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On Peri and Pause the podcast, host interviews women’s health nurse practitioner Amanda Maingi, who shares why she chose women’s health, her education at Georgetown, and how menopause and perimenopause received limited focus in training despite women spending a third of life in this stage. Amanda describes noticing gaps while working in a fast-paced traditional GYN clinic, where time constraints and protocol-driven care could miss the “whole woman” experience. She contrasts younger patients’ typically more straightforward visits with the complexity of midlife, highlighting under-research, life stressors, and chronic conditions. Common perimenopause symptoms often mislabeled as anxiety or depression include sleep disruption, heart palpitations, brain fog, irritability, overwhelm, and feeling out of control. The episode emphasizes validation, individualized high-touch care beyond algorithms, and addresses misconceptions that hormone therapy is inherently dangerous, stressing risk-benefit tailoring and comprehensive evaluation.
00:00 Welcome and Guest Intro
00:53 Why Womens Health
02:17 Academic Journey Highlights
04:09 Menopause Education Gap
05:24 Clinic Reality and Missing Care
08:57 Midlife vs Younger Patients
13:14 Symptoms Mistaken for Anxiety
17:43 Beyond Protocols Individual Care
19:34 Patch And Pill Problem
21:21 Telehealth Versus High Touch
22:56 Layered Whole Woman Care
26:03 Validation First Visit
28:42 Hormone Therapy Myths
30:07 New Patient Expectations
31:53 Outro And Sign Off
32:23 Recording The Closing Script
34:16 Final Takeaway Message
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This podcast exists to normalize, explain, and elevate the midlife healthcare conversation—so women feel informed, believed, and empowered to demand better care for their bodies and lives.
Visit https://periandpause.com for more info
Creators and Guests
Host
Jamie Gallagher DNP, FNP-C, MSCP
Jamie is a doctoral-prepared, board certified family nurse practitioner and a Menopause Society Certified Practitioner. She is the owner and founder of Peri & Pause. She has served as a nurse practitioner in the Triangle area of North Carolina since 2009 in family medicine, urgent care and women's health. She is an active member of The Menopause Society, the HERmedicine Provider Alliance, the National Association of Nurse Practitioners in Women's Health, and the International Society for the Study of Women's Sexual Health. She is also a proud military spouse, mother of four and grandmother of three.
What is Peri & Pause The Podcast?
The Peri & Pause Podcast is for women in midlife who know something in their body has changed—but haven’t been given real answers, or have been left overwhelmed by conflicting information.
Hosted by Jamie Gallagher, DNP, FNP-C, MSCP, a nurse practitioner specializing in perimenopause and menopause care, the show explores hormones, metabolism, mental health, sleep, sex, weight changes, and chronic conditions through an evidence-based, deeply practical lens. We unpack the physiology of midlife alongside the lived experience of women navigating careers, relationships, finances, and identity during this transition.
Every woman deserves this conversation—and the clarity, language, and confidence to advocate for better care.
Because “Your Labs Are Normal” Is Not the Whole Story.
06 - Peri & Pause - Amanda
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[00:00:00] Welcome back to Perry and pauses the podcast. Today I am joined by Amanda Mange Women's Health. Nurse practitioner extraordinaire. And I say that because I know, um, she's one of our nurse practitioners here at Per and Paws, and she comes with a strong foundation, um, in midlife women's care. Gynecology has a extensive history in that, and she takes a.
Speaker: Deeply thoughtful, patient-centered approach with all of our patients and we're super grateful for that. She's passionate about helping women feel heard, validated, and improving their quality of life. So thank you so much for being here, Amanda. Thanks so much for having me. Yeah, I'm so excited. So let's jump right in.
What made you wanna do a women's health? 'cause you are specifically a women's health nurse practitioner. Yeah,
Speaker 2: so, [00:01:00] um, I knew from a very young age that. I wanted to work with women one-on-one. You know, I, I grew up in, um, a single parent household raised by a single mother. I'm one of three girls,
Speaker: yes.
Speaker 2: All, all female household, right?
