Hey hey and welcome to the Forties Formula, your go-to place for insightful discussions
on navigating the forties and thriving in this transformative decade.
We're your hosts, Jasmine and Amanda, two women that are passionate about exploring
the challenges and adventures that come with turning 40 and what lies ahead.
Our guest today, Dr Tash Mirandu, is a British-trained family doctor with experience in both the
UK and here in Singapore.
She's a member of both the British Society of Lifestyle Medicine and the British Menopause
Society and she's developed a well-deserved reputation as the go-to doctor for women navigating
the challenges and changes of menopause.
Menopause is a transformative phase for many women and is a topic that isn't often discussed
openly.
So whether you're approaching this stage in the midst of it or simply curious about what
it entails, we invite you to listen to this conversation with Dr Tash Mirandu.
Menopause.
Now I was trying to think of an analogy as to how I can describe it because I started
going through it when I was 36 years old and the one thing that popped to mind was that
ride in Universal Studios, the Jurassic Park one, you know you're on there and it's going
around quite smoothly and everything's fine and you think you know what I've got the hang
of life I know exactly what I'm doing but you know something's coming you don't know
when it's gonna come and you don't know how bad it's gonna be and I feel like that's what
menopause is like.
What would you say?
I couldn't agree more.
I think this is one of the, I won't even say issues, but one of the things we sort of have
to really battle is each person's different and each woman's experience is different.
Most will be fine, mild to moderate symptoms, if at all there'll be some who just go through
it, breeze through it, don't even realize they've been through the menopause until one
day they go oh I haven't had a period in 12 months oh I guess I've been through it and
for those patients I usually say let's not talk too much about that.
Maybe we say right what have you done right in order to, it's not just about your genes
but you're right it's very individualized and this is why it's so important to talk
about it and for women, for people in general to know more so that we can deal with it and
look at best ways of managing.
Quality of life is what I go for and that's the meaning with managing perimenopause and
menopause.
I remember I was watching TV, I was 36 years old, the twins were babies and I felt like
this hot wave just come over me and I was like Jesus what is going on?
I remember putting on the aircon and then probably within about 30 seconds I was cold
I was like oh that was weird I felt like I was having a hot flush and I joked to my husband
I think I'm going through menopause and then it was like oh shit so I booked a doctor's
appointment and lo and behold I was.
So obviously I experienced the hot flushes and I also got the night sweats.
What other symptoms do women tend to get or can get during the perimenopausal phase?
It's such a vast list I mean we're probably at over 70 plus symptoms now so it's very
hard to I know and it can be you know it can be as subtle as oh I've got some joint pain
or my hearing's changing or I've got some tinnitus which is ringing in the ears.
Generally speaking what we tend to do is broadly categorized if we say physical symptoms so
these are your vasomotor symptoms so the hot flushes, night sweats, things like palpitations,
your joint pains, headaches, breast tenderness.
Also estrogen plays an important role with your hair, your nail and your skin so just
subtle changes there.
Sleep issues and unfortunately weight gain and in all the wrong places.
Looking at it from a cognition point of view so this is your brain health, brain fog, forgetfulness,
inability to focus or concentrate.
You're in working, you're managing life, a family, trying to tackle all of that.
You're looking at short term memory recall which can get affected as well.
Your mood changes, anxiety, impatience, irritability, tough dealing with day to day life as it is
sometimes and then when you add to that tearfulness as well.
And then something that we as women really ignore are sort of urinary, sexual and vaginal
symptoms.
There's a condition called gentorurinary symptoms of the menopause and that's something that
really affects women so you're looking at recurrent urinary tract infections, vaginal
dryness, discharge, incontinence, not forgetting low sex drive, poor libido which we just go
oh you know what it's part and parcel of life so we're just going to deal with it.
Nobody should deal with that.
Yeah I think you get to this point you know you're in your forties, you're busy, you're
a mum, you've either got teenagers who are going through puberty or you've got little
kids and you know they're just driving you nuts and you're kind of and you're just like
I'm so busy I just don't have the time to think about sex but how you know how can they
tell whether it's hormones or just their lifestyle?
It's very difficult because they're very good as women at making excuses so we'll always
find a reason or to come up with a reason as to why we can't do something or why we
feel in a certain way.
