Maria Rampa: Hi, I’m Maria Rampa and welcome to this episode of Engineering Reimagined.

We take a bit of a different path in this episode, as we explore the subject of menopause. Why - you may ask?

Well, by 2030, 25% of the female population will be menopausal, making it the fastest growing demographic in the workplace. For any organisation committed to creating a diverse, equitable and inclusive workforce and business, the topic of menopause should really be openly discussed and supported.

But often considered a taboo subject, menopause and perimenopause are crucially misunderstood, even amongst those women who may be suffering. If you are female, a leader, colleague, family member or friend of a female, then you need to understand what menopause means for you and those around you – at work, at home and in your community.

In this episode, Niki Bezzant, award-winning journalist, editor and author of This Changes Everything - shares her research and understanding of menopause with Aurecon Diversity, Equity and Inclusion Manager, Penny Rush.

This episode was initially recorded as part of an internal learning session at Aurecon, however we received such amazing, positive feedback from our people who said they found the content so useful – and unfamiliar – that we wanted to raise further awareness by sharing it with you - our podcast listeners. We hope you gain some valuable insights.

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Penny Rush: So menopause is something most females will experience and which for many marks the end of fertility. For Australian women, menopause has its average onset from age 45 to 64. But as we'll hear, it can be triggered earlier in certain circumstances. Our event today ventures into territory not commonly spoken about in workplaces. By 2030, 25% of the female population will be menopausal. It's the fastest growing demographic in the workplace and we know that symptoms and aspects of life, including the ability to work, career progression and relationships with colleagues are affected by menopause and they are poorly understood, and awareness is low.

So, it's my great pleasure to introduce award-winning journalist, editor and author Niki Bezzant as someone who translates complex health and science into easy-to-understand, useful information. Niki has been involved in our New Zealand media for over 20 years. She recently edited Thrive magazine and was the founding editor of Healthy Food Guide magazine and is a frequent contributor to top print online and broadcast media. Her best-selling book This Changes Everything, the honest guide to menopause and perimenopause, was published just this year. Niki is passionate about women's health, especially empowering midlife women or whenever they might move into menopause or wherever they might be in their journey to become vibrant old ladies. So, thank you so much Niki and welcome.

Niki Bezzant: Thank you so much for inviting me. Menopausal woman are the fastest growing workforce demographic. We cannot afford for them to be stepping back from senior roles or stepping out of the workforce altogether at this time because that's just not going to work. Psychological safety is still an issue here, so I just looked at some Australian data before which found 44% of women did not feel that they could ask for help. They were too shy to ask for help with their menopause symptoms. We can improve this. We should have workplaces where we are comfortable talking about this and there's no stigma attached to it because there really doesn't need to be. This is the same kind of natural transition as puberty or as pregnancy and so we should feel as comfortable talking about it as we do talking about those things. So these are the things that we need to keep in mind in the workplace.

As Penny said, wrote a book called This Changes Everything, which came out earlier this year and the reason that I did that really was because I got to the age of 49 and this little conversation around menopause was just starting to bubble up in my consciousness and amongst my friends and I realised that I knew next to nothing about the topic, and I think a lot of us were the same and have been the same all through history really, this is something that has not been talked about and hasn't been given much attention at all, and there has been almost a taboo and a stigma around discussing it. And so when I went looking for information, I found that there wasn't a lot that I could really relate to.

