Episode 76
Feeling Off in Your Late 30s? It Might Be Perimenopause And You’re Not Alone | Dr. Fatima Khan
We’ve both treated thousands of women and lived through it ourselves. The truth? Perimenopause doesn’t begin in your 40’s. It starts years earlier, and too many are left struggling without answers.
If you’ve been told you’re “too young” for perimenopause, you’re not alone—and you’re not too early. In this conversation with Dr. Fatima Khan, an Australian menopause specialist, we dig into what perimenopause really looks like and why so many women fall through the cracks of outdated definitions.
Dr. Khan explains how progesterone and testosterone begin declining in our late 30s, long before estrogen crashes. The result? Fatigue, insomnia, anxiety, and heavy bleeding symptoms often brushed off or misdiagnosed. We discuss how the stress of modern life, poor sleep, and constant cortisol spikes are pouring gasoline on an already intense hormonal fire.
But this isn’t just about hormones it’s about support. From rethinking your exercise habits to building better boundaries and giving up the need to control everything (easier said than done), we talk about real-life tools that make this phase survivable and maybe even freeing.
Whether you're a clinician or someone living through the chaos, this episode offers a new lens on the perimenopause transition one that goes far beyond HRT and into the heart of what women truly need.
Highlights:
- Why current definitions of perimenopause don’t reflect what women actually experience.
- The early symptoms no one talks about: anxiety, fatigue, and mood swings.
- The role of progesterone and testosterone before estrogen becomes the issue.
- How cortisol and chronic stress intensify hormonal symptoms.
- Practical tools for nervous system support and reclaiming your energy.
If you found this episode helpful, make sure to subscribe, leave a review on Apple Podcasts, and share it with someone who might need it too.
Get in Touch with Dr. Khan:
Get in Touch with Dr. Rahman:
Transcript
because people treat it the same because there's no training in how to treat perimenopause, right?
Sameena Rahman (:Absolutely. Yeah. So let's talk about that. think what we'll do, like what I do is I'll, have our discussion and at the end, after we're done recording, I'll, I'll, I'll do our introduction and say, this is, know, Dr. Fathma Khan, who we talked about. So we can just start like, you know, like we normally would. And then, and then, yeah, let's talk about it. We'll talk about your experience a little bit.
Dr Fatima Khan (:Well, Samina, I'm gonna tell you to bring this door, because your face, you've got a light source coming behind your right eye. Can you see it? Yeah, there we are. That's better. Can see your lovely face?
Sameena Rahman (:there it is. Yeah. perfect. Okay. So then we'll talk about like your entrance into perimenopause, menopause management. And then, you know, we can talk about some of those nuances that we'd like to discuss. And then we'll have a, you know, just a conversation. know, okay. Hey, y'all, it's me, Dr. and I have someone that edits this. you know, she'll can she can edit out whatever you want.
Hey y'all, it's me, Dr. Samina Ramon, Gyno Girl. Welcome back to another episode of Gyno Girl Presents Sex, Drugs, and Hormones. I'm Dr. Samina Ramon, and I'm super excited today to introduce you to a new friend, a virtual friend I hope to meet one day in person. But we've met through online activities and we have a lot in common. So as you heard in the introduction, she's an amazing menopause specialist, and we're gonna get into some interesting stuff.
talks today around perimenopause and all the things. So welcome Dr. Fatima Khan, the menopause specialist on Instagram, all the way from Down Under. What time is it for you?
Dr Fatima Khan (:It's Monday morning, 10.30 AM. And I understand it's Sunday evening, 7.30 PM. So.
Sameena Rahman (:Okay.
Yes, for me. Yes. So there we go. We finally did it. This has been like, I don't know, six months in the making or something because of the time difference.
Dr Fatima Khan (:Yes, it's always a bit tricky, but thank you for sacrificing your Sunday evening to have.
Sameena Rahman (:No, thank you for your Monday morning. But I follow you on Instagram and now we're in a little menopausey group. talk all the time. But I want the listeners to understand who you are, how you came to this interest in perimenopause, menopause. Because obviously everyone enters this as clinicians in a different way and none of us really get the training we need.
Dr Fatima Khan (:Yeah.
Sameena Rahman (:in the States and I understand it's the same in like UK and abroad too, although it might be a little bit better nowadays. So tell us like how you got into this and where you are right now with your private practice.
Dr Fatima Khan (:So, you know, it's interesting. I was telling someone I've been a doctor for 18 years and I went to medical school 24 years ago. So I might look not as old, but I am pretty ancient in kind of the medical world. And I've been doing many course, sorry. I graduated in 2000, I started 2001 and then I graduated 2007.
Sameena Rahman (:Yeah.
Sameena Rahman (:Wait till you graduate in 2001, medical school, 2001.
Sameena Rahman (:okay.
Dr Fatima Khan (:So in the UK, we go at 18 and then you do five years undergrad, MBBS, and then you do a year of intercalated BSc. So I did pharmacology and therapeutics. You did six years at Imperial College in London. And then I obviously like most women loved obscenity. And so I was going to do obstetrics. Absolutely loved obstetrics. But then back in those days, you would literally start your own call like 18 hours a day.
Sameena Rahman (:you
Dr Fatima Khan (:wouldn't go home for two weeks in a row. And I got married when I was really young. I got married at third year of medical school. So we're celebrating our 20th wedding anniversary this year. We met, we were in our first year. And I think what happens is like he was doing emergency and I was doing obstetrics. We just found out we just wouldn't see each other. And so I was like, okay, what can I do, which involves obstetrics, but also gyne, because a lot of the women on the gyne on call, by the time they were getting
Sameena Rahman (:I'm-
Sameena Rahman (:Yeah, amazing.
Sameena Rahman (:Yeah, it's true.
