Why Parenting Feels Harder During Perimenopause - and What to Do (with Elisabeth Netherton)
Why Parenting Feels Harder During Perimenopause - and What to Do
Maybe you used to be the mom who could keep track of everything.
School schedules. Sports practices. Work deadlines. Playdates. Half days. Teacher Appreciation Week. The endless list of things your family needed from you.
And then something changed.
You're more overwhelmed than you used to be. You lose track of things. You're more anxious. You don't sleep as well. Your child does something that normally wouldn't bother you, and suddenly you snap.
Then comes the guilt.
Why can't I handle this anymore?
For many women, the answer may have less to do with suddenly becoming a worse parent and more to do with perimenopause symptoms.
In this episode of Educated Parent, I talked with reproductive psychiatrist Elisabeth Netherton about a part of parenting we don't discuss nearly enough: what happens when you're raising children while your own hormones are changing.
We talk openly about hormone changes in women during perimenopause, how they can affect mood, anxiety, sleep, attention, and cognition, and why understanding what's happening can be an important part of women's mental health.
Because sometimes what feels like failing is actually information.
We Talk About Postpartum Hormones. Why Not Perimenopause?
Most of us have at least heard that pregnancy and postpartum hormones can affect how a woman feels.
We're increasingly aware of postpartum depression and anxiety. We know the transition after having a baby can involve significant physical and emotional changes.
But then we stop talking about hormones.
As Elisabeth explained, perimenopause can involve another significant hormonal transition, and women may experience symptoms for years.
Yet many women aren't prepared for it.
They might have a vague idea that menopause happens somewhere around age 50 and involves hot flashes or night sweats.
What they may not know is that perimenopause symptoms can begin much earlier.
Elisabeth explained that the average age of menopause in the United States is around 51 or 52, but symptoms of perimenopause can begin years before that. For some women, changes can start around age 40, 41, or 42.
Those are also years when many women are still actively parenting children and managing incredibly full lives.
So when things suddenly become harder, they don't necessarily think, Maybe my hormones are changing.
They think, What's wrong with me?
Perimenopause Doesn't Just Mean Hot Flashes
One of the biggest misconceptions about perimenopause is that it's primarily about periods, hot flashes, and night sweats.
Those things can certainly be part of the experience.
But Elisabeth also sees women struggling with:
Mood changes
Anxiety
Sleep difficulties
Irritability
Problems with focus and attention
Cognitive changes
Feeling unusually overwhelmed
Sometimes a woman will come to her because she's concerned about her mood, anxiety, sleep, or concentration. Then almost as an afterthought, she'll mention that she's also experiencing hot flashes, night sweats, or menstrual changes.
She may not realize those experiences could be connected.
That matters enormously when we're talking about women's mental health because if you don't understand what may be contributing to a change, it's very easy to blame yourself for it.
"This Is Not Like Me"
This was one of the statements from our conversation that really stood out to me.
Elisabeth hears women say things like:
"This is not like me."
They weren't this overwhelmed two years ago.
They could handle the schedule.
They could manage work and home.
They didn't feel this anxious.
And now something feels different.
That experience can be particularly difficult for women who are used to being highly functioning.
You're accustomed to keeping everything moving. Then suddenly you're dropping pieces.
And parenting provides approximately eight million opportunities per day to notice that you're not functioning exactly as you used to.
When Brain Fog Shows Up in Parenting
We often talk about brain fog in women as though it's an annoying inconvenience.
You forget why you walked into a room.
You can't remember someone's name.
You lose your train of thought.
But think about what cognitive changes mean when you're also managing a family.
Which day is the half day?
Who needs to be at soccer practice?
Did you sign the school form?
Did you schedule the appointment?
What was your child supposed to bring tomorrow?
What time is pickup?
Oh, and you also have your own job, relationships, appointments, responsibilities, and needs.
Elisabeth described women coming to her because they're suddenly forgetting things at work and at home. Some even wonder whether they're developing ADHD in their early 40s.
In the cases she's describing, that's typically not what's happening. Instead, the changes they're noticing can be associated with perimenopause.
