Mindful Menopause: Clarissa Kristjansson on Brain Health, Ageing & Real Self-Care.

Clarissa has a doctorate in neuroscience, is an author on menopause (her book “Beyond Hormones” is available here), teaches mindfulness and qigong and frequently speaks at conferences, podcasts and summits about women's health and well-being. Clarissa also holds certifications in nutrition, yoga nidra, acupressure and aromatherapy. Talk about a holistic approach! 

Find out more about her here https://clarissakristjansson.com/about

Clarissa and I cover the below (and so much more) in our conversation:

  • The difference between brain and mind

  • Pro vs anti ageing in mindset and society

  • Two things you might notice way before skipping periods and hot flushes

  • The quick fix trap 

  • Menopause as a moneymaker

  • Markers of long term health

  • Where to start to find time to change (hint…scroll habits anyone :)). 

I think you’re going to get so much value from this one. 

Prefer to listen? Get the podcast here: A mindful menopause - a conversation with Clarissa Krisstjansson 

As a woman who is hugely interested in the impact of culture on individuals, I have a master's in intercultural communication from back in the day in my twenties. And I'm so interested and curious about the things that we believe and the way that informs us in the structures that we exist in. And so it was such a pleasure speaking to Clarissa Kristjansson.

In this conversation around perimenopause, menopause, the midlife transition, because Clarissa has got a really unique set of experiences and expertise in both Chinese medicine, mindfulness, Western neuroscience and has that lived experience in her own life as well. And one of the things that I really enjoyed about our conversation was looking at the view of ageing from different kinds of perspectives and how that impacts our experience of being a woman in your 40s and 50s and older and what our mindset or the way we see ourselves, what role that might play in the way we experience changes in our bodies, in our mind.

Clarissa has a doctorate in neuroscience. She is also an author on menopause. She teaches mindfulness and Qigong, speaks at conferences and on podcasts like these and has certifications in nutrition, yoga, acupressure, aromatherapy and really comes to us with that holistic expertise. I'm so excited for you to dive into this conversation and challenge your view of ageing. We talk about so much, including brain changes and soul changes, as well as physical changes. We talk about hormone tests, perimenopause, progesterone, all the things. So I'm excited for you to listen to this and hopefully get some nugget of something you can take away and implement into your own life.

Clarissa, thank you so much for taking the time to talk to us about the work that you do around midlife and women transitioning from one phase to another. If you could introduce where you are, what kind of work you do in supporting midlife, I would love to hear that.

Thank you, Maude, for inviting me first to have this conversation with you. I'm Clarissa Kristjansson. I'm currently based in Sweden, soon to be returning to Melbourne, Australia. And I have been working with midlife women for the last nearly 10 years.

I am a certified mindfulness and Chinese medicine practitioner as well as a third age women's health coach. And I've been working with women going through perimenopause, through the menopause. And obviously now myself being 64, I'm quite interested in women who are on the other side of menopause too, to live well.

I think that's what I would say in a holistic way that they can thrive through this life transition rather than seeing it as fearful and out of their control.

When I looked at your approach in terms of that holistic thriving, looking at humans with minds and bodies and brains and spirits and souls, it really appealed to me because what I look at in one -on-one coaching is also, yes, our behavior, yes, our thinking, but also how we're using our body, how are we feeling. And it sounds like those are pillars of how you work with women. Is that right? I see you have qualifications in different areas.

That's absolutely true. Absolutely. I think we have to say, first of all, we are a whole, so we're not little bits chopped up. But you know, we're not just a body and a lot of menopause conversation is very focused on the body. But actually, our minds are powerful. And as we get deeper, we'll understand just how much it really is neurological, how much your brains are involved, how important not just our brain but our mind is, and mindset is in this space, but also that we're transitioning into something that's different. So there has to be a soul component to it, because we are going to be thinking, feeling and being received in the world also differently on the other side of menopause.

