#154 Menopause, Perimenopause and Hormone Repair with Lara Briden

Today on the podcast, we have one of our most loved returning guests; naturopathic doctor and best-selling author Lara Briden. If you have had the pleasure of listening to Lara on one of our previous podcasts, you know she is an absolute wealth of knowledge for all things women's reproductive, menstrual, and hormonal health. As a woman, listening to her illustrate the inextricable relationship between female reproductive health, mental health, and hormone systems, there is a sense of belonging and reclamation for the natural cycles that have been medically interrupted.  

Over the years, we've had Lara on the podcast talking about period repair, PCOS, Hypothalamic Amenorrhea, and all they encompass; Today, Lara is joining us to talk about the transitions into perimenopause and menopause. Lara's enlightened wisdom reminds us that menopause is not something to dread or treat as a medical 'condition' to be corrected; but rather a gateway and rite of passage to be honoured and exalted. 

 

In this beautiful conversation with Tahnee, Lara dispels menopausal fallacies replacing them with profound knowledge and biological facts about what this sacred transition within the female body/psyche represents. Lara reframes the metabolic/hormonal shifts between the reproductive years and perimenopause,  details the best diet/herbal medicines for menopause, and offers a beautiful evolutionary perspective of menopause across time and cultures.

"How the perimenopause transition is going for a woman depends on a lot of factors. Your stress, your adrenal system, your stress support system, how stable it is, how strong your circadian rhythm is, how well-nourished you are, how your immune system is. All of those things, including, unfortunately, how many environmental toxins you have been exposed to. Any of those negative things can increase the symptoms of the perimenopause transition". 

 

- Lara Briden

  

Tahnee and Lara discuss:

• Menopause.
• Perimenopause.
• Contraceptive drugs
• The reproductive years.
• Pill bleeds are not periods.
• The phases of perimenopause.
• The transition into menopause.
• Herbal medicine for menopause.
• Hormone therapy for menopause.
• Why alcohol and menopause don't mix.
• The difference between progesterone and progestin.
• Bone density loss with perimenopause/menopause.
• The hormonal shifts during perimenopause/menopause.
• At what age do women start getting symptoms of menopause?

 

Who Lara Briden?

Lara Briden is a naturopathic doctor and author of the bestselling books Period Repair Manual andHormone Repair Manual. With a strong science background, Lara sits on several advisory boards and is the lead author of a 2020 paper published in a peer-reviewed medical journal. She has 25 years’ experience in women’s health and currently has consulting rooms in Christchurch, New Zealand, where she treats women with PCOS, PMS, endometriosis, perimenopause, and many other hormone- and period-related health problems.

 

CLICK HERE TO LISTEN ON APPLE PODCAST 

 

If you're wanting to enrich your knowledge and dive deeper into Lara's work, make sure you check out the resources below linking to Lara's websites, books and previous podcasts.   

 

Resources:

Dr. Lara's website

Dr. Lara's Instagram

Dr. Lara's Facebook

Lara Briden Forum

The Period Repair Manual-Lara Briden

Period Repair with Lara Briden (EP#21)

The Power of Menopause with Jane Hardwick Collings (EP#77)

Is It PCOS or Hypothalamic Amenorrhea with Lara Briden (EP#99)

 

Resources Mentioned In The Podcast:

 

The Power of Eating Enough - Lara Briden Blog Post

The Difference Between Progesterone and Progestin - Lara Briden Blog Post

The Slow Moon Climbs - The Science, History, and Meaning of Menopause (book mentioned by Lara in podcast)

 

 

 

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Check Out The Transcript Here:

 

Tahnee: (00:00)

Hi everyone, welcome to the SuperFeast Podcast. I am here with Lara Briden, she is one of our friends of the podcast. It's our third episode with us today, really excited to have her here. And we're speaking about perimenopause and menopause, really in reference to her book, the Hormone Repair Manual, which if you're my age and over, I'm in my mid 30s, highly recommend getting a copy. It's actually a really good, fun read and really interesting just thinking about preparing for this stage of life. So thank you for joining us on the podcast again, Lara. I'm so happy to have you here.

 

Lara Briden: (00:34)

Thanks for having me. Looking forward to our chat again.

 

Tahnee: (00:39)

Yeah, another one. And we've been sort of all over the world. I think we've done a lot of stuff on menstruation really when you've been on with us, but I was really excited when I saw you publish this. It was last year, wasn't it?

 

Lara Briden: (00:48)

Yeah. Came out early last year.

 

Tahnee: (00:50)

Yes. I think I've had it for quite a while. And I guess from I think women hit this, I hit middle 30s and was like, "I don't have much information about menopause and I've only had these sort of anecdotal stories from family and friends about what happens to women and it's usually pretty negative. It's not really framed up in a positive way." And then I was telling you we had Jane Hardwicke Collings on the podcast and she spoke a lot around the spiritual side of things and these important transitions that we have in our lives. And it just made me a bit more interested and excited about what's coming.

 

Tahnee: (01:28)

I think reading your book, yes, obviously it's a complex time, but just how you mapped out the stages and took something that can feel really sort of dark and unknown and maybe even a little bit scary and... I don't know, I think it just made me feel a little bit more confident and reassured, so thank you for that.

 

Lara Briden: (01:43)

That's sweet. I had one review say, "Yeah, made me feel like everything's going to be okay." Which is-

 

Tahnee: (01:53)

I think it's like with pregnancy, because I'm pregnant right now and you hear about birth growing up and it's always people's hectic horror stories. It's always like, "Oh and you have to carry a baby around this and that." And I think when you actually go through it, it's like, "That's actually really magical and quite beautiful." I mean, I know it's not for everybody, but that's been my experience and it's reframed a lot of that for me. And I think, just this book started that journey for me. So hopefully menopause is a fun experience. But I thought that idea of it being predictable was really interesting that you speak about early in the book, in the sense that there's a rhythm or a pattern that unfolds.