So I am no stranger to what takes a strong, resilient woman. And just, you know, growing up in that environment, but also just being exposed throughout my life. And then when I eventually did branch into nursing and, um, bedside manner and things like that, how. You know how resilient women are and how truly, you know, they go through so many various life changes.
Yes. You know, whether chapters
Speaker: Yes,
Speaker 2: exactly. Chapters and you know how gracefully they bounce back from one change to another and you know, they're just, women are amazing.
Speaker: ? Absolutely. So I am going to tell a little secret about you, [00:02:00] um, that you graduated at the top of your class at Georgetown University. So that to me tells me your drive, your passion, your self-discipline. In education, in knowing, so you can take the gift that you have and share that. So tell me about your college experience, your or your, um, graduate school experience, your education, and what did you think was missing, if anything, in the specific women's um, health NP program there?
Speaker 2: Yeah, great question. Um, so, you know, in terms of my experience at Georgetown. Excellent women's health nurse practitioner program. I felt, yeah, I felt very, very prepared. You know, going out into the field away from the books and working with patients one-on-one. Um, it really did, um, come from a very holistic approach, you know, from the get go.
They really were all about, you [00:03:00] know, whole person, whole woman care and, um, how to approach that with a patient coming in. Um. Despite being a women's health specialized degree, um. Menopause. I still got very limited education in it. Oh yeah. Um, you know, we only focused on, um, you know, post menopause for about a week out of my entire degree program.
And even so that's still so, so limited. If you think about, I mean, granted, I, how I'm trained is, you know, I can treat women from, you know, adolescents all the way to. Time of death, right? Yeah. But you know, in, in that lifespan, in that life, um, throughout life transitions, you know, again, menopause was very limited in focus.
And we know that women live a third of their life in this stage or
Speaker 3: more.
Speaker 2: Yes, exactly. Absolutely. And so to only have that limited foundation going out into, you know, [00:04:00] um, our primary care and traditional GYN settings, you know, I've. I was prepared, but I, I wasn't, you know? Yes, yes. Um, so, but again, Georgetown is a great program.
Speaker: Yeah. So a lot of self-learning since being out in practice that you've done to better care for the midlife and menopause, peri-menopausal and menopausal woman. Mm-hmm. Yep. Yeah. At what point in your career did you realize something was missing in that area? The perimenopause and menopause. Um. Time of our life.
Speaker 2: It was in my, um, initial job outta school, a traditional GN clinic setting, you know, um, in, in that setting. You know, it's, it was amazing at, you know, um. My preparing me like in my efficiency and um, clinical decision making skills. Yes. But it's a very fast-paced environment.
Speaker: Yeah,
Speaker 2: right. And um, you know, you see a very high [00:05:00] volume of people, which again, exposes you to a lot, but it's very limited in terms of the time.
Which I know most, most people, most providers will say is that their time is limited. Absolutely. And you know, you don't, unfortunately, that does limit you to being able to fully understand the patient experience and where they're coming to you from, you know, the whole person again. Um. So that gap was, um, the more, the longer I worked in this traditional GYN clinic, the more I was exposed to women coming in, in their late thirties, early forties, fifties, even sixties, saying, I'm having these symptoms.
Something is not right. Um, you know, I've, I've checked my thyroid. Yeah, I've, I've, I've checked, you know, like my, my glucose levels, I rule out autoimmune conditions. Like, I don't, I don't feel good though. And, um. When it's the things that keep you up at night, right? Yes. Where it's like, you know, you had that, that 15 minute time slot, you're running over that 15 minute time slot and you lay in bed awake at night thinking, oh [00:06:00] gosh, I could have done this, this, and this for her.
Yes. Um, and so I will say, again, kind of going back to education, you know, Georgetown did prepare me in the sense that I. Knowing how to research, right? Yes,
Speaker: absolutely.
Speaker 2: And, um, being able to find good data and kind of, um, extrapolate from that, like, okay, how can I apply this to clinical practice? That sort of thing.
And so that's, I think, where the gap lies though.
