#53 - When mental health meets menopause with Dr. Stephanie Bayliss ND

Have you ever wondered "what the hell is happening" with your mood in midlife? Trust me, you're not alone.  And, as Dr. Stephanie Bayliss ND explains, there's a window of vulnerability in midlife that makes anxiety, depression and PMDD more common than ever.

In this episode, we discuss the hormone changes that increase the chances of anxiety and depression, the difference between PMS and PMDD, and discuss hormonal vs non-hormonal treatment options.

Dr. Stephanie Bayliss is a Naturopathic Doctor practicing in Victoria, BC, Canada. She is a North American Menopause Society (NAMS) Certified Practitioner and has a particular interest in supporting women's mental health, specifically how our hormones can impact mood. Follow her on Instagram at @drstephaniebayliss.

Click here to hang out with me on YouTube!

Looking for more about midlife, menopause nutrition, and intuitive eating? Click here to grab one of my free resources and learn what I've got "on the menu" including my 1:1 and group programs. https://www.menopausenutritionist.ca/links

Transcript

Jenn Huber  00:02

Hi and welcome to the midlife feast the podcast for women who are hungry for more in this season of life. I'm your host, Dr. Jenn Celine Huber. Come to my table. Listen and learn from me. Trusted guests, experts in women's health and interviews with women just like you. Each episode brings to the table juicy conversations designed to help you feast on midlife. Hi there. Welcome to this week's episode of the midlife feast. I'm very excited to welcome Dr. Stephanie Bayliss naturopathic doctor to talk to us about midlife, Peri menopausal menopausal mental health. It's a really big question that comes up a lot. What's happening with my moods? 

Why do I feel like I'm always on this roller coaster of up and down feeling really great feeling really awful moments of mental rage. And I think that there's a tendency for us to maybe kind of brush it off is just normal or expected or part of the journey, so to speak. But as Dr. Bayless and I talked about, there's so much more to these mood swings, than meets the eye. And it's so important to recognize that one, there is a reason it probably has to do with your hormones. But you don't have to suffer. You don't have to wait it out. There is help out there. And that's what we want you to know in this conversation. So I hope that you enjoy it, I know that you will. 

I love everything that Dr. Bayless does in regards to mental health, especially in women's health. And I also want you to know that if you're looking for more support, especially on the food and nutrition side of things, there's support for you inside the midlife peace community, which is my membership community. We have a couple of modules that might be helpful to you on food and mood and mood and menopause. Just to kind of explain a little bit more about some of those things that you can that you can do alongside your healthcare team and kind of as you're working to figure out a way to feel better in this season of life. So on to the episode. Okay, welcome, Stephanie to the midlife feast. How are you?

Stephanie Bayliss  02:10

I'm good. Thanks. Thanks for having me.

Jenn Huber  02:13

And you're on the West Coast, right?

Stephanie Bayliss  02:15

Yes, I'm in Victoria, BC, Canada, so very much on the West Coast.

Jenn Huber  02:20

Yeah, we're kind of like on like, literally opposite sides of the earth right now, which is kind of cool to think about, actually.

Stephanie Bayliss  02:26

100% We're very, very different time zones.

Jenn Huber  02:31

So um, Stephanie is a naturopathic doctor or naturopath like I am and I heard you speak during a continuing education, seminar, menopause intensive. And I was really, really impressed and kind of, you know, as a clinician, but also as a woman in menopause, with how much the information around mental health, especially in this kind of age or season of life has really come, I'm going to say like, you know, it's, it's come a long way, in the last 10 years, really even like 20 years, but even in the last 10 years, about recognizing that it is a distinct event that is happening, and that we need to think about mental health as something that happens, you know, not just because we're not sleeping, and not just because you know, all these other things are happening, but that it could actually be tied to what's happening with our hormones and all of those changes. And so there's something called this window of vulnerability. So tell us about menopause, mental health, and what do we mean by that window of vulnerability?

Stephanie Bayliss  03:38

Yeah, such a good question. So what we mean by the window of vulnerability is that some women, not all, but some seem to be susceptible to those hormonal fluctuations. And as I'm sure many of your listeners know, that Peri menopausal time and through to post menopause is, you know, a lot of hormonal fluctuations. So big swings in estrogen. And so some women are sensitive to those fluctuations. We know that women who have a history of postpartum depression or postpartum anxiety or maybe things like severe PMS or PMDD, those women are likely going to be at an increased risk for depression during the pre menopausal time. And we know that in general, like shocking numbers, right? Like up to 70% of women in perimenopause will endorse depressive symptoms. And like you said, it's not necessarily just because you're not sleeping, it could be a recurrence of a previous depressive episode, or it could be due to that like hormonal fluctuation vulnerability piece.

