The hormonal fluctuations of perimenopause can impact our brain and nervous system, leading to brain fog, mood swings, insomnia and other cognitive changes. 

In this episode, we are joined by women’s health expert, naturopath and nutritionist, Georgia Marion to shed light on why perimenopause can impact our brain health. 

Perimenopause is the phase leading up to menopause, and this transitionary period can last up to a decade for some women. During this time, many women will report issues with brain fog, mood, memory and concentration changes, and difficulty sleeping. Whilst hormonal fluctuations play a significant role in these symptoms, as you will discover there are many other elements at play, including diet, lifestyle, nutritional deficiencies and liver function. 

Key Take Aways

• Perimenopause is the lead-up phase to menopause, and can last up to ten years.
• Symptoms many perimenopause women experience include brain fog, mood changes, and difficulty sleeping.
• Hormonal changes, particularly in oestrogen and progesterone levels, contribute to cognitive and mood changes during perimenopause.
• Other factors that can influence symptoms include stress, age, nutrient deficiencies, and liver function.
• Addressing these underlying factors can help improve women's quality of life as they move through the perimenopause phase.

Episode Timestamps

[00:00] Introducing Georgia Marrion

[01:38] Defining perimenopause

[03:58] How perimenopause influences our brain and neurological function

[06:43] The cognitive and mood changes experienced in perimenopause

[11:25] The oestrogen - brain interplay

[15:11] The stress, progesterone and brain overlap

[18:02] How nutrient status influences perimenopause

[22:21] The importance of liver and gut health in perimenopause

[26:03] You feel rubbish, but your blood tests are ‘normal’

[31:58] How we can naturally support the perimenopausal woman

Episode Transcript

0:00:00 - (Bec): Today we want to talk about perimenopause and why this particular phase in women's life cycles can result in things like brain fog, mood changes, and what actually is happening in the brain when this is occurring? 

I have invited along my friend Georgia Marrion. Now, Georgia is a naturopath and a nutritionist with over 17 years of experience working with women for their healthcare needs. She has completed postgraduate training in women's health with Dr. Andrew Orr, and is part of an expert health group specialising in PCOS, endometriosis and fertility.

Georgia's areas of expertise include fertility, conception, postpartum care, and women's hormonal health. Georgia works with patients every day through the work she does in clinical practice with the Fertile Ground Health Group. She supports women's well-being, both physical, mental and emotional, using techniques that are both backed in traditional medicine and grounded in scientific knowledge. Now, this is a topic that I know Georgia has a lot of expertise and knowledge to share, so I'm very pleased to welcome her to chat to us today.

All right, thanks so much for joining me for this chat, Georgia. I can tell you right now that this is a topic that actually we polled our community and they really wanted to know about. And that is, you know the changes, the hormonal influences on brain health. And one of the most profound ways that this happens, obviously, is in perimenopause. 

(Georgia): That’s right. 

(Bec): But for those who don't know what perimenopause is, let's start there.

0:01:38 - (Georgia): Let's start there. So really when we're talking about perimenopause, and I'm really happy that it's having more of a moment, if you like, in general media, it's not just hidden away in a corner as something not to be discussed. But perimenopause is the lead-up to when menopause occurs. So menopause is when there's been a complete cessation of menstrual periods for twelve consecutive months. And so perimenopause is the lead-up phase to that which can last up to ten years.

(Bec): Yep.

(Georgia): And some women will just all of a sudden realise they haven't had a period for twelve months and where other women are feeling every month of those ten years. So it can be quite varied with regards to the types and range of symptoms that women can experience. And this obviously includes brain-related symptoms. So particularly when we're talking about cognitive function and psychological here, I think.

(Bec): Yeah. A lot of people just think, oh, the only problem women face in menopause is like hot flushes. And it's a bit of a castaway comment, like I'm having a menopausal flush. But actually, when you dig deeper and you are speaking to women, sleep problems, brain fog, concentration, these are some really big issues and they affect us both physically and mental- emotionally.

(Georgia): Absolutely they do. And I think to a certain degree, a lot of these symptoms that we're talking about and we're going to go into a bit more detail are so normalised to being a woman in ‘modern world’. With or without kids juggling a lot of things. It's just become really normal to have things like brain fog or difficulty sleeping and mood changes. But a lot of the time, and this is the thing is that a lot of the time women are experiencing these types of symptoms and not really realising it's to do with the life phase they're in. Which is, just to be clear, it's not a pathology, it's a normal life phase. But there are certainly a lot of factors that will influence the severity of what women are experiencing during this. Which can to a certain degree be really managed and improved if it's affecting women's quality of life.