 

Lara Briden: (02:33)

There's a sequence of events, it's not just chaos. It's portrayed as this hormonal chaotic time. That's not actually what's happening, it's a sequence. We'll start with this, it's second puberty. So we have first puberty, which we know is temporary, which we know is turning one thing into another thing. That's what perimenopause is. It's at the other end, it brackets our reproductive years. And it's second puberty, it's the end of periods.

 

Lara Briden: (03:08)

The other good thing about that is it's temporary. And also, I guess the thing I want to say is that writing this book and going through menopause myself, I've reframed actually how I think about female physiology. I now have this sort of view that we have our basic female physiology, which starts at in childhood, we have low hormones, and then we go through 35 to 40 years at the most of our reproductive years, which is amazing. As you know I'm a huge fan of ovulation and periods and pregnancy and all of that's amazing and that helps us make hormones and build metabolic reserve.

 

Lara Briden: (03:44)

But then that has to end, this is the thing about reproductive years, that is, there's an end point. And then we revert back to our more baseline female physiology. So for me, that's sort of really normalised it. It's far from being, "Oh, I'm longer a woman." No, it's the opposite. This is the basic female physiology and then I'm just thankful to have had, in my case about 38 years of periods, I guess.

 

Tahnee: (04:12)

That's a really interesting way to think about it, I guess, because it's almost like this heightened state through these reproductive years, which are so intensive, really in many ways on us and then having this stability afterwards.

 

Lara Briden: (04:27)

The reproductive years are a special time and that's true whether you have pregnancies or not, actually I would say. I mean, obviously pregnancies are a very special part of that, but even for women like myself who did not have pregnancies, it's still those years of ovulating and it's amazing. It also just, for example, having menstrual cycles and pregnancies increases our metabolic rate, increases our demand for calories. So when we exit that, come up the other end, our metabolism shifts, and that's always portrayed as a bad thing. You start to gain weight with menopause. But again, I've sort of reframed it as we need fewer calories in a way. And so from a-

 

Tahnee: (05:07)

Less resources.

 

Lara Briden: (05:08)

Yeah. From an evolutionary perspective, I might jump to that because as you know, I might have mentioned on the podcast before, before I became a naturopathic doctor, I was an evolutionary biologist and I see a lot of things through that lens. Menopause is particularly fascinating from an evolutionary perspective because all the evidence is now that even in ancient times, even in prehistoric times, there were women who made it through to 80 years old. Contrary to the mistaken belief that we all died by 40, that is not the case at all. A lot of people died young because of injuries and unfortunately childhood mortality and death in childbirth as well. There's lots of hazards before modern medicine, but it was always still possible and not uncommon for individuals to live to 80.

 

Lara Briden: (06:04)

And actually what some of the research shows and in my book, I quote another book called The Slow Moon Climbs, where she builds the case that a longer human lifespan for both sexes evolved because of beneficial selection pressure on women in their post reproductive decades. So basically it's about the fact that 50 something, 60 something women are so productive for their group. They gather more food than any other demographic and they share it and they also need less themselves. So that's the perfect member of a society. They're helping everyone, they're gathering food. They're very lean, efficient machines themselves because they don't need as much energy. And it's a good thing, it's like a superpower. It's that reframing of the shift in metabolism as certainly beneficial for our ancestors.

 

Lara Briden: (07:00)

It's a little bit trickier now in our modern world where we live with so many surrounded by sugar and processed foods. That's what you would call an evolutionary mismatch with our ancient metabolism. We can explore that a little bit, but just the basic message being, menopause is meant to happen. It evolved, it's not an accident of living too long. It's something, if we're lucky enough to live this long, that we do as women. I think understanding all of that just changed it all for me personally, I just feel far from feeling like I'm done. I feel now this is the next exciting chapter where you get to do lots of things.

 

Tahnee: (07:43)

Well, I want to bookmark a little bit there because there's a couple things I want to drill down on. I think that piece around the mismatch evolutionarily is really interesting, but I just want to go back a little bit to what you said about, which I guess it's lining up, if you think about how we live now, back in those days it would've been that support of the older, wiser, probably more hands on members of society to the reproducing ones. And I think now we've got this interesting cultural thing where even with myself, I work full time, I have a kid, I'm going to have another kid. And I can see how that drains women as well as they head into their perimenopausal and menopausal years. I wonder if you've noticed that in your clinical work, is there's this extra pressure now on women during their reproductive years and how that affects menopause.

 

Lara Briden: (08:40)

Oh yeah. Well, there's so many reasons. Couple things I'll say so that'll answer your question about clinically what I'm saying. If I could just allow me for a little bit to talk about the evolution a little bit more and restore of humans because I've [crosstalk 00:08:55]. So what we know now about hominids, well, ancient human groups is that we had to have a lot of... To do what we did and spread over the world and be so successful, there always had to be a high ratio between adults and children, which is very interesting. You had to have what they call, I think they called them alloparents. So you had to have non reproducing adults basically who would support and help the reproducing women do what they had to do.

 

Lara Briden: (09:28)

And that's actually what enabled women, the reproducing members of society, to make babies every three years, back to back like that. Because you can imagine a individual human, a woman in the wild, there's no way you could raise baby after baby with no help. [crosstalk 00:09:46] And a husband isn't enough, one person isn't enough. You have to have aunts and uncles, grandmothers. And so there's that.

 

Lara Briden: (09:57)

So obviously yes, I think to speak to your question, young mothers are under a lot of pressure now that they wouldn't have been. And that is a drain on their stress response system. That's certainly not ideal, in terms of stress level throughout the reproductive years. A lot of what happens at perimenopause, you know how in my first book I talk about the period as the monthly report card, perimenopause is like the final exam. It's everything that's been happening, what amount of metabolic reserve you were able to build up through... When you get to your early 40s, because for a lot of us, the change does start in our early 40s. It's not somewhere off in your mid 50s. I mean, that's a mistaken understanding that a lot of women have, like, "It's happening now." Not now for you, but for a lot of women, by 40, 42, 43, 44, 45, that's pretty common to start to get some of the neurological symptoms.