Dr Fatima Khan (:to emergency, they could have managed a lot of the women's health in the community much better. And so when I was doing gyne clinics, I was like, hang on, but this could be done in the community. Why do I need to wait to see a specialist in the hospital? So then I kind of did a bit of community opposite gyne and then decided I'm going to do general physician or GP after five years of training and then decided very quickly, I didn't want to do that and did emergency medicine.
be. So I did that. started in:And so we would see high risk women with like, you know, IBC filters, pulmonary embolisms and thrombophilias and women who wouldn't be able to have HRT in the community. We're very lucky in the UK, you've got clear guidelines for the straightforward cases that we started. So my training was, yeah, so they've got the nice guidelines, which are available for every physician to start HRT on, but the complex cases. So when I did my training,
Sameena Rahman (:I do, love the British guidelines actually, the British Menopause
Dr Fatima Khan (:It was an advanced certificate which allowed me to then, you can go independently, set up a menopause clinic and accept referrals. So I started doing that 2017, 2018. So I've been doing it for seven, eight years now. And then I moved to Melbourne, Australia in 2019, just before the pandemic and then set up a clinic here. And again, it's multidisciplinary. I work with a hematologist. I work with a laparoscopic gynecologist. So I do the hormone replacement side.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:A lot of my work is with gynecologists, because as we were talking about, a lot of the women would present with gynecology issues like heavy bleeding, fibroids, adenomyosis, and all those things. But I think over the eight years, you learn the nuances of managing menopause. And I always say eight years ago, you would see menopause. You would see women who would prevent with 12 months at amenorrhea. They come to you, they'll have the classic symptoms. You give them estrogen progesterone. I mean, most physicians can do that.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:I think there's been a big shift in this perimenopause and it's getting younger and younger and younger. And so perimenopause normally would be women who are skipping periods as the transition leading up to menopause. But now we're getting women on a monthly cycle and still wanting to take HRT. And I guess we don't have the guidelines because if you look at the stroke classification, it starts with this delay of seven days or more and...
Sameena Rahman (:Yeah.
Dr Fatima Khan (:And I guess we probably need to understand the nuances of a woman presenting with perimenopause. When does it actually start? It's not really when you see a shift. And what are the symptoms initially, which are very different to menopause? And number two, how do you manage it?
Sameena Rahman (:Mm-hmm. Yep.
Sameena Rahman (:Yeah, absolutely. I think we should get into all that. I I feel like a lot of my listeners are clinicians. I mean, a lot of them are looking for help too. But like from a clinical perspective, I feel like the perimenopause transition is the worst part, right? Like it's like, I mean, I'm in the middle of it right now. It's hell. mean, it's like, and I can't, you know, and I do this for a living and I'm trying to figure out like, maybe I need less estrogen right now. Cause I'm sure if you know, if I'll
I wish we, like I think Rachel Rubin was saying that like if only we could do a continuous glucose monitor that's with the hormones and see what is happening with our estrogen. mean, you technically we're not supposed to check hormones all the time, but we know that the shifts are so dramatic in perimenopause that if the average age of menopause for, you know, Caucasian women are 51 and a half, but we have to talk about the South Asian thing too. But, you know, let's talk about, you know, where you see perimenopause age wise, you know, and what are the biggest symptoms.
Because, you know, I'll tell you what the ones that I hear the most, I'm curious to know to think what you feel like. I mean, they're probably the same,
Dr Fatima Khan (:Yeah, think, think number one, need to start with the nomenclature, right? So at the moment it's menopause at 12 months of amenorrhea, but it's cessation of your menstrual cycle. But essentially there's no more eggs to produce. And if you look at, for me, I think we need to redefine perimenopause by not just the menstrual bleeding as a pattern, because a lot of the women would have hysterectomy, have marinas. So we're losing this big chunk of menstrual bleeding history. So we've got to, and also by the time we get the menstrual,
Sameena Rahman (:Applations. Yep.
Dr Fatima Khan (:changes, the hormones are already fluctuating. So I don't think it accommodates for those changes. And so for me, it's okay. Well, if menopause is cessation of your periods from ovarian function or failure, no more eggs, then we know there's a dip in ovarian activity and quality of eggs around 37, 38. And if you look at the recent data that's coming out, they'll say that's when perimenopause start, but the symptoms are not hot, freshers, night sweats. And if you look at
Sameena Rahman (:Yeah.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:the normal menstrual cycle. The first follicular phase is estrogen going up, mid-cycle you ovulate. Now, at ovulation you release an egg, we all know that, but then the whole point of that progesterone peak that you would get in the luteal phase is to support implantation of the embryo. Now, we're not interested at 37, 38. There's a decline of fertility at 35, and 37, 38 is the shift where the progesterone kind of goes a bit flat.
and women will present to you with three presentations. Typically when the progesterone goes down, you'll either get heavier bleeds, so they're still having a monthly bleed, but the period is heavy. So you're not getting that endometrium with the progesterone, but the estrogen is still obviously building up the lining of the follicular base. So for me, very early perimenopause starts late 30s, and they'll come to you with monthly bleeds, but they'll tell you they're getting a heavy period, they've got clots, or they're flooding.
Sameena Rahman (:Yes, absolutely.
Dr Fatima Khan (:Now there's three phase, three kind of characteristic symptoms or points I normally talk about perimenopause. So the first thing, they'll have low iron, because they've got heavy bleeding. When you have low iron, you'll have fatigue, reduced exercise resilience, breathlessness, dizziness, fatigue. So we need to get that iron up and most women are roaming around with low irons and more and more data showing it causes brain fog and insomnia as well.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:So that's the first thing they'll present to you. They're feeling tired, they're feeling exhausted. The second thing is when you lose progesterone, I'm talking endogenous progesterone, which is a GABA stimulator. So that's a calming neurotransmitter in the brain. We lose two things. You don't get deep sleep or deep REM sleep. So suddenly women are getting poor sleep, disturbed sleep, and they're not waking up refreshed with the background of low iron. So now you see they're fatigued, they're exhausted, they're not sleeping well.
Sameena Rahman (:off with you.
Sameena Rahman (:Yep.
Dr Fatima Khan (:And then the third thing is you lose that calming effect in the brain. So you lose the anti-anxiety effects. So now you've lost the sedative effect. You lost the anti-anxiety. So the typical features that I've seen for eight years is fatigue, insomnia, anxiety. And a lot of the time we look at it from the reproductive lens and we don't talk much about the role of natural endogenous promethium or progesterone. And everyone
Sameena Rahman (:Thank you.
Dr Fatima Khan (:is focused on estrogen, but actually the early perimenopause women will present with fatigue, anxiety, insomnia. And when you don't sleep, we don't restore and rejuvenate, so you feel even more exhausted in the background of low iron and anxiety. And now this would be fine if you had two generations before you and have your kids at 20, at 45, you know what? You can have flooding and hemorrhage because your kids are at college.
Sameena Rahman (:Absolutely.
Sameena Rahman (:Yeah. Yeah. Yeah.
Dr Fatima Khan (:and you can afford to like be at home, take your time, have an afternoon and see a step. But that's not the case. The average 40, 43 year old has got three kids under 10 and she's working full time. So her general baseline cortisol drive is high. So the compensatory mechanisms aren't there.
Sameena Rahman (:You throw in there like the sandwich generation where you might be managing like family members that are ill or you're the primary caretaker for everyone, then that's, you know, like a real shit show.