0:03:58 - (Bec): Yeah, absolutely. So I think one of the biggest factors is that there are changes that happen during perimenopause that impact our brain and neurological function and health. So let's get right into talking about exactly what that is.

(Georgia): Yeah, so when we're talking about the brain changes that occur during perimenopause, obviously this is a really big topic and we could just go on and on and on, but we won't. But essentially we're talking about… I'll do my best. 

So let's talk about what it looks like in terms of what women are experiencing and what they're feeling. So when we're talking about cognitive changes, we're talking about things like difficulty remembering words, when you haven't had like… these are things that might feel like you've never really experienced them before and all of a sudden they're happening. So having trouble remembering words or people's names or numbers or going to another part of the house and completely forgetting what you went there for, that type of thing. Right and, 100%. I've been there too. Things like cognitive processing speed, like just feeling like it takes you longer to figure something out than previously. 

And then there's, I guess, less scientific but well-understood brain fog in terms of just feeling like you're a bit more forgetful. And they're just not as across all the many tabs we have open in our brain as an average female compared to five years ago, for example.

And obviously, as with anything with health and particularly when we're talking about hormones, there is a range of severity from quite severe to very mild and everything in between and this pertains to these types of symptoms as well. And then I guess the other main area that we're talking about is mood. And I guess this is where some of the, I guess, general media might be characterising perimenopause along with hot flushes is the mood changes that can occur so it can be irritability anxiety to the other end of the scale. And this is probably a discussion for another day where we're talking about more depression which is a pathology, which I guess warrants a different discussion. And again, with these mood changes, there can be significant variability from in terms of the severity and the type that women are experiencing to do with these. 

Regardless, I think it's important to point out that regardless of where a woman might be sitting on that spectrum we talked about of mild to severe that can still have a really considerable impact on women's day-to-day activities and in some cases their long-term quality of life. So I think it's important not to pathologise them. Pathologise, but also to recognise that they are some things that can really have an impact on women.

0:06:43 - (Bec): Yeah, absolutely and I mean, obviously this is an area that you see have some specialty in in your clinical practice but I think when you're speaking with women who are going through this like, up to decade-long phase, there's this progressive inability almost to just cope with the everyday demands that life is throwing at you. It's like a systematic degradation of your coping skills which has probably got a little bit more to do with kind of the overlap of how stress influences the brain and also the interplay with oestrogen. Would you agree?

(Georgia): Yeah, absolutely. I think it's a combination of the physiology and what's happening in our lives what I mean by what's happening in our lives which are then, you know, to a degree affecting our epigenetics which is then affecting, again, our physiology. So it's a bit of a cycle like that analogy that's been going on for years and years in terms of our genetics is like the gun and lifestyle or everything around it is like the trigger, do you know what I mean? And it's a little bit like that with this as well. 

So I guess when we're talking about prevalence and if you consider that across the world at any time, there's about 1.5million women that are going through in that stage of perimenopause at any time. And even if you're taking into account that a certain proportion of those women are not experiencing any symptoms at all or anything that they're noticing, that's still a really large proportion of women that are experiencing a lot of these symptoms, including the ones we're really talking about today. 

And that this is really speaking to when we're talking about obviously the cognitive and psychological symptoms, obviously the brain changes that are occurring. Because obviously, as we said, a lot of other factors that are modifiable will influence this. But at the end of the day, there's an underlying factor that factors that are making this happen in the first place.

(Bec): So let's go through them. What are some of the underlying factors at play? What is influencing the outcome of these symptoms that people are experiencing?

(Georgia): Yeah, so I think, again it needs to be highlighted that there are a lot of factors that can contribute to cognitive function and to mood. It's not a simple topic. But in a lot of women entering.. going through perimenopause it's a normal physiological process. So I think it needs to be emphasised that it's not necessarily a pathology state and I think that sometimes where the language has been around perimenopause is it's a disease that needs to be not spoken about or just medicated and just go away, please.

(Bec): Yeah, yeah controlled. Controlled. I understand. Yeah.

(Georgia): Yeah, that's right but I mean, it's not a pathology state, but it certainly can be a situation where a lot of the factors and causes which we're about to go into that are contributing to it, contributing to the severity of it, can certainly be modulated and managed. 

So let's talk about some of the main ones. Obviously hormones, such an interesting topic, we could go on and on and on about this. Well, I could, but essentially one of the big underlying causes of these cognitive difficulties is really attributed to what's happening with your main sex steroid hormones during perimenopause? 