It was interesting how you differentiated between brain and mind. What are we thinking? What could we control? How do we view that transition into a different stage of being a woman? And then maybe on the flip side, what's happening to my brain as a result of hormonal changes? Is that how you meant it? Or tell me more about that.

First of all, we know that the brain has hundreds of oestrogen receptors. That's the first thing we'd like to know that the receptors are huge in our brain. have receptors for progesterone, for testosterone in our brain. And there is a change in brain chemistry as our hormone levels fluctuate and change, there is a change in the way in which vital neuroendocrine pathways are affected by changes in our hormones, we can become a lot more anxious, we can become a lot more stressed. There is depression, potentially that exists during this transition, we lose memory, we can even see on an MRI scan that the brain is kind of foggy, if we like in places, and that the brain changes shape and size of different structures. So there is real brain changes occurring in this life transition. But we're also changing in our minds and our mindset, we know that that really matters. And brains and minds are not quite the same thing. They're of course related to each other. Our minds are our attitudes, our values and how those then drive the choices we make, the habits we form or break. So both matter and of course mindset is influenced by outer factors, is influenced by the society and culture in which we live in. They're influenced by our experiences, traumatic and not, and by what we think ourselves about getting older.

Such a powerful piece that you're bringing in here about how we view ourselves, what we learn about ourselves, what society tells us about ourselves as we age. And one of the things that I find interesting about your background is you're saying, you've got this Western background and teaching and training, and you fuse that with the knowledge that you have from eastern philosophy or the eastern side of the world. Would you say that the view of ageing women is different in those two and if so how?

Distinctly so. I think first of all, we live here in the West in a uniquely youth-centric culture. We value youth as having energy and creativity and you know, it's pretty hard once you're the other side of about 50 to get a job.

Yeah, I remember and I'll tell a story that I once was invited here in Sweden to take part in a workshop for people who'd been job searching for a long period of time. 100 people turned up. They were nearly all exclusively over the age of 50. Well qualified and totally unable to find a job. They went to hundreds of interviews, they received no responses to their applications. If that doesn't tell you in one evening whether people are valued or not for their experience and for their wisdom. It was quite a sad event. They just felt broken by the system. But it's like that everywhere, that we value this. We see youth as beautiful. You know, the whole beauty industry is about anti-ageing, not pro-ageing. There's the small shifts, but the whole thing is about being young is good, old doesn't have value, somehow you should sort of disappear into a corner. Some of that is shifting, but not shifting beyond a certain elite who can afford to do that. Not every woman can have a beautiful grey mane and it's all perfect and maintained. I'm 64 and my hair hasn't really gone grey yet. But we are seeing that as centre. We don't value wisdom.

So we don't sit down and so we value somebody's wisdom and experience. We don't look to an older teacher as having value. When you are inside an Eastern tradition, and I would say that I also grew up in an Eastern tradition because my stepmother's Chinese. So I had a lot of my father lived in Hong Kong for majority of his later adult life. So I had a lot of connection with the East on more than just I've read a book.

And when you have an Eastern teacher, your teachers are somewhere between 60 to 100 years old. And they teach you the tradition is to be taught by your teacher and not to question that as much as we would do. But your teacher has wisdom from the experience and that experience has been passed down.

In Japan and in China, old people are treated with dignity and respect. They are everywhere on the transport system, everywhere you go, that there's something to be revered. And of course, in menopause, they don't talk about it as this sort dreaded end of life.

It's the end of fertility, and then another phase emerges. They call it Koniki in Japan, the second spring in China, that there's a rebirth of women and they move into a very different phase. And that is also there in African and Middle Eastern cultures too. And often where women have maybe a more complicated relationship with men and other people when they are still in their stage of fertility, that then disappears. And they regain this sort of revered elder woman who is to be listened to and respected. And that really is the difference that we don't sort of want to shuffle these people away and think, well, let's put them in a home and let's not look at them anymore.

They don't have value, but instead they have new roles. And of course the grandmother role is often there for them, but it's not solely that. We don't want to be doing a JD van saying that's the reason where my mother-in-law exists. But there is this central sort of holding matriarchal figure in the family. It is very important in those cultures.