There's a lot of jokey stuff around menopause, which really gives the impression that menopause is something that happens to older women, old ladies, which I had thought too. That will just happen to me when I get old. I do not feel like an old lady and I don't feel like I'm past my prime and I think that most of us Gen X women, we feel like we're at the height of our power, of our career, of our lives. We've got a lot of things going on and this whole menopause thing can come along at a time when we're juggling a lot already. So we probably need to start I think with some definitions. What is menopause? And what is perimenopause? Because that was a word that a lot of us don't know what it is. The technical definition of menopause is, it's one day 12 months after you had your last period. So at a certain point, you periods will stop, although they'll slow down, they'll stop and then once you've not had a period for 12 months, you are deemed to be in menopause and then anything after that is post menopause. But perimenopause is this time leading up to menopause, which can last between 2 and 10 years. It's a very different experience for different women and it can start as young as the late 30s, sometimes we can start to see hormonal changes. And what's happening in perimenopause, is that our reproductive hormones are, they're starting a decline. But it's not a slow and steady decline. It's not just a gentle kind of coast down the hill. It's more of a turbulent kind of a roller coaster. The hormones, particularly estrogen, which is our main hormone that controls us as women. Estrogen is going up and down and up and down. It's going up to levels higher than it's ever been before, down to levels lower than it's ever been before and really everywhere in between. And that is what tends to cause a lot of the symptoms that we associate with menopause and perimenopause. That's what makes the turbulence and that's what can be quite distressing. So perimenopause is a crazy, turbulent time. The typical age for perimenopause is probably late 40s. But as I said, it can start quite young. You will see many lists of symptoms of menopause and perimenopause. The list out of my book, there are 42 symptoms on this list and every time I turn around on social media. I see another symptom I hadn't heard of before being added to the list. The list reflects really what is going on in our bodies and it reflects the fact that we have these estrogen receptors everywhere in our body so from the top of our brain to the tips of our little toe joints. Estrogen, it's involved in almost every process inside our bodies, so you can see then why we have such a range of symptoms. It's not just about hot flushes or changes in periods or mood changes, it's actually a whole range of all kinds of other things, from joint pain to migraines, weight gain, constipation, gut problems, all kinds of things. Now a couple of things I want to say about this, especially if you're a young woman looking at this list and going Oh my God? What am I in for? Not everyone is going to get everything on the list. You'll be very unlucky to have all of these symptoms and some women will have nothing at all, so one in five of us sails on through with no stories to tell, no symptoms. Most of us are going to be somewhere in between. One in five will have really severe symptoms that are extremely distressing and then one in five will have nothing and then the rest of us, in between there. Most of us will have something. The other thing I need to say is, not everything is menopause. Anything that's not normal for you, that is happening in your body, don't just jump straight to, oh it must be perimenopause. We need to actually look carefully at what's going on. Be really in tune with our body and get things checked out because there can be other reasons why some of these things are happening and they might be quite serious things, so you need to just make sure that anything that's not normal you get checked out properly before you go, oh yeah that's a perimenopause symptom. It could well be, but we need to make sure that we don't skip over that step.

Now. How do you know that you're in perimenopause? Well, this is a question that comes up all the time and it would be so good wouldn't it, if we could just go and get a test that would tell us yes, tick, you are in the perimenopause stage. Unfortunately, it's not that simple, there is no test. This is where you are in the transition. Perimenopause average age of starting is 48 and that's when the cycle start to get variable, I guess different links or regular cycles. Maybe heavier periods. Maybe lighter periods, and then late perimenopause is where they start to stretch out more, so the cycles will get longer. You'll have more cycles without a period. You have no ovulation happening there. Late perimenopause is that time leading up to where you're going to have that 12-month period of no periods. The way that we really can get a handle on whether we're in perimenopause is to track our symptoms. So if you're tracking your periods, it will give you a picture of what's happening in your cycle. And then also tracking your symptoms can be super useful, so just writing down what's going on in your body and then if you are seeking diagnosis or seeking treatment, putting those pieces together can be very useful for a health practitioner, just to see where you are at.

I surveyed over 300 women when I did the research for my book and over 60% of women reported that they were having hot flashes or night sweats and then the brain fog and the mood issues are really huge, so nearly 60% of women are having problems with depression, anxiety, mood issues, panic attacks can be quite common and then the other thing is the brain fog. Any of us who've experienced it know how frustrating and infuriating it is, the cognitive changes that are happening in the brain. That's a real thing, there are measurable changes going on in the brain, temporary changes. So, we don't need to worry that we're getting early onset dementia, but they are for sure, real changes. Sleep can be really affected in perimenopause and then the weight and the body changes as well. This is a time when we have got a lot going on in our lives. We have got kids. We've got family, we've got careers. We've got community. We've got friends. We've got all these things. It's a very dense time of life, as one woman that I interviewed said to me, and so it can be quite hard to separate out what's going on with our hormones and what's just life.

What I'm going to talk about now are just a few lifestyle things that can be really useful for us in dealing with all of these symptoms. And then I'm going to talk about one treatment that is pretty useful and important to talk about as well. The first thing is probably not surprising. There's tons of evidence to show that exercise is great for our brain; for our mood. It is very important for sleep. So, exercising is linked with better quality sleep and particularly if you can get outside and exercise in the morning, so if you can get out into the morning light, it is really very beneficial for sleep because you're getting blue and green light so if you can get out into nature, that's even better. Getting that light in your eyes early in the day will stimulate serotonin and that converts later on in the day to melatonin, which is the sleep hormone, which can help you sleep. So exercise is great for that and even if you don't exercise just getting outside getting that light. But if you can pair the two together, even better. Exercise is very useful for hot flashes, and I know that may seem kind of counterintuitive but there's evidence linking regular exercise with reduced incidents of hot flashes and the reduced severity.

