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Welcome to The Modern Midlife Collective—where midlife isn’t a crisis, it’s a rebirth. Hosted by Dr. Ade Akindipe, DNP, and Dr. Jillian Woodruff, MD, this is the podcast for women ready to unapologetically own their power, thrive through the ups and downs of hormones, weight, and self-care, and show the world that thriving at 40 and beyond isn’t just possible—it’s your birthright.
Biweekly, we bring you science-backed insights on hormones, menopause, longevity, and sexual health—real tools to empower women in midlife and beyond. With a fearless blend of functional medicine, real-life wisdom, and no-nonsense empowerment, we’re here to challenge the norms, break through the barriers, and help you step into a life of vitality, confidence, and unstoppable strength.
Ready to rise? Let’s do this.
Dr. Ade Akindipe, DNP (00:00)
Have you ever found yourself standing in the kitchen, staring into the refrigerator, completely forgetting why you walked in there? Then five minutes later you are crying over the commercial, and by bedtime you are awake at 3 a.m. Okay, I can identify with some of this. Or maybe you're replaying every awkward time that you've ever had since you were younger, maybe in the 90s. Gujama 90s girl.
Jillian Woodruff, MD (00:23)
Yeah.
yes, I definitely can relate to that. I haven't gotten to the crying over the commercials. Actually, because I think I've always done that all of my life. So I haven't really, that's not a change. But the wondering why I walked into the room or what I opened the refrigerator for. Absolutely, absolutely. how about snapping at your partner, at your kids, your I haven't done the coworkers, but people do it. I hear it all the time. They're snapping at them and then they're like,
my god, why did I react that way? Who is this person? This isn't me. That's a real thing. The other thing, right? The other thing, gaining weight. Weight gain, you're doing all the things. We talk about this all the time. You're doing the things you've always done. You may be eating well, exercising, and you're still the weight is like creeping on around your midsection. another thing is anxiety. It feels unfamiliar. Your brain feels different. And when you bring it up to someone,
Dr. Ade Akindipe, DNP (00:57)
That is a real thing.
Jillian Woodruff, MD (01:18)
You get the response your labs are normal or you're just stressed and you know welcome to aging.
Dr. Ade Akindipe, DNP (01:24)
Yeah, or maybe you start to ask yourself the question that we hear all the time in practice. Am I losing my mind? Is something wrong with me?
Jillian Woodruff, MD (01:32)
Yes, before we go any further, we want you to hear this. You are not crazy. You are not losing your mind. Your symptoms are real. And there just may be a reason that nobody has connected the dots.
Dr. Ade Akindipe, DNP (01:45)
And today we are going to talk about perimenopause, that hormonal transition that affects millions, millions of women, often years before menopause, you know, starts. And far too often it's completely unrecognized. So there's a lot of chatter out there, and we're going to talk about the real evidence. So let's get into it.
Jillian Woodruff, MD (02:07)
Yeah. The problem isn't that women aren't speaking up. It's that no one has been taught to
Welcome back everyone. This episode has been on our list from the very beginning because there may not be another phrase we hear more often in our offices than this. I don't feel like myself anymore.
Dr. Ade Akindipe, DNP (03:19)
Yeah, and sometimes women whisper this almost like they're it's almost like they're afraid to say it out loud, that something is wrong with them. So what they want to do is just push through, just thinking like it's aging, right? So we hear it, we hear that and we feel it because so many women have spent years believing they w that you know they were failing when in reality their hormones were just changing.
Jillian Woodruff, MD (03:43)
Today let's connect the dots. We are talking about perimenopause, the transition before menopause that can affect your brain, your sleep, your mood, your metabolism, your relationships, even your sense of identity.
Dr. Ade Akindipe, DNP (03:57)
Hmm. Yes. And our goal today isn't just to give you information, it's to help you feel seen. And we hope you do feel seen after this. Because if you've wondered whether you've been exper what you've been experiencing is real, the answer is yes.
All right, so let's start with the definitions because menopa menopause terminology can be very confusing for folks. ⁓ menopause is often diagnosed after 12 consecutive months without a cycle, without a menstrual cycle, period. perimenopause is that transition leading up to that point. And what surprises women is that it can last anywhere from four to ten years.
And symptoms often begin in their forties, but sometimes maybe a little bit younger, ⁓ in their late thirties.
Jillian Woodruff, MD (04:43)
Yeah, and here's the part that confuses people even more. You can absolutely be in perimenopause while still having periods. Sometimes the periods are regular, sometimes they aren't, sometimes they're heavy, sometimes they're light, sometimes there is no change at all. they can be closer together, they can be farther apart. It is not a straight line. All of those things can occur in perimenopause.