So I think it's pretty well understood that what is happening during perimenopause is your two main actors, if you like. So your oestrogen and progesterone, they're going from having a fairly depending upon if there's been any particular reproductive issues present prior, but generally they've been going along their way of their cycle. Do you know, fairly predictable if you look at someone's cycle over a period of years. But what's happening over this period of time is all of a sudden they're fluctuating, they're all a bit all over the shop and again, how much they fluctuate and the impact of that on an individual woman will vary. 

(Bec): Yes. 

(Georgia): But when we're talking about well, what does that matter in relation to brain? I guess we really need to be thinking about prior to perimenopause, what are oestrogen progesterone actually doing with brain health? Like, why are they important to then really understand? Well, this is why then the symptoms can often occur. Right? 

So what we're talking about broadly speaking, with oestrogen, oestrogen can sometimes have a bit of a bad name but it's really important for health like hormones, it's all about not too much, not too little and the activity that they're having in the body. So it has a role, particularly with brain health, to do with protecting your neurons or your nerve cells, if you like. It helps them grow, it protects them from damage or injury, if you like.

0:11:25 - (Bec): I always think of oestrogen as that hormone that keeps things supple. So we see a decline in it and you can see it outwardly as well as inwardly. You'll get a decline in skin texture and skin elasticity. Well, that is happening on the outside, but it's also happening on the inside both in the brain, nervous system, the gut, the urogenital tract, like kind of everywhere as the oestrogen starts to dwindle down. 

(Georgia): Yeah, that's right. And so that's like, one of the other things it does with regards to your nerve cells is plasticity, which is a really nice lead into that. 

Obviously, and when we're talking about protecting neurons from injury, many things can affect it, but two of the big ones that we're always talking about is oxidative stress and inflammation in the brain and obviously all around the body, but particularly in the brain we're talking about today. Oestrogen has a lot to do with the engines, if you like, inside your cells, like your mitochondria, and so their function and therefore how energy is produced. And we all know that the brain uses glucose. It needs glucose which comes from your carbohydrates. So how that's metabolised? Like oestrogen has a role to play with that. 

And then as an extension of that, it has a role to play in brain insulin sensitivity, which is like insulin is like what unlocks, if you like, your cells, so the glucose can get inside them, so the mitochondria can use it to then produce energy. Right? 

And then we're talking about from a hormonal point of view, oestrogens have a role to play in terms of slowing down or suppressing the breakdown of things like your serotonin and your dopamine, right? Which I guess are your feel-good type of hormone. So you can already see, even if you're just talking about oestrogen and you're not taking anything into account, how you can see how fluctuations and how this gradually declines is already going to have a big impact on your cognitive function. Because you're talking about energy and you're talking in terms of energy that your cells need in your brain to be able to do what they need to do.

(Bec): Yeah. 

(Georgia): And we're talking about your actual functional units. So your neurons, right, in terms of then how well they are able to regenerate when the injury naturally occurs. So that's just oestrogen. So this is where you're getting things like your cognitive symptoms, right? But of course, forgetfulness the type of things that we mentioned to start with. 

So then when we're talking about, I guess more mood-related symptoms, obviously that can be a few different things. But when we're talking about these two hormones, I guess it's really progesterone is coming in, because I guess it's a bit more of a feel-good hormone, do you know?

It also has a role to play in terms of your neural cell growth. It's involved in stimulating your brain-derived neurotrophic factor. So the synthesis of that, which has to do with your energy processes in your cell, has a real calming effect on your neurons. 

(Bec): Yes. 

(Georgia): So this is where you might see things like sleep disturbances and a reduced capacity to handle stress that you referred to before and mood changes. So you can already see just with those two hormones, that as these are gradually declining, many of these processes are obviously going to be affected. And that's where you're often seeing the types of symptoms that we speak about. 

But then there's a whole of other things that we need to consider, like hormonally. Is there high prolactin? Which can have effect on mood symptoms. Like that's a whole other topic in itself. Is there high histamine? Histamine is certainly not widespread. It's not in everyone but in some people it can be. So is that happening?

(Bec): Increasingly common, yep.

(Georgia): Yeah, but I think it's important not to like… everyone has histamine type of thing. It's like how many years ago where everyone had candida. I think it needs to be also always be cautious with it but if someone's getting brain fog and mood changes like anxiety, it's a consideration and looking at that as a differential, right? 