I think it's specifically a very significant drop in sexual desire, sexual function, inability
to have sex in a sense as well and I think it's again really thinking back on things,
looking at how things were versus what has changed and getting the help you need early.
Do you get clients to say it's almost like it's an overnight thing or does it come in
gradually?
It's usually a gradual process, there are some symptoms that can just hit you like a
ton of bricks so your hot flashes, your night sweats as Jasmine you were mentioning but
there are other symptoms which can be very subtle so change in your memory, your ability
to focus or concentrate, your sleep, you're not going to gain 15 kilos overnight so from
a weight gain point of view as well that's something really to keep an eye on.
So I've been told that perimenopause symptoms can last anywhere between 5 and 15 years,
that's a scary number, a scary time frame to sort of go through.
What can we do to help manage all of this?
With the perimenopause yes, the average timeline is about 7 years but it can be anywhere between
5 to 10, sometimes 5 to 15 years and it's not that the symptoms are disastrous from
the get go.
It can start very subtly and then build up or it could just be very subtle and people
manage.
For me the main stage is that prevention side and what we can do about it and I think the
two of you would know more really in a sense from a nutrition point of view and the lifestyle
medicine side.
Yeah, and I'll tell you, you know that 5 to 15 years timeline when you were listing off
some of those symptoms I was like gosh a lot of that sounds like pregnancy, you know I'm
22 weeks pregnant right now, a lot of that sounds like the brain fog and sweating in
general sounds familiar.
But I know it's going to end, right?
I know that I'm going to deliver that baby and there's the end.
But I do think in a way, and tell me if you think I'm crazy, that pregnancy is almost
like your first preparation for the impact of what hormones can do to your body.
Of course, I mean PMS and periods are the very first.
Pregnancy though is that I feel this preparation of a time when hormones affect you in a way
that you absolutely cannot control.
And it changes your body and it changes your mind and it does all of these things to you
in a way that preparation and prevention can only go so far.
But that being said, I think that there needs to be better awareness of the role, and this
is what I do right, of fitness and nutrition in preventing some of these symptoms, right?
We know that a higher protein intake can help prevent some of the vasomotor symptoms.
We know that having more muscle mass can help you have an easier time through your paramedic
and impausal period.
How do you work with patients to encourage those lifestyle changes before you jump into
different types of treatments?
Oh, I love that you mentioned my favorite word protein.
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Now back to the show.
We made a very good point there about pregnancy, but not forgetting menaki, which is when you
first start your period.
So these are the main stages.
We're in a way good at talking about, oh, when your period first starts, here's what
you look out for.
It's also the teenage hormones going up and down.
Or pregnancy.
Roughly here's what you can expect.
Here's a lot of support.
But then what?
It just stops there.
So this has been the issue is we have those two big stages in life, and then everyone
forgets about what comes after, and especially with pregnancy.
And as women, we're getting pregnant later on in life.
So that surge in hormones sometimes can almost trigger things off.
So it's looking at that surge in hormones, and it suddenly drops post-pregnancy.
And then depending, are you breastfeeding?
All of that.
It plays a huge role.
From a lifestyle point of view, it's never too late to start.
So it's something that I'm a firm believer in.
I'm doing a lot of extra work for it as well.
And it's really looking at the six pillars of lifestyle medicine.
So for me, sleep is number one.
Because if we're not sleeping, so quality, quantity, and consistency, that's automatically
going to make us feel more tired the next day.
We're going to consume more calories.
We're not going to want to exercise, et cetera.
It's this vicious cycle.
Nutrition.
Looking at things.
So with hormonal surges, it's looking at how nutritionally can we improve our phytoestrogens,
our progesterones, our testosterone.
A lot of it is protein-based.
So your soy, your edamame, your lean meats, your fish.
Looking at flax seeds, a little bit of dark chocolate.
Not a bad thing.
I am all about that intervention.
All about the chocolate, definitely.
But also the exercise.
It's not about going for runs and doing massive HIIT workouts.
You need to lift weights.
Girl, preach it.
Say it again.
You have to lift weights and safely.
It's not about suddenly showing up at a gym and trying to deadlift 80 kilos or 100 kilos.
Gradually build it up.
Because again, with the more muscle mass you have, increases your basal metabolic rate.
That unfortunately the fact that things can slow down a little bit as we get older with
the hormones going up and down.
All of this can just help to counteract that and give us the best chance to have as good
a quality of life as possible.