So when you think about approaching this time, maybe you're in your late thirties, your early forties, your mid forties, and you're approaching a time where your periods are maybe becoming less regular, things are shifting and changing in your body. What are the main challenges that you see within the women that you work with and support around that time?

First of all, I would actually say that many women don't know they're in perimenopause. And if the listeners are listening, this is this phase prior to going into menopause, which is a year after your last menstruation, we're going through a lot of changes that we sometimes don't know what they are.

They look like stress quite often. They look like, and we are stressed probably most of us as well, but we start to think I'm sleeping less well. We can start to feel anxious. We are not seeing the classic or less rarely the classic hot flush, bigger weight gain, real brain fog at this stage, because perimenopause is unfolding in stages, we would actually say we're seeing more of the brain related changes that are mood and emotion changes. And we're not quite sure why they're happening.

We may be lucky and go to a clinician and a clinician knows about it, or we're dismissed and told, well, you're working too hard, you need to take a holiday or something, do some yoga, whatever it is they tell women to do. And then we'll notice the weight gain. And that's what I see is that these physical and mood, emotion changes that are happening. But I would actually say the really acute time is a few years before and a few years after the actual event of menopause. Things start because prior to that, we're actually seeing a decline in progesterone, but we're actually got more oestrogen in the system earlier on relatively. And if that can be managed and corrected more easily than when we get into this real oestrogen fluctuation decline, which is happening in those years prior and after menopause. So we often think, menopause is it, my periods have stopped. It's not, there can be two to three years afterwards. This is when we see the brain fog, the depression, the bigger increase in weight gain, we're really putting the weight around the middle and it doesn't move.

And we may see elevated blood pressure, cholesterol levels, things that need to be taken care of. That's what's happening physiologically and psychologically at this time. Those are some of the hardest years for the women I work with. They were some of the hardest years for myself too.

And then we seem to move through that because we see a stabilisation of hormone levels and we're into them really into the next phase. So it is it is really a step by step by step. Earlier on, we'll have more heavy periods, which are difficult maybe. And we're obviously still potentially can get pregnant at that stage. So there's an interesting dynamic. But afterwards, we'll have very few periods, but but other issues.

One of the things that you were saying we're looking at it from a body based point of view. And I think when a lot of people Google or think about menopause, they're really looking at bleeding, right? Am I bleeding? Am I not bleeding versus what else is going on?

What's interesting to me working in the field of burnout prevention is sometimes when I inquire into, where is your cycle at or have you had your hormones tested, women are surprised that that might be something that's causing their anxiety or their lack of sleeping or the way that they're feeling. We haven't quite put that together. And another challenge that I see in the work that I do is that health professionals are often under equipped in this field, undertrained in where menopause or perimenopause or this midlife transition may be showing up and linking symptoms together. Is that also your experience? I see you nodding.

That's definitely my experience. Unfortunately, if you go to a general practitioner, the chances that they've had a couple of hours worth of lectures on menopause throughout the whole of their medical training. And so they arrive ill-equipped to deal with women who, and I would say the Gen X and even some of the top end of Gen Y that are now experiencing perimenopause and coming into menopause, probably don't accept what women of an earlier generation just accepted. We're under a lot of pressure, work-wise, career-wise, family-wise. It's a crunch time.

And they're not really equipped to women who may be a little bit more demanding in their surgeries. And it's been very common to fob off women with SSRIs and the like, which don't help really at all. It can for some women, I mean, there are some specifics they can help with. But for the majority of women that's not going to do anything. And it just leaves women hanging out there and looking for providers. We've also got to remember that only one in five OBGYNs, or specialist gynaecologists have any real training in menopause. So you're meeting a profession that has not had a lot of dedicated training, which leaves women sort of, where do I turn? What do I do? And if your clinician has training, that could still be lacking things around nutrition, management of stress, appropriate exercise, sleep management, a lot of that, let alone psychotherapy that could help.