 

Lara Briden: (11:05)

And the way that is going to be will depend on a lot of factors and certainly your stress, your adrenal system, we call it naturopathically, or your stress support system, how stable that is, how strong your circadian rhythm is, how well nourished you are, how your immune system is. All of those things, including unfortunately, how many environmental toxins you might have been exposed to. Any of those negative things can increase the symptoms of the perimenopause transition.

 

Lara Briden: (11:40)

Because I'm convinced from a biology evolutionary point of view and also as discussed in the book that I mentioned, low Moon Climbs, the actual transition of perimenopause to menopause, historically would've not been symptomatic. There's no reason that we would've... The body should be able to make that change symptom free. Obviously you stop ovulating and stop having periods, that's what happens, but there's no reason that should go along with distressing, sleep or hot flushes or all the things that can happen. Just as there's no reason periods should be... Periods are not painful inherently. They are commonly painful, but that's a mismatch a lot of the time with our modern food supply and other things going on.

 

Lara Briden: (12:30)

So that's the idea of evolutionary mismatch. I think actually to perimenopause and perimenopause symptoms is the classic example of evolutionary mismatch. This idea that symptoms arise from a mismatch between our ancient physiology and our modern environment. And not just food, not just environmental toxins, but circadian rhythm would come into that a lot, disrupted circadian rhythm. On the topic of environmental toxins, there's actually a bit of interesting research. I do include it in the book just only like one sentence [crosstalk 00:13:00].

 

Tahnee: (13:00)

Lead stuff?

 

Lara Briden: (13:00)

Yes.

 

Tahnee: (13:01)

Yeah. I was going to ask about [crosstalk 00:13:03].

 

Lara Briden: (13:03)

Good eyes. There's like one sentence about that, but possibly, and this is just one example of the way environmental toxins can affect us, but there's some research to suggest that some of the neurological symptoms of the perimenopause transition, so that would include anxiety, sleep disturbance, potentially hot flashes, may arise at least in part from the release of lead from our bones. It's sounds awful, but this is the case. That we've accumulated through a lifetime and now with increased bone turnover with dropping oestrogen levels, more of that lead is liberated into the bloodstream.

 

Lara Briden: (13:44)

And so for example, just to give you... When I was a kid, we had leaded petroleum or leaded gasoline. Obviously the society has been trying to reduce lead exposure, but some of us, especially born in the '60s and '70s, were exposed to more. And with heavy metal toxins, as you probably know, the body sequesters it, so it's like, "Oh, this is bad." Puts it in the bones, which takes it out of circulation for a while, but eventually comes back. So that's an intriguing bit of research to kind of wonder if without body burden of lead, what would... I think there's other factors too. I don't think that would mean we're all of us symptom free, but it's an intriguing-

 

Tahnee: (14:26)

It could be a tipping point or something.

 

Lara Briden: (14:27)

Yeah. It's a factor.

 

Tahnee: (14:30)

I found that really interesting too. And even just because you hear about osteoporosis in sort of menopausal years, but I think, I didn't really understand that it was just that turnover process was heightened and faster, I suppose.

 

Lara Briden: (14:43)

Yes, it's an increased bone turnover. Which is real, and a lot of that's comes from losing oestrogen and progesterone to some extent.

 

Tahnee: (14:50)

So that's happening in the body anyway. We have osteoblast clast going around and [crosstalk 00:14:56].

 

Lara Briden: (14:55)

Yes, the turnover is always happening. Yes, exactly.

 

Tahnee: (14:57)

So can you explain, is the difference with menopause is as the progesterone and oestrogen drop-

 

Lara Briden: (15:04)

Yes.

 

Tahnee: (15:04)

Is that just completely affecting the speed of that process, is that [crosstalk 00:15:09]?

 

Lara Briden: (15:09)

So there's more osteoclast activity or the cells that kind of chew up bone. Osteoclasts are suppressed by oestrogen, not completely, but... So as you know, we're always, from peak bone density, peak bone mass around age 30, we, everyone, men and women, it's downhill from there basically. We're losing bone mass incrementally, continuously, and that's normal. But the idea is we want to have hopefully strong enough bones to last into our 80s or 90s. At some point we're not going to need our bones anymore. But around the later phases of perimenopause when oestrogen drops, because I just point out oestrogen is actually high in the early phases, which is interesting. But around the later phases and into after your final period, it is true, there is acceleration of that bone loss for at least about five years. And it's real, I think it's just, it's a lot of it your outcome.

 

Lara Briden: (16:15)

And then, the concern is because you're not going to break bones from osteoporosis in your 50s, it's actually, what's going to happen when you're 75, 80. So it's all about this prevention for down the road, so it's about assessing risk. What other risk factors for low bone density might you have? A good example is eating disorders like undereating as a young woman is not good. There's some evidence that hormonal birth control actually impairs bone density, smoking. These are some of the obvious ones, smoking's [crosstalk 00:16:48] not good. So if you have any of those risk factors and then plus, especially if you have an earlier then for the sake of bones, there is a real argument to be made for taking oestrogen potentially long term to protect bones. So I'll just acknowledge that.

 

Lara Briden: (17:04)

There's also lots of other ways to help bones. The muscle and bone are just connected like hand in hand. So maintaining strong muscles is a excellent way to maintain bone health. And we are unfortunately with the final phases of menopause or perimenopause and dropping oestrogen levels, we tend to lose muscle mass, which it's real. It's like you lose your bum, you just start to not have... You can maintain muscles, but you have to work at it. And well, it's a sad reality. And I guess just also speaking back to our ancestors, they didn't work at maintaining muscle exactly. They were walking around carrying [crosstalk 00:17:49]. Yeah. Carrying bundles of food and babies and-

 

Tahnee: (17:52)

Children.

 

Lara Briden: (17:52)

Yeah.