Understanding brain fog in women in this context can help change the story from I'm suddenly incompetent to Something has changed, and I need to understand what's happening.
That's a very different place from which to solve a problem.
Why You Might Be Snapping at Your Kids More
Cognitive changes aren't the only part of perimenopause that can affect parenting.
There's also irritability.
You may have a clear idea of how you want to respond to your child.
You've read the parenting books.
You've listened to the podcasts.
You know what the calm, thoughtful response is supposed to sound like.
And then your child does the thing.
Instead of that beautiful parenting response you had envisioned, something much snappier comes out.
Now you're not only irritated. You're ashamed that you got irritated.
That's where hormone changes in women can collide with the enormous pressure moms already feel to parent perfectly.
You may assume your reaction means you're failing to regulate yourself.
But if your baseline has changed because you're more anxious, you're sleeping poorly, you're overwhelmed, and you're experiencing hormonal changes, then you may be working with a very different emotional capacity than you were a few years ago.
That doesn't mean you have no responsibility for how you respond.
It means context matters.
Your Five-Year-Old Might Not Be More Annoying Today
One of my favorite parts of our conversation was talking about how simply knowing what's happening can create perspective.
Imagine you're tracking your cycle and begin noticing a pattern.
Certain days consistently come with worse sleep.
You feel more anxious.
You're more irritable.
Your mood changes.
Suddenly, when your five-year-old is driving you absolutely bananas, you can ask:
Is my child actually behaving differently today, or am I experiencing this differently today?
That's useful information.
The same thing can happen with anxiety.
Maybe the situation isn't objectively more threatening. Maybe your brain and body are perceiving it as more threatening today.
That little bit of distance can help you understand your reaction before immediately believing everything your emotions are telling you.
Start Tracking What's Happening
One of Elisabeth's first practical recommendations is simple: track your cycle.
Pay attention to where you are in your cycle and what's happening with:
Your mood
Anxiety
Sleep
Energy
Attention
Your period itself
Are your cycles changing?
Maybe they were consistently 28 days and now they're 35.
Or 34.
Or 23.
Are certain emotional or cognitive changes showing up at predictable points?
Tracking these patterns can help you recognize possible perimenopause symptoms and give you useful information to bring to your medical providers.
It can also help you give yourself some grace.
Instead of thinking, Why am I such a mess today? you may be able to recognize, This tends to be a harder part of the month for me.
Use What You Know to Plan Ahead
Once you recognize patterns, you may be able to accommodate yourself.
We do this in other areas of our lives without thinking much about it.
If you know you're returning from an international trip and will be exhausted and jet-lagged, maybe you don't schedule an important meeting for the next morning.
You plan around what you know.
Why couldn't we do something similar when we understand our own hormonal patterns?
If you have some flexibility and know there are days when you're more likely to struggle with sleep, mood, or anxiety, Elisabeth suggests considering whether you can create additional buffer.
Maybe you don't pack those days with unnecessary commitments.
Maybe you schedule more downtime.
Maybe that's a good night to get a babysitter.
You can't reorganize your entire life around your cycle, and most parents don't have complete control over their schedules.
But even small accommodations can matter.
Learn About Perimenopause Before You're In the Middle of It
When we're pregnant, we prepare.
We buy books.
We download apps.
We learn what happens at 20 weeks and 30 weeks and 40 weeks.
We research postpartum recovery.
But where's the perimenopause manual?
Most women aren't handed one.
Elisabeth recommends learning about perimenopause before you're desperately trying to figure out why you suddenly don't feel like yourself.
Understanding hormone changes in women ahead of time gives you a framework for recognizing what's happening if symptoms begin.
And if you're already in it?
It's not too late to start learning.
Ask Your Mom or Older Sisters
Here's another surprisingly simple strategy from Elisabeth:
Ask the women in your family what perimenopause was like for them.
When did symptoms begin?
What did they experience?
How long did those changes last?
Elisabeth actually did this with her own mom while preparing for our conversation.
She thought she remembered what her mom's experience had been because she had been there for it.
Then they talked.