Dr. Ade Akindipe, DNP (05:07)
Exactly. And people imagine hormones slowly declining, but perimenopause is actually much more messier than that. Estrogen doesn't just simply decrease, it fluctuates a lot. ⁓ progesterone often declines first, and then because ovulation becomes less consistent, these hormonal shifts create very real symptoms for women.
Jillian Woodruff, MD (05:30)
Often tell women that perimenopause feels like being on a roller coaster. And you know, Dr. Aday, that I do not like roller coasters. So this is the roller coaster that you do not buy a ticket for. And someone just made you get on it. And so now together, the woman and I were trying to catch up to the ride and trying to slow it down enough that you can function and feel like yourself again.
Dr. Ade Akindipe, DNP (05:39)
You don't.
Yeah. Yeah, that roller coaster is a really good description for that because that's what's going on. And the challenge is that women don't even realize they're on this roller coaster. They just think they've suddenly become anxious all of a sudden. They've become this person they don't recognize or forgetful and feel like they're not capable of what they used to be able to do.
Jillian Woodruff, MD (06:13)
Yeah, when often there's a biologic explanation for everything they're experiencing. And I just want to go back to you talking about these definitions, menopause and perimenopause, and then there's postmenopause. And I think these just really confuse people, and they think that they have this definition or this this label of mm postmenopause, and that means it's done. It doesn't. You know, post postmenopause just means
You've gone through those twelve months without without having a period. Everything after that is postmenopause, but you still could have symptoms and there are still things that you can do during postmenopause that will affect your quality of life, your longevity, your health span. So there's no you you never graduate, right? You don't you don't graduate from menopause or from postmenopause and
Dr. Ade Akindipe, DNP (06:49)
Yes.
Jillian Woodruff, MD (07:05)
have nothing to do. This is, you know, ongoing. We're always transitioning through life, right? We're born. We have puberty. We have, you know, reproduction. We have perimenopause, right? There's always something. Right? so let's talk about some research. The science is important here. There's a pretty significant study. I think we I talked about in the last episode, the Swan study. It's the study of women's health across the nation.
Dr. Ade Akindipe, DNP (07:18)
Absolutely.
Jillian Woodruff, MD (07:31)
It was also a landmark study. They followed women for more than two decades to better understand this menopausal transition. And researchers found that symptoms like sleep disruption, mood changes, cognitive ⁓ complaints, hot flashes ⁓ commonly emerged during perimenopause. So this time period before they actually
have menopause, which is that just that one day, twelve months after their period. So often well before the final menstrual period they're having these significant symptoms.
Dr. Ade Akindipe, DNP (08:05)
Yeah, that is such an important study because it really truly validates all of the things that happens, accumulates all the way to menopause and beyond. so these symptoms aren't imagined, you know, they're not weaknesses that we are going through. And we've said it in multiple episodes before this that, you know, you have hormone receptors pretty much all over your body. So ⁓ with this tr roller coaster of hormones happening, it's
you know, you can see how that can really impact the biological transition of women, whether it's, you know, in weight loss, whether it's ⁓ how you metabolize blood sugar, how you deal with stress, all of those things are impacted.
Jillian Woodruff, MD (08:46)
Right. And separately, there's researchers from Harvard Medical School and Brigman Women's Hospital. They demonstrated that estrogen interacts with brain regions involved in memory, mood, mood regulation, sleep regulation. This explains why so many women notice changes in cognition. So the brain fog, the memory loss, and they also notice the changes in their emotional resilience. So their
either more irritable or angry or more emotional and sad during this time.
Dr. Ade Akindipe, DNP (09:17)
My goodness. Medicine is finally catching up to what we have been talking about and feeling in our body for decades. you know, so just talking about that, you know, we had a patient, you know, 44-year-old woman who is successful. You know, she's married, has two children, exercises very regularly, you know, eats well. And this is the kind of woman that will sit across from us and
You know, they you they've been depending on her for years and you know, she starts to notice these changes. You know, she's developed anxiety driving to work. And sometimes what I find is women can't really articulate what's happening. they're not even calling it anxiety. They just again, what like you said, snapping at their children, snapping at their spouse because they just don't have the resilience that they used to. Or they're waking up in the middle of the night because they can't shut off their brain. ⁓ gaining weight in the midsection.
despite doing everything right, right? And they're forgetting words in meetings. Imagine being an executive and you can't r you know, communicate what you're trying to say. So one day they just come in and they look at you and they say, I just don't recognize myself anymore. And that's just how it feels. Like I don't know what's going on. Please help me figure out what's happening.
Jillian Woodruff, MD (10:28)
Right. I'd be willing to bet that she's already seen multiple doctors. She probably saw a cardiologist, right? Because she's had palpitations. She's probably seen her primary care doc because she had fatigue. maybe even she saw her therapist or psychologist or ⁓ psychiatrist maybe wondered whether something serious was really wrong with her because her memory felt so different. And she probably had labs done.
Dr. Ade Akindipe, DNP (10:32)
Mm-hmm.