 

Tahnee: (17:53)

Yes. 20 kilos to laugh that to me at the moment, people like, "Look at your arms." I'm like, I would, I have a 20 kilo child. I think that's a really interesting piece with our modern society. And we seem to keep looking back at this mismatch, but we would've been so much more active and just incidentally active through our day to day lives [crosstalk 00:18:17].

 

Lara Briden: (18:17)

They didn't exercise.

 

Tahnee: (18:18)

Yeah. They're not working out at the gym or anything.

 

Lara Briden: (18:20)

No. [crosstalk 00:18:22]

 

Tahnee: (18:23)

And I think that that losing that throughout our whole lives, it's a challenge, and for younger people.

 

Lara Briden: (18:29)

Younger people. Sure.

 

Tahnee: (18:29)

But I notice you mentioned walking, that's something you do a lot and-

 

Lara Briden: (18:33)

Yeah.

 

Tahnee: (18:34)

Some of the women I know who've had easier transitions movement does seem to play a part in that for them the more active jobs or people who walk a lot or do those more active things.

 

Lara Briden: (18:45)

For sure. I love the fact that you use the word movements rather than exercise. I'm a convert to saying movement because of the inherent sort of just joyfulness of it. You're not, as you say, working out, it's not a chore. You're moving your body. So I would emphasise, it's pretty important to find a style of movement that is enjoyable because that's the way you're going to do it on a regular basis. Not to be healthy, not to specifically to build bone, but because it feels good to move your body.

 

Tahnee: (19:19)

You actually like to do it. And I think that was interesting because you had some research around, I think it was yoga and hot flashes, which I hadn't heard and thought was super interesting, but I know yoga's not for everybody because some people it's too much stretching. Because sometimes I think resistance training can be better for like what you're talking about, holding muscle mass and strengthening bones and things. But I thought that was an interesting study because I hadn't heard of that symptom.

 

Lara Briden: (19:45)

A lot of things affect hot flashes actually, because there are nervous system symptoms. So there's lots ways to help to stabilise. The nervous system is recalibrating. We can launch into that now, but I'll just say a word for... I love yoga and I agree [crosstalk 00:20:01].

 

Tahnee: (20:00)

I love it. I'm a yoga [crosstalk 00:20:02].

 

Lara Briden: (20:01)

You either love it or you don't. If you don't, that's fine, but it has a lot of things going for it. You do build muscle with yoga, especially if you're doing some of the stronger squats and lunges and things. And also as I talk about in the book, it's so good for the nervous system. It's this combination of actually arms above the head, controlled breathing, long exhales. That's really good for the vagus nerve as you probably know. And it's very stabilising for the nervous system. So I love it. I acknowledge not everyone feels the same, but I'm in the camp of how do people survive without yoga? [crosstalk 00:20:36]

 

Tahnee: (20:36)

No, trust me, that's me too. But one thing I've noticed with, I don't know, I used to teach a lot of menopausal women and they seem to have, you mentioned it in the book, a lot of energy. And I do find sometimes I feel like they actually don't connect to the... They seem to enjoy moving more.

 

Lara Briden: (20:58)

Okay. More vigorously maybe sometimes [crosstalk 00:21:01].

 

Tahnee: (21:01)

Which is something interesting because I teach a lot of Yin and slower. I did used to teach hectic stuff too, but it was just interesting when I was watching how different people responded to practices. And look, it could be a nervous system thing too, like you're talking about. I thought that was an interesting chapter. I guess just thinking about how much, I mean, that affects all of us, like heart rate variability and all of these things. But I thought that was really interesting in relation to peri and menopause. So can you talk a little bit about that side of things?

 

Lara Briden: (21:33)

Oh, about the nervous system [crosstalk 00:21:35]. Yeah. So let's talk about that. Perfect, because I mentioned about recalibration of the nervous system. And we'll get our terms straight too. So perimenopause is the lead up to menopause basically. I mean, there's different ways. Menopause itself as a word has different definitions depending on who you ask. But the definition I use comes from the professor who helped me with my book, Jerilynn Prior. She is in the camp that defines menopause as the life phase that begins one year after your final period. So she would call that menopause is the next 30 years going forward from perimenopause.

 

Lara Briden: (22:22)

Some people define it differently. Some people call that post-menopause I'm with her, that menopause is all of those decades that come after. Whereas perimenopause is the change and that's where the symptoms come from. Most of the symptoms are temporary. With the, we probably won't get to it today, but just acknowledging that longer term symptoms with menopause or post menopause depending on how you want to define it, would be things like vaginal dryness and that whole syndrome that goes along with low oestrogen and how that affects the pelvis and bladder. And so that's obviously [crosstalk 00:22:57].

 

Tahnee: (22:56)

Not the prolapse sort of.

 

Lara Briden: (22:58)

That sort of thing. So that's-

 

Tahnee: (23:00)

And you speak to that in the book.

 

Lara Briden: (23:01)

I do. There's a chapter section on that. That's not temporary, but a lot of the other symptoms are temporary, especially the neurological symptoms of which most symptoms of premenopausal are neurological, and they arise from the recalibration process. So just as first puberty is, as you can imagine, a recalibration of the brain. The brain undergoes pretty major changes in first puberty, obviously. And the immune system undergoes changes with first puberty. The same happens with second puberty or perimenopause. So a brain rewiring, that's what I call chapter to seven in the book, is rewiring the brain.

 

Lara Briden: (23:44)

The other system that undergoes quite a profound recalibration is the immune system. And that's why there's such thing as perimenopausal allergies and an increased likelihood of autoimmune flare. And the other system that undergoes a recalibration is the metabolic system and cardiovascular system all around a shift to insulin resistance, unfortunately, which also affects the brain.

 

Lara Briden: (24:09)

But in answer to your question about the nervous system, I'll just talk about the nervous systems. So nervous system symptoms include hot flushes, night sweats. Night sweats are usually first, premenstrual night sweats, first in terms of sequence of symptoms to arise. And then sleep disturbance is quite a common one, increased likelihood of anxiety and depression, dialled up premenstrual mood symptoms potentially, and migraines. Did I already say migraine?

 

Tahnee: (24:44)

No.