0:15:11 - (Bec): Yeah. And so, when we go through menopause, obviously the corpus luteum which is the egg…

(Georgia): Or, the leftover of the egg…

(Bec): Is responsible for initiating progesterone production. Right? So once that trigger is removed, obviously our progesterone levels plummet or are virtually nonexistent. Whereas with oestrogen beyond menopause there are other organs that can still make oestrogen but just at a much lower level. And one of those is the brain.

(Georgia): Yes, that's right. And the other one, I guess that we're really talking about is your adrenal glands and that's important for both oestrogen and progesterone. So it's like, I guess in terms of your hormone production your adrenal glands are a little bit like the little brother in terms of, all of a sudden they've got to step-up and they've got to do something they haven't really had to do a lot of. 

So you can see how adrenal function if that is affected in terms of stress. And obviously stress has a role to play. Like stress, we're talking about psychological and we're talking about physical, and the hormonal impact is the same. In terms of whether you're running from a bear or whether you're sitting in traffic and you're just really angry about that. Like the hormonal cascade is the same. 

(Bec): Or, dealing with a toddler meltdown, for example. As women have become mothers often later in life as well, I think as your hormonal levels are dwindling down that would normally offer some kind of support or buffer to the stressors of motherhood as well. As we become parents later on in life we've kind of almost lost that physiological crutch to support us through that process.

(Georgia): Absolutely. But then what can be the case is that often I see and this is just obviously a generalisation, but given I see mostly women, or I see a lot of women, is that a lot of the time women are then internalising that making it about something they're doing wrong or you know what I mean? Or that they're failing or whatever messaging they have in their brain about that. But a lot of the time it's to do with this physiology of what's going on in terms of women are really stretched really thin and making it about something that they're failing at. When it’s not the case.

0:17:19 - (Bec): The biggest takeaway message for me, it was a real light bulb, aha moment when I learned it was that the more stressed you are, the worse your symptoms are going to be. Because if your adrenals are so busy in the background, like the hamster in a wheel throwing out your stress hormones because you're always constantly on the go, then it doesn't have that phase, or doesn't have the resources left over to produce oestrogen that it has to output from the same building block material…

(Georgia): That’s right. 

(Bec): Which is fat cholesterol, which is the whole other premise of women's health is that we don't eat or consume enough fats in order to make the building blocks to begin with. Right?

0:18:02 - (Georgia): Yeah, well, that's right. And that's another factor we need to consider when we're talking about causes, is nutrient status. As far as and there are some key nutrients that we need to consider, like what's going on with iodine status. Like iodine has been a nutrient that's been having a moment for quite a number of years. Not everyone should just go start taking iodine, just to be clear. But definitely, it can be something that is not at the level that it needs to be to support brain health.

You know, B12 is a really common deficiency, particularly when we're talking about where there might be gastrointestinal pathology such as Crohn's disease or celiac disease, that type of thing.

(Bec): Or something as simple as low stomach acid.

(Georgia): Yeah, that's right. Like PPIs for a long time, for example, that sort of thing. Or if someone's been vegetarian or vegan for a really long time, that kind of stuff and not necessarily supporting it in other ways.

(Bec): Some of those nutrients as well are also influenced by long term oral contraceptive use. Our body will burnthrough B’s and zinc as well.

(Georgia): Yes, zinc is another one I was going to mention. But to your point about essential fatty acids, I think it's sort of fluctuated between fats and carbohydrates being the root of all nutritional evil. And I think I've had, with all the talks that I've done, I mean, everyone's physiology is different in terms of, broadly speaking, the proportion or the ratios, if you like, of your fats, carbohydrates protein that is really best for your individual system. But generally speaking, most women that I see could do with having more essential fatty acids. Because, as you say, for lots of different reasons. But when we're talking about brain health, we're talking about it is the material that is part of what makes up your brain cells. And so it's like cars. If you put junk material in, that's all your body has to use to make them and that's obviously going to affect the functional capacity of those cells. So it's the same just on a simple scale to do with cells. If you're having a lot of trans and saturated fatty acids that are the non-beneficial type, you're going to have a higher proportion of those in your cell membranes, which affects their capacity to communicate with each other, which is a pretty key factor when we're talking about your brains. 

From the other point of view, when we're talking about the certain degree of progesterone and oestrogen that the adrenal glands are, to a certain degree, producing that requires fats as a raw material to be able to produce them. So if you're just not having enough fats, that's going to affect that when it's already a lot lower than would be the case during pre-menopause. And if you're having less anyway. And that's not even taking into account if the adrenals are already taxed anyway for all the different reasons we spoke about. 

