Episode 50: Mood, Hormones, and Midlife: Navigating Emotional Health in Menopause with Dr. Jennifer Degler

In this episode, psychologist Dr. Jennifer Degler helps us unravel the complicated relationship between hormones, mood, and life stress during perimenopause and menopause. Many women wonder: is my anxiety or irritability a result of overscheduling and constant demands, or is it a hormonal shift? Dr. Degler explains how to recognize the difference, and we discuss the role of hormone therapy and antidepressants in managing these symptoms. Together, we explore how to build strong support systems, lean on humor, and shift your mindset to see menopause not as an ending, but as a new chapter full of possibilities.

Find Dr. Degler:

JenniferDegler.com

Resources from Dr. Degler:
Take the MENO-D questionnaire to screen for perimenopausal depression.

Link to the FEMM app for tracking symptoms.

CBT and Mindfulness-Based Interventions for the Treatment of Anxiety and Depression in Perimenopausal Women

3 Free Mindfulness Tools

Articles:

Perimenopausal depression – an under-recognised entity - PMC

Development and validation of a new rating scale for perimenopausal depression—the Meno-D  

SSRIs vs HT in treating perimenopausal depression 

JOIN Dr. Degler at Empower Your 'Pause:

-Live in-person event at Tates Creek Presbyterian Church on Saturday, Nov 1, 2025 

-Also available as live webinar on Nov 1, 2025 with option to watch replay video at your convenience. 

-Also available as online video course on Thinkific.com 

thestartinggatepodcast.com

Email us with questions and topics you want us to cover at
contact@thestartinggatepodcast.com

Follow us on social media @thestartinggatepodcast




The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive, or to be applicable to any
specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Mood, Hormones, and Midlife: Navigating Emotional Health in Menopause with Dr. Jennifer Degler

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship, and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment, and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz Two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz So we're continuing on our menopause series today, and we got lots of great nutritional advice from Amanda Nighbert last week. But this week we're turning our focus to our mental health. Menopause isn't just a hormonal rollercoaster, it's a mental and emotional rollercoaster too.

So when you're having all these shifting estrogen levels on top of all the stressors that come with midlife careers caregiving kids, it really is no wonder that many women feel like their minds are experiencing menopause even more than their bodies. 

Today we're so excited to have a return guest, Dr. Jennifer Degler. She had joined us back on [00:02:00] our episode 16 where we talked about anxiety and stress and trying to manage all the things that we do as women. And we have her back today, Dr. Degler has a PhD in clinical psychology. She's also an author and public speaker and has changed her career interest over time and has really started to put a lot of emphasis in caring for women in midlife during this perimenopause and menopause transition, and has created a program called Empower the Pause, where she's helping educate women how to navigate this time of life.

So we are so excited to have her again today to talk about this topic. 

thank you for having me back. It's so fun to be with both of you all and like everything that I seem to get particularly interested in, I have to go through it first and then I'm like, what is happening to me?

And then trying to figure that out. And so I turned 60 this year. And I was actually later to menopause. I didn't actually go into [00:03:00] menopause until I was 57. So I had thought I am gonna be buying tampons with my social security benefits. Just, it's nev my period is never going to end which I now know is actually, it's good.

It has good health benefits. Yes, you're lucky. Yes I'm lucky. I had a lot of, lot, a lot of eggs. However, just the looking back I realized, wow, I was suffering and did not know what was going on with me. And I want other women to have an easier journey and to be more educated in this area. And certainly there's a menopause movement going on right now where women are saying, we wanna know more about this and we want to not just suffer through this.

We want to thrive. Through. 'cause you're, you're gonna be in menopause about a third, at least a third of your life, depending on how long you live. Yeah, I wanna, I'm gonna just really enjoy that time of my life and also make that transition [00:04:00] through menopause easier. 

One of the reasons we're always wanting to bring information on this show is I feel like women in general look to their moms, right?

To ask them questions. And this was just a period of time of neglect in women's care just because it was almost shunned to talk about. Also, there was not many treatment options because of the difference in the studies at that time. Education can really help women feel like they can get the care that they deserve to have.

Yeah. 

Hopefully the next generation of women, this will be normal that we're talking about. It it seems like menopause is in your face everywhere you turn right now, which seems like it's kind of a lot, but I think it just went from, we weren't talking about it at all and now we're trying to catch up and hopefully it just becomes a normal part of now what we get educated about 

as women.

Yes. Yeah. It's happening to 50% of the people in the world, so we definitely should be talking about it. 

Yes, we can. You get us started by just [00:05:00] telling us a little bit about how these hormonal changes that happen during menopause are affecting our mood and our brain, 

that is such a good question because so many times we think these hormonal changes are just about hot flashes.

And oh, it's night sweats, it's hot flashes and I'm not sleeping well. And that's menopause. And what we realize now is those fluctuations and those hormones have a tremendous impact on mood, on the way you think. so getting women to realize this, even if you are not having hot flashes, you may be having a lot of other symptoms related to that.

We know now estrogen, I always think of estrogen's, like the big sister, and then serotonin and dopamine are like the little sister and the little brother and everything the big sister does, the little brother and the little sister wanna do too. And so as estrogen is high, then serotonin, which is a neurotransmitter in [00:06:00] your brain that helps you feel calm, it helps you sleep better, helps you feel less anxious, and your mood be better.

And then dopamine, which is that neurotransmitter that has to do with pleasure and that feeling good those follow estrogens when estrogen begins to drop naturally as we're going into perimenopause and menopause, those drop too. And so all of a sudden women are having a lot more mood swings. A lot more irritability, sleep issues that can come, even if you're not having those vaso motor symptoms like hot flashes and whatnot.

And then we know progesterone. It helps you relax, it helps you feel less anxious. And as that is dropping, women typically will feel more anxious, maybe anxious for the first time in their life during this perimenopausal time. And then of course, testosterone begins to drop too. And we think of testosterone as a male hormone and as a sex hormone.

However, women's bodies actually make more [00:07:00] testosterone than they do estrogen. And we need to keep that balanced. Not that they're totally imbalanced, but the ratio of those two. And as that ratio begins to get off, then women begin to experience some of the effects of lower testosterone.