 

Lara Briden: (24:45)

[crosstalk 00:24:45] No, increased frequency of migraines. I just had a patient the other day actually with classic. She said she'd had maybe two migraines in her first puberty and then they went away completely. And then they came back at 42, 43, they started coming back. And so I can talk about some of the underlying physiology that's contributing to that.

 

Tahnee: (25:07)

Well, I just think it's super interesting because I guess reading the book that I noticed a lot of it seemed to come back to that nervous system piece around there's all the sleep symptom and that's really, if we work on regulating nervous system that helps. The hot flash if we work on [crosstalk 00:25:25]. And I guess one of the things I hear a lot from people is, how do I fix my hot flashes? Or how do I fix my insomnia? How do I fix my... And it's like the symptom becomes the focus instead of really drilling down to that root cause around well, maybe there's this imbalance in the activation of the nervous system.

 

Lara Briden: (25:43)

Right. Or just the general strategy of supporting the nervous system rather than having to eliminate that [crosstalk 00:25:50].

 

Tahnee: (25:49)

Yeah. Like focus on cooling down or eating [crosstalk 00:25:53].

 

Lara Briden: (25:55)

For sure. And one thing before I launch into the nervous system and the physiology underlying that, I do just want to point out while I'm thinking of it, there's no diagnostic test for this. This is a little bit... This is worth mentioning-

 

Tahnee: (26:13)

Like it's subjective kind of?

 

Lara Briden: (26:15)

Because it's such a classic story, as women start having night sweats, increased migraines, they feel different. They're like, "Ooh something's happening? Could this be perimenopause?" And then the answer is probably yes. But they go to the doctor and they're like, "Oh, your blood tests are fine." That means nothing. That means absolutely nothing. And same with DUTCH testing or any kind of... There's no diagnostic test for perimenopause. It's purely based on context and symptoms. By context, meaning if you're older than 35, and symptoms and ruling out other causes. For example, thyroid disease can look and feel a lot like perimenopause, but it's something different. Although you can have both happening at the same time, which is confusing.

 

Lara Briden: (27:08)

But I will say just to be clear, so I'm talking about a normal perimenopause, a normal progression where your symptoms might start in your late 30s or early 40s, but you're heading to a final period anywhere between 45 to 55, that's normal. Period stopping due to early menopause at like 35, that's different, and that can be diagnosed by blood tests. We'll leave the early menopause thing. I talk about it in the book, but we'll just leave that separately because obviously that's a whole other conversation.

 

Lara Briden: (27:45)

Today we're talking about the normal timing of things. So what's happening with the nervous system is the sequence of events. Like I said, there's a logical sequence of events, it's not just random chaos. The first thing that happens is start to make less progesterone because we're having shorter luteal phases, your listeners know what I'm talking about, so we're-

 

Tahnee: (28:13)

Yeah, I think so. I mean, the book has that beautiful graph I think. That visual was really good to show my husband. [crosstalk 00:28:20] But so we get that big curve of progesterone and sort of [crosstalk 00:28:26].

 

Lara Briden: (28:27)

In the ovulatory cycle when we're healthy, when we're younger than 40, if we're not on hormonal birth control, we should be having every month, a couple weeks of strong progesterone production. And that helps to lighten periods, that is usually quite good for mood. Although there's a little bit of nuance around that, but generally progesterone for most women is a little bit tranquillising. Well, you've got lots of it right now. Second trimester pregnancy is usually quite tranquillising. I mean, again, it can vary as other factors.

 

Lara Briden: (29:00)

But with on the journey to perimenopause, we just start, our ovulation just becomes less robust. It's nothing you've done wrong. In my first book, I talk about all the ways to promote healthy ovulation and we still want to do that. And in my new book, I have a chapter called cycle while you can. You still want to ovulate as best you can for as long as possible and always remove any obstacles to ovulation, but also accept the fact that ovulations are becoming less robust. Eventually they're going to stop, that's normal.

 

Lara Briden: (29:35)

So with this reduction in progesterone, with shorter luteal phases, maybe a shift to having more anovulatory cycles or cycles where you don't ovulate, but still bleed, we make less progesterone. And that feels like trouble sleeping, increased migraines, increased anxiety potentially, and heavier periods as well, which we might not go into today. We'll see if we have time. But there can be heavy periods going along with all of this. So we lose progesterone, which is one of the reasons taking progesterone, not a progestin in the pill, but natural progesterone can be actually very helpful.

 

Lara Briden: (30:18)

At the same time, we're getting in the early phases of perimenopause. And there's four phases, which I give a little chart in the book. But in the earlier phases, which in total last four or five years, we're also getting potentially oestrogen higher than ever before, up to three times higher than before and spiking up and down. And you can't really that with a blood test, because it's all over the place. But you know from symptoms and from some of the testing research that professor Prior has done, you can see this big oestrogen spikes. And along with oestrogen spiking up high can come this whole immune system reaction that I talk about in the book of high histamine and which is also very-

 

Tahnee: (31:04)

Muscle reaction.

 

Lara Briden: (31:04)

Very muscle activation and this in part is the perimenopausal allergies and it's headaches and irritability and hives sometimes or urticaria sometimes. There's definitely an immune thing going on that can feel terrible. And that I have noticed sometimes gets called oestrogen dominance, although I don't really use that word. But that's that kind of high oestrogen immune stimulated picture with very little progesterone sometimes to counterbalance that. And so that's the first phases and that is not pleasant. Sorry, so that affects the nervous system. That's where some of the other anxiety symptoms come from is that high oestrogen, high histamine plus then estrogen's on a rollercoaster. Then you get some oestrogen withdrawal symptoms leading up to the period, which also doesn't feel very good. That's where the night sweats come from is oestrogen dropping from high to low. So lowest [crosstalk 00:32:02].

 

Tahnee: (32:01)

Kind of addictive. I just want to quickly dive in because I thought that was interesting. I'd never thought of it that way. It's a first.