Jillian Woodruff, MD (10:53)
And probably not hormone labs, but she probably had labs done and she was probably told everything was normal. And she may not have even gotten questions about her menstrual cycle or any changes. Probably no one looked at the whole woman. Does that sound right?
Dr. Ade Akindipe, DNP (11:07)
Yeah.
That's about right. That's about right. And when yes. man. And when you step back and you look at the full picture, it's pretty clear that this woman, we know, was falling apart, but you know, visiting all these doctors, like you said, but it's perimenopause.
Jillian Woodruff, MD (11:09)
That you're patient.
And the relief she probably feels when or she probably felt when she heard from you. There's a reason for this that was probably powerful.
Dr. Ade Akindipe, DNP (11:28)
Yeah.
Absolutely. It's like finally somebody can listen and hear what I've been experiencing. And ⁓ sometimes the diagnosis of self is the beginning of the healing. You know, they just feel better that finally there is something. There is a name to it. It means something.
Jillian Woodruff, MD (11:44)
Right. Well, if this patient sounds familiar, may sound a bit like you, you're not alone. We hear versions of this every week in our office. This patient that Dr. Day has, I've had, and they've been my friends and my family. So that's why we're here. Let's talk about the symptoms of perimenopause, because this is where women often feel dismissed, like your patient.
is this gonna be too is this gonna be depressing? I think we still have to talk about it right. Well, you know, everyone knows about the hot flashes and night sweats. I think some people may be confused about hot flashes because it may not be what they imagine it to be, you know, or they may not have sweating with it. They may just have a sense of feeling warm. That's still a hot flash.
You know, it just may not be a severe one. Having this sense of warmth, especially if you haven't had that before, that's a change. but perimenopause is much bigger than hot flashes, than night sweats, and you can have hot flashes at night. So without sweats, and you can have sweats during the day. So that's a big thing to know. ⁓ but women also experience anxiety, depression, you know, low mood.
brain fog, short-term memory loss. That's walking into a room, forgetting what you're doing there. Insomnia either can't fall asleep because their mind is running, or they can't stay asleep. They're waking up multiple times throughout the night, or they're, you know, not getting into their deep sleep. And that could be because of night sweats or hot flashes at night. And it may not be. joint pain, that's a that's a big one. Just random things hurting.
migraines, headaches, palpitations, vertigo, heavy periods, like I said before, shorter cycles, longer cycles, vaginal dryness, pain with intimacy. ⁓ what am I missing?
Dr. Ade Akindipe, DNP (13:38)
⁓ low libido. yeah.
Jillian Woodruff, MD (13:40)
yeah. Yes.
That's a big one. ⁓ difficulty with arousal. And the weight gain you mentioned, weight gain around the midsection. And you know the some weird ones. Have you had more some weird ones? I'd say ⁓ yes. Itching everywhere.
Dr. Ade Akindipe, DNP (13:45)
Yes.
I've seen itching in the ears. Itching inside the ears. It's
like I just have like yeah, itching of d really dry skin. Also, hair thinning. Yes.
Jillian Woodruff, MD (14:01)
Right skin.
Yeah, why did I miss that? Yes, that's a big one. Hair thinning, hair shedding. People having clumps of hair coming out. I know my hair is thinner now. I had a lot of hair and it's like you know, less hair. So, yes, that's a big one.
Dr. Ade Akindipe, DNP (14:07)
Mm.
Yeah. Yeah.
Yeah. yeah. I
think a lot of symptoms of like inflammation too, right? 'Cause our estrogen drops, we start to get more inflammatory. So joint aches, ⁓ you mentioned already joint aches, just feeling like now they and sometimes maybe that might overlap and they get a diagnosis with like things like fibromyalgia. I see that kind of very often with with women. Hmm. Yeah, so what's with the it's very confusing. You know, women often see multiple specialists by the time they come to us and
Jillian Woodruff, MD (14:38)
Absolutely.
Dr. Ade Akindipe, DNP (14:45)
Like you said, cardiologist, a neurologist, a psychiatrist, and even a rheumatologist. very rarely does someone ask, you know, could this be hormones? And that's basically what started my journey and Dr. Woodruff, and you were like, Hmm, maybe this is a hormonal thing, so thank you for that. but no, seriously, this is what women often have to deal with and then finally they get that answer.
Jillian Woodruff, MD (15:08)
Yeah. Yeah, I think even as medical providers, and we know this, we make we don't make the best patients, it's hard to recognize things in yourself, right?
Dr. Ade Akindipe, DNP (15:14)
Mm. ⁓
It's
really hard. I was like, Mm, I'm forty. Mm, I don't think so.
Jillian Woodruff, MD (15:19)
Right. I'm young.