Speaker: Absolutely. And I'm super grateful for that. For my DNP program at. UNC Wilmington, that's the core of that. Mm-hmm. How to evaluate research, how to apply it.
Default_2026-04-17_2: Mm-hmm.
Speaker: And you can, it's, it's a practice doctorate, so you can practice, you have the research, you understand how to understand it and apply it safely and whether you want to apply it.
Speaker 2: Yes.
Speaker: And then you give that feedback back to the, the PhD. Um. Researchers, and this works, this doesn't work. That contributes to extra data, but I, I fully agree with [00:07:00] that, that we understand how to interpret research, how to apply it safely based upon the woman. So yeah, exactly. Spot on on that. Thanks for that.
So what's the difference between caring for a woman in her forties and fifties and caring for a younger woman in her twenties and thirties? You would say? What's the difference? Yeah, like, think about like. You have her in your head and you have the younger women, like again, there's a huge chapter jump between there.
Mm-hmm. Maybe two chapters in there. Mm-hmm. You know, having children, wanting to have children, not wanting to have children. Right. To having children or career oriented. What's going on with my body? Oh, I need to understand my body here. Like what are, what did talk about that difference?
Speaker 2: Yeah. So when. I feel like when a woman comes to you in her twenties and thirties, you see that, that age pop up on your schedule.
Yeah. You know, it's, it's typically. Not always, but typically [00:08:00] much more straightforward. Mm-hmm. Visit. Right, right. And it's simply, you know, at 20 and 30 years old, you just don't have as much life experience typically as the, your 40 or 50-year-old Right. Woman coming in and the
Speaker: hormones are nice and wavy.
Speaker 2: Exactly. You know, majority
Speaker: of them.
Speaker 2: Right. Exactly. Again, the majority right. You have, again, a very cyclic rise cyclic fall in your day-to-day. Granted, you have some fluctuations. You're pretty much the same person like throughout the month, right. Versus, when it comes to caring for a woman in her forties and fifties, you know. We simply don't have as much data during that time of a woman's life, you know, to correlate her current symptoms to, right. Like we have a, a ton of, of data on, you know what it's like when a female hits puberty, what it's like throughout pregnancy, right?
Yes. You know, but then she comes to perimenopause and menopause and post menopause and, you know. It's often a very, you know, under-recognized, [00:09:00] under-researched area. Yeah. Of, um, so in terms of, you know. All of putting all those pieces of the puzzle again and then doing the research to kind of, again, how can I help best help this person knowing there's a lot more at play.
Speaker: Yes.
Speaker 2: At that stage of life.
Speaker: Yes.
Speaker 2: That isn't just, oh, you're just stressed out.
Speaker: Right. We are, but we are chemically as well as where we are in life. Um, I think as well, but yes, the. Research component is huge. I'm glad you brought that up, because there's so much study in the fertility and childbirth and mm-hmm.
It's wonderful. Yes. I love that. But then the difference is not every woman's perimenopause or menopause experience is the same. Generally it's generally the same, but not the same.
Speaker 2: Yes. '
Speaker: cause of where she is in life, where she is in the chapter of her life. Mm. Her relationships, her career.
Speaker 2: Mm-hmm.
Speaker: Um, her, her health.
'cause our, our health shifts, chronic diseases start creeping in. Yes. Her autoimmune diseases start creeping in Exactly. Adverse childhood [00:10:00] events start popping back in our head.
Speaker 5: Mm-hmm.
Speaker: Like, it just makes us potentially more complex.
Speaker 5: Mm-hmm.
Speaker: What would you say are, since we're talking about stress, what would you say are common symptoms that a perimenopausal woman experiences that can be hormone related, directly hormone related, that are often labeled as generalized anxiety disorder or major depressive disorder when it's anxiety symptoms?
Depressive symptoms like what? What symptoms do you see commonly when women come to you with those, you know, more, more psychological symptoms that we label as stress?
Speaker 2: I would say sleep disruption is a big one. Yeah. Just waking up in the middle of the night, two to 3:00 AM I have no idea why I'm awake right now.