I recently wrote a blog and it's called Why HIIT is Shit.
For women over 40.
I don't think there's that big of a role for that style of workout.
But somehow that's the more popular workout these days.
I'm confused as to how those two messages have gotten so crossed.
I think it's there for the right person at the right time.
And it's doing it correctly.
All of this is very individualized.
But getting that zone two training in, getting your walks in, getting your bike time in,
cross trainer and really looking at.
And I'm not saying everyone needs to be paying to get a personal trainer or join a fancy
gym.
There are lots of resources online.
Go on YouTube, lots of exercise programs.
Just start with body weight exercises at home.
Five, ten minutes and then build it up.
And as you start to enjoy it more and you start to see the benefits, automatically that
behavior change comes in and you want to do more and more.
Which means then you're going to look at your nutrition even more.
You're going to sleep better.
Your mental health is going to be better.
You're going to want to do things socially.
I mean, Singapore has lots of places to walk.
Oh yeah, we are in a walking city.
Absolutely.
Spore for choice.
And also if you smoke, stop smoking.
If you drink, look at how much you're drinking.
Cut back.
Today is World Temperance Day.
Which is basically about moderation and looking at cutting back and stopping alcohol.
So I just thought I'd mention it since it's the third of October.
Amanda's already there, aren't you?
Yeah, it was a trick.
You know, here's my halo.
I stopped alcohol entirely for 22 weeks.
I actually feel like I have cut back loads and I don't know if it has coincided with
the whole paramentapausal thing.
But for me, I know how alcohol affects my sleep.
And like you, sleep is number one for me.
And I know that if I have more than one drink, I'm not sleeping.
So I'd rather just not have a poor night's sleep.
Plus then I've got to deal with the kids as well.
So it's kind of balancing everything out.
And I think it's important to make, so for example, you said that you know alcohol interferes
with your sleep.
I know that alcohol interferes with my muscle protein synthesis.
So that's something for me that's non-negotiable, right?
It's like I know that if I'm in a phase where I'm trying to be anabolic, there's no way
that alcohol is going to have a role in that.
And I think that sometimes the symptoms of paramentapausal are confused with the symptoms
of lifestyle choices.
And how do you help women kind of parse that out?
I think this is where the conversation piece, and it's finding somebody who actually is
there to listen and look at things holistically.
It's not about a symptom-based approach and going, oh, you have this symptom, we'll do
this test, we'll fix it.
It's looking at that sort of overall holistic viewpoint.
And a lot of the times, I spend most of my time just sat listening and just letting people
talk because the more information you get, the more you get to know your patient, you
get to know the person, you actually go, hold on, now this makes sense.
Have you thought about it?
So it's then bringing that into light and looking at the behavior changes that can be
made.
And it's not easy.
This is not about fixing everything overnight.
These things take time.
Somebody has been overweight or obese, it's been 5, 10, 15, 20 years.
I don't want anyone to lose that over three months because it's going to come back with
a vengeance.
It's doing it in a sustainable way where you look at things in the long term so that once
you get to where you need to get to, you are in the best place possible to deal with any
stress that comes your way.
And this again comes into play with the perimenopause, menopause, and also as women getting older
risk of heart disease, chronic conditions, born health, all of that.
So when I went to see the doctor, HRT was mentioned to me and my immediate thought was
cancer risk.
Is there a risk?
Is there a link between the two?
What would you say to your patients?
That is a very good question and that is what is always making the news and that's what's
been in the studies and this is one of the reasons sort of in the early 2000s with the
Women's Health Initiative where sort of the data was represented in a certain way and
then it just spiraled from there.
Since then, a lot of extra data.
Most women, 90% of the female population have a low lifetime risk of breast cancer.
Okay, so I want to start with that.
HRT and estrogen alone is not associated with increasing breast cancer and may even lower
it.
This is for women who have had a hysterectomy, for example, so you don't need that progesterone
component to protect the lining of the womb.
Also we've got much newer hormone therapy, so the body identical treatments, so our gels,
patches, eutrogestin, which is a micronized progesterone, there's no increased risk of
breast cancer for the first five years of taking it.
Also under the age of 60.
If I put it into context, the risk is so low that it's actually, the risk is lower than
if you're overweight or drinking a couple of glasses of wine each night or being sedentary,
meaning doing no exercise.
So that is just putting it into context.