It leaves women hanging out there and turning to supplements to influencers. As I might be not a medical professional, would highly say that getting your menopause information from a celebrity probably isn't the best idea for you.

The next question I was going to ask you was around challenges generally in finding resources and finding information. Because if we're saying, the medical professionals that we're used to turning to might be under equipped here. And then we're turning to Google or the internet to find out information, number one, possibly about our individual symptoms. But if we've managed to put it together or we've had somebody who's pointed us towards perimenopause or a menopause transition. There's still quite a lot of information out there. Some of it is conflicting. Some of it is somebody punting their own thing or their own methodology or their own particular cream. What challenges do you see around women getting help, getting support?

I think first is reliable source of information. And you're right there, people got start looking around the internet. And unfortunately, when an industry becomes worth billions and billions and billions of dollars, there are a lot of people who would like to give you some advice, but they want to sell you a lot of tests, which I have on very liberal authority from people like my good friend, Professor Joyce Harper, University College of London's hospitals.

They show you nothing. They are a waste of money. They are because your hormones are fluctuating and changing all the time. So that test is is like you wasting money, but they're very popular to be sold hormone tests or supplements. Supplement instead of good diet, one must question. There are some supplements that are useful, but not supplements for supplements sake.

And certainly all these other things that purport to do things don't have any clinical evidence backing them up quite often. So I think it leaves women looking down that avenue and for somebody, something might work or it might work for a while and then doesn't work. So the most reliable sources of information is like the proper menopause societies. So the British Menopause Society, the North American, the Australian, wherever you live, if there's something like that or something similar, that evidence is fact-based, it's scientifically verified, and it is the best state-of -the-art information.

Unfortunately, for the people who want to influence, it often doesn't say you must have this, that and the other it generally tends to be err on the side of caution. So we won't see hormone therapy there being purported as being a preventative measure, except in the case of osteoporosis, which we know it can do if you take it.

It's only protective when you take it and there could be some other protective effects. But there isn't an evidence that taking hormone therapy will prevent dementia. That science isn't there yet. So although it's widely touted, the science doesn't yet back that up.

There may be some studies falling around, but that's it. So print out the nice guidance from the UK and then go to your clinician and say, well, could it be this, that and the other? Have more structured conversations. Find somebody that the societies recommend in your country who has had an accreditation through them and can give you proper help and support.

That's the way to go about it. Much as it looks wonderful to look on Instagram, and there's been some great information, but there's also a lot of cherry picking of data to fit a narrative, which isn't necessarily 100 % correct.

One of the things that I see over and over again in coaching, preventing burnout, stress management, life in general, is this desire for a quick fix. Desire for one thing that's gonna make it all go away. And I think, when you were talking about things like nutrition, sleep, exercise. What am I thinking? What's my mindset? Those are long term behavioural changes. And when we think about that period of transition and we're saying that maybe 10 to 15 years, that's actually me changing the way I do life. And that's not as easy as taking a supplement.

No, or even hormone therapy to be honest. I would actually say that hormone therapy generally needs a lot more tailoring and working with and tweaking and going back and forth and management than is shown on the surface. And in fact, it can be a very long journey for some people and for some people it doesn't work or adversely affects them. So that's not a straightforward quick fix either, even if it appears to be in the information that's put out there in the social media.

But yes, you're absolutely right, Maude, that in making life changes, we're making quite long term, small steps that lead to a big change. And of course, it depends on your start point. If you have been eating ultra processed foods, and we know that 60 or 70% of the dietary intake of American and British women, and I would hesitate to say Australian women, is processed.

So it's a big change around to a whole food kind of approach where you maybe have to have more scratch cooking. We may be looking to minimise our alcohol consumption, but if we're to drinking three, four glasses of wine a night to crash out and relax, that's a big, a big change. Getting up and moving on a daily basis with the right kind of strength exercise, involves strength training as a very core pillar. When women either haven't exercised very much or we've still been caught in our leggings doing cardio. Or we pound out on a treadmill or a cross trainer. And that so often is where women's exercise is at. And we're having to now really get into the gym and start maybe lifting some weights. It's a big shift and it's not just a big shift in the way we exercise but the sort of psychology around it. And we're used to an hour on the treadmill and suddenly we're saying well 15, 20 minutes in the gym lifting some strong weights is going to be just as good, it's going to be better for you long term. That's a huge shift.