 

Lara Briden: (32:10)

Yeah. Oestrogen is addictive [crosstalk 00:32:11] for the brain.

 

Tahnee: (32:11)

So when we're swinging, that's this kind of the low is like a withdrawal. [crosstalk 00:32:18]

 

Lara Briden: (32:17)

Yeah. We get oestrogen withdrawal. Yeah, for sure. It's not pleasant. And just to reassure, it was perfect timing with your question, because I was about to say that once we get into that menopause phase, stable, low oestrogen... Not no oestrogen, we still make actually quite a lot of oestrogen still, but we don't get hot flushes and night sweats because it's not the like up and down crashing down part of the oestrogen roller coasters. So a lot of it comes from oestrogen withdrawal and also the oestrogen addiction side of things. It's worth mentioning that if women do take oestrogen therapy... And I think it's fine to take it. I just want to say, in general pro hormone therapy, not everyone needs it, but I think it's reasonable to take that.

 

Lara Briden: (33:09)

Just one thing to understand, that if and when you decide to stop it, you have to taper down oestrogen. I've had patients who they want to take a break and so they've just stop it immediately, and of course get hot flushes back because you're going through oestrogen withdrawal. That doesn't really tell you anything about your underlying need for it, if you know what I mean.

 

Tahnee: (33:30)

Okay. So that makes sense. It's like, you're got to be gradual in changing the body biochemistry [crosstalk 00:33:37].

 

Lara Briden: (33:36)

When you're coming off hormone therapy, you can go on it more-

 

Tahnee: (33:39)

Aggressively?

 

Lara Briden: (33:40)

Rapidly. No, not aggre... No, I always think start low actually. I don't know if we'll have time today to go into all my thoughts about hormone therapy, but if [crosstalk 00:33:46].

 

Tahnee: (33:46)

I think you really talk a lot about that option in the book and I think it's probably something better discussed clinically I think with a practitioner appointment and [crosstalk 00:33:57].

 

Lara Briden: (33:57)

So read book and we'll talk, because I think we want to talk more about the nutrition side of things and-

 

Tahnee: (34:02)

Yeah. I guess the distinction I thought was interesting in the hormonal chapters or sort of, was around the, so you're distinguishing between body identical, bio identical and then the more chemical like synthetic hormones, I suppose. Do you mind just giving us some distinctions around?

 

Lara Briden: (34:18)

Yeah. So just very broad strokes. And I agree, because I think we should focus more on the nutrition side of things today. But I will say, put this simply, so-

 

Tahnee: (34:27)

Good luck.

 

Lara Briden: (34:30)

There's a confusion happening, which is that up until about eight years ago in Australia, it's different in different countries, but I remember exactly when body identical hormones went mainstream in Australia, it was 2016. So that's seven years ago. No, six years ago.

 

Tahnee: (34:48)

Five or six.

 

Lara Briden: (34:49)

How many years ago? I don't even know. With the pandemic, we're like, "Wait, how many years..."

 

Tahnee: (34:53)

"Have I been?" I think it was five because my daughter was born in 2016 and she [crosstalk 00:34:58].

 

Lara Briden: (34:57)

Okay. So it's only five years ago. Five or six years. [crosstalk 00:35:00] That's when body identical also called bioidentical hormones became mainstream. So until that point, which is not that long ago, the only way to access hormones that are actual hormones, actual estradiol, identical to the hormones we make, the only way to access those was compounded. You have to see an integrative doctor. So we have to be a special route to get to those hormones. And now they're pretty much mainstream, and I talk about it in the book, you have to ask for them by brand name. Not all the hormone therapy products on the market are bioidentical, but some of them are, and doctors do know now that it's safer and it's better.

 

Lara Briden: (35:51)

And the real advantage, one of the big differences is that body identical or bioidentical, means the same thing, progesterone is safer for the breasts. So progestins, not progesterone, but the progesterone analogue drugs are not safe for the breasts. And that's actually where a lot of the breast cancer risk came from was the progestin part. So real progesterone in Australia is called Prometrium. This is the brand name in the US. It's Utrogestan in New Zealand and the UK. So hopefully there's a lot more detail in my book, but I hope that clears things up for some people listening.

 

Tahnee: (36:30)

Well, I think that was interesting because you talk about women who've been on the pill until their 50s or some, and then they're like, "Oh I want to go back on the pill, because I got..." [crosstalk 00:36:43].

 

Lara Briden: (36:44)

Don't do that. And then I say, "Yeah, no, no, exactly." And then [crosstalk 00:36:49].

 

Tahnee: (36:49)

In the book you were like, "No," but they were yes in... Anyway, I thought it was an interesting, because I might have mentioned this another time [crosstalk 00:36:54]. But I had a professor who was doing all this research into how the pill's so great because it stops us having periods and blah, blah, blah. This is when I was 18, so this was a long time ago. But he made the point that if you're on the pill, it's mimicking preg... So he was coming-

 

Lara Briden: (37:10)

No.

 

Tahnee: (37:11)

Yes, I know. It's very [crosstalk 00:37:13].

 

Lara Briden: (37:12)

Keep going. Yeah, yeah.

 

Tahnee: (37:14)

But he was like, "It's just like these, our ancient ancestors, how they had lots of babies and they never were bleeding and blah, blah, blah." And so 18 year old Me's like, "Okay, this is making sense." And anyway, long story, but I feel like there's a little bit of that lingering sense of the pills keeping everything in balance and if I go off that it's going to... I hear that a bit in the world when I talk to people and yes, I'm curious if you could talk about how the pill relates to perimenopause and menopause.

 

Lara Briden: (37:42)

Very good question. There's a whole section about that in my book. Again, I'll try to be concise here so we have time for some of the other things too. Just quickly to answer to what this professor was saying to you, which is that the pill mimics pregnancy, which is absolute standard narrative that we've been fed, not my strong word, but that's been out there-

 

Tahnee: (38:07)

Well, this was in university biology course on human reproduction. It's a big thing to teach a bunch of kids.