So it's always worth the conversation, but it's not about going, oh gosh, I could never
go on it because I don't want to get breast cancer.
And I think that's how people tend to look at it, don't they?
They've just heard something, and I think it was a flawed study.
Not even flawed, it was just that the study was done for a particular reason, and it was
also done in older women.
Once upon a time, hormone therapy was used more from a prevention point of view, so preventing
heart disease, preventing bone health, and it was also much older synthetic hormone therapies.
You know, technology is passed, pharmaceuticals have improved, and what we have now is way
superior and in a sense safer, more natural as well.
So we have to take all of this into context, and it's very individualized.
I have some women who come and say, listen, I'm pretty sure I'll go through the perimenopause
soon.
I'd like to go on HRT because I don't want to get XYZ.
That's not what it's there for.
So it needs to be used correctly.
Yeah, and that's something, you know, at the Lyft Clinic, what we always say is know your
numbers, and this refers to know your, you know, we do exercise testing, know your VO2
max and your resting metabolic rate.
This applies to your iron, right?
Know your ferritin level, and this applies to your hormone profile.
I always say, you know, if you are a woman that is 40 and over, get a baseline, get a
baseline, get your hormones tested, see where your estrogen, progesterone, testosterone
are falling.
That way, in the future, if and when you're experiencing symptoms, you have a baseline
against which you can test, and then you can have a sense of what you might need in terms
of BHRT or HRT or estrogen replacement.
Then you have an idea.
But if you have no idea what your numbers were to begin with, then you're really just
kind of shooting in the dark for where you have progressed.
So this is a bit of a gray area with testing.
Simply speaking, the consensus is that only specific instances to test hormones.
If someone's having symptoms under the age of 40 or in their early 40s, now less than
sort of one in 100 women will have symptoms under the age of 40, one in a thousand under
the age of 30.
So you know, these are, yes, they sound like bigish numbers, but they're not.
So it's always taking that into consideration.
If you're in your, you know, depending on where you are, so mid-40s, late 40s, you're
symptomatic, it's a clinical diagnosis.
We don't need to do hormone testing at that point.
Another time we do hormone testing is actually if somebody has a marina coil in as part of,
yes, contraception once upon a time, but also as part of protecting the lining of the womb
if they're on hormone therapy and to help reduce that sort of up and down in your periods,
your heavier periods.
Then before we remove it, sort of 55, 56, we do a blood test just to make sure you've
been through the menopause.
And then again, it's a choice.
You know, we do therapeutic trials on HRT, on hormone therapy.
We can do therapeutic trials off hormone therapy.
You're on it one day, you come off it the next day, the hormone's out of your body.
So this is not a magic medicine.
This is just giving back what the body needs.
I love that.
So full disclosure, I am on BHRT.
So I take estrogen, progesterone, micronized progesterone, the eugestrone that you mentioned,
and testosterone.
And I've noticed that any time I feel my symptoms coming back, and it's usually the sleep, that's
the one that I can tell straight away whether something is not right.
You know, I will have to sort of go and figure out how to tweak it.
I'll speak to my doctor and I'll say, look, this is coming back.
I don't feel great.
And I can just feel it in my body.
And I think straight away, you know, you kind of know, I think I've gotten to the point where
I'm very, what's the word?
I'm very self-aware.
Self-aware, yeah.
Very self-aware.
So, you know, straight away, the night is the one that gives it away the most.
And that's very, very common because at one point in your life, you may need a certain
amount of hormone therapy and then that could change.
So this is why it's not about starting somebody on something and then saying, okay, go away
and just carry on.
You know, I would do an initial follow-up in a month, then three months until we've
got the person in a nice steady state.
After that, every six months.
And this is why actually being on something like hormone therapy, if somebody needs it,
you're actually monitored much closer.
The screening is up to date.
So your breast screening, cervical screening, if you need a pelvic scan, for example, your
examinations.
So if we're going to pick something up, we're going to pick it up much earlier than somebody
who is not having this level of monitoring and screening.
Yeah.
And what's really different in what you're doing, Dr. Tosh, is that you're actually spending
time with your patients and you're monitoring them on several markers, not just one.
And you're also looking at what is optimal versus what is normal.
And I think functional medicine allows you a different paradigm than traditional medicine
in that you can get deeper with your patients.
And you mentioned the word holistic.