But then once you're awake, brain starts
Speaker: Oh yeah. Planning for the
Speaker 2: day. Yeah. Worrying about yesterday. Right. Exactly. Going through that to-do list. Um. Heart palpitations is another big, um, symptom mm-hmm. That [00:11:00] women can have. That, um, can also be, oh, you're, you're just stressed. It's coming on with anxiety.
Yeah. Things like that. Um, other mood changes, just again, being irritability and just a overall sense of overwhelm. Right? Yes. Things that you once were able to cope with, you feel like you can't, this has always been in. A stressor in your life, but now it's like I'm handling it differently, right? Like, or I'm not, I'm over able to handle it.
Yes. I'm
Speaker: angry about this. Why did I get so angry? Why did I pop off on my kid? I have women that will say, like, I ripped through my daughter the other day and I had to apologize to her.
Speaker 2: Yes.
Speaker: I had a woman come in last week and she said, you know the memes that are like, where you get mad at your husband chewing?
Mm-hmm. She said, I took his plate and went, pew, stop chewing like that. Yes. And she said, then she's like. What am I doing? You know? Right. So. Right. Yeah. And then feeling outta control sometimes
Speaker 2: feeling out of control. Yes. I had a, a multiple women, actually, their husband's breathing, they're sitting next to 'em on the couch.
They're like, he's breathed the same for 15 years. Why is it [00:12:00] bothering me now? Exactly. Exactly. I was like, why? Why is it bothering me now that he's so loud? Stop breathing, breath. She's like, I can't just tell him to stop breathing, but you know.
Speaker: Yeah. Yeah. Bliss.
Speaker 2: Yes. I know. You just wanna give him a hug?
Speaker: The husbands do.
Speaker 2: The husbands do. I know everyone involved, the whole family. Right, right, right.
Speaker: Yeah.
Speaker 2: You know, all of these, the, these mood changes, these sleep disruptions, the brain fog that can come on that are often attributed to stress, they may be stress related, but I don't, I think as providers we can't overlook that there is likely a hormonal component there to the, again, the change in.
Ability to cope with these life stressors. And, you know, if we don't recognize that hormonal component, then we are, you know, not providing women with, you know, a, a treatment that could really help get to the root cause of, again, why these stressors are all of a sudden way more exacerbated than Right. [00:13:00] The perception causing these symptoms.
Yes.
Speaker: Yeah. And it. Is reassuring it. And what I will also tell women is that what, let's get this on board.
Speaker 2: Mm-hmm.
Speaker: And then see how these new symptoms, new anxiety, new panic, new irritability. Get better to what extent? Fully. Awesome. Partially we have other treatment for that. Absolutely. As well. This is where antidepressants, anti anxieties can play a role.
Absolutely. And it's nothing that you're dependent on. It just says, Hey, estrogen, you know, helps our serotonin in our brain. Mm-hmm. And these help our serotonin kind of stay in the right and left limits instead of just being all over the place, which in turn can make us, you know. See stress in a much more magnified way.
Absolutely. So there is a place for that. Also, hormones, I wouldn't say fix everything by any means. Mm-hmm. So, but it, it sure does remove that component of the symptomatology of a midlife woman that's impacting her. Mm-hmm. And allows us to see more clearly what is [00:14:00] under that.
Speaker 2: Absolutely.
[00:15:00]
Speaker: How would you say that you approach the care you give here with a more protocol driven practice that we've all worked in as nurses, nurse practitioners? Like what's, what's the difference? How are you providing care?
Speaker 4: Mm-hmm.
Speaker: Just through your own, without. An algorithm. I don't believe in the algorithms, right.
That a [00:16:00] lot of, um, places do. I don't wanna say I don't believe in them. They fit the majority. But how do you, I guess I'm trying to ask, how do you take the nuance in with each woman,
Speaker 2: you know? Protocols are, are important. Yes. They, you know, they provide consistency. Yes, safety, you know, and evidence-based care.