It turned out her mother's symptoms had started much earlier than Elisabeth remembered.
In fact, her mom told her they had started around Elisabeth's current age.
That's useful information.
We can't assume our experience will be identical to our mother's or sister's, but asking questions may give us another piece of the puzzle.
When Your Doctor Doesn't Have the Answers
Recognizing what's happening is only part of the problem.
Then you have to figure out who can help.
Elisabeth explained that many medical professionals receive limited training specifically focused on caring for women during perimenopause.
That doesn't mean your doctor doesn't care about you.
It doesn't mean they're a bad doctor.
It may simply mean this isn't an area in which they have substantial training or clinical experience.
That's an important distinction.
Because if you bring up significant symptoms and your provider essentially tells you to tough it out, that doesn't necessarily mean there are no other options.
You Are Allowed to Ask More Questions
Advocating for yourself doesn't mean assuming you know more than your doctor.
It means participating in the conversation.
If a provider isn't recommending a particular treatment, Elisabeth says they should be able to explain why.
What are they concerned about?
What does the evidence say?
What are the risks and benefits?
And if they don't have expertise in treating perimenopause, it's reasonable to look for someone who does.
Elisabeth also mentioned The Menopause Society as one place women can look for practitioners who are comfortable treating patients during this stage.
The larger message is important for women's mental health in general:
You deserve to feel heard.
If you're suffering, you don't have to automatically accept this is just what women go through as the end of the conversation.
Parenting Through Perimenopause Isn't a Personal Failure
This may be the most important takeaway from the entire episode.
Imagine a mom who has always been incredibly capable.
Now she can't sleep.
She's more anxious.
She's forgetting things.
She's overwhelmed by schedules she used to manage without a problem.
Her child starts melting down, and she responds much more sharply than she intended.
What's the story she tells herself?
Often, it's:
I'm failing.
I'm a mess.
Why can't I handle my own kids anymore?
Understanding brain fog in women, mood changes, anxiety, sleep difficulties, and the other ways perimenopause may show up doesn't excuse behavior that needs to change.
But it gives us a much more useful starting point.
Instead of shame, we have information.
Instead of assuming we've become terrible parents, we can get curious about what changed.
And instead of silently suffering, we can look for support.
You Deserve Support, Too
Moms become very good at noticing what everyone else needs.
We know when our kids need sleep.
We know when they're overwhelmed.
We know when their schedules are too full.
We know when something feels different and it's time to call their doctor.
But we're not always as good at noticing those things in ourselves.
Perimenopause is another opportunity to change that.
Pay attention to your body.
Notice patterns.
Learn what to expect.
Ask questions.
Talk to the women in your family.
And if you're struggling, find a provider who understands what you're experiencing and can talk with you about your options.
Because parenting is hard enough without adding the belief that every new struggle means you're failing.
Sometimes the most powerful thing you can do is recognize that something has changed, understand why it might be happening, and give yourself permission to get the help you need.
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CONNECT WITH ELISABETH NETHERTON:
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[00:00:00] Leah: At this point, we are all aware that we're going to experience hormone changes in pregnancy and postpartum, and that those things might affect our parenting and how we show up with our kids. But the thing that nobody talks about is the way that perimenopause changes our parenting, and in fact, it's something I haven't even thought much about myself until recently.
[00:00:21] Leah: And that's why I am so excited to bring on Dr. Elizabeth Netherton, our fantastic guest, and a psychiatrist who is also an expert in perimenopause, to share our conversation together. I hope you enjoy.
[00:00:36] Elisabeth: Leah, thank you so much for having me
[00:00:38] Leah: I am so incredibly glad that you're here. I've been excited about this episode for weeks because I feel like all I do now is talk to moms in perimenopause who just feel like they are lost
[00:00:49] Elisabeth: Lost and alone, I think.
[00:00:51] Leah: Lost and alone and desperate. Can you tell me a little bit about how you got into specifically working with women in perimenopause?