Like testosterone is a hormone of wellbeing. Not just, ooh, I feel like getting busy, getting down with somebody. It's not just that it's a hormone of wellbeing, and of course that all of these estrogen and testosterone are affecting muscle mass. They're affecting bone strength. So there's a lot of things that these hormones do, but we're here today to mainly talk about how they affect mental health and they can have a profound effect on mental health.

 So what do you 

find are the most common symptoms women experience in the early onset, like the perimenopause stage and is that different than the symptoms that women experience once they're truly in menopause? 

That is a [00:08:00] great question. And the perimenopause, it's kinda the menopause before your menopause.

So as your body is beginning to get to the point where you're running outta eggs and then you're gonna have no more period, those fluctuations, that is what makes women feel like, I'm going crazy because one day they're feeling completely fine and then the next day they are on their broom riding around that house.

And the way people are breathing is incredibly annoying, let alone the way they chew. , So many women talked and I felt this way as well. I don't even know who I am anymore. I'm like losing my sense of self. Who am I? And then a week later I'm like, oh, I know who I am. I'm feeling good now.

And so what we're experiencing is , these fluctuations that show up mood wise and it can look different than once you're in menopause, assuming you're not on hormone replacement therapy. Then eventually all of those [00:09:00] symptoms, usually within four to seven years, it evens out for women , their bodies adjust and their brains adjust to these new hormone levels and they feel better.

But that perimenopausal stage, which is, can start as early as 35, but oftentimes for women is coming up in their forties and it can last anywhere from six months to 14 years. This is going on. And so they're gonna be experiencing oftentimes, like we said, the irritability, cognitive issues where the brain fog, A lot of times women will come to me and say I think I've got dementia.

I've got early onset dementia , but I only have it periodically throughout the month. I don't have it every day of the month. And I'm like that is a sign you probably don't have early onset dementia. The sleep issues, sexual issues, feeling I'm not interested in sex anymore. My body is not responding.

And so looking at that it's [00:10:00] oftentimes just more chaotic. you'll hear people refer to this perimenopausal time as the zone of chaos because people do feel like they're all over the place. 

Yeah, and I'll go ahead and put myself into the mix here. 'cause I think I'm in the very early stages of perimenopause and I'm 42.

And what you're saying is exactly what I feel 'cause it's chaotic because most of the time I feel like I'm myself. And for those of you who don't know me in general, I'm a pretty laid back, go with the flow person. I think I have more patience than the average person does, but then these days come where I yes, am annoyed by the sound of someone breathing.

 I am annoyed by everyone around me. Every little thing. And then you don't realize it at first a day goes by and you're so irritated and you forget, even though this starts happening every month, you forget. And it takes about a day of being annoyed. And then I'm like, oh yeah, that's right.

It's been about a month since that happened [00:11:00] to me before. And then. I'm like, okay, I can get through this. , I know it's gonna end, but then I start to worry each time like, oh, is it not gonna end? And I'm gonna feel like this forever. But then it ends and it's really abrupt. Like I can , notice that I'm still annoyed at 10 o'clock in the morning, and then at two o'clock in the afternoon I can be like, oh my gosh, thank goodness I'm back to my normal 

self.

Yeah. And that feeling I is why women do think I'm going crazy. And then the people that live with them are walking on eggshells what was that, what person showed up today? Exactly. Oftentimes this coincides when we're in our forties and early fifties with really a lot of demands are being made on us.

Many women are raising children. They're moving into raising teenagers, which of course we all know are the easiest people on the planet to raise. And then they've got elder care. So you oftentimes are beginning to [00:12:00] take care of elderly parents and perhaps working outside the home, volunteer work, all of those things.

It's just coming together in this perfect storm. And so for women to understand, okay, part of what I'm feeling here, that sense of, I don't know who I am or I'm, as you said I'm afraid this is who I'm gonna, become. 'cause she shows up. I don't know who she is. Nobody likes her.

She shows up. She's real irritable. She can't think straight, not as decisive. And how long is she gonna be around? And I can tell you she won't be around forever. But we do need as women to be talking about this and then providing women with good care. Because usually women just feel so ashamed. I'm so ashamed that I just bit my husband's head off or that I just snapped at my kids and I just wanna hide that and I'm just gonna try harder.

And then women just get so exhausted because they're fighting against something that [00:13:00] is not their fault. It's not your fault that your hormones are doing this. 

maybe for some women they've experienced mood issues before. Mm-hmm. Whether they've had issues with postpartum depression or dealt with anxiety off and on in their life, what is something to help them recognize maybe the difference of it being more hormonally related versus some of these conditions that they've dealt with in the past?

Or is there a way to help. Women tease that out. 

That's a great question. And I would refer women to, and I think this is something you're all gonna provide a link to in the show notes to where people can access for free the MENO-D, which is a rating scale to detect depression and menopause or in perimenopause.

And this was developed in Australia it's based on a five factor model where they're looking at specifically when this is a hormonal depression, hormonal anxiety, versus what we would [00:14:00] consider your run of the mill clinical depression. And three things in particular, the research suggests distinguish if you've had a previous episode, maybe you had postpartum depression or an earlier depression in your life.

and then now this is more of a hormonally related depression. It's cognitive symptoms, paranoia, and irritability. And so for the cognitive symptoms, that's what we would consider cognitive fog word recall is a big thing. Like you're talking and then you're like, what? Yeah. When is the word going to come?

Yeah. And you have to develop sense of humor. I always tell people the train has left the station, but it will come back, particularly if we're not pushing for it. That cognitive fog it can be hard to concentrate and hard to focus. Irritability is irritability where we're snapping at things and things are bugging us, that in the past we were able to roll with it.

Whenever I say the word paranoia, people are like well, I'm not paranoid. I don't think they're poisoning my water. But keep in mind this was [00:15:00] developed in Australia, so they use that word a little differently than we do. I would think of this more of like self-consciousness, like feeling do you like me? All of the sudden, women are getting more concerned about, I think so-and-so's mad at me, or I'm concerned like that everybody's talking about me. So when we think about paranoia, don't dismiss that just because you're not thinking the CIA a is out to get you. It can get to that point.