But I think where as providers, you know, we can get hung up. You, you can't stop at the protocol, right? Yes. Okay. You have to look at the patient, the woman that's sitting in front of you, and realize that that protocol's only gonna take you so far. How can you individualize? A treatment plan and come up with something that's going to serve her, what her current symptoms are, you know, where she's at in her life and kind of meeting her at, at her current experience versus, you know, again, just, just stopping at the protocol.
Right. And it's not black and white at all.
Speaker: Yes. Um, check box, if yes, go to this arrow. If no, go to this arrow. No, no. I mean, [00:17:00] but you have that in your mind. Oh, 100. Yeah. Yeah. We appreciate all the nuance you give your, your patients, Amanda. Back to talking about algorithms. There are services that we are super grateful for as midlife women out there online, you know, on virtual care platforms that, you know, follow protocols to get this care to women, and I am so grateful for that. But talk about your experience with the difference between that type of care and protocols versus individualized care that you give to your women.
Speaker 2: So we love a good telehealth, you know, midlife women's service. It's an excellent. You know, resource Exactly. For women, you know, especially in, we're very lucky where we're at in the, um, the triangle area where we have so many options of brick and mortar locations, of places you can go and sit with a provider and [00:18:00] have these conversations.
Right. And, you know, in some women in areas of the country, they don't have that option, right? So going through like a telehealth clinic is, is for
Speaker: any type of care,
Speaker 2: for any type of care is. You know, the what is offered to them and available to them. Right. Okay. Which is fantastic. But you know, , in terms of midlife women's care at Per and Pause, we're very high touch. It's a very, we apply a much more personalized approach to how we develop a care plan for you. Um. Protocols. Again, very important kind of get you started, but where the individuality of a visit truly unfolds and becomes layered is after we get past that and your initial like chief concerns.
Mm-hmm. How can we, what further questions can we ask in terms of, um, you know, okay, you're not sleeping. [00:19:00] Why is it 'cause you're waking up at 3:00 AM and you don't know why? Or are you waking up 'cause you're having a hot flash, you're waking up 'cause you have to urinate. What? There's your husband's snoring, what is it?
Right, exactly. Um, and then at that point you can kind of, again, layer in. Alright. Maybe hormone, um, management and evaluation is a good fit for you. Is it more of lifestyle interventions? Is it sleep medicine and sleep hygiene practices that we need to talk about? Is it a sleep
Default_2026-04-17_2: study
Speaker: she
Speaker 2: needs? Exactly.
Exactly. Um, so I, I think whole
Speaker: woman care,
Speaker 2: whole woman care, right? And, um, you know, just not slapping, especially with hormone therapy, not slapping a patch and a pill on it and going about your day, right? Mm-hmm. There's, again, there's a lot more to. Symptoms often than just again, patch and pill. Right.
There's other things on the market too that we can talk about if that's not a good fit for you in terms of hormone therapy options. So just again, personalizing what treatment option is gonna best [00:20:00] fit this woman sitting in front of me?
Speaker: Yes.
Speaker 2: Perfect.
Speaker: So when a patient comes to see you, what do you think she, what is. What you find women need most when they come to see you the first time
Speaker 2: to be validated.
Speaker: Oh, yes. I was hoping you'd say that. It's so
Speaker 2: true. I know.
Speaker: I knew you were gonna say
Speaker 2: that. You did. Yes. That's that Telepo tele telepathy. Gosh, can you edit that out?
Speaker: Take it back. That we can't speak and, and correct that? Yes. No, no,
Speaker 2: no. Um, so. To be validated because I feel often more times than not, women come to us. They're already drinking from the fire hose. Yes. Right. They've already seen one, if not multiple providers, and felt either dismissed or not necessarily dismissed, but just, Hey, this is a part of life.
Every woman goes through it, and that is true. Every woman does go through this, ends there. Mm-hmm. Exactly. But you can s [00:21:00] we can provide support. To help you optimize and feel like the best version of yourself through this season, right? Yes. You do not have to feel stuck in this, um, shell of yourself for two years, over a decade, and some women, right?
So I, I think that's. That's the biggest thing is listening to women, hearing their stories, validating their concerns, and then again, coming up with an individualized, comprehensive care plan to help meet her where she's at in this transition.