So it isn't just that easy to do. I think quick fixes are sold. That's why an awful lot of what's going on in menopause world right now is on the quick fix, but it doesn't build long-term health and wellbeing, which is what we need. First of all, perimenopause can last up to 10 years or more. But for many women it is a three, five years quite commonly. And then we're into menopause and into the next phase of the rest of our lives. We want to be laying really good foundations that we can continue to work with and build on. You know, we are very different at 50 than we are at 60.

We see 60 now as being quite a big turning point in women's lives, in their health. There are now some markers coming around that somewhere in the mid 50s, just post that actual menopause, and somewhere around about 60 are quite big turning points in women's long-term health. I'm 64. I've had lots of relatives that have lived to into their 90s and over 100. I saw them change tremendously through their late 80s and in the 90s and 100s it's a very different conversation. So we're in different stages all the time. If we don't have a good base, and we look for quick fixes all the time, it gets harder as we get older.

Something that you said really resonated there with the thinking and the behaviour. We were making a behaviour change or we desire behaviour change. And there's a mindset that goes along with that. There's a mindset around creating time for it or giving it importance or saying, I'm going to be stopping work because I'm going to go to the gym instead, or I'm going to buy these vegetables. I'm going to do the batch cooking and where do we take from? Where do we create that time? How do we see our health on that value of importance? And there's so much conversation now about longevity or living past a hundred, and on the flip side, we've got this rush, rush, rush convenience food. Let me get through the day as quickly as possible. And as you say, drink three or four glasses of wine to decompress and then seven cups of coffee in the morning, cause I'm so exhausted and let me do it all over again. And we haven't quite put these two together of the foundation I'm building now is what leads me into my 70s, 80s, 90s in a way that is healthy, in a way that is independent, in a way that is joyful.

Absolutely, and I think that's the biggest challenge because I was there 15 years ago. I didn't have that much time to go to the gym. And I think we have to do it in small bite sizes. We can't say I'm gonna do all of these changes at once. So we have to start somewhere and recognise that that's maybe the first foundation. I

f I was to say, where am I, where am I going to take it from? Well, one of the things we do is we spend 150 minutes a day scrolling in social. So we're a lot of time, flip, flip, flip, flip, or watching TV or vegging out. So can we use time differently? So I think there's a big time understanding, where does my time go? Where could I put it? What kind of things do I do that drain my energy?

So as a big mindfulness exercise I do with people and I've worked a lot with pain patients here. How do I apportion my time for less fatigue and use it more in a different way that benefits me? But only pick one thing you want to change at a time, because how can we change everything all at once? Nothing ever happens when we do that. And if for you, it is..I eat reasonably well, actually I know that drinking three glasses of wine at night isn't benefiting my health and it's not benefiting our health on many, many, many levels. Then maybe that's where you start. And there are lots of really good programs for women to help them do that. If you know that your day is peppered with snacks and picking up food fast and that maybe that's where we need to start.

But it's often choosing some of those things to sort of make, choose one, make it work. And then probably trying to prioritise in some rest and downtime when it's you time. And that doesn't mean we have to buy stuff or go to a pamper salon. It's just, can I find 10 minutes for me? And we start really small.

10 minutes of practice every day of something and make small changes until they're embedded and then work from there. And actually, if we want to lose weight and be healthier and sleep better, which many women do obviously, because putting on weight is one of the major concerns, the nutrition wins over exercise initially.

90 % of weight loss is related to diet and then reducing our stress and then exercise. If we're very anxious and really struggling mentally, then a combination of movement and more rest might be the right place to start because we're all individual.