Dr Fatima Khan (:Yeah, so I mean, the typical, you know, 40, early 40 woman has got three young kids, she's working full time, and she's also got elderly parents, most likely with Alzheimer's. So now you've got a situation where you're feeling fatigued, you're not sleeping, and you're feeling anxious all the time. And we know a stress would exacerbate this thing. So background cortisol from lifestyle responsibilities will make, will affect your sleep, will make you more anxious. And then
in the background of when you're supposed to be performing, you can't. I think it's also important to realize that I personally think progesterone is what we need to replace in the luteal phase. So suddenly the first thing what happens is we see the bleeding is controlled, they're sleeping better, they're feeling calmer, they're coping better. I always screen with three questions asking about the three B's of estrogen excess, because we know you have unopposed estrogen.
And I think for practitioners who are starting to use a lot of estuaries, you've got to be careful in that early phase because you have these massive peaks. If you look at any kind of data point, progesterone declines first because we're not trying to produce a baby.
Sameena Rahman (:And more steadily too, like it's a client steadily, not as.
Dr Fatima Khan (:Yeah. So estrogen, if anything, you kind of get this kind of higher levels of estrogen because the FSH is telling the brain to produce more. So we actually see double, triple amount of estrogen. Now you've got to think about unopposed estrogen on the lining where you have to have risk of endometrial hyperplasia. So you've got to make sure you're looking after that. Everyone knows I'm obsessed with the lining of the uterus. And so someone will find that they will need either a DNC, they might need a polypectomy, or they might even need a marina.
Sameena Rahman (:Okay. Great. Great.
Dr Fatima Khan (:Now I know some people hate the marina, but I think for a lot of women it's life changing because at this phase of life it offers them contraception, but also that endometrium control. And you can still add in the natural progesterone on top, micronized progesterone, which will help with the sleep and the anxiety. Typically, find going back to asking the question if they've got too much estrogen, I always screen by asking them, have you got breast tenderness, breast enlargement, bloating, fluid retention, and heavy bleeding?
Sameena Rahman (:Live streaming.
Dr Fatima Khan (:So if they're getting that, that already tells them they've got sufficient estrogen. And we know when the estrogen is fluctuating, you can get hot flushes, night sweats from tachypallaxis. Sometimes women will say to you, they've got hot flushes, night sweats. And I'm like, okay, tell me more. they'll say, oh, I've had heavy bleed. I had clots dripping down my leg. had breast tenderness. And the ester was running at 3000. And so it's really important to actually just not focus on hot flushes, night sweats. You've got to look at the whole body.
Sameena Rahman (:Yeah.
Sameena Rahman (:Right.
Dr Fatima Khan (:And we also see this unopposed estrogen on the breast where women start presenting with lots of cysts, because I do lots of breast imaging for women. So I think when we think about unopposed estrogen and perimenopause, not just on the endometrium thickening it and putting you at risk of hyperplasia, you also need to think about the breast as well, overstimulating cysts. Now that doesn't mean it causes cancer, but we don't want to be overstimulating. We don't want painful breasts that you can't wear your bra. If they're having to go and buy a new bra or they can't hug their children or change...
Sameena Rahman (:Yes. Yeah. Yeah. That's true.
Dr Fatima Khan (:lying, turn around in bed, too much estrogen. So I normally look at, I would normally screen and then I might add a very low dose estrogen. But typically if they're very early perimenopause with heavy bleeding, I'll do micronized progesterone, lethal phase, and then I'll add testosterone. It's really important to know that I don't know where this came from, but testosterone does not go down suddenly after menopause. It starts to get peaks in our 20s.
And it goes down in a late, kind of, would say mid to late 30s. And typically a lot of my early 40 patients or late 30s have almost no testosterone. Now, if you go back to the same, you know, you've got a lady in front of you, she's coming and telling you she's fatigued, she's overwhelmed, she's exhausted, she's got brain fog. So testosterone is very good for three things. Of course it's licensed for persistent low libido postmenopause. Using in perimenopause is unlicensed.
Sameena Rahman (:Yeah, agreed. Agreed. Yeah, it's so true.
Dr Fatima Khan (:However, we know it helps with emotional resilience. In some women, it will help with brain fog and mood. Just like men, it helps with mood, lifting mood, helping mental clarity, helping their muscle mass, helping with metabolic syndrome. I think it has a similar effect. Of course, you need to replace in a physiological range. Now, if you look at the bigger data and the big RCEs, sorry.
Sameena Rahman (:Right. But you can do readily in Australia. was gonna say, it's easier to do in Australia because you guys have an Androfeme. We have to be creative.
Dr Fatima Khan (:We're very lucky you have a TJ approved, but you have to understand it's only licensed for postmenopause. so we obviously, know, using testosterone perimenopause is off label anywhere where you use it. But in the perimenopause, know, we in the UK, we've used it for things like not just low libido, but for fatigue as well. And I think we need to have a paradigm shift
Sameena Rahman (:I see.
Sameena Rahman (:Controversial. Yeah. Absolutely.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:by using more micronisobugestrion and testosterone in that early perimenopause transition. And estrogen comes a lot later. And the hot flushes night, so it's come when they're very low. Actually, before that, you start noticing the periods become lighter. They might tell you they're getting menstrual migraines. They might get more arthralgia or joint pain. You have to be careful about joint pain. You can get them even with high estrogen.
Sameena Rahman (:Agreed.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:And similarly with dry eyes and dry skin, I've got women coming in with like four pumps of ester dial and their estrogen is through the roof and they're flooding. Too much estrogen can also cause this kind of dry itchy skin and dry eyes as well. So testosterone is what helps those women because we know testosterone helps with myobrhobin glands, it helps with dry eyes as well. So I think we've got to explore in the early perimenopause more of this testosterone progesterone role by adding in estrogen later.
but everyone is focusing very heavily on estrogen without kind of understanding what's actually happening in that Bavarian lifespan in the woman's life.
Sameena Rahman (:I agree, I think that's actually a wonderful summation. We have those patients that really do well with oral micronized progesterone, the prometorin, which is body identical. And we know that there are those patients that really, it's like a life-saving thing for them. But there are a subset of women that we always talk about who have a sensitivity to progesterone, right? Like they're the ones that you might see who have worsening irritability, they have worsening bloating, they have worsening sleep.
What do you do for those patients that, you know, when you're thinking about, I mean, obviously, if it's the bleeding issue we can address, when you're thinking about supporting that perimenopausal transition and that stuff doesn't help them.
Dr Fatima Khan (:think so in my experience is the community who are sensitive, they tend to have underlying traits of either ADHD, neurodivergent minds, and there's a lot of background of PTSD, PMDD and ADHD, it's a cluster. And they've got this kind of GABA sensitivity in the brain where they either become really anxious, really flat, or actually get paradoxical insomnia.