This isn't happening. Yeah. It's hard to see that. And also there's so many different ways it presents. ⁓ you mentioned the dryness of the skin, dry eyes, dry mouth. You know, people are starting to there's these little tablets you can put in your ⁓ in between your skin and your gums of your mouth because dryness in your mouth overnight is is not good. You need that saliva as part of your
Dr. Ade Akindipe, DNP (15:28)
Mm-hmm.
Mm.
Jillian Woodruff, MD (15:46)
Tooth cleansing mechanism. We may not need to get a dentist. They explain it so much better. And so as we reach midlife and we have less of that, it actually starts to cause issues with our teeth and gums. And so you need to do things that moisten. ⁓ and so they have these little tablets you can get on Amazon that will will moisten for you. But the fact that that happens, people don't connect to perimenopause. Yes. Dry eyes.
Dr. Ade Akindipe, DNP (15:46)
Yeah.
Right.
Hm.
Yeah.
You don't connect it. Yeah. Yeah.
Jillian Woodruff, MD (16:13)
You know, that's another one. So they need to be asking our hormones part of whatever is happening because estrogen receptors are found everywhere. Brain, bones, heart, blood vessels, bladder, skin, muscles. And when estrogen fluctuates or declines, women feel it everywhere.
Dr. Ade Akindipe, DNP (16:22)
Yeah.
Absolutely.
Jillian Woodruff, MD (16:31)
And so then these women feel so fragmented by the healthcare system. So one doctor's looking at the heart because that's what they are trained to do, another one maybe looking at sleep because that's what they're trained to do. Somebody else is looking at the mood, but who's looking at the whole woman? So that's why we're doing this episode.
Dr. Ade Akindipe, DNP (16:49)
Yeah,
yeah. You know, one of the biggest misconceptions I hear is I can't be in perimenopause because I'm too young. I mean, ⁓ even though we tend to see this, you know, in the women in their forties, women in their thirties, and I don't know if ⁓ sometimes it's environmental, if it's genetic, if it's just some other, you know, things like metabolic issues and sulin resistance can cause a lot of these hormonal things. And then sometimes
they're overlapping. I'm not sure if you see this in women who have things like ⁓ PCOS or you know that's now called PMOS, where there's a lot of overlapping symptoms where they're having s hot flashes or they just feel hot. so sometimes it can be a little tricky. So going to someone like Dr. Jill can kind of help figure this out if this is a ⁓ hormonal issue, if this is a you know metabolic issue or or both. Sometimes it can be both of it.
Jillian Woodruff, MD (17:41)
I'm glad you brought that up because you see that too. And one there's an overlap, but then also, especially with PCOS now PMOS, there is an exacerbation. So some of the things that you've had in the past, or maybe you've had them and you've learned to manage them, they become more exacerbated during period menopause. So that's a that's a big thing. And I think
Dr. Ade Akindipe, DNP (17:53)
Mm-hmm.
Yes.
Jillian Woodruff, MD (18:07)
I think I was talking to somebody, yes, I was. I was talking to somebody just the other day about that because they said I had that problem before. So I don't think that's what this is. But unfortunately, they had that before, but now with the hormone fluctuation, they're having an exacerbation of it. It's same with depression, same with anxiety. So you can have new onset anxiety during periamenopause, but you can also have an exacerbation of anxiety that was previously managed.
Dr. Ade Akindipe, DNP (18:21)
Yeah.
Yeah, and and some I think some of the other misconception is, I've had my uterus taken out, so I won't have this issue. But absolutely you can still have these symptoms if you've had your uterus taken out. You still have, you know, if it's surgical menopause, you may still have some of these symptoms. Sometimes people think, that's the end. Organs are out. We can still have some symptoms, unfortunately.
Jillian Woodruff, MD (18:55)
Yes.
Well that's that's a big one. Okay. Yes, because you can take out the uterus and you can you have to take out your ovaries for your surgical menopause. And those symptoms that you have from surgical menopause, there's a wealth of research about this that the your longevity is really impacted. Your your symptom burden is hard. Yeah. It's it's more severe your symptoms that you have. So
Dr. Ade Akindipe, DNP (19:02)
Right.
Absolutely. Very drastically too, isn't it? Yeah.
Jillian Woodruff, MD (19:20)
that's you know a big decision to make. If you're taking out just the uterus, you may not it's hard to tell when, you know, what's happening menopause wise, right? Because you're not having that period anymore. Also some people, and I'd say more in the past that people were going through earlier menopause when their uterus alone was taken out. Now with some of the techniques that we use, I feel like that's that's much less often because we're able to do so, you know
Dr. Ade Akindipe, DNP (19:23)
Mm-hmm.
Yeah.
Jillian Woodruff, MD (19:47)
avoid injury to the ovaries and such. So it's happening less, but there's a different host of symptoms that can occur. So yeah. Mm-hmm.