And so we can't make prescriptions for everybody. I think that's the important thing as well. You have to know what's possible for you in your own day and be honest about that as a person and then start where you are and do small steps. And we notice as each thing gets better, the more we can do the more change we can make the more it's sustainable.

We learn what we don't like and we do like and what works for us and look to the past and say, well, that worked really well. For example, for my own life, when I counted calories or counted what I ate, it was really good for me to be more aware of what I was eating on a daily basis. That might not work for everybody. For me, it was like, right, now I know. Now I can work from that forward and get help.

Get a personal trainer, get a nutrition coach with a burnout coach, practice mindfulness, whatever it is, get supported.

I think that's also such a shift in mentality for so many women. I can get help, I can be supported. It's also quite different when we are the person who is often propping everything up in this stressful time where we may have teenage children, ageing parents, big careers, so that permission for self to receive support, to have somebody guide us or hold our hands or help us be accountable can also be so huge.

One of the things that you talked about earlier in terms of hormone replacement, really struck a chord in terms of that experimentation, because I think, first there's that decision of, do I take hormones or not? Do I want to explore replacing hormones? And then, and I think a lot of people see it as the magic. Of, well, I just will, and then I'll feel better. And actually my experience has been similar to yours in that it's a process of which hormones in what quantity, how do I take them, how frequently, does it work for me, does it actually make me feel worse, better? What was your decision around replacing hormones if you're comfortable to share and would you do it again the same way?

Yeah, so I never had hormone therapy because it was never offered to me. But I think that it's an individual choice. That's my personal opinion that it is absolutely a choice and a decision that is made between the woman and her clinician. And there, every each of us is individual as to what we want to do, how long we want to do it, if we want to do it, if we need it. And I don't think it's like everybody needs it, or no one should have it. Each of us is where we are. If you're really struggling, then that has to be something that supports you because it's there and it exists. And it's safe if it's used in a prescribed way.

And then for me, I absolutely would say to people, if you want to use vaginal oestrogen, that's fantastic. Has transformed for me what was vaginal dryness when nothing else worked. It transformed it for me completely. And my OBGYN said, well, that's fantastic. Keep doing it because it's working. And obviously, I had an internal examination. I got to look at all on the little ultrasound. I said, well, everything's normal here. And you need to keep doing this because we recommend it. It's perfectly localised. The dose is minute compared to the dose you would have. And that's over the counter in many countries. So why wouldn't we do that if that makes a difference? Because urinary tract infections are horrible and they get worse and worse as we get older. So for me, would I have taken hormone therapy? Possibly if it had been offered to me, but it never was. You know, I got really no support in that space. But I think it's for each of us.

We're still not sure about things like testosterone, even though that's a big conversation out there. The answer is if we look to the work of Professor Susan Davis at Monash University, she's the world leading expert, she says I cannot prove that it works, sometimes it's supposed to work and it doesn't.

We are still really in an era of learning about some of these things because there's been so poor funding around women's health and particularly women's hormonal health that we aren't maybe able to answer some of the things that look so glossy and glamorous on social media and that are pushed. And obviously something that is private can make some clinicians very wealthy. So we need to know what might be right for you, but it might not be, you know, and I think let’s look again to the science and reputable experts in the area.

Hormone therapy is there for a reason, it's there to help women and it's there to support them if they need it. But it is not as you rightly said, a quick fix. You take it and it all works perfectly from the beginning and you feel fine. Now some women will say that they feel a lot better quite quickly and report all these wonderful things that have happened. How much of that is genuine symptom and how much of that is also a halo effect from being heard, supported, given a medication. That's extremely hard to unpack because as we said earlier the mind is very powerful too.

I can get into so much rage and resentment around the poverty of information around menopause, medical studies of women in general, which I won't do here. You've got knowledge of brain/ hormonal health, physical health, how does all of that work together to support our whole hormone. So what actually happens inside the body when we're doing practices like acupressure or feeding our body different things. Could you speak to that a little bit?