Sameena Rahman (:Yep. Yep.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:from taking micronized progesterone. Those women, obviously we probably have to go with non-oral routes because there's normally the allopragnalinone from the liver metabolism that they get this very potent effect. Vaginal bypasses that, so they'll get the endometrial protection. Of course, vaginal perimeterum is off label for perimenopause and menopause use. Or we think about things like the marina. Again, they'll find that helps them.
Sameena Rahman (:you
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:And in those subset of women, they again will find that testosterone helps because the testosterone is very useful for PMDD, PMT, endometriosis, they tend to have low levels of testosterone and they don't tend to tolerate estrogen or progesterone you'll find. And I think we're gonna find more and more women
Sameena Rahman (:them.
Dr Fatima Khan (:insensitive to estrogen and progesterone, despite it being body bioidentical and the role of testosterone in these women because it helps with this resilience to stress. A lot of them will say they feel calmer, their premenstrual symptoms feel calmer. They get this mental clarity if they've got that ADHD picture. With the PMDD, it reduces that irritability. It helps them with their sleep, helps them with their vaginal dryness. You do get some more aromatization into estradiol.
Sameena Rahman (:Yeah.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:But if you're replacing in physiological ranges, you don't see that obviously. But obviously if it's too much testosterone, then you can get breast tenderness and breast enlargement. So you just got to keep an eye if someone is either overweight, they've got a lot of fatty tissue, you can get this oromatization in adipose tissue leading to breast tenderness, breast enlargement. So you just got to keep an eye on that in bleeding as well.
Sameena Rahman (:Yeah, absolutely. And I feel like, you know, testosterone, you know, on social media can be so triggering for so many people, right? Because there's so much, you know, obviously we know based on our consensus guidelines that, you know, for hypoactive sexual desire disorder, this is like the go to. But you and I both see this in our office. Like we see it all the time where people are like, my God, my brain fog is better. Or like, I have the most clarity. I feel so much better. My mood is improved.
You know, we all know that this is affecting our brain. you know, we see it. So that's what oftentimes what I'll tell patients is like, what we know is that it's for hypoactive sexual desire disorder. That's what it's sort of approved for in this perimenopausal. And not, I would say like based on our consensus guidelines and research, but anecdotally, we see patients all the time with these symptoms that are improving.
Dr Fatima Khan (:And I think you've got to realize guidelines are there for safety. And I think as long as you are practicing individualized medicine, you've got a woman in front of you and you got a baseline, which is undetectable or very low. You're placing in physiological ranges. You do a trial for three months. And if they get benefit, great. And you keep an eye on that. If they don't get benefit, then you don't do it. You know, we use, I think there's so much research that needs.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:to be done, especially around that perimenopause and the phase around the role of testosterone. There's lots of data coming out on endometriosis and obviously a lot of my patients have endometriosis. But part of my understanding is, I guess going back to the progesterone again, we need to understand that we now, I'm seeing more and more progesterone insufficiency. So the hallmark of premenstrual tension,
Sameena Rahman (:Yeah.
Dr Fatima Khan (:and perimenopause is progesterone insufficiency, which happens number one from anovulatory cycles because we're not trying to have eggs not pumping out every month and also you're not gonna have lots of progesterone. I'm also seeing now in younger women these premenstrual symptoms and the perimenopause being exacerbated because of the whole mental load from the sandwich generation. You got...
Sameena Rahman (:Thanks.
Sameena Rahman (:you
Dr Fatima Khan (:So, daily micro-stresses, your entire cumulative load of stress is so high that your hypothalamic adrenal axis now is activated chronically, which means we know that chronic stress will suppress your LH surge. And then you have, you don't produce as much progesterone. And evolutionarily, that is to keep you safe. You know, if you're in caveman days and there is no contraception,
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:you can have sex, but you're not going to get pregnant because we don't have enough progesterone to implant that embryo because it's about survival. It's about human species being continued. So they need you to procreate. And so we're seeing that. That's what if you look at infertility and subfertility is rising, not only because women are having kids later. And of course, again, we know that that progesterone is not there, but we got to understand that women now, even in their thirties and forties, I'm seeing this.
premenstrual tension and PMD and a lot of it to do with this progesterone insufficiency. We're getting more and more heavy bleeding, insomnia, fatigue and mood disturbance because we're losing that relaxing, calming, anxiolytic effect, the sedative effect of natural progesterone. And natural progesterone is the first thing that will go down when you've got chronic stress. And on top of that, when you have excessive screen use, which we know the blue light will stimulate cortisol
and further keep those cortisol levels high. And you see that, women will come to you, they'll tell you, they can't switch off, they're on all the time, they're in this sympathetic drive. So I'm seeing more and more shift in the last five years of this nervous system dysregulation where women are stuck in this sympathetic nervous system with just not being able to bounce back into a rest or a pair, relax phase.
Sameena Rahman (:Yeah. Yeah.
Sameena Rahman (:Yes, I agree.
Dr Fatima Khan (:where, because you can't, you start your day in the morning, you do the lunch boxes, you run, run, run, you're thinking about what you're going to cook for dinner, you come home, and physicians are more at risk of burnout than amongst other professionals like lawyers. Yeah, and a lot of my patients will then say, then I'm like, you know, we do have school because that's scroll, that's the only thing that calms us down, but that's pushing the cortisol up, and then you're trying to sleep, and you can't sleep because you need at least, you know,
Sameena Rahman (:Yeah, the chronic to-do list. We have a chronic to-do list in our head.
Dr Fatima Khan (:good two, three hours of no blue light, you wanna relax, but you can't relax because you're thinking about the mental load and most women are preparing their next day to-do list while they're sleeping and waking up at three and stressed. so, yeah. So I think all the Mike Canis progesterone will buffer a little of that cortisol. know that it's, so GABA is like having a glass of wine or a jar of Parmesan X, right?
Sameena Rahman (:Absolutely. I forgot, I forgot this. That happens to me all the time. I forgot to do this. Yeah.
Dr Fatima Khan (:But we have to always focus on the fundamental pillars of good health. And if you want to support your hormone health, you need to think about good nourishment through lots of protein and fiber. And a of us, especially physicians, are on the go. Black coffee, croissant, sandwich, not eating, and we're not getting our fiber, we're not getting our protein. And we know that your insulin resistance gets worse, not just through fluctuating estrogen level, but when you've got poor sleep.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:That's an independent risk factor for type two diabetes and insulin resistance. And you all get that through stress and low progesterone. And then secondly, when we are eating on the go, our body's general ability to maintain those blood glucose are reduced because we have less muscle mass as we get older. So now we're not sleeping. We have high cortisol, we have reduced muscle, so we don't buffer that glucose as well. And then you tend to gain weight, but also the mood fluctuates as well.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:So you've got to start at 35, looking at making sure you're having those lovely, nice protein breakfasts with fiber in it and fat in it. And that's a typical time most of my patients won't have. They'll have a black coffee, shooting that cortisol through, then they'll have something on the go, pick up a cookie. And we just neglect our health because number one, we don't have the knowledge or education. And number two, we don't understand things like how does estrogen, progesterone, and cortisol
Sameena Rahman (:Yeah. Yeah.