But more about just increasing worry that people are thinking badly of you. Which, if you're snapping at a lot of people, then you're thinking, now what are they thinking of me? So those three things in particular can help distinguish that maybe this is more hormonally related. 

And for me it's very, specific, there's a certain set of days.

Mm-hmm. And then I'm back to normal for a while. Is that typical for most people where they feel that. Like for four days in a row and then they're back to normal for a couple weeks and then it [00:16:00] happens again. Or are some people feeling 

it all the time? And that's such a great point, kitty, because that's one of the ways we know this is hormonal because depression, that we would just consider run of the mill clinical depression.

to get the diagnosis, we have to have two weeks of a certain number of symptoms. And it often does feel like this blanket, this heavy blanket that is over you of sadness and despair. And oftentimes women that are dealing with that kind of depression, they stop taking care of themselves. Maybe they're having trouble getting out of bed.

Whereas the kind of depression you're talking about is sometimes we used to call it smiling depression because she's still functioning. She's going to work, she's putting her makeup on, she's doing all the things, but on the inside she feels terrible. And then a few days later she feels fine. Which is why tracking this is really important.

There's an app you can get the FEMM app, [00:17:00] FEMM, y'all are nodding like we are. We 

had Alexis McNally on our show this spring so y'all can go back and listen to that show. She introduced that app to us Yes. And the value of it. And it is really helpful for women to be able to make these associations.

I've noticed that even with my own patients that have been able to have those connections because when you know that it's a slightly predictable it gives you a sense of calm, just like Kitty had mentioned, knowing that it's not here to stay. Yes. And you're able to see the ups and downs that are occurring and how long they last.

And you're doing your own little science experiment on yourself. 

so a lot of period trackers are just tracking. Blood flow. What I like about the FEMM app is it actually has you track your emotional symptoms as well, and that data is really important. It does help you realize, I am not crazy. I am being affected by hormonal fluctuations, which [00:18:00] can be a little bit predictable, but sometimes they're not, particularly as you move closer and closer to that menopause time.

And so tracking that and then being able to go to your provider and say, this is what's happening. What can we do to help manage this? So that this transition is easier and that you're suffering less. 

And it's really interesting to me to see, like the first time it happened, when I first had this, I had a glass of wine. I was like, wow, I feel back to normal. But at that point I didn't understand what was happening. I thought I must just be stressed about something. Mm-hmm. And then once I realized this was happening regularly, I was like, okay, I can't uh, just have a glass of wine every time this happens.

That is not gonna be good for my health. So I've been just trying to figure out other things I can do to get through those few days. What are your suggestions for 

that? Yes, and I will say, a lot of us like, yeah, let's try the [00:19:00] glass of wine, but then you're like. I believe I had like a third one.

And actually part of the way your hormones are changing, it really is best to very drastically reduce your alcohol consumption. Not just because you could develop an alcohol dependency, but your body is just not as able to process alcohol as it once did when you were younger. And it will really disrupt your sleep.

And we know disrupting your sleep is just gonna mess up everything. Yeah. 

Disrupting my sleep is probably my number one motivator to have healthy habits. And so that, that's a big one for why I wouldn't wanna use alcohol to help with this symptom. Yeah, sleep for sure. And another 

symptom that comes later in this is the hot flashes and alcohol and hot flashes.

Are not a good combo , more alcohol intake definitely can cause more hot flashes, again, affects your sleep and that the whole cycle just can exacerbate. women [00:20:00] sometimes will use that as a way to treat some of these symptoms because they're like, oh, I'll, it's just a bad couple of days.

But it's definitely not the answer for this problem. 

And we know you can build up a tolerance and so just realizing what else can I do? Here are some things you can do. So menopause education, like what we're doing right now is huge. Empower Your Pause, which is the program that I've created along with Heather Mara, who's a pelvic floor physical therapist.

Helping educate women so that we have the right kind of mindset, because mindset is huge. there's some interesting research now about how mindset actually affects the way our bodies physiologically react to certain things. We know in cultures where aging is more revered. Women experience fewer menopausal symptoms because they're actually welcoming the process of aging.

And there are things to look forward [00:21:00] to. So mindset is huge. Education, cognitive behavioral therapy can be very helpful. And let me just say, 'cause sometimes people call me and go, do, I've heard, do you do CBT? Most therapists do cognitive behavioral therapy. They may not call it that, but when you get trained, it's a big umbrella.

And there are a lot of things under that basically we're helping you with your thoughts. What are you thinking? We're helping you with behaviors and challenging you to try things. And that can be very helpful. Mindfulness based interventions. In the show notes, there's a link where you can download three free mindfulness based intervention strategies that you can use to help with lowering your anxiety level and feeling an also boosting mood.

Your nutrition, which it sounds like you, you just did a podcast with Amanda Nighbert about nutrition and the things that you're eating and [00:22:00] exercise is so important . It's great that people walk and I hope they will keep walking. 'cause being outside, getting sunshine, being in a green space is really good for your brain.

But it's important that you're getting out of breath because we want that blood flow to go all throughout your body. And that's an easy way to know, am I actually getting blood flow to all the parts of my body?

Oxygen and nutrients, which is gonna help it. It helps your genitals, which, sex is usually an issue during this time. It helps your brain and lifting heavy weights. There is a relationship between muscle and mental health. And so keeping building muscle , is important as well. some of these things take time.

And oftentimes women in this stage in their forties are like, I don't have time. I gotta take this one to practice. I gotta go to work. I've gotta do all of these things. And this is where it's important to invite people to partner with you in [00:23:00] making these things possible. Because you may notice that the man in your life just goes to the gym when he wants to go to the gym.

He makes it happen. When he wants to take a nap, he just goes and takes nap, guilt free. So oftentimes as women, we are the ones that, again, this is mindset. This is where it can be helpful to work with a therapist and look at what are some of the things I believe about. What women do and what a good mom does and what a good daughter does.

You know that I need to really look at those things and see where do I wanna hold onto some of those thoughts, or how do I wanna adapt them and change them so that I don't neglect myself in this process as so many of us do. And then who can I invite to partner with me so that my self-care stays really good during this time period?