So the other thing, sleep is the other thing. And it's kind of ironic that sleep also affects brain and cognitive function. Like we all know..

(Bec): It’s one of the first things to go isn’t it? It’s one of the first things perimenopausal women struggle with. 

(Georgia): You forget one of the most basic functions in life. That's right, exactly right. Or anyone who's had children in those first couple of years when sleep deprivation is a real factor. We've all had situations where just basic day-to-day functions is just beyond us. 

(Bec): Yep, true. 

(Georgia): So you can really see so that as alone will affect brain or cognitive function. So it's the ultimate irony that this hormonal fluctuation that is happening is also having an effect on the quality of our sleep. So women are then affected, like they're waking up through the night, they're taking longer to fall asleep. They're just feeling like they're not getting as much quality sleep. And then that's also then impacting our mood and our psychological function. So we talked about hormones…

(Bec): Mood, blood sugar… 

(Georgia): That's right. Everything. So as far as broadly speaking, the causes of what's going on here is like, there's the hormonal ones. We've spoken about sleep. We've touched on nutrient status. Obviously, stress is a big one. And also age as well. Age just normal even in the absence of any pathology or any imbalances, which is pretty much nobody. Is that normal ageing, there's going to be a certain degree of cognitive function that will be affected if it's not really supported in all the different ways that the evidence is coming out to do with how to support cognitive function across your life.

0:22:21 - (Bec): Yeah. And I think another area that is often forgotten about and that sometimes if you just also support this pathway for women, it can make a real difference both in mood, but hormonal health and particularly the hot flushes but the liver pathways because that is how our body processes oestrogen and progesterone or recycles it, removes it and does what it needs to do.

(Georgia): Well, that's exactly right. So if you're talking about, say, gut health. Like so gut health is one of the many key factors that we always look at when we're addressing hormones, obviously. And we do that. That's what we do at the clinic. That's what I do in clinic. 

But essentially, just very simply is that say you have oestrogen in the pill and you've had that for a long period of time, or you're exposed to it in xenoestrogens in terms of the environment, like with the water that we drink and plastics and everywhere. Or what your body is producing as a normal part of physiology. So then all of that goes through your liver. And all going well, that is converted to different forms of oestrogen. And then a certain amount of that goes into your bile, which then travels down to your large bowel. And then again, all going well and everything being imbalanced, a certain proportion of that is converted into a particular form and then it's removed from the body. 

So if your liver isn't working very well, that affects that process of conversion and then if your gut is not working very well, in terms of you got an imbalance of your microbiome, which is also extremely common across the population, but extremely common in reproductive health, is that that will affect that. So you're getting more oestrogen being recirculated around your body, which is then obviously having significant functional effects. Right?

(Bec): Definitely something to think about. Like if you're not going to the toilet and doing your number two’s daily, you are far more likely to… what it does is it recycles the oestrogen. So it's like you almost get like a double whammy of it and then your liver's got double to deal with as well. So it's this like perpetuating cycle in fact. Yeah.

(Georgia): That’s right. So in terms of then liver function, then we're looking so from a clinical point of view, obviously we're looking at symptoms, but if we're looking at bloods, we're talking about say, if you're looking at someone's biochemistry, what's going with someone's liver enzymes? Obviously they have to be generally fairly elevated for them to actually be really reflecting quite significant liver capacity. But as far as we're looking at that, we're looking at someone's lipids in terms of when you get cholesterol tested, what's happening with all of them? That type of thing. Again tying back to insulin that we've spoken about before, what's happening with someone's insulin capacity, which is very much affected by liver. And again, when we're talking about gut and liver health, that's also something that is really common to be out of balance in women during perimenopause for lots of different reasons. Whether it's they've gone through their life and all of a sudden they find out that they're Coeliac or that they've had IBS all this time, or that they've had a parasite and they even realised they had it type of thing. Or even just something as clinically simple as having dysbiosis or an imbalance in your bacteria type of thing and all of that. Also they might suddenly be getting.. like not tolerating foods that they previously were able to or getting bloated after eating pretty much anything and they don't really know why or that type of thing.

(Bec): They're suddenly allergic to shellfish. Like a sudden allergy in your forties to shellfish. And I think to myself, you may or may not have had somewhat of an allergy in your earlier life, but as your gut health has become poor and as your coping mechanisms in your body have become poor, as your inflammation has ratcheted up, as your resources and your capacity to produce cortisol to deal with some of that, all of these factors come into play. And so suddenly it's like your immune system is so much more reactive.