Dr. Ade Akindipe, DNP (19:55)
That can occur. Yeah. Yeah,
we gotta go into that in another episode. That's a whole nother another thing. Yes. yeah, it's really important because many women are, you know, waiting for their periods to stop before they allow themselves to ask whether hormones might be contributing. And ⁓ I think the fact that we're having this conversation will prepare you and you know, if you're ⁓ maybe you do are considering having ⁓ your
Jillian Woodruff, MD (20:00)
Yeah. Yeah, we should. Yep. I love the uterus, you know.
Dr. Ade Akindipe, DNP (20:22)
uterus taken out for whatever reason. You know, it's important to know what the repercussions are like you just talked about. So yeah, it's not just necessarily waiting until those periods are done. So it's a big conversation to have with your provider.
Jillian Woodruff, MD (20:33)
Talk a bit about anxiety. I think this is a really important conversation that we should have because many women experience anxiety for the first time during perimenopause. And we've talked about progesterone, ⁓ that it has a calming effect in the brain. As ovulation becomes less consistent, so as we're getting closer to menopause, progesterone levels decline. Estrogen fluctuations, so estrogens going up and down, up and down, also influence our.
neurotransmitters like serotonin and dopamine that come from our brain.
Dr. Ade Akindipe, DNP (21:04)
Yeah. And then adding life on top of those hormonal changes, you know, especially women that are juggling a lot, careers, teenagers, aging parents, relationships, sleep deprivation and the invisible labor that so many women carry every day. And you can see it sometimes when they come in and you know, they're
They're heavy laden, I call it. And it's like, I'm I'm I'm I'm I've got it, but do you really have it? And ⁓ you know, when they write down their symptom questionnaire and they say their stress is low, but you can see their blood pressure creeping up, you can see that they're not sleeping at night, they're, you know, wired. So it's no wonder women feel overwhelmed and then you have the hormonal decline on top of that. So
Jillian Woodruff, MD (21:44)
They're saying, do I have it, but should they have it? Should we be asking ourselves, should I put this down? Yeah. Right. And I know you're also probably seeing their blood sugar go up as well.
Dr. Ade Akindipe, DNP (21:51)
We put this down. Yeah. Yeah.
Absolutely.
It impacts their metabolic health so badly. And yeah. Yeah, it it's impacts all of it. Mm-hmm.
Jillian Woodruff, MD (22:04)
Yeah. Well right.
This is where nuance matters because mental health symptoms are real. Hormonal symptoms also are real and they can absolutely exist together. So it's not an either or medicine. It's a whole person medicine.
Dr. Ade Akindipe, DNP (22:20)
Yeah, yeah, absolutely. Women are often told it's just stress and as those stress and hormones exist in separate universes. They do not hormones affect how resilient we feel to to stress, how we sleep, how we recover, and how our brain processes information and our emotions. So
Jillian Woodruff, MD (22:26)
Mm-hmm.
Yeah, most women, the cognitive changes they notice during perimenopause. The word finding difficulties, that's one, the brain fog, they're just not feeling as sharp. ⁓ you know, looking through one of those those see-through, what's that muslin, see-through sheets? What is that fabric? You know, that's what they're there you go. That's a word finding difficulty. No, it's not a word finding difficulty, Doctor Day. I just don't remember what it's called.
Dr. Ade Akindipe, DNP (22:56)
Word finding difficulty.
I'm messing with you.
Jillian Woodruff, MD (23:05)
Anyway, these things are temporary and they are related to the hormonal transition. They're not early dementia. That distinction really matters because fear fills in the gaps when women don't have information. So the you know, anxiety that's coming can be coming from perimenopause and those fluctuations and the progesterone decreasing, which is affecting our relaxation neurotransmitters.
Dr. Ade Akindipe, DNP (23:15)
Yes.
Yeah.
Jillian Woodruff, MD (23:31)
the estrogen going up and down. So then, you know, you're having an increase of, you know, dopamine one moment and then a decrease the next moment. Those things all together really do make it tense, make you not recognize yourself. And then when you can't find your words and you're looking, you're hazy, that's really affecting you as well. And you're trying to do all of these things.
Dr. Ade Akindipe, DNP (23:44)
Yeah.
Yeah, I'll have to say though, I I do feel like I have dementia when my teenage son starts to talk of talk about things and say, remember we had that discussion. I'm like, what are you talking about? And he's got proof that we had this discussion. And you know, it does happen. So but no, it's not dementia. But knowledge doesn't make symptoms disappear, right? But it replaces fear with understanding, right? So it's important to know what is actually happening. And I recognize it in myself and I'm like, okay.
I need to do something about this or maybe I do need to rest, maybe I need to put certain things down so I'm not overwhelmed because I'm not able to handle all of that. Right? We don't have to carry everything and just push through everything. So
Jillian Woodruff, MD (24:30)
Exactly. Your body's telling you something. Listen to it.