Yeah. I found for 

myself too, if I'm having one of those times where I'm irritated with the way people breathe if I can just go [00:24:00] to the basement and lift weights for 10 or 15 minutes and I'll say, I don't want to do it. It's not like, yes, I wanna go lift weights while I'm irritated at everyone,

, but even just 15 minutes, if I lift something heavy, that can really just get me through the rest of the day. It doesn't have to be, you take, 20 minutes to go to a gym.

Go to an hour long class, 20 minutes back. 15 minutes of lifting something in your house can help reset you. 

Yes. there's something when we are stuck emotionally in an emotion, whether that's irritation, sadness, there is something about moving your posture that helps your brain shift out of that emotional state.

So if I'm sitting on the couch and I'm just feeling really blah, and then I stay on the couch and I'm trying to like change my mindset while sitting on the couch, it will be much easier if I will change my posture. So if I will get up. Move. There is [00:25:00] something about that helps the brain then shift its mindset as well.

And a lot of us, we're numbing. We're just sitting there scrolling on our phones, watching, goat yoga videos over and over, whatever it might be that the algorithm is feeding your Instagram feed. And so realizing I need to, like you said, just jump up. I'm gonna go down there.

I don't wanna do this. I'm not gonna wait until I want to do it. I'm just gonna go do it. Help my mind shift, help my body emotionally shift and then I will reap the benefits of that. 

I want to go back with a comment you just said, 'cause I feel like it's so common for us today is we do lean into our phones as the distractor when we have one of these mood flares.

Can you help our listeners understand why that is such a. Bad coping mechanism to develop, because I feel like many women are using that. I've been guilty of it as well. Why does that not help the overall problem? 

So what it's doing, it's [00:26:00] numbing you. , It's like the glass of wine. It will work temporarily to numb you so that , you're distracted and you're not feeling that emotion in that moment.

But the emotion doesn't go anywhere. It's just waiting and it's building up, which makes it more likely then that you are gonna explode over something small it's gonna be harder to concentrate on the things you wanna concentrate on. so realizing pushing emotion away and numbing emotion.

Does not actually make it go away. And also when we're trying to numb emotions that are unpleasant, we end up numbing joy too. we are actually lowering over time our dopamine, which is that feel good pleasure neurotransmitter. And so we need novelty. And that's how it's hooking you is it's every 30 seconds there's another little video and it's novel.

And so if I'm getting these little [00:27:00] tiny burst of dopamine, but then , I'm also numbing at the same time. And so what we end up with is we get done and you know how you, like, how do you all feel after you look up and you have been on your phone for 45 minutes looking at videos of whatever. How do you feel, 

blah.

Yeah, never. Good. And the other thing that you mentioned I have noticed and has made me just Ooh, I hate it, is if I do that, I feel so much more irritable after the fact. It definitely does not fix feeling irritable. It exacerbates. My mood, especially when it's irritability. Why is that? 

Again 

so the irritability was there or we're feeling frustrated, we're feeling tapped out, we're feeling exhausted. And so , what I'm gonna do then to make myself feel better is I'm gonna sit in one place. I'm gonna hold something small in my hand and stare at it for 45 minutes. [00:28:00] And if you think about that, you're laughing because it's I know this is true.

I'm laughing 'cause I've done it. Oh, I've done it too. There, they're, they've, they know this. Yeah, this is done. We can be paranoid about this one. They really do. They wanna sell us something and keep us on, you know, it all, it all boils down to money. So realizing what is happening in my brain is not good.

What has happened is you have not actually experienced your life for those 45 minutes. You have viewed something and you have not experienced your own life. And the only way we can process emotion is through experiencing that emotion.

And one of the reasons why we're seeing such a rise in children and mental health issues, is children are observing and viewing things without actually experiencing life. And [00:29:00] so when I am frustrated and I am so tired, and then I'm like, all right, I wanna pick up my phone and numb, but I'm not gonna do that.

I'm gonna go lift weights for 15 minutes and maybe I'm gonna listen to a fun podcast, or I'm gonna listen to this music or just have some blessed golden silence. You are experiencing that you are in your body, you are feeling that is helping you process emotion. Even if you're not thinking about the thing that's got you so stressed out.

You are in your own life and in your body, or maybe you go talk to somebody, you mean you go find your spouse or a friend and talk it through. You are in your life experiencing it. And so then that emotion has a chance to process. Otherwise it's in your tissues, , you've got issues in our tissues and then it's in our body and then we just feel yuck.

I can remember when I was growing up, we understood children need to go outside and play. And if they were acting up, then they just need to get outside and play. They need [00:30:00] something to eat, they need a nap, they need to go outside and play and. we are still those same human beings.

A lot of times. We need to get outside and play. We need to move our bodies. We need perhaps to take a nap or to have something to eat. I even found 

satisfaction the other day in pulling weeds. Love it. I was shocked. I was like, oh yeah. I got out there. I was pulling until that trash can was totally full.

Yeah. Half 

weeks. 

Then I felt better. Yeah. You were working out the issues in your tissues. You think about it, that feels good. Jerking them up and getting something done. 'cause so much of a woman's life, it's never done. There was always more laundry to do. There's always another meal to cook.

There's always another project at work. Was there a 

secret sauce to women decades ago that did a lot of hand work? Like my grandmother did a lot of quilting or knitting or those type. Behaviors that are pretty much gone, that we don't [00:31:00] do as women or very few women do that 'cause we're on our phone.

Is that better for our brains than a phone? As a distraction? 

Almost anything is better for your brain than a phone. We, let's just go ahead. Other than like perhaps shooting up heroin and almost anything is better than staring at your phone. Anything that you are doing where you are actually experiencing, you're not watching someone decorate a cake.

I love to watch cake decorating videos. I don't like to decorate cakes, but I've, it's terrible. I'll look up and I'll spend 10 minutes watching cake decorating videos. But I didn't actually experience, I didn't smell that cake. I didn't taste that cake. I didn't bake that cake. I don't get to eat that cake.

I just watched someone else have an experience. So you could watch videos of someone knitting or you could knit and then you're actually experiencing it. And in fact, it is mindful. Okay? So mindfulness is not just sitting quietly in the [00:32:00] lotus position and saying um, mindfulness is using our five senses to bring ourselves back into the body, into our present day life.

