everything, they They do. And they can take a normal hard day that you've probably had a hundred times and turn it into a crying fit. They can make a manageable worry and turn it into a panic attack. So, if you are wondering what you're feeling right now, if it's normal stress or if it's hormonal, you need to ask yourself is your baseline shifted?
Are you reacting to things and avoiding things not in the way that you used to? And if the answer is yes, then it's very likely, depending on your age, depending on where you are, your hormones could be likely playing a role. And they are worth getting checked out. Question number two, will antidepressants alone fix this? According to doctors, experts who have been on the show, experts I talked to in the book and the films, sometimes yes.
For some women, an SSRI can change everything and they can feel like themselves again and it's very helpful. For other women, the antidepressant helps a little bit, but not quite get them all the way home because the underlying hormonal part is still there. So, if you've been on an SSRI for a while and you still don't feel right, I would bring bring that up to your doctor. I'd bring up hormones cuz you might need both or you might need something totally different or you might need a different SSRI. Question three, does this ever get better?
Yes. Yes. Yes. Yes. For most women, mood stabilizes after period stop for good.
You know I'm a huge fan of Dr. Lisa Mosconi. She is a top neuroscientist who has dedicated her life to studying women's brains. I respect her so much. And she told me something I want you to hold on to.
The brain dip you go through in perimenopause does not last forever. For a lot of women, cognition actually bounces back somewhere between two and four years after the final period. Postmenopause for a lot of us is honestly more peaceful than perimenopause, especially for me cuz my hormonal roller coaster ended. And I wasn't I wasn't like constantly in this state of chaos. Help is available and that is a whole point of this episode.
And by the way, Dr. Lisa Mosconi, follow her. She's got books. She is just so incredible. She wrote the forward for my book and I am just I just love everything about her.
And she is the author of the menopause brain, which is an incredible book. Question four. I don't have hot flashes. Could this still be perimenopause? Absolutely.
This is one of the most important things to know. Anxiety and mood changes can arrive years before the hot flashes start. Especially the anxiety piece, which is what looking back I realized was going on in my life. Progesterone is one of the first hormones to drop. So, if you're in your late 30s or your 40s and your mood is shifting and doesn't make sense, you don't need to have a hot flash to take this seriously.
Bring that up to your doctor. And finally, question five. I'm in my 30s. Am I too young? And I get this a lot and I'm I'm actually excited about this question because that means that young women are going into this knowing what's going on.
The answer is probably not. The average age of menopause is 51 in the US. But remember, perimenopause could start a full 10 years before that. Most of the time it's less, but it could be a full 10 years or more. So, your mid-30s through your 40s is exactly where this these hormonal changes can begin.
And we just did an episode talking about like kind of this shift between your reproductive stage in life and perimenopause. And I'm going to link that below because I learned so much in this episode. But that's when the hormone change it hormonal changes are starting. If anyone tells you you're too young, get a different opinion. Period.
Okay, now let's get back to how to talk to your doctor. It's really important and it's not always easy to bring it up to your doctor because a lot of doctors will reach for an SSRI first or tell you, you know, to make some lifestyle changes. And they're not wrong. But, it could be incomplete. Your hormones are part of the picture.
And if nobody is checking them, you're missing half the answer. First, who can prescribe what we're talking about? You can go to your OB/GYN, primary care doctor, a menopause specialist. Menopause Society has a huge list of doctors that have been trained in this specialty of menopause. Like, they understand it.
They're They are certified in this. Or you can go to one of the telehealth platforms that focus on menopause. If your anxiety is your main concern, a psychiatrist who is informed about hormones is also a good option. But, they can be hard to find. So, what to ask?
If your symptoms could be hormonal, especially if your anxiety, mood, or sleep changed, bring a symptom log with you if you can. Write it down, put it in your notes on your phone. I have a downloadable for free on the website, tamizdavidel.com. And write this down. When did they start to look different?
What times of day do I see it? How many times does it happen? All those things make it harder for a doctor to wave you off. Also, I would ask if bioidentical progesterone could help you, especially if you have anxiety and racing thoughts, and you're waking up at night, and those are some of the worst symptoms, because that could be really helpful. And of course, ask about estrogen, too, especially if your mood is the bigger piece, and you are just feeling that kind of low-grade dread all the time.
You're going to want to know if anything interacts with it. You're going to want to talk about existing antidepressants, ADHD meds, blood pressure meds, anything you're on. I always bring a complete list of that. I have it in my notes, so it's always there. I make sure and update it if I get a new prescription, even if I'm like on antibiotics for a little while.
I just add everything in there so they have all the details, cuz you're not going to have a lot of time with a doctor. We We never do. And finally, if your doctor is not willing to have this conversation, you need to break up with your doctor. You deserve better care, and I promise you it's out there. I promise you that.
I'm going to leave resources in the description down below for all of the things I mentioned, how to find a menopause specialist in your area, a link to the menopause society, telehealth options for you. I don't want you to waste another year of your life. I don't want to waste another day of your life not feeling like yourself or being with somebody who is not taking you seriously cuz you deserve that. A real quick update, I am driving in LA again, windows down, music on. Anxiety's not gone.
It's just not running me anymore. And that feels good right now. Okay, I hope this episode taught you everything you need to know about anxiety and mood changes in perimenopause and menopause and by the way, postmenopause cuz that's where I am right now. I'm post I'm past menopause and I still have a lot of these things. If you have any more questions, my email is always open to you to ask away.
Me or some of them or team will do our best to get back to you as soon as possible. You can email podcast@tamsenfadel.com or if you want to leave a voice message or text, the number is 917-382-4277. We love hearing what you think. We read all of your reviews. We really appreciate them because they tell us how to build out these episodes like this episode's being done because of questions that you all have had whether it's on Apple or Spotify or YouTube.
I can't wait to hear what you think about this one. Make sure you subscribe so you don't miss any of the upcoming episodes. We drop episodes on Mondays and Thursdays and we have a lot more coming from you. I'm here to make sure this next chapter is your most confident and healthiest one yet. I love you all and I'll see you in the next episode.