0:26:03 - (Georgia): Yeah. And then that can then tie into when we're talking about gut health, there's a whole lot of research and a lot of people would be across this anyway. In terms of the connection between then your gut and your brain. That is also really significant. So along with the hormonal side of thing and the connection, there is well, obviously you're neurotransmitters which are reduced in your gut as well as your brain. And then if your gut health isn't very happy, that will also have an effect on all of these symptoms that we spoke about as well. 

So you can really see how women who are traveling along and they're doing life and they feel like things are generally working for them in terms of how their body moves and what they eat and their mood and that type of thing. And then they usually get to a point in their 40s well, obviously, women are coming to clinic because they feel like they need to be supported, but they get to that point, and it's just not working for them in one way or another in terms of how they're feeling or what they're doing. Like they've always exercised, and now it doesn't work for them anymore, whatever it might be.

And so usually I find obviously sometimes it can be an overt pathology, for example, pernicious anaemia, like we've spoken about with B12. But more often than not, it's a combination of a few of these different factors that are not at pathology stage, but in that, I guess that middle stage in terms of out of balance. But if they've gone and got a blood test and say, they might have gone to a medical professional that may not be as well versed in, say, reproductive hormones, they're often told that they might be ‘normal’ and ‘everything's okay’. And then they walk away feeling like it's probably something I'm doing, you know what I mean?

(Bec): I’m just going to put it out there, but whenever I've had someone say, oh, I went to the doctor, I've had my blood test and they said ‘everything was perfect’, and then you get your hands on it and I'm sure this happens to you, get your hands on it, you're like, look, you are within range within a bunch of things, there are a few things that are at the high end or the low end that are starting to give you clues as to where their health journey is headed. But I would rarely say that bloods are perfect.

(Georgia): No. Obviously when we're seeing people in clinic, it's a particular population and they're coming to us because they're having challenges from one way or another. What I explain to patients all the time, is that there's a difference between so if you look at your average blood test, just say we're talking about I know we're not talking about this is a topic today, but just for an example, let's say we're talking about TSH. So your main thyroid, thyroid stimulating hormone that is produced by your pituitary to communicate with your thyroid, to do what it needs to do. So when you look at a range, as far as what a ‘normal range’ is on a blood test, it's between 0.5 and five. But from, say, a fertility point of view, and even just a general living your life point of view, we see that if it's not between one and two, there can be symptomatic and functional consequences to that. 

But women will very commonly be presenting with a lot of the symptoms associated with thyroid issues in terms of mood and gut and a lot of things we've spoken about. And then if they're not over five, like they're told, everything is normal. So I think it just comes down to the difference between medically they're really just looking for overt pathology. 

(Bec): Proactive. 

(Georgia): It's just a different way that people are trained, is all. As opposed to we're really looking for, I guess, really obviously overt pathology, but we're also looking for that in between stage. Between when things are not imbalance, but they're not necessarily at disease state.

(Bec): But you can see the trajectory. 

(Georgia): Yeah, because you've got experience in knowing what you're looking for, but that's really what you see as far as what you're looking at in terms of not so much about… and again, it doesn't have to be. You don't. Have to be in that perfect one to two range. But there's an awful lot that can be done to support, say, if your levels are 4.5, like on lots of different levels in terms of diet, lifestyle, medication, in some cases, that type of thing, to really bring that back into range in a way that's clinically significant for how they're feeling things. 

So what I'm saying is, all that to say is that if someone has had that experience where they are feeling, like physically, their body is just not right, whether we're talking about brain health or we're talking about lots of different other factors, and they've had some tests done, they're told things are normal. I think it's worth getting seeking a second opinion on that, because, you know, your own body is the point. It's not a criticism of the person that you've seen.

(Bec): No.

(Georgia): It's really just trusting your own body wisdom as far as something doesn't feel right, to get the right information. As far as why that is so.

(Bec): True, such great advice, because, yeah, a lot of times we'll take that initial piece on face value, but you'll know in yourself that you're just not feeling, why can't they pick something up? Well, maybe we've only tested a specific set of criteria and the answer hasn't presented itself yet.

(Georgia): That’s right. 

(Bec): Or the answer could be in your gut, it could be in your diet, it could be in your environment, it could be in your psychosocial sort of relationship, social...

(Georgia): That's right.

(Bec): There are so many aspects.