We're warm, we're fed, we're dry, we're okay. Okay? And most of the time, and so realizing, yeah, when I actually am doing something, I am not watching a video about pulling weeds. I'm out there pulling weeds. That's why I think for some women we can look up and a lot of our life is watching our children do interesting things, not us doing interesting things.

So we are like always in the stands watching them do things. And while, yes, I, it's wonderful to watch your children do things. I do think the balance is getting off to where now children have so much that they're doing and parents are spending so much time watching what their children are doing and they're not having enough experiences of their own.

And so just being aware [00:33:00] of that. 'cause that's kinda what we're swimming in right now, is this culture of we need to be at every practice, we need to be at every game. We need to just watch our children have experiences. I was 

just talking to a friend about that while watching my child play softball the other day.

. You came on and talked to us about. Overscheduling as women and how to identify just the fact that you've overscheduled yourself and your children and you're doing all of that versus having anxiety. One thing I worry about , I think it also can go on the flip side where you can just say, oh, all of this is hormones and perimenopause, and maybe ignore the fact that you still need to address these other things.

The over scheduling your, personal time and all the things that you taught us on your last time here. Any tips for how women cannot just write everything off to perimenopause and menopause? 

 notice, okay, these are my [00:34:00] responsibilities, and we can just look at our calendars and see what our responsibilities are.

And then you do some experimenting. when I work with clients, , a lot of times I'll say, would you be willing to do an experiment? Would you be willing to experiment with this and say, okay, this is a responsibility I've taken on, I'm gonna experiment with maybe stepping back from that position and then I'm gonna notice, 'cause I'm tracking what is my mood like now?

Am I less irritable? Can I concentrate better? Am I sleeping better? Then we know, okay, this is schedule related. Or if it doesn't change, maybe that it's hormone related. It's honestly, for most women, it's probably a little bit of both. Particularly once they're in their forties and fifties and whatnot.

But just experimenting with when you do work with that schedule and I think, kitty first, being able to say and give ourselves permission, I am allowed to work with my schedule. I am allowed to, like everything [00:35:00] that's on my plate right now, I don't have to say yes to all of those things, and that can induce a lot of guilt in women.

I find that having ovaries and feeling guilty kind of go hand in hand. And so even after those ovaries quit making eggs. Yes. Yes. Although, I will say, this is so interesting. One of the things that , menopausal women will report is a lessening. Of first of all, concern what other people think. And then as well just that guilt, that obligation I have to do this or I'll feel guilty.

And that can be I don't know if you all have seen on social media that we don't care club. 

Yeah. 

I've seen that with Meno, with perimenopause and I made my own little video about that, talking about i, I going to the gym and I don't care that I don't have a cute little ponytail.

, I pull my hair back in a headband that I used to wash my face at night. I don't care that, [00:36:00] whatever. And so that can be really freeing for women who have struggled for so long with feeling like I do so much out of trying to avoid feeling guilty. And that's another thing you can work with a therapist on is.

Is guilt 'cause guilt is a harsh task master and you can work on having a healthier relationship with that. 

If you are someone that's struggling with this, remember you can have perimenopause and you can have other things going on. So if you are struggling and you seek care for the perimenopause side of things or menopause side of things, remember you also can have other things going on mm-hmm. or anxiety and still need to address that too. Mm-hmm. Don't blame everything on on it.

I do feel like at least women. Once they have stopped having periods and they're like, oh, I've hit menopause. I need to go talk to my doctor about this and figure out where to go. But I feel like , for women in perimenopause that are just now starting to notice some of these mood symptoms, it is [00:37:00] really complex on who to see and what treatment is gonna be beneficial for them depending on where they are in different stages of this.

What are some pieces of advice that you have for women trying to tease this out? Because I feel like a lot of times they don't even wanna bring it up because they're afraid they're bringing it up to the wrong person, and then they're just gonna have the door shut in their face again. 

Yeah. And Sarah, I'm so glad you asked about that because it's.

Oftentimes there's such patchwork care, like this doctor says this and this person says this. And I know in my own journey and empower your pause, I very briefly just share about that. And I think it's so important as women that we do share our own journeys so that we can help normalize it for women.

I just didn't understand perimenopause and so I waited until I, had been a year without a period before I ever sought help with getting hormone replacement [00:38:00] therapy. And I can look back and in that perimenopausal time, I was on an antidepressant a couple of times and I look back and I really probably needed to be on HRT.

 I don't think I necessarily needed to be on an anti. Now I have had one episode of . Depression where I really I did need to be on an antidepressant and sometimes you need to be on both, but realizing, okay, I wish I'd had care then, but who would I even have talked to?

Because so many OB-GYNs, which is typically who women are talking to because of the Women's Health Initiative study, they weren't over the last 15, 20 years, they haven't been trained in how to administer hormones. 

Yeah. And that's something that kitty and I talk about as primary care providers. When we received our training, it was left out.

Yeah. And so now we do not talk about it at all. So now we're like trying to go backwards and be like, oh, I need a, I need this education so bad. Yeah. And it does present a challenge for women 

and depending on who you go see, [00:39:00] they're going to offer you what they have to offer you.

So if you go and see a psychiatrist or a psychiatric provider a prescriber, they're gonna offer you probably an SSRI. A selective serotonin reuptake inhibitor, which is typically what they would prescribe first for anxiety or depression, maybe an SNRI. If that doesn't work , 'cause that's what they do and that's what they know.

But if this is hormonal, that may help some, but it is not gonna take care of everything. And I can tell you that as somebody who experienced that. And then if you go see somebody who does hormones, they may offer the hormones again. And if you go see like a therapist, they don't prescribe.

So they're gonna offer the therapy. If you go see a nutritionist, they're gonna talk nutritionist. One of the things that I hope will happen as we have more education about this is that we do have a more holistic approach to treatment because this needs what we call, it's a big [00:40:00] old mouthful, a bio-psychosocial approach, mind, body, soul, like we are.

We are looking at this woman as a total person and not just, we're gonna give you this and then we're not gonna check in on anything else that's going on with you. And we just don't have that right now. What we have are unfortunately as very patchwork and in my own journey,, some of the best advice I got was from the lady who injects my Botox into my wrinkles because she is a family nurse practitioner who knows a lot about women's health and knows a lot about hormones and was already doing hormone replacement therapy herself.