Dr. Ade Akindipe, DNP (24:33)
Yeah. So we got we get this question constantly. Should I have my hormones tested? You know, women have often been told by a provider that hormone levels fluctuate. So there's the you know, don't don't worry about it. It doesn't really show anything. That as long as you're still having periods, testing isn't warranted. And while there is some truth to that, that's not the whole story.
Jillian Woodruff, MD (24:54)
Yes, I get a lot of that too. They're coming in saying, can I just have my hormones checked? Because they heard that they should. and they're told, you know, that there's no clinical there's there's nothing clinical that will be gained to this. I I don't like that, you know. Perimenopause is largely a clinical diagnosis. You know, we hear your symptoms, we look at
your age, your what's happening with your period, how symptoms have progressed. And you kind of, you know, you're like, okay, yeah, that's that's perimenopause. We do know hormone levels can change dramatically from day to day, from month to month. One blood draw may not tell us the full story. It's a snapshot, you know, it's not the full the movie. But that snapshot still tells us something and you can track levels over time and that will tell us tell us quite a lot.
And what do you think about labs?
Dr. Ade Akindipe, DNP (25:46)
I absolutely agree. lab work also helps us rule out or rule in conditions that can mimic or worsen perimenopausal symptoms. ⁓ one of the ones I think is important is vitamin D levels. it acts as a hormone in the body. So if you if it's low, that can also, you know, cause, you know, a lot of mental health conditions, you know, you know, thyroid issues, iron deficiency can cause fatigue, right?
Vitamin deficiencies, insulin resistance, especially insulin resistance as women are getting older, metabolic dysfunction. So it's important to put the pieces of a puzzle. So it's not just checking hormones, it's seeing how, you know, ⁓ even if your hormones are normal on the labs, what else could be working against you in the setting of you gradually going towards menopause? So it's still important.
Jillian Woodruff, MD (26:37)
Yeah. The full picture comes from putting all of those things together, your symptoms, your history, your physical exam, ⁓ your menstrual patterns and labs too. And sometimes you have to repeat your labs over time. and that's where the diagnosis lives.
Dr. Ade Akindipe, DNP (26:53)
Yeah, absolutely. So if one lab comes back normal and you are sent home without answers, you still need to keep asking questions because normal for one person may not be normal for you. You might need a more optimal level to feel better. So numbers have to be interpreted interpreted in the context of what's happening, looking at your symptoms and your history and such. So okay, so let's
Jillian Woodruff, MD (27:15)
Yeah. No, I wanted to say,
you know, I always say normal does not mean optimal.
Dr. Ade Akindipe, DNP (27:22)
Yeah. Absolutely agree. So if you're listening to this and thinking this sounds exactly like me, we're gonna talk about what to do next.
Jillian Woodruff, MD (27:30)
Okay, I would start with tracking symptoms. And yes, you know, tracking your period is important to me as a gynecologist. I want to know the first day of your period. And then how long does your period last? So how long are you bleeding and what is the quality? Is it heavy to you? Is it light? And I want to know the first day of the one period to the first day of the next period. The days between that, that's your cycle length.
So yes, I do want to know that. But when we're talking about perimenopause, I would like to know about symptoms you've been experiencing, anything strange, even that you may not think is related, you know, put that on your list and then track when that happens, especially if you are having periods. When do these symptoms occur in relation to your periods? Because at different stages of perimenopause, they may at the beginning be more concurrent with.
cycle time so that time the first week or two before your period, some women have symptoms only during this time, only during what we call the luteal phase of their period. Whereas when it gets to later stages of perimenopause, they may have these symptoms daily and it may have nothing to do with bleeding. So we want to know does my anxiety get worse the week before the period? Does my libido change and then increase during my period?
What are the patterns? What patterns are you recognizing? So the hormones tell a story and we just I want you to share that story with me.
Dr. Ade Akindipe, DNP (28:57)
I'm so glad you do that because women sometimes assume their symptoms are random. so if you go to the doctor and you just say, I feel depressed, or you know, I just or maybe you Google something, I think I have this, it's really easy for things to get missed. So I absolutely agree that tracking your symptoms, your period, there's so many different ⁓ applications that are available for you to get data.
you know, ⁓ whether it's getting a notes app or journal, you know, I'm into metabolic health. So one of the first things I I recommend for women to do is track their blood sugars using a a continuous glucose monitor. because you can see patterns of when you are exhausted. Are you exhausted after you eat? Are you exhausted when you're ⁓ after going for a run? Or you know, all all of those different things can leave ⁓ can can give you trends, you know, a voice memo. I have someone that actually does a vo a voice memo.
to say what she felt like, what she ate, how she felt after eating, especially for women who have insulin resistance. yeah, very you you get to see in real time what is happening just by paying attention to those trends. So
Jillian Woodruff, MD (30:04)
And now you can get your blood glucose monitor without a prescription. So you can order them straight from manufacturers and use those. And even do you have your patients connect with you? Like are you seeing their data? How are you doing that?