[00:00:59] Elisabeth: Absolutely. so I am a reproductive psychiatrist, which means that a, a good chunk of my training was focused on first of all, how hormone shifts impact how women feel. That right there is a revolutionary thing to say that I think a lot of us don't talk about, that how we feel does change, um, as our hormones change across the course of puberty and our menstrual cycles and with pregnancy and the postpartum period, and then with perimenopause.
[00:01:23] Elisabeth: And so a lot of folks don't know that, learning about how hormone shifts impact our mood is not a required part of psychiatric training. So, so most psychiatrists that somebody might go to see don't actually have training uh, kind of how women are at risk for having mood symptoms, uh, around these times of, of hormone transition or hormone change.
[00:01:42] Elisabeth: but it was a, big part of my training, and it's what I love to do is, is talk with women and learn from them about their experiences and then give guidance, that is informed by expertise in women's mental health.
[00:01:52] Leah: When you are talking to moms who are struggling with challenges during perimenopause, do they come in and they know that's why they're struggling? Like, they-- do they come in and say, "I'm in perimenopause and this is what's going on," or do they come in and just start describing other things that are bothering them?
[00:02:09] Elisabeth: A lot of the times the latter. I see a lot of women who come in and they are talking to me about m-mood difficulties, anxiety difficulties, sleep difficulties, focus and attention, and, and cognitive difficulties. and then, "Oh, by the way, I'm having hot flashes and night sweats."
[00:02:26] Elisabeth: Or, "Oh, by the way, there's this hormonal thing going on. I think somebody told me maybe that's perimenopause," but like back to, back to, you know, this, you know, mood business that's bothering me. And, and they don't necessarily realize that those two things are linked, that the hormonal environment influences the cognitive symptoms, influences the mood, anxiety, and sleep symptoms that they're having.
[00:02:45] Elisabeth: They don't necessarily realize those are intertwined. And, and I guess I would say that's understandable because many doctors don't realize that those things are intertwined. A-a-and we have a tendency in medicine, to kind of talk about, you know, some of the reproductive changes and hormone changes that women go through as really separate from what happens with how they're feeling.
[00:03:02] Elisabeth: And of course, It's not. Totally, completely intertwined.
[00:03:06] Leah: So you have someone in-- talking about how they're suffering. They don't even realize it's perimenopause until you start talking to them about it. What do they talk about in their parenting? Like, what are you seeing on the ground about how it's affecting women and their relationships with their kids?
[00:03:21] Elisabeth: Oh gosh, I think there's so many different ways that this comes up. you know, I, I guess I would back up and say that, that the perimenopausal period is a time of really unique vulnerability for women. and you mentioned pregnancy and postpartum, and I think a lot of us are kind of conditioned now to think, "Oh my gosh, postpartum, we gotta be watching for depression."
[00:03:38] Elisabeth: Yeah, that might happen. but we don't talk about this big period of, of years in our, you know, 40s and, and into our 50s when we might be also having kind of big hormone shifts that impact, impact how we feel. And so, it's super common for women to start struggling with feeling more down or feeling more anxious, and those are two of the most commonly reported perimenopause symptoms.
[00:04:01] Elisabeth: and they're much more common than, than they are, you know, in the years prior to perimenopause. Women have particular vulnerability to those kinds of symptoms in that window. So, so people are feeling more anxious, as, as they've got, you know, kiddos running around doing all of the crazy, zany, dangerous, wild, impulsive things that kiddos do.
[00:04:20] Elisabeth: and that anxiety can be really hard to manage. women are struggling with feeling really overwhelmed with, how to manage all of the things that are on their plate. And, and women will tell me, "This is not like me. I was not this overwhelmed two years ago. You know, I'm able to normally manage these things okay.
[00:04:35] Elisabeth: Eh, something's different." women will struggle with sleep and, and gosh, if everything does not feel, more anxiety-provoking, more volatile, more overwhelming when we haven't been sleeping well. women will struggle with irritability , and that comes up a lot. You know, feeling like, I have an idea of how I wanna respond to my kiddos and, and you know what that should look like based on, you know, parenting books or podcasts or things that, that all of us have read or been taught.
[00:05:00] Elisabeth: And instead what comes out is, you know, a lot snappier than we had intended or had envisioned.