I think that is so far describing your approach beautifully.
And this is, you know, for us as a clinic, this is what we do.
It's not just about...
And I think the privilege we have is time.
I still do my NHS work.
Do I have time?
No, I don't.
And it's very unfortunate because I would love to do more for 40 patients, 50 patients
a day.
But I'd be there constantly.
That's not going to happen.
Yeah.
Whereas having that privilege of time and being able to listen and have that conversation
and be able to really look at things holistically, looking at the lifestyle measures.
So you know, medicine 3.0, we're going for the prevention rather than waiting for something
to happen and then trying to fix it.
So I understand that as you age or after menopause, post menopause, your risk factors for certain
conditions increase.
Can you tell us what these risks are and how we can minimise the risks?
Lifestyle medicine.
It's really looking at that prevention piece.
So looking at your nutrition, your sleep, your exercise, your mental health and wellbeing.
These are things that we can do sometimes more easily than other times, but we have
to take that responsibility and that's on us.
From a risk profile point of view, two of the main things are heart disease plus strokes
and osteoporosis, which is where the bones start to thin, which is osteopenia, and then
start to break down.
So both of these factors, looking at your exercise, your nutrition, your sleep, you
could automatically reduce it.
For women after the menopause, the risk of heart disease is higher than men if they haven't
had any heart disease by the age of 50.
Other things to look at is urinary symptoms, so recurrent infections, incontinence, especially
after childbirth as well.
Sexual dysfunction.
Just because somebody goes through the menopause doesn't mean you stop having sex.
Weight gain.
So this is where looking at sleep, generally speaking for an adult, and you may laugh at
this, but the average should be 8.5 hours of sleep every night.
Who gets exactly?
I got eight hours last night.
I took seven hours and 59 minutes.
Go ahead.
Yeah.
Well, I was just, you mentioned osteopenia and osteoporosis, and I think that's something
that by this point in 2023, most women are aware of.
But in Asia specifically, we have this other issue of sarcopenia and muscle loss.
And I don't know that women yet are connecting how important their muscle loss is to their
bone loss, meaning if they had more, a higher ALMI, higher skeletal muscle index versus
just looking at bone density every time, how those two interact.
How do you educate your patients about this issue, and how do you encourage more women
to think about their muscle mass in addition to their bone mass?
I think this is something where everyone's striving for this perfect BMI.
Am I the biggest fan of BMI?
No, because it doesn't take into account quite a few things.
It's about being healthy.
So really looking at your in-body scan, looking at the breakdown of things.
So you're looking at your bone mass, your muscle mass.
With women, so we do after the age of 50, we say it's recommended to get a bone density
scan done, and that's important to look at a baseline.
Getting a little bit more weight within the right range will help with your bone mass,
and this is where that strength training and your protein plays a big part.
So it's having that conversation and almost educating women to say, you know, it's not
this or that.
You put it together, it's two for the price of one.
You know, you're building your muscle mass, you're reducing your chance of sarcopenia,
which is loss of muscle mass.
And muscle mass can go like this.
You fracture your wrist, you fracture your lower limb.
You notice your calf just go down like this.
You'll notice your forearm and your muscles just drop.
So that's why it's important to be consistent with that.
So it's that education piece once again.
Yeah.
And as an aging athlete, right, my concern has shifted so far away from performance and
so far into injury prevention, because exactly what you said, I cannot suffer a lower limb
injury because I cannot afford that muscle loss at this age.
And also from, you know, whether you were an athlete at a higher level or you're still
competing, you're doing things socially, it's about that injury prevention.
And that's one of the reasons for me is I play a lot of tennis and I want to be able
to be on that court for however long I need to be on and put that work in in the gym with
the nutrition, et cetera, to make sure that it helps from a quality of life point of view.
You mentioned risk of cardiovascular risk and stroke.
My grandmother actually had a stroke when I think she must have been over 50, definitely
under 60.
And I wonder had she had been given some form of HRT, whether that may have helped prevent
that.
And it's crazy because I feel like, you know, there was a whole generation of women who
were sort of not given the opportunity to, I guess, manage symptoms, manage other risks
in their life.
I'm sorry to hear that.
It's tough because these are things that can be severely debilitating.
And also at that time, it's a conversation piece around not just medication, but what
can you do to rebuild yourself, which unfortunately even now is a struggle, you know, trying to
get the older generation to do the work that needs to be done to make sure that sarcopenia
doesn't play a role.