Now remember I talked about those estrogen receptors all through our body. We have them in our muscles as well and estrogen is important in building and maintaining muscle, and so when we start to lose estrogen, we lose muscle mass and that happens in women. Men and women both lose muscle mass as they get older, that's a natural decline. But for women, it's accelerated, and it's thought to be because of that estrogen going down, so it's really, really important for us to be in the habit of doing some strength training. So not just moving our bodies regularly, which we need to do 150 minutes a week, but also including in amongst that some strength training. So, pushing, pulling, lifting, whatever you can do that's got some resistance and try and get some heavier weights in there. That is so, so super useful for building and maintaining muscle. If we have more muscle, we have better weight control and we're protecting our bones as well. And we're helping ourselves to stay mobile, so I can't rave enough about how important strength training is.

The next thing that I want to talk about is diet and of course, these are linked. There's a lot to say on this because we know that eating in an anti-inflammatory pattern is very useful for us at this time of our lives because again our estrogen is an anti-inflammatory hormone and when we lose estrogen, we tend to see an increase in inflammation in the body and that manifests in things like joint pain and muscle pain. The most common and well studied anti-inflammatory pattern of eating is the Mediterranean, I really dislike the word diet and I'm quite anti diets in a formal sense, but a pattern of eating that involves lots of whole foods, lots of fruits and vegetables, whole grains, nuts, seeds, legumes, small amounts of meat fish, some dairy protein if you like that. You know, healthy fats, olive oil, your oily fish, that kind of thing. This is a well-documented anti-inflammatory pattern of eating, also very good for our brain, and good for us in general, so think about that. If you're anything like me, you will have seen tons of stuff on social media coming at you all the time, promising this diet and that diet to ease menopause symptoms. We don't have any evidence for any one particular diet at the moment apart from Mediterranean. We really don't have any evidence around any of the other popular things like keto, like fasting. We just don't know. Those things for sure are going to help you with weight control, if you follow them, but the point about diets that I always do try and make is that you need to be able to keep that up if you start a diet. Can you do it for the rest of your life because if you can't then you're probably not going to maintain the benefits. So maybe try and do some small changes, some small habits that will be more useful for you long term. The couple of nutrients to pay attention to: one is protein and this relates back to the muscle mass issue. We need to eat more protein as we get older and we can tend to eat a bit less. So, as women in particular, to maintain our muscle and to build muscle, so try and get protein into your meals and snacks all through the day, so not just having a big protein meal at the end of the day, which we can tend to do, having protein at breakfast, protein at lunch and some snacks as well throughout the day. The protein is the fuel really, for building our muscle so if we're doing weight training, strength training, then we need to fuel the muscles with protein, that's really important. And then the other thing nutrient wise that I think is really worth focusing on is fibre for our gut health. Now there's quite a lot of evidence around, and emerging evidence, really interesting stuff, I've got a whole chapter on gut health in my book because I think it's such a fascinating area. There are links between the gut bacteria and the gut motility. So women can report increased bloating, constipation. So if we are focusing on fibre and if you're eating tons of vegetables. You're eating that Mediterranean pattern of food. Then you are going to be hopefully getting a lot of fibre anyway, but really focusing on those two things, protein and fibre, can be really useful.

The next thing I want to talk about is alcohol. Alcohol is just not our friend in midlife, it's our frenemy in fact. We think it's good. We think, oh that glass of wine is so relaxing at the end of the day and it's helping us get to sleep. But in fact, alcohol is just really kind of a disaster. It's going to exacerbate or trigger hot flushes. It is terrible for mood and it's not going to help at all with brain fog, alcohol destroys sleep. Because it really interferes with the deep, restful, restorative sleep that we need and then of course, alcohol is a super energy dense food, one of the most energy dense foods that we can have, so it's not helpful for weight gain either. If you're struggling with symptoms and you want a quick win. If you're not already cutting right back or cutting it out, cutting out alcohol is a really good thing to try. Just try for a couple of weeks and see how you feel. You might find that a real game changer. And of course again, alcohol is associated with inflammation. It's just really bad news all round. If you can give up drinking completely, awesome, and tons of women have done that and told me that they feel amazing, but really just keeping it to very occasionally, is going to be helpful. And we lose our ability anyway, as we age, and men will know this as well, that we lose our ability to metabolise alcohol as we get older and so men and women both tend to have worse hangovers just from not drinking so much. So getting rid of the booze can be a really, really important, and a big step to take.