[00:05:05] Leah: So it sounds like what, what you're experiencing is women coming in feeling like they're failing. Like, you know, I am failing as a mom. I'm, like, not managing my emotions. I'm not handling things the way that I should be. it feels like a personal failure instead of a, like, medical transition that no one is talking about.
[00:05:26] Leah: So there's, like, the guilt, the shame, especially in this, like, very perfectionist-focused parenting culture with all of these rules that I often talk about aren't real. But, you know, already parents are so concerned, and now here they are, and they don't know what's going on. And I imagine even people listening to this episode right now might be thinking, "Oh, is what's happening to me perimenopause?
[00:05:48] Leah: And maybe I'm not, like, a terrible mess."
[00:05:51] Elisabeth: Yeah, absolutely. I think the other thing that's important to hold in mind too when we think about parenting, there's kind of the, the pieces that we are all, kind of holding in mind with how we respond to our kiddos. How am I, you know, when, when I am, alone playing with my kiddo?
[00:06:04] Elisabeth: And, and then there's all of the procedural things that moms do, all the things that we are holding in mind around, the play date scheduling, and we just finished May-cember. Which days are half days, and what does my kid need for these particular days, and Teacher Appreciation Week? You know, all of these details alongside all the details women are managing at work.
[00:06:23] Elisabeth: And, and brain fog can be a big part of perimenopause, and so we see women that are struggling to remember things, struggling with attention and concentration, uh, you know, things that feel like a big departure from their normal. And, and they'll come in and say, "Oh my gosh, I feel like I'm failing. I'm kind of dropping pieces here and there.
[00:06:39] Elisabeth: I'm forgetting things at work. I'm forgetting things at home. It feels unlike me, unlike my normal baseline." I have women coming in, you know, wondering if it's new onset ADHD, in their, you know, early 40s, and, and, and it is typically not. It is not.
[00:06:54] Leah: Yeah. I can completely understand why that would be so hard. You and I were even talking before this podcast started about how overwhelmed we get managing our own kids' schedules. You know, there's so much going on, especially with women who are usually very high-functioning, and then it's so easy to just start blaming yourself when things go wrong instead of acknowledging that there could be something else that's happening.
[00:07:19] Leah: And then often, even if you do realize that, then you have no idea who should even help you with it because you're talking with people and they're giving you advice that's not useful
[00:07:27] Elisabeth: Yes. I think we're talking about this... I think sometimes when we think about perimenopause and what many of us kind of have heard about perimenopause or know about perimenopause, it's talked about, I think sometimes like it's kind of this very discreet kind of, moment in time. I know, you know, back in my medical training, we, we didn't even really talk about perimenopause at all.
[00:07:48] Elisabeth: It wasn't really part of training. We talked about menopause, like it's a thing that happens one day, and then you're done. and there's, you know, nothing to see here, nothing more to learn. You just stop having periods. You're done. and you don't talk about... Actually, actually, there could be years, years and years of symptoms that have the potential to be really impactful to your life
[00:08:05] Leah: Oh, this sounds really fun. Super, super enjoying.
[00:08:08] Elisabeth: Yes, and all of us will go through it if, if we, you know, live to, to live long enough. If we are lucky to, to live to that age, we will all, we will all be in the same boat
[00:08:19] Leah: Okay. So since all of us, if it's not happening to you right now, it will someday happen to you. So if all of us have to parent while, like, going through such a huge physical hormonal change, tell me what we can do. Like, what can we do so that we're still parenting in, to the best of our ability through this kind of transition?
[00:08:40] Elisabeth: I, I think one of the first things that's helpful for all of us to do is to track our cycles and to know, kind of generally speaking, where we are in our cycles and if we're starting to have funky symptoms. noticing that we're feeling more down on certain days or more anxious on certain days, or sleep goes off the rails on certain days.
[00:08:57] Elisabeth: Having a sense of where in your cycle that happens, whether your cycles are regular, whether your cycles are changing, is really, really important for knowing, you know, whether symptoms that you're having kind of tie in with hormonal shifts and, and, and starting to pick up on some of the early symptoms of perimenopause that you might notice, or early symptoms that, that you are in kind of a, a late reproductive years kind of transition phase, but before, you know, be-before kind of other symptoms might start to appear.