Dr. Ade Akindipe, DNP (30:10)
Yes.
Yeah.
So ⁓ for metabolic health, since that's mostly what we do, we sometimes we'll put it on in for them in the clinic right there. that way we are able to just set up the app with us in the clinic. That way we can see it. If they don't have the capability of doing it with their phone, which it's just a couple of I I don't remember if it's not the Apple phone. Apple phones tend to work really well with transmitting the information.
But you could also just, you know, download it onto your phone the the list of your blood sugars and we can look at that in clinic as well. So there's different ways to track different things. There is, you know, the aura ring that can check your sleep. I mean, it's so much easy for us to do these things now.
Jillian Woodruff, MD (30:58)
Yes.
Yes, and there's so much with the the aura ring also is tracking things that are happening in perimenopause and menopause as far as the changes in temperature. That's really interesting to see. And tracking your right and your sleep quality. That's a really ⁓ you know, big I love the aura ring for that. And I'm realizing that I took it off on vacation, did not put it back on. So I have to get mine.
Dr. Ade Akindipe, DNP (31:12)
Yes, that's right, that's right.
Yeah.
I always forget to charge it, but I could tell the difference on the days that I sleep well and I don't sleep, how hot I was overnight. So
Jillian Woodruff, MD (31:33)
Yes. And yes,
you learn. So you we probably don't even need to wear it now because after you wear for some time, you know by how you feel, how well you slept. And also you learn the things that you do before sleep, how they impact your sleep quality. That's a big thing to know too. So all of this is, you know, gaining knowledge that we can tweak and make changes because none of us are the same. Something something may affect you that doesn't affect me, and vice versa.
Dr. Ade Akindipe, DNP (31:41)
You know mm hmm.
Yeah.
Yes.
Jillian Woodruff, MD (32:01)
⁓ moving on though to the second thing ⁓ that I think women should know or do is know their family history as best as you can. Ask your mother, your sisters, your aunts, when did menopause occur? ⁓ did you have severe symptoms? these things they carry over to you. I feel like most people, women will go through menopause at similar times to their mothers.
⁓ and symptom-wise as well, very similar. However, because of our environment and toxin burden, and this may be another episode to have, you kind of alluded to this earlier about changes in our environment and how we're going through earlier menopause. And there's a lot about things that we're doing that are leading to our ovaries aging quicker and things that we can do to slow that down. So
Dr. Ade Akindipe, DNP (32:48)
Mm.
Jillian Woodruff, MD (32:51)
There are changes that will happen, so it's not going to be exactly the same as your mother as we move through. And, you know, the way we're caring for our environment and and our food system and, you know, that the way we care for ourselves changes. So that all impacts the aging of our ovaries. But you also want to know about osteoporosis. You want to know about heart disease. You want to know about cognitive changes, risks of dementia. So family history, it doesn't determine your future, but it does give us an important context.
Dr. Ade Akindipe, DNP (33:18)
Yeah, absolutely. I'm so glad you mentioned that last part about environment. Our environment has a lot of impact on, you know, our hormone health and, you know, how quickly we navigate everything, hormonal changes and aging. So and and that leads to this next one, you know, building your midlife foundation. you know, you have the genetic predisposition, but you can also impact that by how you manage your lifestyle.
you can't outsupplement sleep. You know, women always ask, what are the best supplements I can take for sleep? There are great nutracycles, they are great supplements, but when you are not sleeping very well because you have really poor sleep hygiene or you're not managing stress and taking time out for yourself or building a good protein foundation for your meals and it's really hard
So things like prioritizing protein at every meal, especially if you already know that your blood sugars are starting to creep up, you know, focusing on ⁓ you know you know more macros that have more healthier fats and protein can significantly improve your insulin sensitivity and lower your blood sugar. And of course, strength training, ⁓ starting it even with body weights two to three times a week, moving, fiber, ⁓ and then ⁓
Figuring out if hormone replacement might be a good supplement for you in terms of sleep if you're not sleeping well. give yourself grace because what worked when you were thirty ⁓ may not work at forty five. So and it's not failure. It's just, you know, the transition that happens as your physiology changes.
Jillian Woodruff, MD (34:52)
Another something that popped in my mind with the eating is or with the sleep is you're eating not aside from the protein, but if you're eating too close to bedtime, because after you eat a meal, especially if you're eating a heavy meal and then you're going to bed, you have to metabolize that food. And now you're sleeping, right? And so you're you're trying to, but your body has these other processes that it needs to do that it really shouldn't be doing while you're sleeping, metabolizing your heavy meal.
Dr. Ade Akindipe, DNP (35:02)
Mm-hmm.
Yeah.