And then the last thing just in terms of lifestyle is around stress. We all live now in a very stressful world, don't we? Life is stressful in general. We're all pretty much stressed most of the time. Stress hormones and estrogen, our reproductive hormones are linked and there's a lot of interaction going on there in all of these areas, so if you can, try and find ways to address stress in your life and that's going to be different for everybody. Exercise is a great way to reduce stress. There's a lot of evidence around that, but whatever it is for you whether it's meditating, whether it's just going outside for a walk, whether it's taking 10 minutes to just go quietly and do something on your own. Whatever the thing is for you, having a laugh with your friends. Try and practice that and get in the habit of finding ways to deal with it. The harder work of dealing with the sources of stress in your life, that will pay off big time. It's very easy for us as women in particular, to think or to feel that we are being selfish when we prioritise some of these things, when we take time to exercise or when we take time for ourselves for a bit of R&R or the things that we need to do to ease our stress. We can think oh, I'm being selfish. Try and reframe it and think of it not as selfish, but really as self-care. It's really important self-care.

So I want to talk about HRT, hormone replacement therapy, because we have to talk about this when it comes to menopause. There is still a lot of misunderstanding out there about this and I think it's not well understood in general. HRT has been sort of rebranded now. You might hear it described as MHT as well, Menopausal hormone therapy. And you may have heard that HRT is risky, that it's dangerous, that it's linked with breast cancer. That's still an impression that's out there and that's unfortunate. That came from a study that was carried out over 20 years ago now, called the Women's Health initiative and that study was a big study of women looking at the effects of HRT, actually not on menopausal symptoms, on a whole range of other symptoms, but they stopped that trial early because of what they identified as an increased risk of breast cancer amongst the participants, amongst a few other things. Unfortunately, the way that that study was interpreted and then also the way that it was reported, the message that came out of that was HRT is dangerous. We are not going to be going near it anymore, so women threw away their HRT. Doctors stopped prescribing HRT and a lot of research into women's health and menopause and hormones and general just kind of went out the window. So really a couple of generations of women were really done a disservice by that. It was only quite recently that the learnings on HRT have been updated so that the information from that study have been reanalysed over the years and more research has been done and also forms of HRT have changed. So, what we know now about HRT is that it is extremely effective, and useful treatment for women who are really struggling and menopause, particularly with hot flashes and also GSM which is Genito Urinary Syndrome of Menopause. It is generally considered to be helpful for mood and for other things like joint pain and brain fog, all those kinds of things. So, the risk associated with HRT is low for most women. Everyone is different and you need to talk to your own doctor about your own personal risk profile. But most of us, if we start HRT before the age of 60 and we are or within 10 years of the last period, then it's a very, very safe treatment and the risk in terms of breast cancer is less than the risk would be if we were drinking one drink of alcohol a day or the risk that if we're physically inactive, or if we are overweight or have obesity.

So the message that I kind of want to leave you with, is that we actually have an opportunity because we're gonna live another half of our life, potentially, a third or a half of our life, and so menopause and perimenopause is this great opportunity to get ourselves into healthy habits now, so that we can be those ******* old ladies for the rest of our lives. We want to be able to live as well and be as healthy as we can for as long as we can. So, think of this as a great time to reset. We're learning about this and then starting the conversation, having some compassion, being a community together talking about menopause is going to make all the difference. Knowledge is power, so don't be scared to talk about it. That's my message - learn about it. Ask your colleagues and friends - talk about it rather than letting women feel like they are suffering in silence, or on their own, which they definitely are not.

Penny Rush: What's the good news? I mean, it's a transition, isn't it? It's not something that's a set and forget?

Niki Bezzant: Yeah, there's tons of good news. It's temporary so it will end. And women who have come out the other side say that they feel amazing - they feel strong, they feel new power. They feel incredible. So, I think it's really worth holding on to that and thinking, Yes, that's where we're going to all get to.

Penny Rush: Wonderful place to finish on. Thank you so much, Niki.

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Maria Rampa: We hope you enjoyed this episode of Engineering Reimagined.

I hope you, like me, found this conversation empowering and you now have a better understanding of menopause, its symptoms, and the small changes you can make to improve your health and wellbeing, or better support those around you – at work, at home or in your community.

You can purchase Niki’s best-selling book This Changes Everything - The Honest Guide to Menopause and Perimenopause online and in bookstores. If you enjoyed this episode, hit subscribe on Apple, Google Podcasts or Spotify and don’t forget to follow Aurecon on your favourite social media platform to stay up to date and join the conversation.

Until next time, thanks for listening.