[00:09:28] Elisabeth: So, so a lot of times women will start to notice changes in their period before they start having things like hot flashes and night sweats, and so noticing that your periods used to be twenty-eight days and now they're thirty-five days or thirty-four days or twenty-three days, it can be very, very helpful.
[00:09:45] Elisabeth: And then noticing where mood and sleep and anxiety shifts can attract to that.
[00:09:49] Leah: Is it so you can kind of say to yourself, "It's not that my five-year-old is extra annoying today, it's that I am extra annoyed today because this is just where I am hormonally"? Is that like-- Or, "It's not that I am in a threatening situation, it's that I perceive that I'm in a threatening situation because it's this day."
[00:10:10] Leah: So you're able to like have some like, like perspective basically. You're able to separate those things out.
[00:10:15] Elisabeth: Absolutely. Absolutely. I think having more information about where you are in your cycle and where mood symptoms or anxiety symptoms or sleep symptoms start to appear helps you both better understand yourself and what's happening, and give yourself some grace if, if, you know, things are not going the way that you had hoped they would.
[00:10:33] Elisabeth: I think for women that have some, some flexibility in their schedule or have some control over, over their schedules, it can also really help to then know, you know, okay, if I have a window where, you know, I am likely to have more difficulty sleeping or be more exhausted or have more mood or anxiety symptoms, can I build in some additional buffer during those days or those weeks?
[00:10:53] Elisabeth: Can I try to load my schedule to a different time of the month and schedule more downtime or schedule, you know, a date night and get a babysitter for a night or two those weeks? It helps kind of, plan ahead and cope ahead when we're, when we're looking at our calendars. And any, any little kind of piece of that information ahead of times can sometimes be very helpful.
[00:11:12] Leah: Yeah, like lets you, uh, accommodate for yourself. You know where I see people do this the most? And maybe I'm thinking about this because it's the summer, is around vacation. They'll be like, "Oh, no, I don't wanna meet with you the day after I get back from Europe because I'll be sleep deprived." You know? And it's almost like a similar sort of a thing, except for it's like you don't have to tell people, but you're like, "That's not a great day for us to meet because I'm gonna not be really attentive in that meeting."
[00:11:37] Elisabeth: Yes. Some people learn from those kinds of experiences. I don't, but some people, some people do, and plan ahead accordingly. Yes. Yes. Absolutely. And, and it also gives you information to, to give to, to your doctors that, that I think, again, a lot of times moms that, that I know, moms, moms I work with, uh, might be true for me too, are, are very used to like pushing aside things that are happening in their own bodies to focus on like, "Yeah, but we got sports practice today, so we gotta..."
[00:12:05] Elisabeth: You know, I'm doing the things for the kids, and, and they, you know, may not be kind of as aware or tracking what's happening in their own bodies and how that impacts how they feel
[00:12:14] Leah: Yeah. That's so important. Okay, what else can we do? So we can know what's going on, we can h- kind of understand ourselves, predict things. What, what else can we do to get through this?
[00:12:23] Elisabeth: k-kind of continuing in the same line with, thinking about having more information at your fingertips, I think another one is to inform yourself ahead of time about what perimenopause looks like. You know, we are really used to, to, having a manual or a baby book when we get pregnant and, and kind of, you know, reading through that for what to expect at different stages, what to expect postpartum.
[00:12:42] Elisabeth: But there, there is no kind of similar manual that most of us buy or are handed or talk to our girlfriends about for like, what do, what do we expect in our, you know, perimenopause years? When would that even happen? What do those symptoms look like? What's, what's happening hormonally during that timeframe?
[00:12:58] Elisabeth: And getting some information about those things ahead of time i-is, is, is immensely helpful for knowing what to expect.