(Georgia): Even just with our conversation today, already anyone that is listening would have an awareness that there's just so many different factors that.. and we're just talking about brain and cognitive health today, let alone hormones, in terms of a really extensive and already there's so many factors that you need to be thinking about. So anyone listening, we kind of go, oh, that's really worth looking at, as far as, is that me? Is it to do with a nutrient deficiency, for example? In one of the case, it might just be that, but it's a matter of knowing what you're looking for as far as when someone's presenting clinically and what are the most likely culprits and then working your way through that in terms of clinical assessment with symptoms and also then in terms of actual blood assessments.

(Bec): Yeah. And so let's say someone is identifying themselves in what we've been discussing in terms of long-term consequences, if it's not gotten on top of or if you don't intervene early or anything like that, what are some of the long-term issues that we could run into?

0:31:58 - (Georgia): So I think when we're talking about just for the sake of clarity, we're really talking about women who have been tracking along life and generally their health has been not too bad and then all of a sudden they're starting to get these symptoms. As far as the ones that we've spoken about. So when we're talking about that population group, it's really interesting because when they've done studies on this, is that even when women are experiencing their subjective cognitive and mood changes, when they do objective measures of that, they're still within the normal range, which is really interesting in terms of why is that so?

But it's just to say that with that sort of population, just because someone is starting experiencing these symptoms, it doesn't, in most cases then lead to that is a sign that there's going to be long-term cognitive decline down the track. As far as broadly speaking. Of course, then there's a whole lot of variations to that, such as if there all the different risk factors to do with mental illness or cognitive decline which need to be taken into account. So if someone is concerned, they should always get assessed and go start with seeing their GP and getting some assessments and referrals for that. Like if we're talking about things like more depression or significant cognitive decline that is ongoing. That type of thing, I guess, is a different category to what we're really talking about today in terms of their risk of long-term health consequences is different to the group we're talking about potentially.

(Bec): What kind of things? I mean, you're seeing women all the time. So what kind of things do you typically suggest that just sort of help support during perimenopause both lifestyle or otherwise. 

(Georgia): Lots of different things. But it always comes down to identifying, okay, someone is coming in, they're experiencing a lot of the stuff we've spoken about, what are the actual underlying factors for them? So we always start with that in terms of how they're feeling physically, mentally, emotionally, and then what's going on with their actual pathology. So we're looking at all of that and then that narrows down. Well then what do we do about that? 

Broadly speaking, we might be looking at okay, addressing when we go back to the causes that we've spoken about here, like hormonal fluctuations. Obviously we've mentioned that the fluctuation and decline is a normal physiological process, but there are certainly a lot of factors that can exacerbate these and make them more severe. So looking at that and supporting those. 

Insulin resistance, is that present? So if someone, say, has more like an apple-shaped sort of body shape all of a sudden, or over a period of time, or extra weight around the middle, but are they getting fatigue or sugar cravings or the fatty liver, that type of thing. And then looking at that nervous system, we've spoken about supporting their nervous system again, and then we're talking about lifestyle. So then how we do that is, again, quite varied. But broadly speaking, we're always looking at someone's diet because that can definitely impact the severity of a lot of the symptoms someone's getting. 

(Bec): Yep. 

(Georgia): And also their overall physiological health. So broadly speaking, we're talking about increasing the amount of fruit and veggies, increasing protein foods I find particularly perimenopausal women, I think most women particularly. But you need to be pretty intentional with having enough protein, having protein with every meal because it can be very easy just not to be getting enough, particularly if women are quite active during during this phase. And it can be vegetarian, it can be meat or a combination of the two. So having plenty of those and obviously then working that out with how much you need per gram, per kilo of body weight, broadly speaking, based on your activity level. Because often, more often than not is that most women are not having enough of it, right? 

And then we're talking about fats. We've spoken about before, like making sure ones having enough fats and then women in this stage phytoestrogenic foods as well. As far as and I think the caveat here is that there should always be whole versions of them. So like of tofu of tempeh, soy milk or soy yogurt, if you like the taste of them, rather than the processed junk ones, they're not recommended. 

And then overall dietary, we're looking at generally speaking, again, this is pending someone's activity level is looking at someone's overall energy levels. It'd be sort of around 2000 or so calories, generally speaking you're aiming for. And like having and reducing the amount of your sugar and your salt, refined grains and too much carbohydrates and too much of your high GI carbohydrates. 

So broadly speaking, the high moderate to higher sort of protein intake, definitely still having carbohydrates, but good quality ones and good fats. That really is the basis of, like, in terms of that helps modulate a lot of the things that we spoke about in terms of the underlying causes that can exacerbate the symptoms. So that's just diet. 