It's huge.
Now tough question because again, hormone therapy is there not to prevent heart disease, but
it's for the symptomatic management.
Yes, it does help to reduce the risk of heart disease, again, with osteoporosis as well,
because it's the estrogen component.
So we need estrogen for our bones, for our muscles, our ligaments.
In the heart, what is a heart?
It's a muscle.
What are the blood vessels?
So again, yes, there is a role to play.
It's very hard to look back in retrospect, but again, it's looking at your grandmother
as an individual and looking at, okay, what happened at that time and what may have helped
her, but here's the situation now and how can we move forward with it.
And this is where that sort of lifestyle piece plays a huge role.
What can husbands and partners do to help support their wives during this period?
Because obviously we can become psycho bitches, right?
So much shit going on.
And some men may not understand what is happening, obviously psychologically, emotionally.
How can they support their wives during this crazy period of our life?
I think this is where the conversation piece comes in, starting conversations early.
And also as, you know, with families, if you have sons, daughters, it's starting that early
because it's looking at it from a period point of view, going through those teenage years.
Most moms going through perimenopause are likely to have teenagers at home.
So can you imagine the hormones surging in that household?
I mean, to be fair, I had newborn babies.
I was just like, I don't know what's worse.
Newborn twins as well.
So for me, that conversation piece, and sometimes it's hard as a couple to start that conversation.
So you know, use a healthcare provider, use online resources.
There are, you know, there are videos done by husbands about how they helped manage sort
of symptoms with their wives.
Also for partners and in the workplace to know and understand people working with them,
for them, above them.
When you start to notice changes, to be able to offer that support.
It's not always easy because you have to, there's a lot of compromise.
But again, it's looking at, right, how can we work together?
Can we look at our sleep together?
So let's make sure, you know, we're both sleeping at the same time, waking up at the same time.
Because even a slight shift in that, if someone's sleeping a bit earlier, waking up a bit earlier,
a little bit of light that comes on.
Yeah, it advances your, you know, sort of circadian rhythm and changes things.
So that's a good piece, looking at exercising together and looking at nutrition together
at home.
Because if you do it as a family, you're also teaching your young children, your teenagers,
how to eat better.
So that as they grow up, this is the norm.
So it's not, you know, you've already learned what the norm is.
So as you grow up, you know exactly what to do.
Yes, there'll be times you go have your kebab after a night out.
Still has protein.
Thank you.
That's my favorite word.
Get a bit of salad in there, you know.
But all I'm saying is it's about making good things the normal so that you're not having
to make that effort.
So exercising shouldn't be an effort.
You know, go for a cycle together as a family, go for a walk together as a family.
Do a Joe Wicks online program as a family.
But it's just making things as normal as possible.
And doing it together makes a big difference.
It's funny you say that to do it as a family, because my boys know now that I always prioritize
their protein.
And they'll say to me, mommy, I'm full, but if I eat all my protein, can I finish?
Can I be done?
I'm like, yes, okay, fine.
Technically, yes, you can.
So one of the things that I realized is that when you are going through all of this, sometimes
and other people are not going through it at the same time you are.
How can you, how can you better sort of find the support that you need?
Because people don't talk about it.
And I think whenever I used to say, oh, I'm going through menopause, I'd be like, they'll
get the response, what, already?
Really?
And I'm like, well, yeah, it can happen at any time.
And that's actually a common misconception that menopause happens when you're older.
And this is why a lot of women, a lot of people will not think about it or talk about it because
the assumption is, oh, I'm fine.
I'm not old enough.
But as I mentioned earlier, you know, less than one in a hundred under the age of 40,
less than one in a thousand under the age of 30.
And this is where I have to say with, and this is the beauty of where social media has
played a big part over the last year to 18 months, is getting that message out, getting
people talking about it.
It's actually to a certain extent a bit of a problem in the UK because you can't cope
with the demand.
And that is because from a time point of view, you don't have the luxury of time.
But I think with access to pharmacies, with access to pharmacists who can have that conversation,
so using that multidisciplinary team, nurse practitioners, general practitioners, specialists
in hospital, it's we have to work as a team.
And I think for women, just keep talking.
You know, if your own friends shut you down, you keep talking.