What we know is that, translating a Chinese medicine system into an indoor Western one is not quite the same. But we do know that acupuncture is very relaxing for the body, very uplifting for the body when we do acupressure, and that it's very soothing for the body. We certainly feel a rush of endorphins through practices like that. And just think about some of it when we're doing it for ourselves, is we are self massaging ourselves. That is pleasurable, stress relieving. So we would feel that and therefore that would shift us from a sympathetic into the parasympathetic. We're seeing a reduction in cortisol and cortisol can interfere with progesterone and oestrogen's normal pathways. So we will see that come together. And we'll also see the various endorphins and serotonins come through. So from that perspective, that's how it's working in a hormonal context. It translated from East to West, I would say a lot of it.

Movements that are slow and gentle, which a lot of Qigong movements are, are pleasurable to do. And they're not terribly hard to do they're not as strenuous as yoga. So I think yoga is wonderful. It has benefits around flexibility. It's very strength and resistance building a lot of that. Chi Qigong is not quite the same. It's more slow movements, more like restorative yoga. So it's good for the nervous system.

There's another piece there about women allowing themselves the time and allowing themselves to feel good, which can be so edgy and counterculture in a Western hustle hustle, do more work harder kind of context.

Yes, and give ourselves permission, we don't have to do these things for hours. You know, we can spend 15, 20 minutes in our day less doing that. And what I really like about movements, whether they're Qigong related or whether they're yoga related, is that the mind quietens better.

What we know is that women often find it incredibly hard to sit in meditation because there's so much racing in here of what I've got to do and on my list and here and here and here that often they either fall asleep or they're simply frustrated with mindfulness practices. So movement is often a way to allow women the permission to quieten and become still and bring the system down into some different space.

I think that's part of why we see such a growth of restorative yoga and a yin type yoga in the last few years. It seems you're allowed to do that. We see qigong more so in places like Australia and New Zealand, obviously there's huge Asian culture, but they are becoming more common as part of something that mainly women do and it's permitted forms of winding down. As you said to someone, I'm gonna sit here and meditate, someone thinks they have some sort of permission to interrupt. And obviously meditation practice is often done at home. And that makes that more challenging, I think, for women because finding a quiet space where someone isn't going, isn't easy.

Also making mindfulness or present attention to my senses or my environment, personal. Is what you're saying of maybe that doesn't work for me. Maybe I'm walking, maybe I'm lying on the grass. Maybe I'm moving my body gently, finding something that works in my context and my life which is one of the things I love about one-on-one work.

When we're actually working with individuals of how something fits into their busy life versus one size fits all. I feel like I could keep talking to you for days, so thank you. If we close with your best advice and you've given us so many places to tap into and start. But if you would give your best advice for women who are starting to notice changes and who are questioning, am I at the beginning of this? What would that be?

I think go to a reputable source, like some of the ones I mentioned earlier, take a look at your symptoms, map what's going on, track what's going on with yourself. Have a look, does that look like perimenopause? And actually begin to just track and follow yourself for a week or two. When you've tracked things, create those into some questions you can go to your clinician if you're concerned and say, these things are occurring to me, could I be in perimenopause? What options do I have? Are you able to help me?

That's where we can start, but we have to know and give ourselves enough time and it's just jotting them down. You jot them down, or you can use an app if you like. There are plenty of apps around the world coming through, but you start to get to know yourself what's going on because we can't have a conversation until we've built some baseline awareness of ourselves, our bodies, what's happening.

And then I would say after that is connect with like-minded, supported people because it isn't a journey to do alone. So try and find a tribe that's positive. So that might be some local group to you.

Avoid some of these big Facebook groups where people want to download their marital problems and create drama and stuff. Find somewhere where there's neutral space, where it's safe to share. And when you're not realised that I'm not the only person that's going through this while everybody else is having their variation of this, there's strength in that too.

That piece of gathering data and being able to ask questions and then finding other people where we can have open conversations with sounds like a really beautiful way to support yourself at any stage of the game, but particularly this one. Thank you so much for the time. It's been a pleasure to have you here.

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Maude Burger-Smith