Dr Fatima Khan (:interact with insulin and blood glucose. I think the movement we need to change. Everyone is doing this crazy exercise in the treadmill, but again, that's a form of physical stress and it puts this bird further, bird and not. If you're someone who's feeling refreshed after you run, great, but most women I speak to that's not the case. They're feeling exhausted to even walk, let it out and run. And I think just saying, okay, let's do 20 minutes of resistance training every other day. We're getting some
Sameena Rahman (:all the hormones, right?
Sameena Rahman (:you
Sameena Rahman (:Yeah. Yeah.
Dr Fatima Khan (:core stability work with really kind of focused pilates. And so changing that and having a really good sleep ritual. Like for me, magnesium is a must, micronized projection is a must. I tend to have no blue light. I put my phone in the study. mean, two nights I might scroll on the weekend. But generally I have this thing around nine o'clock or eight thirty. There's no blue lights. All the lights start going off. I have a candle on and I'm starting to snooze. I'll read a chapter of book and then
Sameena Rahman (:Mm-hmm.
Thanks very much.
Dr Fatima Khan (:I think you have to cultivate practices to support these things because modern life is detrimental to your home and health. And because everyone is just doing it, everyone is struggling. And I think the final one comes to stress reduction because we do passive stress reduction, is doom scrolling and watching Netflix. But actually you've got to do active relaxation. That might be either for some women having a nice bath, it might be doing a little bit of yin yoga stretches.
Sameena Rahman (:is nuts.
Sameena Rahman (:you
Dr Fatima Khan (:It might be doing breath work. It might be doing meditation, something that is actively communicating with the mind. I'm not stressed because the brain is getting 105 mile an hour and you've got to tell it, no, I'm okay. Either you do some deep belly breathing, which we know stimulates your vagus nerve. And I think the more we focus on vagus nerve work, which is comes to, you know, your rest of repair, you'll find your sleep better. Your hormones react better as well.
Sameena Rahman (:and talk to you.
Sameena Rahman (:Yes. Right.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:You can do HRT, but you need to do the other four pillars as well. If you're not doing them, you're not going to see the difference. So all my patients who come, you know, and we haven't even talked about alcohol, because as you know, if you choose to drink, you just won't sleep. And we see that obviously the liver, the alcohol dehydrogenase is not the same quantity, not there, it's decreasing. So it's ability to clear the alcohol is reduced and hormones are metabolized to the liver.
Sameena Rahman (:Right, right. It's a tool in the toolkit. Right.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:So then you have more premenstrual tension. And most women, you tell them, I tell them to do a liver detox, because it sounds cooler than saying don't drink alcohol, for the first few months, or when I give them any form of hormone therapy, because I want them to sleep. I don't want them to get premenstrual mood disturbance. And I'll tell them to try and not eat after 7 p.m. and focus on really those four fundamental pillars, no caffeine after midday, try and eat some good protein, fat breakfast.
Sameena Rahman (:Yeah.
Yeah. Yeah.
Dr Fatima Khan (:Time-restricted eating is a lot better than fasting because fasting puts a lot of, especially in perimenopause, post-menopause, if you look at the fasting data, it comes from post-menopause because when hormones are fluctuating, we have fluctuating cortisol levels and fluctuating glucose level. You need to support that. And when you fast, post-menopause, it's fine, but in peri, it's too much stress for most women's body. But you're better off having, if you look at most of the data with time-restricted feeding,
which is circadian fasting, essentially eating within daylight hours. That is better, rather than starving till midday and then eating at midday and then eating till 9, 10 p.m. So I normally encourage that. But I think going back.
Sameena Rahman (:So clearly, that's what I think people, yeah.
Sameena Rahman (:Like stop you can get like two or three hours before you go to sleep is what I tell people like, know, yeah.
Dr Fatima Khan (:Yeah, exactly. You know, I normally say, you know, try and eat in daylight hours. I mean, and the reason is if you look at Sachin Panda from Salt Lake City, he's done a lot of research around circadian rhythms and he's done, you know, if you give the same diet to people who eat within daylight hours, sunrise to sunset, and the same diet, if they start eating at midnight, midday and go all the way to say eight, nine p.m., they just put on weight purely because they're eating later. And that's because our insulin is more sensitive in morning.
So, a.m. in afternoon time. So, I don't think you need a massive breakfast. I just think if you're going to eat your complex carbohydrates, which are important, like sweet potato and complex grains, they should be eating during the daylight hour, just because you metabolize the glucose much quicker and clearer than in the evening. And so, I think you've just got to look, you see, just giving them progesterone issues is not going to help with their weight, their mood, their anxiety, their sleep.
Sameena Rahman (:Mm-hmm, absolutely.
Dr Fatima Khan (:they're always going to be unhappy. And I think we must as practitioners educate them on all of these things because they'll come to you and say, I've been doing this in my twenties and thirties and that's not working because we don't have the education on how many to shift the way we move, the way we eat, the way we sleep. And I think part of stress also comes from not just actively relaxing, but also I think stepping back and we're conditioned in our twenties and thirties to keep saying yes and over committing.
Sameena Rahman (:Yeah.
Thank
Yes.
Sameena Rahman (:I know.
Dr Fatima Khan (:But I think for me, the most liberating thing is stepping back and just saying no to a lot of things. And it's like, actually, no, I'm actually gonna spend more time, just, we don't have to be on the go because it can be quite stimulating to be that adrenaline and cortisol and socializing and meeting. And I think that's important, but I think we need to be more intentional and more, like, intentional around our interaction and social interactions.
Sameena Rahman (:Yeah,
Sameena Rahman (:Yeah.
Dr Fatima Khan (:which are around meaningful conversation is just fueling up our bucket rather than hanging out with people and doing things which are draining us. So for me, when I see someone or if I do something and I feel really exhausted but I'm not getting joy from it, I mean, of course we all have obligations, but I just think we just need to step back and journal and really reflect on what we're doing and be a bit more intentional. And that's one of the good things I think when you're entering this phase, it's just...
Sameena Rahman (:Absolutely. Yeah.
Sameena Rahman (:Right.
Dr Fatima Khan (:kind of if you lean in and do the inner work, you'll find that transitions a lot better. Cause I think a lot of the issues are not just hormones, they're stress and our life responsibilities and the people around us who exacerbate the journey as well.