 

Lara Briden: (38:13)

Yeah. So the problem with that version of things, is that contraceptive drugs, just if we name them, let's say the drug called levonorgestrel and most pills or ethinyl estradiol, that's the synthetic oestrogen. They are not the same as the oestrogen and progesterone you make during pregnancy or during menstrual cycles. In terms of mimicking pregnancy, I mean only very superficially, not in terms of what that means physiologically for the body because the hormones of pregnancy are actually quite beneficial and particularly on the breasts.

 

Lara Briden: (38:53)

And as you know, pregnancies in general, have a risk reduction effect for breast cancer long term. And part of that is the progesterone exposure because real progesterone that you make during pregnancy, that you make during a menstrual cycle, that you can take as Prometrium arguably has a risk reduction effect for breast cancer, whereas progestin increase the risk. So that's just one example of how progestins are different from progesterone. I have a blog post called the crucial difference between progesterone and progestin. So you can look at it there. So an answer to-

 

Tahnee: (39:28)

I think you had the diagram in your book with the two different molecules as well.

 

Lara Briden: (39:32)

Yeah, they're different. So an answer to your question, what does the pill mean for perimenopause? Well, it masks it for one thing. So as we talked about, we'll have to refer, you can put the show notes back to our first episode where I'm sure we had a little discussion about why pill bleeds are not periods. That's true in our 40s as well. So if you're having regular pill induced bleeds, you'll keep having those even after your body went through menopause. It doesn't delay it. If anything, the pill brings menopause a little sooner, it doesn't stop menopause. What will happen is if you've been on the pill and having those bleeds, then when you stop it, you'll be instantly into menopause, over the oestrogen cliff, which is probably why you asked that question thinking, but that's an example of oestrogen withdrawal going straight over. It's like... It's potentially not good.

 

Lara Briden: (40:32)

And so in the patient story that I think you were mentioning from the book, she's like, "Oh, I need to go back on the pill is this is awful." And I'm like, no, well you might as well go on to modern menopause hormone therapy, which is body identical, which is at least giving you real hormones and safer than the pill because the pill is hormone therapy. It's a big dose of synthetic, almost like an old school type of hormone replacement therapy that's not even as good as what they give menopausal women now. So it always feels like a bit of a cruel thing that now finally menopausal women get access to natural hormones conventionally. The young women are still put on these horrible synthetic hormonal drugs that don't have...

 

Tahnee: (41:19)

Very not good for us.

 

Lara Briden: (41:21)

Yeah. So I have a chapter in Hormone Repair Manual called cycle while you can, making the argument. And I quote, professor Pryor, she said, "The 40s is not a time to take the pill because if you need something, you might as well take real progesterone to get those benefits rather than..." Yeah.

 

Tahnee: (41:39)

Well, I thought that was an interesting point you made, I think it was in that chapter around just to have as many cycles as you can leading up to menopause and even pregnancies and things like how biologically we would've probably had babies until we couldn't. And that's actually quite potentially helps smooth that transition. Again, this is sort of [crosstalk 00:42:04]

 

Lara Briden: (42:04)

Good eye. You have a good memory for all those parts of book. Yeah, it's true. Because-

 

Tahnee: (42:08)

Not as much as I usually do, pregnant brain.

 

Lara Briden: (42:12)

No, I'm impressed by those little parts that you remembered from the book, but yes, that's another example of evolutionary mismatch is our prehistoric ancestors. Well, and even historic, to some extent, would've had quite a different life menstrual history in that likely they would've kept having babies and breastfeeding and severe periods. Potentially what perimenopause would've looked like for them was you have your last baby at 42 or 43 or something, and then you breastfeed for three years and then you just never get your period back. It's just kind of a slow glide into... You come from the low oestrogen stage of breastfeeding into... And so there's no oestrogen withdrawal. You don't necessarily, they wouldn't have been going through these crazy up and down oestrogen roller coasters that we modern women do. So that's another explanation potentially for why they wouldn't have had the symptoms. I say wouldn't have, I mean, they don't have. In modern, I mean, the information we have is modern day hunter gather people like the Hadza don't report symptoms. They report stopping their periods at 45, but they're generally happy about it.

 

Tahnee: (43:30)

Well, I've often fed this to my husband and it's something I think about with all stages of our biological shifts through life, but it shouldn't probably be as hectic as it is. You think about puberty, you think about pregnancy. Some people I talk to, they just have the most awful time. And I think, there has... And I guess that comes back to what you were talking about at the beginning around that mismatch around how we live and what we eat.

 

Lara Briden: (43:59)

And environmental toxins. I mean, we really can't underestimate, environmental toxins are affecting our menstrual cycles and our perimenopause experience, unfortunately. And that's not-

 

Tahnee: (44:10)

On pregnancy too, I'm sure.

 

Lara Briden: (44:13)

... women's fault. This is why I talk in the book and I'm starting to talk more about our environment, including our food environment, because we're like animals inside an environment. Certainly in terms of diet, we're eating because that's what's around us. I mean, it's not all about making the wrong choices, it's-

 

Tahnee: (44:34)

It's what's available.

 

Lara Briden: (44:35)

Yeah.

 

Tahnee: (44:37)

Well, so on diet, I think in terms of what women... Because I noticed the piece on soy as well, which was interesting because I think we all grow up hearing soy good for menopause and don't really... Thought that was an interesting... You sort of debunked that.

 

Lara Briden: (44:52)

Well, it's not oestrogen. This is the thing with phytoestrogens is their antiestrogen in young women, which can be good. That's not a bad thing. I actually think phytoestrogens are great. And they're somewhat pro oestrogen with menopause, just very briefly on phytoestrogens, and I do talk about it in the book, we're calibrated to them actually. Our ancestors, there's some research to suggest that especially those of us with agrarian ancestors, so ancestors eating grains and legumes, women evolved a higher level of estrodiol, ramped up our oestrogen to sort of overcome the anti antiestrogen effect from phytoestrogen.