And I was in there. She was talking to me about, we consult with one another. Like I'm help, like she's getting like a little therapy stuff from me. And then I'm like tell me about this. And she's the one that was like, oh, it sounds like you're not able to absorb enough of these hormones through your skin.

Have you [00:41:00] considered pellets? And then she referred me to somebody else and I'm like, this is crazy. Like my doctor that I went to go see who I loved my OB, GYN, but she told me I don't, I said I wanna have my testosterone level checked. And she said, we don't do that. And so I had to go back to my primary care provider to get my testosterone level checked.

She told me, now I'm not gonna manage any of this. I will test it 'cause you're asking me to, but I'm not gonna manage any of it. Then I go back to my OB, GYN, I said, okay, I'd have my testosterone level checked. It's at a three. So it's no wonder I have no interest in sex. Nothing on my body is responding sexually.

Everything's, it's like dead. Everything's dead. I'm all the things. And then she's we don't prescribe testosterone. I was like, I need you to prescribe me some testosterone cream because I am at this point. She's okay. And then, but again, through all of this, nobody was testing my hormone levels.

Yeah. And then finally, while getting [00:42:00] my Botox, I find out, oh, here's a provider that could, and now every three months I get my hormone levels checked. They monitor that. They adjust the dosage based on that, but that it shouldn't be that difficult. And I could only do that because I have the time and the money to make all these different appointments, and I have insurance and I can go around and do all of this.

It's a lot of time and a lot of wasted time. So I hope that we will be able to have. More cohesive care for women where they don't have to have it be so patchwork. 

Yeah. And I do feel like that is a big fault right now for women trying to get all the different pieces. 'cause even, I know Kitty and I have experienced, some women may be able to get their hormone replacement, but then they're not getting some of the lifestyle things that, we're always talking about.

And it's I need it all. It'd be great if it's in one place. So 

we're 

hoping, 

you're making me imagine something great. I know. See if we can build it. I like being 

creative,

I like that [00:43:00] you brought up, the fact that we as physicians, or at least the ones around, my age, we were not trained in what perimenopause 

and neither was I, as a therapist.

I had no training in any of that. 

And so looking back now that. I am experiencing some of these symptoms myself and have just read and learned about this. I had quite a few women come to me in this time of their life thinking they had new onset ADD In hindsight, I think they were experiencing this brain fog that can happen.

Yes. Can you tell us a little bit more about what's happening there? 

Yeah. You just summarized it. That's it. There we go. It's like all of a sudden, okay, I can't concentrate. I used to be able to read, I used to be able to retain information and now I can't. I'm having trouble paying attention and I think maybe I've been ADD and I just never knew it, a true [00:44:00] ADHD evaluation.

We do go back it. You're born with it. when I was a little girl, I could have won an award for sitting still. So there was no way I was born with ADHD, but I get it how when you're going through this zone of chaos, you can feel like this must be what this is. And so retrospectively if you were in school and you could attend and you could concentrate and you weren't called a daydreamer and .

Really that has not been an issue for you. It is much more likely that what is going on is something hormonal. And again, sleep, our ability to concentrate and focus is really affected by sleep. Our nervous system repairs itself while you're asleep, when you're not getting good sleep. The whole system just does not work as smoothly,, And so that is another factor as well. And not that there aren't people that I do have clients, and typically it is when their [00:45:00] child is being evaluated for ADHD and as their child is being evaluated and they're filling out the questionnaires, they're like, oh my goodness.

, 

I'm reflecting on this. I had more than one. Patient, all of their kids were being evaluated. I hadn't put that part into it, but yeah, I guess as they were going through the list and they were like, yeah, I have all of those same problems. 

And the issue when I'm talking with people and diagnosing is, did you have these when you were young?

If you did not have them when you were young? And I will say 100% of people who really do have ADHD will be like yeah. And sometimes with girls in particular, it's not so much that , they were like hyperactive and intrusive climbing the mini blinds. They may have been more of a daydreamer, and so that can get under the radar, but they'll be able to say, oh, yeah, that was the struggle in school.

But if they're like no I never experienced any of this until I turned [00:46:00] 45. That's not ADHD most likely. But sometimes that is when someone who has undiagnosed ADHD, that is when they discover it, is when their child is diagnosed and they come in and they're like, oh my goodness.

And usually they're heartbroken because they realize they never got any help when they were a kid and they really could have used it when they were a kid. 

 And then I'll also circle this back too, because one of our most common coping mechanisms is our phone. It only exacerbates the concentration issues as well.

So it's not only are hormones against us,

and one of the things that is so important to remember is that you are decreasing your frustration tolerance when you numb out on your phone. . We need to build our tolerance to be able like, oh, I'm feeling a distressing emotion.

I can feel that it'll pass. There are things I can do to help myself as I process this. But if we're constantly numbing ourselves and checking out every time we [00:47:00] feel something distressing, you are decreasing your tolerance for that distress. So that next time you gotta be on your phone 20 minutes, and now you gotta be on your phone 30 minutes, and now you gotta be on your phone 10 times a day.

It's the same process with drinking or using drugs. You build up a tolerance. But in this case, we are building up intolerance to frustration. Frustration is actually good for us. Boredom is good for us. that's how we build resiliency. So thinking about when we're feeling like, Ooh, I wanna reach for my phone and numb out realize me rejecting my phone, putting it down and going and doing something else is helping me build my frustration tolerance.

I would say 

the good news is too, is from my research, and I'll see if this is your experience as well, is that the brain fog does improve. It's worse in that perimenopause [00:48:00] stage, but then most studies show that it goes back to your cognitive baseline. 

Yeah. Your brain menopause, your brain adjusts to the different hormone levels, whether you're on HRT or you're not.

But let's say you're, you decide not to do HRT. Typically within four years, sometimes it's longer. For African American women, it is typically longer than it takes. I'm not sure why, but that's just one of the things that research suggests is that African American women experience sometimes more severely in that time period where your brain is adjusting to the different hormone levels that it can take a little longer in African American women.

So that's important to know when we're providing care for people, that we don't put an expectation well, most of my friends were through this in two years and they felt normal again. Why are you, , acting this way or being dramatic or whatever and realize for different people with different DNA and whatnot, it may take longer for the brain to fully [00:49:00] adjust to the new hormone levels.