Sameena Rahman (:Yeah, absolutely. I think we have to be very intentional on who we choose to interact with and give our energy to. Because some people are just suck it all up. you know, we were talking about earlier, like some people just take and take, and then other people, you know, are really contributing to your wealth, your well being. So I feel like you're totally right.
Dr Fatima Khan (:Well, I guess we're just conditioned to people please and we do that. You know, in your 20s and 30s, you say yes to people, you wanna be seen. And I think you've got to look at it as a transition, not just in a neuro endocrine and hormonal transition, but also I think you're evolving into the person that you want to be. Before this, everyone is so busy with ticking the boxes. You go to uni, you get the job, you get married, have a partner, have kids.
Sameena Rahman (:No. No.
Sameena Rahman (:Yeah. Yeah. Yeah. Yeah.
Dr Fatima Khan (:And if you continue on that path, you start becoming quite resentful and angry and upset because you're pouring from an empty cup. And I always say, know, Ferraris are very fast cars, but if you're driving at 120 mile an hour, doing, you know, 20,000 mile every week, the engine will wear out, right? It has no more to give. And so it's a similar thing with this transition, not that we're Ferraris, but you know, I think you get to perimenopause and there is no fuel in the engine. There's just...
Sameena Rahman (:Yeah.
Sameena Rahman (:Bye.
Sameena Rahman (:Yeah. Yeah.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:You've got to either reboot it and you've got to do the things which are serving you and you can't pour for an empty well. So I think we just need to stop.
Sameena Rahman (:Absolutely. And I feel like that's why, right, and I think when women realize that, they find this period of time so liberating, right? Like once they're like, you know what, I don't have to do this. It's like, you know, big F you to everyone else. I'm not doing it kind of thing. And they, they feel like very liberated by it.
Dr Fatima Khan (:Yeah, they liberated and I think you start, I mean, we all have values that shift as we get older. I think it's important to reevaluate things that are important to you. Where do you want to invest your time and energy in? a bit more, you know, I mean, for me, you know, death, proximity to death is a good reminder of being intentional. And I think just thinking that we're not here for long and we can get so busy.
Sameena Rahman (:Yep. Yep.
Dr Fatima Khan (:We're just ticking boxes rather than being intentional every day and serving what serves us and the people around us. What's important to us. quite, you know, you see a therapist, see a counselor, see whoever you need to see, work through a journal. And what is it that you want to do now? It's a very good time in your forties to be like, where do I want to spend my energy? You've got teenage kids, they're going to go off to college, you know, you know, work will always be there.
How can we, there's no balance. I hate the word balance, but it's where am I going to put less energy? So, you know, wherever you focus, your energy will flow. And if, as long as it's something that's bringing you joy and even the difficult things in life, I think you've got to think of as like with every adversity, it's an opportunity to grow and learn from it in life, in careers, in relationships. And I think the more you lean into that,
Sameena Rahman (:Yeah, me too.
Dr Fatima Khan (:the more you're likely to grow and become more. You've to approach it with curiosity. And if you don't do it with that lens, you're going to get very angry because we're used to controlling things. And in perimenopause, everyone is trying to control their work, control the kids, control the husbands, control our aging parents and control this transition. have zero control over. Letting go can only happen when you understand, I think the uncertainty of it brings a lot of
Sameena Rahman (:Yes.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:fear and that's what we want to control. But if you're going to try and control this phase, you're going to be very unhappy and very angry with the whole world.
Sameena Rahman (:Yeah.
Sameena Rahman (:Yeah, right. that's, don't you feel like that's one of the most common things you hear is that I'm just so irritated, irritated all the time or I'm so angry all the time. Like, I feel like that's one of the common symptoms that people come to in this transition. And it's because of all of what you're saying, right? Everything that you're saying.
Dr Fatima Khan (:So irritability and impatient comes from this heightened cortisol sympathetic drive, right? So it's just, we just don't allow ourselves to recalibrate into a parasympathetic system because we're going from on, on, on, on, on. And it served us well, as I said to you, in our 20s and 30s, but it's not gonna serve you well. I've got a 13-year-old teenager, just from one of my letting go is, do not go into a room and tell her to tidy the room up.
Sameena Rahman (:Hmm.
Sameena Rahman (:You too.
Dr Fatima Khan (:because that's, it's like, know, she's in a McDilla, she's not in a prefrontal cortex, she's not processing any rational logical thing. And I think we, a lot of the women think that they're older kids and they should be sensible, but actually they're gonna make the most irrational, silly decisions because they're not rational. They have this massive recalibration happening. You need to support them. And if you try and have,
Sameena Rahman (:Yes, very.
Sameena Rahman (:Yeah.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:You know, we have challenging times, but you've got to try and connect rather than control teenage kids. I'm learning all the time, similarly with your husbands and we have a dog too. So I think for me, it's about connection over control. I'm a type A personality from birth, but I'm having to learn to really...
Sameena Rahman (:Yeah.
Sameena Rahman (:Yeah. Yeah.
Dr Fatima Khan (:let go of control and try and connect more and understand more and be more curious and is to, you know, how I respond. But I utilize a lot of acupuncture and Chinese herbs and breath work and yin yoga and all those things, because I think the biggest issue now is taming that nervous system. You know, the antidote to stress is your parasympathetic. You can either do gargling, you could do singing, can deep belly work.
Sameena Rahman (:Yeah.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:Hugging is really good. We don't have the oxytocin anymore. We don't hug anymore. Even doing this, that's why hugs help us do that. It's the antidote to stress. I was listening to a really interesting lecture. Evolutionally, what would happen is you would get pregnant in your teenage years and you would just have like eight to 10 babies. There would be no contraception. So you'd either be pregnant where you have high levels of progesterone or you'll be holding a baby where you get a lot of oxytocin. So women have...
Sameena Rahman (:Yeah.
Dr Fatima Khan (:conventionally the stress biology is not used to what we have now in modern life, which is a lot of them may not be having kids. So they basically don't spend time getting pregnant on a haptoxytocin. And I think generally speaking, we don't generally connect with hugs and kisses with people around us that much. Yeah.
Sameena Rahman (:Yeah.
Sameena Rahman (:Well, yeah, the social media and messengers and text messaging. Yeah.
Dr Fatima Khan (:You know, like the other day, I sent someone a birthday gift and they just text message me back instead of saying, you know, let's meet up a coffee and give a hug. You know, we just, it's just go on Amazon, send someone a gift, do this. And I think we missed those sitting down, the energy that we get, the reassurance we're tribal human beings. We need people around us. Now we don't need the wrong people around us because they can be sources of stress. But I just think you've got to find what works for you. And I think for me,
Sameena Rahman (:Yeah.
Sameena Rahman (:Nah.
Right. Right.