[00:13:05] Leah: Yeah, that sounds really useful. So again, you don't have this idea like, "I'm crazy." You're like, "Oh, there's something going on with me," and it's, it's real
[00:13:15] Elisabeth: Yes. And so a lot of women, you know, a-a-again, kind of s- don't have information about when perimenopause even is. When does that even happen? You know, the average age of menopause in the US is 51, 52, but that's not when people have perimenopausal symptoms for the most part. Those can start, you know, 10 years earlier or longer depending on the woman.
[00:13:36] Elisabeth: For some women, there are symptoms for a couple years ahead of time. For some women, those symptoms can last for a really long time. and, and so a lot of women might kind of have a vague sense of, yeah, yeah, hot flashes, night sweats, 51. Yeah, I'm not there yet, but don't know, oh, but age 40, age 41, 42, I might be starting to show symptoms.
[00:13:53] Elisabeth: For a lot of women, those are years that, that women are still very focused on pregnancy and the postpartum period and parenting little ones, and they're just not looking out for those kinds of symptoms.
[00:14:02] Leah: Yeah, it makes more, so much sense. The more you know, the more you can take care of yourself.
[00:14:07] Elisabeth: Absolutely
[00:14:08] Leah: And what else can we do?
[00:14:11] Elisabeth: I think the, the next big one that comes to mind is asking your mom. Asking your mom, asking your older sisters, "What did symptoms look like for you and when did they start?" we do not always track kind of how, how symptoms presented in our moms, but, but often, and, and it can be a really, good place to start in terms of gathering information about what kinds of symptoms you might have in a, in, in an expected time course.
[00:14:34] Elisabeth: and, and I will say, I guess embarrassingly, I will, I'll admit, I, I talked to my own mom about this when I was preparing for this podcast with you. and, and I had thought, "Oh yeah, I, I know what those symptoms look like for her. I remember. I was there." I was, I was in high school, college, and I remember it well.
[00:14:50] Elisabeth: a- actually, you know, she and I had a very productive, lovely conversation about like actually symptoms started for her much, much younger than I was even remembering. And, and gosh, if that isn't super helpful for me to know about. you know, uh, she's like, "Oh yeah, it was about your age." Thanks. That's, that's that's super helpful for me to know. For me to know now. Okay. Okay. Yeah. I thought I, I thought I, you know, had, had a lock on what that looked like, but maybe, maybe I didn't. So, so finding out from them what the time course of symptoms look like for them, um, can be very, very helpful
[00:15:25] Leah: So if people have this information and they're like, "Oh, wow, this is really affecting me. This is really a thing," how do they find you to get some help?
[00:15:35] Elisabeth: I think y-you're, you're kind of cluing into this, this, like, last part about, like, what do you then do about it? What... You're having symptoms that are distressing, what, what next? And one of the things that's really tricky is, is, and this won't surprise many women, but, but for years and years and years, the American medical system has really not focused much on women's health, women's well-being.
[00:15:56] Elisabeth: And there's been a lot of focus on how do we help women deliver babies and try to safely deliver babies and, and not a lot of focus on how do we help women, you know, feel well in navigating menopause and perimenopause. And in, and in fact, there was a, a big study, some years back that polled, um, graduating family practice residents and OBGYN residents and internal medicine residents about, you know, their education in taking care of women in perimenopause, and it was like crickets.
[00:16:23] Elisabeth: Like, really, really minimal, numbers of lectures that they had received, really, really low numbers of graduating residents that said, "Yeah, I've got this. I know what to do for women. You know, we had good training on this." People did not say that. They said, "Oh, no, we didn't really, we didn't really talk about that," or, "Maybe we talked about it once."
[00:16:40] Elisabeth: which is not the same thing as talking about it day in, day out as part of, you know, routine medical training. And again, psychiatrists are not required to have training in this. So, having a-an awareness, I think as a woman, that, that the providers that you have been seeing may not actually have much training in this.
[00:16:57] Elisabeth: They may be well-intentioned, they may care very much about you, but they may not have had much training in perimenopause or any training in perimenopause. And then being prepared to ask them questions, being prepared to advocate for yourself and your symptoms, and being prepared to seek out providers that are comfortable working with women in perimenopause and do have a sense of what those symptoms look like and how to help women navigate it, using medication if warranted or if necessary, I think is very important.