And yeah, you get your brain back, it's a different brain, oftentimes for women, it's interesting, this is when happiness goes up, when you look at the research, some of the happiest people in the world are women that are post-menopausal. Wow. 

Oh, that's exciting. 

Yes. There's something to 

positive to look for, to, 

yeah.

On the other side of it really is the rollercoaster ends. Yeah. And things stabilize and you don't care as much anymore what people think, which is wonderfully freeing. And particularly if you can, keep doing those healthy lifestyle things that you all talk about and you're enjoying now this new level of freedom yeah.

In the way you think and can still. Like we're getting, my husband and I were leaving in a couple of weeks to go to Yosemite for two weeks and have a big RV camping trip and go hiking and do all of the things. And I love it 'cause there's nobody, your children at [00:50:00] home and it can be a really it exciting, fun time of life.

So I'm hearing from you when you're thinking about treatment, if you are struggling with mood issues during this time, that for some people hormone replacement therapy could be helpful. And for some people, antidepressants might be helpful for some people both. Might be helpful. Is there any way to tease that out or just , seeing a provider to talk about all of those things or there, or anything you can recognize in yourself to know where to start with that? 

 I will say currently in the United Kingdom, the standard of care when a woman who is in the perimenopausal age range, so a woman in her forties or fifties, and she is reporting for pretty much the first time depression or anxiety, the standard of care now is HRT.

It is not an SSRI that is different than in the United States. In the United States. What you will typically get [00:51:00] is we will put her on an SSRI and we will hopefully recommend that she see a therapist. And that's, one of the things about having socialized medicine as they can track things better.

And what they have found is that it. It is very effective in the treatment of depression and anxiety. HRT is assuming a woman can take our HRT. So I would encourage women , particularly if they don't have a long history of dealing with depression and anxiety, so like teenagers, like women that can go back and say, oh yeah, I've struggled with this my whole life.

That doesn't mean that HRT still wouldn't be helpful for them, but if this is new to you, I would encourage you to really explore the HRT first because you're replacing things that your body just naturally made anyway, and there are not the side effects that you might have with a psychiatric medication.

And so one of the things that an SSRI does and I enjoyed this effect when I was struggling with [00:52:00] unpleasant emotions, is it numbs you. And that can feel really good when life feels really overwhelming, not numbing and like, , I'm spaced out. But what people will report is, I can't cry very easily anymore.

It's like you would feel the urge to cry and then it's almost like something just pushed it down. Which can be a real blessing when you're really dealing with tremendous sadness and whatnot. Or suicidal thoughts, something like that. But it also like numbs your genitals. So if you are interested in an active, vibrant sex life, that can really be an issue.

And it can also, they can contribute to weight gain. So they're very, they're useful. We need to see this as the, there's a tool here, but for every woman to be aware that right now the state of medicine in the United States is that unless you are going to see someone who is very well trained in menopause and perimenopause care, probably not gonna get the whole picture.

And you may actually know more than your prescriber does. [00:53:00] Right now you may have educated yourself more. And I would just say that's why this kind of stuff like we're doing today is so important so that we can educate ourselves and be confident to be able to go into a provider and say, I wanna talk about a lot of things and I wanna try some different things and see what happens for me.

So let's say someone goes and starts menopausal hormone therapy and then starts having new mood symptoms. Are there things that tend to happen if, let's say you're getting too much estrogen or too much progesterone, or too 

much testosterone? Yeah. And I'm not a prescriber, so let me just say that again.

I would say I'm a feeling s doctor, so if you're having a heart attack and you fall on the floor, I can ask you how you feel about having a heart attack, but I'm not gonna be much help otherwise. So think, yes, and I know like when I started doing pellets, [00:54:00] my testosterone level got too high and I started losing a little bit of hair on the top of my head and I was incredibly angry for about a month and every day had to have a little talk with myself, like be just, I just really tried to not speak a lot because I could tell I was so angry and it had just gotten too high.

And in fact, that's what , my test results showed. So we had to work on that and sometimes when you start HRT, you may experience breast tenderness. It's if you are like on your period again, so are things leading up some PMS type symptoms? And it is a, it's a bit of a moving target, so sometimes they'll get you, okay, this is a nice balance, but then over time you need that adjusted again.

So yeah, there, there can be symptoms associated with that too. As my prescriber says when I come in and I'm like, okay, now I have a little bit of this and she's I can't [00:55:00] make it perfect. I can do my best, but I can't make it perfect. And I still have uterus, so I have to take progesterone.

And I do bleed now sometimes. Which I don't. Again, I am definitely gonna be eye now tampons with my social security benefits because I'm still bleeding. But that is, that's not always pleasant. But I'm trying to balance that out with, I love having a sex drive. I love having a body that is very sexually responsive.

So we can't make it exactly like it was when you were 32 years old, but you are gonna have to hopefully with a good provider, figure out, okay, this is what's working for me. This is, and I'm willing to pay the cost if there are some side effects that go along with that. 

And I think that's also something that many people in their younger life, if they were on birth control and they had.

Big mood changes when they're on birth control makes them more [00:56:00] fearful of HRT. And I think some of that is understanding that using lower doses at this time of life than maybe what you had on birth control as well as knowing it's gonna take some time to get the correct dosing for you and trying to get through that can get you to where you wanna be, but it may not be perfect from the beginning.

Exactly. And I go to Orange Theory supposedly three times a week and work out hard. And if your metabolism is boosted you're gonna a lot of times get through like the pellets. , You're gonna metabolize 'em more quickly. So depending on weight gain, weight loss, exercise level, stress level, that can change how your body is metabolizing.

HRT, whether that's a cream or a patch or a pellet or whatever it might be. So we're. We are we have to be flexible and we have to have a sense of humor, which is why one of the things that I hope will happen maybe out of, I know you all are getting excited about just thinking big about [00:57:00] what can we do as a community here.

I'm the same way. That's one of the reasons why we created Empower Your Pause Interactive educational groups have been shown to be very helpful for women in the management of perimenopause. Being in a group with another group of women that are going through this, getting some education and then sharing about what they're experiencing really helps women with this, and I don't know of anything like that do you?