Dr Fatima Khan (:One of the things that I try and educate women on is working on that nervous system because irritability and impatience is the first sign that you've got heightened sympathetic nervous system. And we know that what is hot flushes and night swabs and perimenopause, the rage comes from this. You have these high cortisol. It's an inflammatory, we get autonomic dysfunction happening in perimenopause because estrogen is stimulating in the nervous system with background cortisol.
Sameena Rahman (:Yeah.
Sameena Rahman (:Right.
Dr Fatima Khan (:you're losing your progesterone, which is the GABA. So you don't have the inhibition of that nervous system. So now you've got these high estrogen and perimenopause where lots of stress, then lots of coffee, then alcohol, and you're no wonder that we're a mess. And so I work with lot of nutritionists and naturopaths, because I think we need to really support women in managing stress. can't...
Sameena Rahman (:Yeah.
Sameena Rahman (:No wonder.
Dr Fatima Khan (:You can't tell a woman it's a stage of life and you've got to put up with it because obviously you can't, you know, you've got your work, you've got your kids, you've got your parents. But what you number one have to do, make them aware. And you you've got to make them either find a way that is helping them reduce having tools and things that support them. You know, I started transcendental meditation earlier on this year. For me, it's been life-changing. I've got to make a conscious effort every day to do something to help with that.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:stimulating of the parasympathetic. That's the only way to relax your nervous system. But also when you're in chronic stress, your perimenopause journey will be far worse than someone else's.
Sameena Rahman (:Absolutely. And you know, our phones don't help anything, right? Like it just puts us into this chronic, you're right, the doom scrolling, the chronic stimulation, the chronic stress from, you know.
Dr Fatima Khan (:Well, it's a cognitive overload. So not only you've got a cognitive overload from work, then you've got a cognitive overload from children and family and then the phone. So I think going back to that intentional thing, just put phone away. I have it on silent. When I'm meeting a friend, actually never put it on the table. I put it in my coat. It's so nice to be present. You know, was finding like my brain was always distracted. And I think we just got to go back to those basic principles of intentional connection with yourself.
Sameena Rahman (:Yeah.
Sameena Rahman (:Right. Yeah.
Sameena Rahman (:connection.
Dr Fatima Khan (:Knowing what's really important, in the way, Samina, you and I have forgotten who we are. We become wives, we become mothers, we become physicians, we become daughters. But who is Samina and what does Samina want to do? And once you honor that, the irritability will go because you're actually doing something to fill up Samina's cup. And so I think along the way, that's what I find that helps me and my patients. Rather than, think, hormone is, it's obviously you need that, and especially at menopause.
Sameena Rahman (:Yeah.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Yeah.
Dr Fatima Khan (:You know, I always say there's a mismatch of life expectancy in what menopause happens. Menopause happens at 51. And there's a mismatch of our reproductive lifespan, which is 51. But we live on until 90, 85, depending on life expectancy statistics you see. And we know that there is the biological, due to the decline of our hormones, there is chronic disease, goes up, increased burden and that accelerates aging.
There is no argue that every organ in the body has an impact. It's a multi-organ transition. Every organ is suddenly lost, estrogen, progesterone, not testosterone, that's been down for a while, and it panics, you know? It doesn't know what to do. And that's why you see these baseline cortisol go up and stress go up because the heart's like, hang on, I've lost my estrogen, blood pressure going up, cholesterol going up.
Sameena Rahman (:Yep, absolutely.
Sameena Rahman (:Yeah.
Sameena Rahman (:Yep.
Dr Fatima Khan (:The metabolism doesn't know what to do. The gut goes haywire, the brain goes, the ears start tinnitus, the mouth goes haywire. Yeah, and then, you know, we're all obsessed with sexual intercourse, but we know it's really important for your recurrent bladder infections, for your thrush. So I think when we're, the menopause is, there's no argument you need all those three hormones and they'll help.
Sameena Rahman (:Don't want to talk about the vagina and the urinary system, right?
Dr Fatima Khan (:But in the perimenopause in your late 30s and 40s, a decade before, you've got to incorporate and change your nutrition, your movement, reduce your stress, which comes with boundaries, learning what's more important to you. What do I need to do to fill in my cup? My needs are not just going to be fulfilled as being a mother, a daughter, and a wife. I need to honor what I need. And if you start doing that work, when you get to 50, those women find it's a lot more easier because they've done the work.
Sameena Rahman (:Yep. Yep.
Sameena Rahman (:Yeah, no, that's great. I love that actually. You just calm me down a little bit. All of a sudden I feel very calm thinking about all the things we're saying. Yeah. Yeah.
Dr Fatima Khan (:Because I think, because I think it's knowing that it's a transition, it will come to an end. But I think knowing that you've got control over yourself and how you react, because at the moment we've been told we're relying on estrogen to control it, we're relying on progesterone to control it. They of course are gonna help with those fluctuations and they'll buffer them. But you have so much more power through your everyday actions on what you eat.
Sameena Rahman (:modulate that.
Dr Fatima Khan (:how you move, how you sleep, how you interact, how much you use that phone and how much you Instagram stroll, you know? And I think those are just simple things, but very powerful tools.
Sameena Rahman (:Yeah, yeah.
Sameena Rahman (:Yeah, no, I think that's why we always say it's not, there's no magic bullet here. know, like estrogen, testosterone, progesterone, they're not like the magic combination that's gonna cure you and help you. And I tell patients that all the time, it's part of the tool and the tools in the toolbox, but you have to do the work. You have to do the work. It's just.
Dr Fatima Khan (:Yeah.
You have to do the work. I think at menopause, yes, of course it will help with your symptoms dramatically, but perimenopause is very different. It's the impact of stress in your early 40s and perimenopause, it's going to be very different to when everything tanks at 50. I mean, we're saying, obviously you can go through menopause much earlier as well. And I just think we need to understand the role of, you know, elevated cortisol. We know that.
stress will suppress your testosterone, just like in men, you get an L8 suppression, they reduce their testosterone, so they'll get all the symptoms. Similarly, in women, you get low testosterone and low progesterone, which then lead you to fatigue, insomnia, anxiety. I think, hopefully, I think if people are going to get anything from this, it's just understanding that the perimenopause transition symptoms are completely different to menopause, and they're around low progesterone, low testosterone, and high cortisol levels.
and addressing those really helps and that kind of starts 37, 38.
Sameena Rahman (:Absolutely, absolutely. it's, cause you know, here you hear a lot, like, you know, patients will get told like, you're too young for that. You're too young for that. But that's just, obviously the clinician doesn't have a broad scope of what their understanding is of this reproductive lifespan really.