If you have, you see a healthcare provider who shuts you down, you keep going, you find
the person who will listen.
And that can take time.
Yeah, I think the keep talking part is so important and so different from our parents'
generation.
You mentioned that your grandmother had had a stroke and maybe if HRT could have helped
her.
I think about my own mother.
You know, she went through postpartum depression and was told, not real, not a thing, you don't
need anything.
She went through a very long, almost decade long menopause and was told again the same,
you just white knuckle it, you don't need anything, this is normal.
And I think, you know, had she just been born a little bit later, you know, and been in
my generation with access to information and professionals that are reassuring her, you
know, it's definitely one thing to talk about it with a friend, but it's something to be
told by your healthcare professional, you are not crazy.
This and this are things you can try.
Here's some actionable tools I can put in your hands.
And my mom never had that.
And I think that the talk is the first step and health professionals that are supportive
and willing to give actionable tools is that second step.
Thank you.
And I think that's one of the reasons I'm even, you know, here I do all these talks,
we as a practice will do all these education pieces is because we want people to be empowered.
We want them to have the right information.
And also it's about looking at other causes to things, you know.
Yes, a lot of the times it's a perimenopause, menopause, but we've ruled other things out.
You know, we need to make sure that is there something else going on?
Could this be your thyroid?
Could you be diabetic?
Could it be your kidneys?
Could it be your liver?
So we look at all of that and also look at the screening side of things.
So this is where health screening plays a big part.
And actually Singapore is very good with health screening.
It's just making sure you get the explanation rather than just going to get the test done.
So would you say then that if you feel any different in your normal self, you know, whether
you are feeling a little bit more anxious or, you know, you are getting that little
bit of joint pain, you should go and see somebody and then question further, why is this happening
now and could it be perimenopause?
Absolutely.
It's always worth the conversation.
It's not going and saying, I am going through the perimenopause.
You know, yeah, you could be, but it's also looking at your symptoms overall and saying,
actually, could it also be X, Y, Z?
We need to rule out those organic causes.
And it's a really good time then to just get the health screen done.
Just make sure you're on top of things.
Make sure your breast screening is up to date, your cervical screening, all of that, to chat
about other things.
And also look at the preventative side of things and starting at any point.
It's never too late.
You're 70 or 80.
Get going.
Start, you know, lifting a bag of peas.
That's right.
Fill up your water bottle.
Go for a walk.
See how, you know, even if it's up and down in your living room, time it.
Can you do it faster?
Oh, I like, oh, you're speaking to the athlete in me, girl.
There you go.
You know, it's funny.
You just said about that.
So my parents are visiting, they're 74, and I was reading one of my favorite weekly news
letters from Arnold Schwarzenegger, health guru and, you know, life advisor to me personally.
And he was talking about the sit to stand test.
And I thought, you know what, my parents are over 65.
Let's hit up the sit to stand test.
And they loved it.
They took it on like it was me taking on high rocks this weekend.
You know, they were like, let's do this.
And then when I didn't tell them the norms to begin with, you know, so they hit their
number and then I was like, well, this is the average.
And they're like, oh, let me do it again.
Let me do it again.
I love that.
You know, don't, I guess the message there, right, is don't underestimate older people
for having the vim and vigor to take on physical challenges and to make lifestyle changes.
You know, don't assume that they're just heading out to pasture.
They want to be vibrant and in control of their health as much as we do.
Couldn't agree more.
This is looking at it from not a lifespan point of view, which is how long you live,
but your health span, your quality of life, that marginal decade, which is your last 10
years of life, you need to be living it to the full.
But you start early.
But again, it's never too late.
It's always looking at that quality of life.
When I found out that I was going through perimenopause, I think it was a couple of
nights later, I had a dream.
And in that dream, I felt like I'd fast forwarded my life by 10 years, which I kind of probably
felt like it had happened.
And I was trying to work out, did I do this?
I used to be a serial yo-yo dieter, always trying out different things.
I have had different hormonal issues.
And so I'm looking back and thinking, did I do this to myself?
Was this my fault?
And then after that point, I thought to myself, right, it doesn't matter now where I've got
to, I'm now going to make a change.
And it was almost like a switch in my head, a mindset shift.
And I thought, from this point onwards, it's not going to be about how I look or how much
weight I gain.
It's going to be about making sure that I'm strong and I'm healthy, especially for my
boys, because like I said, they were babies at the time.