Nope. No. Yeah.

How do we create that community? Or especially if you're someone going through this and you don't feel like your friends are talking about it yet, like how do women 

create that support network? You know what? You open your mouth and you start talking about it. You be that woman. I have this memory from when I was really, I was maybe in second grade and my mom was in the car and I was with my mom and we were with a bunch of other families and I think we were like at a dairy queen 'cause everybody was outside getting ice cream.

And it was just me and my [00:58:00] mom in the car. And then one of the other mothers came and got in the car and she said to my mom, oh my goodness, I think I'm having some menopausal, sometimes something about menopause. 'cause she was older than my mom. And I just immediately said, I'm gonna go see what everybody's ordering for ice cream, and I just jumped out of the car because I just had this sense of this, oh my gosh, we don't talk about this. This is the change, right? This is, and that literally was the only time I ever remember anything to do with that. In my whole life and how wonderful it would be if when we're educating our daughters about reproduction or birth control or their period that we just naturally start talking about this and it just becomes something that women, not just women who are in it talk about, but that we as a whole, it's just part [00:59:00] of a woman's health.

And yeah, I'm gonna tell you about getting your period and I'm gonna talk to you about perimenopause and then I'm gonna talk to you about menopause and then I'm gonna talk about post menopause when life really, it's good post menopause. 

No I'm a firm believer in that and that's I being open about things and having discussions and just.

Asking and bringing it up. 'cause more than likely your friend wants to talk about it. Mm-hmm. Right. Or is experiencing it and questioning it. And so just having these conversations can be very powerful in uplifting and not feeling alone. 'cause when you're dealing with changes in your mood, you already are, having feelings of loneliness a lot of times.

And so we should just have this conversation more often. So women do not feel like they're in this by themself. 

Yeah. 'cause we feel lonely, we feel ashamed. Yeah. And so we just are like, we hide what we're ashamed of. And there is no need to be ashamed here. This is [01:00:00] not your fault. these are powerful forces that are acting inside of you.

, That's why I think interactive support groups where we're talking about it are so powerful because it does normalize it. And I don't feel so alone anymore and so ashamed because you know what? You get on your broom too. 

 And do you have any advice for those of us that are getting on our broom how we can get our partners to best understand and support or, let them know that we're on our broom?

Katie, it's so interesting you asked that because as I was prepping for this interview, I just kept, I was thinking about a male client that I saw yesterday and his wife is going through, she's 50 and so she's really going through it. And he was like, she's really irritable. It's just like even our children are coming to me like, boy, mom's really snappy.

And he goes, I really don't know anything about this. And the, our tendency is to wanna like judge and [01:01:00] say, what's wrong with her? Her character's not good. She should be doing better than this. And I just was listening to him and I was thinking, oh, we need an education group for the husbands and just and the support people in their life, right?

The people that don't understand this. And so I do think that would be, I think a part of this is if we just educate women, we are missing out on a really important opportunity to educate men. About this and how they can support their spouse and, how they can understand what's going on.

And because men, you've probably heard of something called the patriarchy. Men tend to have a lot of power and political influence and money so that we can direct funds and we can direct energy towards managing and treating and educating and helping support families through this. 

Yeah.

And also because if the kids are avoiding you, then your husband's gonna have to deal with getting all the [01:02:00] questions which they're used to. 

Oh, yeah. And we, again, we can have a sense of humor about it so that we can come back. The successful relationships are not based on the absence of conflict.

Successful relationships are based on repair. Can you make a repair after? You snap at people. And so when people understand, oh, okay, mom is going through a tough time right now and a few days outta the month she's irritable. And then to be able to say to them, Hey guys, I'm gonna give you a heads up.

I'm, this is where I'm at right now and I apologize. Can we all help me? Just I'm gonna need to do less. I'm gonna need y'all to do more over the next few days and then apologize. And then that way we normalize it. Like we don't have to pretend like none of this is happening and mom is exactly the same.

We wouldn't do that if mom broke her leg. [01:03:00] We would acknowledge that. But this is something where we have so much shame about it. We don't talk to anybody and tell anybody in our family what's going on. 

That's a really good point. I love that analogy. We would not try to hide a broken foot. And try to.

Walk on it without it healing and wearing a boot or using crutches, et cetera. So why are we not talking about this? so for all of our listeners, let's put the shame away. Yes. Let's put the shame away and let's talk. 

Yeah, I think that's, I won't summarize all the details of everything you taught us today, but I think the overarching theme is we need to talk about it.

We need to be self-aware, and that may involve doing specific tracking, but being able to just recognize your symptoms when you're having them. Be able to talk to friends, be able to talk to your family about it, and then be able to talk to your providers about it to make sure you're getting the care that you need and not being embarrassed if you try something and it doesn't work [01:04:00] or, you try something that's not working enough or new symptoms emerge.

And just being able to be comfortable. With that. 

Yeah. Being really patient with this process and patient with yourself and keeping that sense of humor. Can you tell our listeners how they might hear more from you? So they can go to my website and Jennifer ler, D-E-G-L-E-R, Jenniferdegler.com.

If they're interested in Empower Your Pause, I think you're gonna put a link in your show notes to if they happen to be listening to this before November 1st, 2025 possibly to be able to be part of the live audience at Empower Your Pause, which will be at Taste Creek Presbyterian Church or part of the live webinar audience.

So women all over the world can be a part of that. And then we also have the recordings where you can access the recordings up on Thinkific, and I think you've provided all the links to that in the show [01:05:00] notes. I'm excited, girls. I'm excited. I we need to like, keep working on this and just come up with something for our community.

my wheels are turning. Yes. Yes, my wheels are turning. Hopefully you all enjoyed today and if you learn something from Dr. Degler today, we also did a show earlier this year so you can go back and listen to her show, especially if you are struggling with the stress and life management and the anxiety portion.

She has lots of tips that she gave in that show as well. And we look forward to next week. We are really going to tackle perimenopause next week with Dr. Elizabeth Elkinson, who is a menopause certified physician here in Lexington. So we're really excited to hear from her about that specific topic.

And we're gonna continue the theme of this month, really trying to bring education about perimenopause and menopause to our listeners. So keep tuning in. We have lots more to come. See you next time.