[00:17:25] Elisabeth: And I think a lot of women go to, you know, might go to the OB that's delivered their babies and say, "Okay. Hot flashes, night sweats, not feeling good. What next?" And that person, you know, if, if that person doesn't validate that experience, doesn't have training in how to provide hormone therapy or feel equipped to do that, or doesn't have training in how to give them guidance about what their options are, or if that person says, "Uh, ma'am, I deliver babies, but I don't really do much of that," then women don't really know what to do next or, or might think that that's the only answer available.
[00:17:58] Elisabeth: And, and sometimes I have well-meaning doctors across the spectrum of medical practice that kind of say, "Yeah, you, you, like, tough it out and, you know, I don't know, come back to me in three years." You know, they, they, they kind of give them, you know, guidance that might not, be based on current medical literature, might really, poorly describe the risk or benefits of various treatment options, might be outdated or, or might, again, really minimize the degree of distress that these symptoms can cause.
[00:18:27] Elisabeth: And then women kind of accept that as the final answer. Like: "Well, I was, I was told no, so, so I guess there's nothing else to do." And I think it can be really helpful to have to come in kind of equipped with information and with knowledge and with questions, and be prepared if your provider does not feel comfortable to practice in this area.
[00:18:45] Elisabeth: Be prepared to, to seek out, providers that do have training and experience in a, in a clinical, in clinical experience in this area. And there are, you know, you can tell from sometimes from somebody's website kind of what kind of work that they do. You can tell from, there's a, The Menopause Society has a, has like a national database of practitioners that, are comfortable in, in treating women in perimenopause and, and kind of being prepared to, to go looking, I think is important.
[00:19:10] Elisabeth: And not kind of accept, answers or feedback that, that, if you feel like you're not being heard or like your concerns are not being adequately addressed.
[00:19:18] Leah: Yeah. What I'm hearing you say is that if you go in and you say, "Hey, like, this is going on with me, and I feel really weird about it," and you either hear something like, "Well, just tough it out. Like, this is what women go through," or, "Well, I don't really have a whole lot of experience treating that," or if you just feel like you're not being really heard by that provider, those are all signs that it's time to go find someone else.
[00:19:43] Leah: It's time to find a specialist and get some actual treatment, because you don't have to suffer to that degree. There are actually effective options that can help you
[00:19:52] Elisabeth: There are, and, and you deserve to have a conversation with somebody in any corner of medicine about, you know, what's available. And if somebody is not recommending a certain kind of medication for you, they should be able to tell you why, and, and what they're worried about and what the evidence says about that treatment
[00:20:09] Leah: Well, I think this is incredibly helpful. I love anything that empowers people to... Like, it's this mix, right? Like, you need to trust doctors because they're trained, and then also you have to know when to push back and when to trust yourself, and I think that nuance in all areas of medicine is really tricky.
[00:20:27] Leah: They can then, they can just play that, this part of the episode of the podcast. Feel empowered, go in and, and advocate for the things you need. Well, clearly you are someone that they can go to if they need their psychiatry needs met. Tell everyone how they can find you.
[00:20:42] Elisabeth: I have a website, elizabethnethertonmd.com. I can be reached by email through that website. My email address is, is there on the website. my, office is located in Houston, and I'll be officing out of, uh, Alamo Heights in San Antonio one day a month starting, starting this month. So to see patients face-to-face both in Houston and in San Antonio, and I can see folks across Texas by telehealth.
[00:21:04] Elisabeth: So again, my, my practice as a reproductive psychiatrist is really focused on the mood and anxiety and sleep components of things. And often I am working arm in arm with OBGYNs, with lovely caring family practice docs and, and other, medication providers kind of as they are working on the hormone piece of things and, and, um, prescribing sometimes HRT for folks, and I am kind of working on the other pieces
[00:21:27] Leah: I love this. I'm sending so many people to you. Yeah. Thank you so much for coming on the show. Thank you for listening to this episode of Educated Parent, and I hope that you feel more empowered and you can let go of some of that guilt and shame that often happens for us as moms.