Jillian Woodruff, MD (35:19)
Your heavy meal should have been used to fuel you for some sort of activity. And so that's going to impact your sleep too. So it may not even be that, ⁓ I ate bad food or I had alcohol before bed. It just may be the timing that you ate too close to bedtime. Right? Yeah. Fourth, find a clinician who's trained in menopause care, who specializes in hormones.
Dr. Ade Akindipe, DNP (35:33)
Timing mac matters. Up absolutely. Mm-hmm.
Jillian Woodruff, MD (35:43)
menopause medicine is a specialty. Maybe one day we will see a residency program or you know training for specifically menopause because menopausal women are important. And it's it is a specialty. So not every provider receives extensive training in menopause care or hormone care. And so that that's not a criticism. That's just simply the reality of how medical education is. You know, the menopause society.
maintains a directory of certified menopause practitioners, but that's just at menopause.org. That's just one part of it. there are several you know organizations and and that you can look at to see who is going to be most helpful to helping you with your transition with your hormones even before perimenopause or
During perimenopause with helping to set you up for your longevity. But the importance of it, I cannot stress enough, is having someone that has done the extra work because it is going to be extra work for anyone who does this, because it's not standard of education in our medical school.
Dr. Ade Akindipe, DNP (36:54)
Mm-hmm.
Yeah, yeah, great point. It definitely isn't standard and you know, it's important that the provider realizes the nuances around that transition and how that impacts everything else, including lifestyle and metabolic health. And I'm gr glad that you also incorporate that in your practice too, because ⁓ met metabolic health, lifestyle medicine, all of those pieces go together, especially during this stage. So ⁓ very important.
Okay, let's take a few listener questions. The first one is: Can I be in perimenopause if my periods are still regular? Absolutely. This may be the most common misconception we encounter. many women experience symptoms for years before their cycles become irregular. In fact, the symptoms
often arrive first before anything starts to happen with your cycle. So if something feels different, you feel off, which is what something sometime women will just say, I just feel off, trust that instinct and bring it up with your provider.
Jillian Woodruff, MD (37:56)
Okay, next question. Is this something I just have to suffer through? No, no. There are evidence-based treatments available, there are lifestyle interventions, there's non-hormonal therapies, there's hormonal therapies when they're appropriate and when desired. Treatment is individualized or it should be individualized. Options exist. And there is no prize for suffering.
You deserve to feel well.
Dr. Ade Akindipe, DNP (38:23)
my gosh, I can just imagine a t shirt with those words right on there. Just there's no price for suffering. There's no price for suffering.
Jillian Woodruff, MD (38:27)
There's no price for suffering.
I would absolutely wear that.
Dr. Ade Akindipe, DNP (38:34)
You do not have to suffer.
All right. ⁓ last one. My doctor keeps telling me I'm too young for perimenopause. What do I do? All right, take this one, Dr. Jill.
Jillian Woodruff, MD (38:45)
Okay, this is common and frustrating. Bring your data, keep a system log for a couple months so we can see what's happening through a couple cycles, and then ask specifically: can hormonal changes be contributing to what I'm experiencing? If you don't feel heard, it's completely appropriate to seek a second opinion.
And ideally from a provider that specializes in in hormones and these menopausal changes and perimenopausal changes. Advocating for yourself isn't being difficult. It's just it's being informed.
Dr. Ade Akindipe, DNP (39:19)
Absolutely.
Jillian Woodruff, MD (39:19)
well, we're we're out of time. But before we close, let's come back to where we started. If you've been wondering if what you're experiencing is real, it is. If you've been told that this is just stress or this is normal aging or you have anxiety and just see a therapist, it's probably more than that. And you deserve someone who's willing to just listen and look at the whole person.
Dr. Ade Akindipe, DNP (39:45)
Yes, and perimenopause is a transition. It's not a diagnosis of decline. ⁓ with education, support, and evidence-based care. Women don't just survive this chapter. If you've been told you just have to push through, that is not the case. There are options. Women can move through this transition with clarity, confidence, and a much deeper understanding of their own bodies.
Jillian Woodruff, MD (40:11)
Yeah, I think that's worth holding on to.
Dr. Ade Akindipe, DNP (40:14)
⁓
Jillian Woodruff, MD (40:15)
Well, thank you for spending time with us today. Thank you for joining us on this journey. If today's episode resonated with you, please share it with someone in your life, a woman in your life who hasn't felt like herself lately, who may have been told that this is just a part of normal aging, that everything is normal. She deserves to hear this episode, so please share it with her.
Dr. Ade Akindipe, DNP (40:38)
Yeah, and please leave us a review. This is really good feedback and your questions via email to connect at modern midlife collective.com. Your questions shape future episodes and reread every single one.
Jillian Woodruff, MD (40:53)
Thank you, Dr. Ade. And everyone, take good care of yourselves. We'll see you next time.