And I wanted to be able to be there for them and do things.
I didn't want to be that mom who couldn't keep up with the boys.
And so I felt like for me, that was the driving force on making a change in my lifestyle.
And you need that where it needs to come from you.
As a healthcare professional, I can tell you till I'm blue in the face, till you're blue
in the face, here's what you need to do.
But until that behavior change, that switch flips, it has to come from the person.
And then that's where that constant conversation, we keep addressing it, we keep addressing
it.
And there'll be something where, in your case, it was the boys.
And it's not just about being able to be there for them.
It's also looking at as you get older, from a travel point of view, from quality of life
point of view, grandchildren, you want to be able to pick up your grandchildren.
You want to be able to, when you're on a flight or on a bus, anything, to be able to pick
up your own little hand carry on and put it up instead of somebody else doing that for
you.
If you have a fall at home, you want to be able to get up with your one hand, rather
than being on the floor for three days until somebody finds you.
So it's about day to day practical things and how you can start early to reduce the
risks for you as you get older.
And I think that, again, is a way, one of the recurrent themes that we've been talking
about here is like women needing to take charge of their own health and women needing to own
their own identities.
And I think that exactly that by encouraging them to make these better lifestyle choices
as an act of empowerment and an act of self-reliance for your eventual future, I think that is
a complete reframing from what our parents were told.
Yeah, absolutely.
It's that reframing and also what we have access to now compared to once upon a time,
the amount of data we have.
Love data, love research, because that's what we base our advice on.
And yes, sometimes we don't always get it right.
And then we say, listen, we're sorry, we didn't get it right, but here's the new data.
Here's how we move forward.
But that's the whole point.
And it's that constant learning experience as well.
Thank you, Dr. Tashi.
It has been absolutely wonderful.
And before we finish off, we do have one more question to ask you.
And we want to know what is your prescribed 40s formula?
What piece of advice or wisdom would you like to share with our listeners about navigating
this next phase of their life?
I think this is such a brilliant question and a great way to end a fantastic conversation,
really, a chat.
You're going to hear the same things from me.
Prioritize your sleep, protein up, lift some weights and manage your stress early.
In your 40s, you're likely to be juggling a lot, you know, career, family, the good
and not so good stress that comes with it.
So be a little bit selfish.
Prioritize self care and emotional well-being so that you can thrive.
Love that.
Incredible.
Take that one to the bank.
Thank you so much, Dr. Tashi.
It was amazing.
Thank you so much for having me.
Thank you.
This is Paul, our editor.
He's a 25 year old unmarried Singaporean guy listening to the ramblings of 12 older women
on everything from menopause to weightlifting to sex.
Paul, what's your thoughts on today's conversation?
Hey, hello there again.
So for me, I'll be honest, this isn't exactly my area of interest or expertise as well.
I mean, let's be real, I'm a guy in my 20s and menopause is just not something that I'll
ever go through, I guess.
But well, for me, I guess I do have a partner and it is interesting to better understand
what menopause is from the perspective, at least like when she gets to the station live
further down the road.
So great topic.
All right.
Catch you guys soon.
See y'all.
Hey guys, did you know that you can leave us questions and comments on FanList?
That's right.
On fanlist.com slash the forties formula, you can leave us a voice note where you can
ask us anything, leave us your feedback or just say hi.
And now a word from listener Balwant09.
Wow.
Episode one was so empowering.
I fucking love it.
Balwant, we fucking love you too.
Thank you.
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Bye.
It's being confident enough to say yes, I'll come for brunch, but no, I'm not having that
bruise brunch.
I'm still there.
I'm still, you know, I don't need to be drunk to have a conversation with you.
I probably remember a lot more if I wasn't.
Because we were just saying like this first season, right, is all about just establishing
experts in these areas of relevance to the forties, right?
And then we can get into like little things.
I said we could do a whole episode on alcohol.
I think so.
A whole episode on how women in their forties are using alcohol and being honest, like you're
using it as a crutch to get through what is a difficult time.
And we've established all the reasons why and man, you touched upon that in your talk
as well, didn't you?
I do remember you talking about, you know, like just having that glass of wine because
you just want to, but it's not actually helping.
It's just putting a plaster over.
It's all, and this is what, the more plasters you get, what happens, it just stops.
So you're not getting to the root cause of things.