Obviously exercise, it's really important to move for everybody, but particularly when you're moving into this perimenopausal stage, it really needs to be shifting more in the direction of resistance training. Because often someone's always been…

(Bec): Muscle mass and bone..

(Georgia): Yeah, that's right. In terms of bone health, in terms of your body, the hormones that all those hormonal fluctuations are happening in terms of oestrogen, progesterone, insulin, glucose thing. But what can be really common, for example, is that a woman might always be active and she's always, say, been a runner, for example, her whole life. And she's finding she's doing a thing. She's sort of eating, sort of moderate to low carbohydrate intake. And then she gets to her forties and she's finding she just can't lose weight and she doesn't have the energy and all the things that you mentioned her brain is not working very well.

So often it can be like a pretty simple fix as far as looking at not eating enough energy overall, not having enough protein and doing too much, say, cardiovascular exercise as opposed to a resistance exercise. So just tweaking the balancing can be enough along with the other things. And then obviously when we're talking about other lifestyle factors as well, will have a big role to play on lots of different levels like alcohol, which obviously is not very good for the brain, as we all know.

Sleep, obviously we've talked about that, smoking and stress management. So as far as beyond the diet and exercise types of things, particular nutrients that I would tend to consider obviously magnesium. I think most women I see will be on some version of magnesium.

(Bec): Men and women probably need that. 

(Georgia): Well that's true, but I'm largely seeing women, I find definitely most women. Things like taurine, B12 if it's indicated. Choline, obviously, which can get lower as we get older. Iodine again, if it's warranted it's not a go out and just dose up an Iodine type of recommendation. 

And then some of your other nutrients like your zinc and your B6, like you mentioned, and of course your essential fatty acids if you're finding you're not getting enough with food. So EPA DHA.  

So some herbs, I guess I would tend to be, again, I love herbs, not everyone will take them. But herbs, I'm talking about things like your adrenal herbs like your Withania/ ashwagandha and your passion flower. Motherwort can be really good, particularly menopause or women, if they have the anxiety type of presentation in certain situations Vitex or Black cohosh again, not something just go out dosing willy nilly because you can cause all kinds of problems. 

(Bec): Yeah, best to get advice on those ones 

(Georgia): That's right. St. John's Wort. And then obviously, for a lot of women this might be enough. But then some women, they might also need medication support and this still works really fits really nicely. Everything that we recommend here sits really nicely in a lot of women along with those type of things. So that can definitely be helpful. 

So we're talking about oestrogen, ideally with progesterone as well. And that comes down to what we sort of spoke about in the beginning as far as what oestrogen progesterone do in the body, and do in the brain, particularly if someone is particularly getting these symptoms quite severely along with all these other factors and management strategies that we've spoken about. Is that can really help with adding extra support in that way, particularly if it's really affecting how they can function every day.  

(Bec): Yeah, but obviously, um, the caveat is, always get advice. And advice can be from a team. I think sometimes we forget that, um, you know, you don't have to just see a GP. You don't have to just choose to see a naturopath or a GP. You can in fact have them work together. 

(Georgia): No, no, that's absolutely right. 

(Bec): Yeah. Osteopathic massage. In fact, massage is also encouraged because it's an incredibly good stress reliever, which is going to benefit your hormones. 

(Georgia): A hundred percent. Yeah. So at the clinic I work with, so I work with Fertile Ground and the clinic I work with, we're very big on working with someone's healthcare team. Whether that's IVF, or whether it's to do with someone's GP, or, and, you know, we have acupuncturists at the clinic, we have massage or, you know, or we always recommending that as adjunctive therapies as appropriate, like acupuncture or massage, or osteo, or counselling.

So I think,it's definitely, a case of, it doesn't have to be just one health professional, you know, sometimes that might be all you need. But, you know, everyone has different.. is coming at it from a different angle, I guess, so, it's a matter of just really, I guess, integrating and working together to really best support that person is really what's the most important thing at the end of the day.

(Bec): Yeah, absolutely. Agreed. And on that note, I think that's a great place to end it and say thank you so much for providing a download from your brain. Which, you know,  I love. I love speaking to you, Georgia, because, yeah, so your expertise on women's health is, is up there with some of the, the best authors and PhDs and masters people that I know, so yeah.

(Georgia): Thanks Bec.

(Bec): Thanks so much. I really appreciate you sharing your knowledge.

(Georgia): Thanks for having me.