Dr Fatima Khan (:I think it's because the definition is you need to have, you know, you need to have delayed your period for seven days or less or more, some irregularity, but you and I see these women in our clinics, obviously you're seeing them with heavy menstrual bleeding, they obviously have their pelvic scan. I think that's the other thing we need to be mindful is that as much as hormones are to play, you must have a pelvic scan to exclude any other pathology, gynecological pathology. And the other thing is,
Sameena Rahman (:Uh oh, you're frozen.
Yeah.
Dr Fatima Khan (:Hypothyroidism is very common. You've got to make sure that that's being treated. And then you add in the hormones. think if you focus a lot just on giving lots of estrogen for just actually makes a whole thing worse. So currently I'm finding everyone is coming on double, triple doses of estrogen. And then I'm pulling that back and adding in all the other things that we've talked about.
Sameena Rahman (:Yeah.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Mm-hmm.
Sameena Rahman (:Yeah, absolutely. Well, I think that's a great note actually, thought them ought end on. But just one last piece of advice, like what is the advice you give to these peri-menopausal women? Like if you just had, I mean, you've given them a lot, but in terms of like that stress reduction, that cortisol reduction, because obviously, you know, hopefully they can find people to get prescriptions from and, know, some guidance. But what would be your last thing to tell them?
Dr Fatima Khan (:I think you want to obviously correct any underlying medical course. So if you're iron ed to fishing, you must have an iron infusion or take iron. mean, you know, anything, your ranges are different. So our ranges are between 30 to 300. And so you need to be over a hundred for you to have good function when it comes to brain, freezing the brain. And that's why a lot of the low iron are getting brain fog and restlessness. And I think
Sameena Rahman (:That's true.
Dr Fatima Khan (:we keep giving estrogen, but they're still running that suboptimal lower range iron level. And it's something really basic, but we have an epidemic of iron deficiency, not anemia, but just low iron, and that's so easily corrected. Then I'm a big advocate of obviously adding in micronized progesterone and testosterone, because that will help with your fatigue, insomnia, your anxiety. When we put that in, women will generally find they're coping a lot better.
Sameena Rahman (:are.
Dr Fatima Khan (:That's what I find. I add in magnesium because that relaxes the body along with the glycinate component, which calms the mind. I get them to look at the gut as well because obviously gut dysbiosis can also cause some anxiety, but we know there's a gut brain connection. So when you're stressed, your gut gets affected. know, kiwifood a day is great for prebiotic in the gut. And again, chronic stress will give you that increased intestinal permeability, which they're called leaky gut.
Sameena Rahman (:All right.
Dr Fatima Khan (:So a lot of it is driven around them. But when I find we get the iron up, give them micronized progesterone, give them testosterone with some magnesium, iodine, vitamin D as well. And if they're not eating enough omega-3 fish oils, that helps them as well. Otherwise eat sardines and mackerel. And that's where we start. And then they get like a Crip sheet at the end and they need to do 20, 30 minutes of resistance training three times a week. I just tell them two kilogram, two kg weights for the upper body, five, 10 for the lower body. Start with something.
Sameena Rahman (:Mm-hmm.
Dr Fatima Khan (:You don't need to go to a crazy gym workout, do 15, 20 minutes at home, and then start planning your food, and then just be, keep your phone away. And I just want you to get a journal, read something, write something. Those are really powerful things.
Sameena Rahman (:Yeah, I find gratitude journaling actually in and of itself is so powerful, right? Like you can really get caught up in so much of the negativity around the world and, you know, experiencing loss and all the things. But I've found that gratitude journaling has been very helpful.
Dr Fatima Khan (:Well, we have a negative bias. So if you just think about you've had a tough day, you know, your husband forgot to pick the kids up and the kids not listening to you, the laundry's not done, then the brain thinks you're just worried and it gets stressed and it starts to pick up on everything negative because his job is to protect you. And the whole thing, gratitude works by is it's suddenly you're focusing on more the important things. And if you look at it, most of us have so much like shelter, food.
Sameena Rahman (:Yep. Yep. Yep.
Dr Fatima Khan (:comfortable bed to sleep in, the fact that we have the opportunity to serve women,
Sameena Rahman (:Yep. Our health, our general health, know, like is such a gratitude.
Dr Fatima Khan (:Yeah, but I think you've got to do it again, being in tension, you've got to do it every day, but we're so distracted. know, I think attention is your biggest commodity at the moment and trying to get back away from technology and phones, obviously is something so you can spend more time. But that's what I would start adding an estrogen is very easy and that's important to add in when it's needed, but the very early late thirties, you need to focus on these things.
Sameena Rahman (:Hmm.
Dr Fatima Khan (:and the people pleasing has to kind of go as well. But that happens when you learn more about yourself and who you are and what's important to you.
Sameena Rahman (:what you want. Yep, absolutely. Amazing. I love all of that actually and I try to incorporate that in my own practice as well with my patients but I think you said it so eloquently so I really appreciate that. All right, well that's great. think, you know, this we're almost at an hour so I'm gonna go ahead and end on that great note that you told everyone and I really appreciate you being here today and joining us from the land down under. I hope that, are you gonna come to the States anytime soon?
Dr Fatima Khan (:I normally visit every two years, half of my family's in the US, but probably next year and we'll come and connect for sure.
Sameena Rahman (:Next year. All right, we'll get together then. Because you said the East Coast, right? And why have our families on the East Coast?
Dr Fatima Khan (:My uncle used to be in Chicago and my uncle and aunt were in upstate New York and I've got cousins in Westchester. And it's really interesting. I don't know if this is being recorded, but I spent, my parents took me out of school for nine months and we were upstate in Rochester. So I've spent a lot of time in Home Depot. yeah, that's fine. I spent a lot of time in Home Depot building my cousin's basement in upstate New York and my
Sameena Rahman (:I can tell her to edit this out if you want. Okay. Okay.
Sameena Rahman (:Dr Fatima Khan (54:56.59)
My mom's brother Mamu was in Chicago for years and my mom's brother and my mom's sister were in upstate New York. So we used to go from the age of 14 every summer to spend time with our cousins while I was in the UK. But no, it was good. I hope they find it useful. It was so nice. For me, I think there's a lot of fear and reliance on hormones, but there's so much more we could do.
Sameena Rahman (:Yeah.
Sameena Rahman (:I wonder... Okay. Well, I look forward to
and thank you.
Sameena Rahman (:Absolutely.
Dr Fatima Khan (:and it's just focusing on that nervous system is what helps a lot.
Sameena Rahman (:Absolutely, I agree. Well, thank you, Dr. Fathom-Macon. My name is, Gyno. Thanks for joining me today on Gyno Girl Presents, Sex, Drugs, and Hormones. Remember, I'm here to educate so you could advocate for yourself. Please join me on the next episode. Yay! I'm gonna stop recording. If you...