 

Lara Briden: (45:41)

So in that sense, we're calibrated to have those in our diet and phytoestrogens actually do have quite a stabilising beneficial effect on all stages of female hormonal health. In part with menopause, one thing they do that's very beneficial is they help to, this is a little bit technical, but they increase something called SHBG or sex hormone binding globulin, which actually helps to prevent some of the testosterone dominance and insulin resistance that can also happen, that I talk about in the book. So just to say, no, soy is not a substitute for oestrogen therapy or anything like that, but phytoestrogens generally are probably quite good for the perimenopause [crosstalk 00:46:26].

 

Tahnee: (46:26)

Which would explain, I guess, why all those herbs that you use in those periods are very estrogenic.

 

Lara Briden: (46:32)

And linseeds. That kind of thing can be very beneficial. So I certainly in trying to debunk that soy is oestrogen, would never want to take away from the fact that phytoestrogens broadly speaking are quite good for us. Yep.

 

Tahnee: (46:48)

And I guess you did speak specifically to the isolates if I'm remembering correctly. So I'm probably putting words in your mouth.

 

Lara Briden: (46:54)

Yeah. No, no. It's [crosstalk 00:46:57]. It's good to [crosstalk 00:46:57].

 

Tahnee: (46:57)

But it's an interest. I do think like with that herbal piece, because there's... I mean, you mentioned black cohosh and there's a few talked about for sleep, which is one of my favourite herbs.

 

Lara Briden: (47:07)

I love it.

 

Tahnee: (47:08)

Yeah, it's a beautiful one. But I thought that was interesting because a lot of women, I think lean toward herbal therapy in the sort of, I guess alternative space. Can you speak a little bit to [crosstalk 00:47:20]?

 

Lara Briden: (47:19)

Yeah. So herbal medicine can be very helpful. So I would say in the perimenopause space... So let's say if we're in the earlier phases of perimenopause, when oestrogen, as we've said is high, going high and then spiking low. There's different strategies to try to help with that. We're trying to stabilise the immune system, so stabilise histamine, that herbal medicine can be very helpful for that. We're trying support the gut so that the high oestrogen can clear safely through the gut, herbal medicine and supplements can help with that. And then there's the whole during the recalibration of the nervous system is where adaptogens can be quite helpful. So I don't name a lot of them, I don't go into a lot of the detail in the book, but things like Ashwagandha. A lot of those have anxiolytic kind of like, I mean calming, tranquillising-

 

Tahnee: (48:16)

Effects. Yeah.

 

Lara Briden: (48:17)

... stabilising the nervous system. So there's a role for, I use herbal medicines quite a lot. I mean, I guess I do talk about how I've never seen that black cohosh as a standalone single intervention.

 

Tahnee: (48:33)

Yeah. Well you mentioned you don't really use it, [crosstalk 00:48:35].

 

Lara Briden: (48:36)

I've just never seen that it's... But I think as part of the whole programme, including diet, which we can talk about, and no alcohol, which we'll have to talk about, then I think adaptogen type herbal medicines can be part of that for sure and helpful. And phytoestrogen herbal medicines can be helpful in terms of stabilising the oestrogen roller coaster, sheltering from the spikes and at the same time helping with SHBG levels. And so it's lots of mechanisms by which phytoestrogens are helpful.

 

Tahnee: (49:10)

It sounds like it's sort of a tapestry in a weave of maybe using the herbs, but also lifestyle changes. And maybe if we can talk a bit about diet and the alcohol is interesting because of the histamine. So let's jump into that.

 

Lara Briden: (49:23)

Let's do my two big things. For my patients, this is basically what I say. If you could do these two things, there's a 50% chance that's all you're going to need to do. And then's 50% chance you might need some adaptogens or you might need some hormone therapy eventually or different options. But the two things are take magnesium because it's-

 

Tahnee: (49:45)

I was about to say.

 

Lara Briden: (49:46)

... so stabilising and so-

 

Tahnee: (49:48)

Nervous system, everything.

 

Lara Briden: (49:49)

The nervous system loves it. And in the book, you'll see I talked about using of the magnesium taurine formulas, which is very easy to get in Australia. Taurine is an amino acid but it's also a neurotransmitter that's very calming. It's one of my favourite things for perimenopause, obviously, because I talk about it so much in the book. So, magnesium.

 

Lara Briden: (50:12)

And then the second thing I would have to say quit alcohol. I mean, not forever potentially, but during the thick of it. If you're in that more intense part of perimenopause, phase two heading into phase three, approaching your final period, just removing alcohol entirely can be a game changer. There's several mechanisms by which that helps. I think definitely you talked about alcohol itself destabilises muscles and causes a histamine release. Also alcohol is just, well to put it bluntly, it's toxic to the nervous system, so there's that. I mean, it's just not friendly. It causes intestinal permeability, actually quite profound intestinal permeability when drinking, short term after alcohol intake and depending on the number of drinks.

 

Lara Briden: (51:14)

And then also there's some research around habitual or even just moderate alcohol intake, sort of weakens the circadian rhythm response. So this is where alcohol can disrupt sleep. Not just the night you've had it, but more broadly. So I would invite people if you haven't before, try quitting it for a month and see what happens to your sleep, because it can be really quite interesting.

 

Lara Briden: (51:43)

And the other thing about alcohol, I always try to mention this because for some reason, this is not common knowledge, but alcohol is conclusively linked to a higher risk of breast cancer. Now, the risk is not enormous. I don't want to scare people, but it's very robust in terms of the research is very clear. It's not, oh, we need more research, it's it definitely increases the risk of breast cancer. And as much as oestrogen therapy does in fact, moderate alcohol intake, five or six drinks in a week increases the risk of breast cancer as much as oestrogen therapy does. So it's quite a strong effect.

 

Tahnee: (52:32)

And a fairly, I mean easy one to... I guess it's that sort of thing around a lot of women probably reach for a glass of wine as a nervous system thing. And it's really about reframing how you manage that.

 

Lara Briden: (52:46)

They do, and I see on social media, a lot of messaging around wine for menopause or kind of...