Speaker: Right, exactly. I have women that come in that will share that they've even told what they're feeling is not real.
Mm-hmm. And that. Is 100% not real. What if a woman verbalizes how she's feeling the best way she can. It's true. Mm-hmm. I don't know what else to say about that. Like Right. How you're feeling is not wrong. It's true. And how you're expressing it is true. So let's validate what you're feeling because you're not wrong.
Speaker 2: Right. And just because you can't measure it in a lab test Yes. And detect that you know, this lab values out [00:22:00] of reference range doesn't mean that there's not something going on.
Speaker: Agree. And, and. Like we also say we have menopause hammers. Yes. But there are other things that cause these symptoms besides menopause.
And we address those as well. Absolutely. While we have you with us, we look at the whole woman. Mm-hmm. And I, we tie up the loose ends. That's my favorite little phrase. All these little things. We also look at. To anticipate things in the future that's true prevention. Mm-hmm. And also catch things that may be, um, missed, like low ferritin.
Mm-hmm. Or low vitamin D because those aren't often checked, but we see them every day.
Speaker 2: Right, right.
Speaker: Low ferritin, low vitamin D, but also high ferritin, which would be an inflammatory process. And that's a whole other podcast.
Speaker 2: Yes.
Speaker: So let's go back to what do you think the biggest misconception. I have my thoughts on this, on hormone therapy is right now.
Speaker 2: Whew. Um, lots of misconceptions out there. Biggest one, I would, I still think a [00:23:00] lot of providers are under the impression that it is inherently dangerous for most women to take, and that it is poses a huge risk to, again, cancer and cardiovascular risk. Um. This is, this is not the case, right? You know, exactly this.
Um, just because you have a family history of breast cancer or you yourself have, you know, some clotting, factor deficiencies or things like that. Come talk to us. Right? This does not mean you, it
Speaker: rarely means that
Speaker 2: at all. Exactly. It's, again, it's not black and white. There are multiple, um, treatment modalities that we can provide that, you know, each kind of.
And progesterone comes with its own, you know, risk benefit, side effect profile and mm-hmm. Again, we tailor that to your personal history, your risk factors, what other medications are you on, what else do you have going on in your life that can [00:24:00] make this, we're keeping it as safe for you as possible, but also providing you with that symptom relief.
Speaker: Yeah, absolutely. I hate to wrap this up. This is going so well. Last question though. What can someone expect when they are a new patient getting ready to see you at per and pause? Validation right out of the gate, right? You know that
Speaker 2: right out of the gate, um, that, you know, I feel like that you'll, you'll be heard, right?
Mm-hmm. Like, come, come and share your story. We, you have the time to sit with us, and again, we look at you as the whole person. Bring, bring your previous labs, bring your medication lists, imaging studies, things like that, that you've been working through. We. We do annual exam visits. That's what I did love about my traditional GRN clinic is, you know, again, I all that preventive medicine, it's so important, you know, because what's happening to you in this season, again, you have another third of your life, if not more to live.
So let's set you up for success now to, for, [00:25:00] to live your healthiest fullest life after 40, 50, 60 years old. Right? It doesn't stop there. So, um, I just would expect to. You know, be heard and, um, just be
Speaker: yourself.
Speaker 2: And be yourself.
Speaker: Absolutely. I see women. With you do that. They feel safe, they feel heard, they feel truly, deeply cared for.
And I love seeing you behind the scenes. And if any of you have seen Amanda, she is caring for you even when she's not sitting in front of you and does deep work behind the scenes to stay ahead of all the research and know exactly how to plan and develop your your care plan. Deeply and very nuanced to you.
So I appreciate you so much. So glad you're a part of our team.
Speaker 2: Oh, I'm so happy to be here. You're wonderful. You're wonderful.
Speaker: . . If something you heard today resonated with you or helped you feel seen, your symptoms may be common, but suffering through them is optional. Every woman deserves this kind of care and deserves this conversation. [00:26:00] Thanks so much for listening.