Jenn Huber  04:39

Yeah, so here's a familiar tale that I hear all the time and I'm sure you do to somebody who's in the early stages of perimenopause, which can happen as early as mid 30s. I was 37. I'm now 45, almost 46 and fully menopausal. So for me it was definitely happening in my late late 30s. But a lot of People say, oh, you know, I feel like I feel like I'm anxious. And I've never had anxiety before. But it can't be perimenopause. Because my, I'm still having a period I'm not having hot flashes, what can I do for the anxiety? And what I find sometimes difficult is kind of getting them to see that, like, the anxiety is probably a symptom of the hormonal changes that are happening underneath. And so just treating the anxiety isn't necessarily going to give them the same relief that maybe they had, like 20 years earlier when they had a bit of anxiety, right, because we tend to think of it as like the same. But midlife and Peri menopausal anxiety in my experience, my personal experience, my clinical experience, is a different beast altogether. What are your thoughts on that? Yeah, I

Stephanie Bayliss  05:45

would agree completely. And I think that, you know, in some cases, it could be a recurrence of anxiety. And maybe there is like an underlying Generalized Anxiety Disorder. But then we get this, like, you know, the peaks and the troughs that happened during that period, menopausal transition. And I think one of the things that you probably talked to women a lot about is tracking their cycle and tracking some of those symptoms. So we can start to tease out, okay, well, maybe there is an underlying anxiety disorder, but there's clearly periods of the month where things are, you know, worsening and symptoms. And so, there Yeah, it's the treatment is not necessarily going to be the same as when you were 20. It's a good point.

Jenn Huber  06:23

Yeah, so let's talk a little bit about those hormonal changes. So walk us through the estrogen changes that happen, that we think are tied to those peaks and troughs and valleys and ruts of kind of mood that tend to happen in midlife.

Stephanie Bayliss  06:43

Good question. So in early perimenopause, like you said, could be happening as early as you know, late 30s, we sometimes seen on everyone, but cycles will start to come closer together, so periods are going to be happening more frequently. And so we can get increases in estrogen kind of stacking on top of one another. And so when that happens, and that could be because women are not like having anovulatory cycles are not ovulating consistently. And with those that increase in estrogen, some women, again, not all are sensitive to that increase during early perimenopause, all the way through to late perimenopause, when the cycles get further apart, and then that estrogen starts declining. And so a whole other subset of women are sensitive to that decline and estrogen that's happening. And so this is why we know women who have a history of you know, mood disorders during pregnancy or postpartum or during PMS, they're gonna like slot in a little bit differently when they're at when their risk time is. And there's also the subset of people who are immune to all of that, and like, we think it's maybe about 30% of women don't are impacted mentally and move them to wise by those changes. But the other, you know, 70% ish, probably is. And there's like about 20 to 30%, who, unfortunately, are sensitive to both the increase in estrogen and the decrease. So it's not a one size fits all approach.

Jenn Huber  08:11

And am I correct in understanding that you can be sensitive to the increase of but also the decrease at the same time?

Stephanie Bayliss  08:21

Definitely. Yeah. And that would make for a lot of fun.

Jenn Huber  08:25

Yeah, and because one of the things that I put together I don't know when but at some point along this, this personal professional journey, working with people in midlife was that a lot of women in perimenopause and it was true for me started to experience this what we called like a mini PMS around ovulation, where it was like it felt like this 48 hours of like, intense every thing. And then it was like crash, and then there'd be like a good week. And then it was like back to the shitshow for a few days. And I started to notice this pattern in myself. And then I started to notice it in other people. And then as I started to really kind of learn that, you know, this Peri menopausal shitstorm that we're in isn't just hormones going up in hormones going down, it's hormones going really, really up and really, really down at unexpected times, because we're our brain and our body. And all of the parts of us that are used to swimming in this regular hormone soup, as I call it, are now kind of swimming in a totally different ocean. And nothing is the same and we don't like it. Because that's what human being do is we don't like things that we don't know.

Stephanie Bayliss  09:39

It's very unfamiliar, I would say because there's not really quite another time like that except maybe postpartum like going from being pregnant to not being pregnant. That shift is quite dramatic, but that's a short period of time. It doesn't go on for years and years like it does during perimenopause. So

Jenn Huber  09:56

yeah, absolutely. And that's a good analogy. I mean, as someone who's had two pregnancies, and that you know, those baby blues that kind of kick in 48 hours after, where you're totally not expecting it because you're still riding the high of having this baby and then like it crash lands and you cry over like soup. It you know, it really is quite. It's humbling. And it is a good analogy for anybody who has experienced that because I think that that some think that's relatable. So that's about estrogen. So what about what about progesterone? What's happening with progesterone that can also contribute to just not feeling like our mental selves?

Stephanie Bayliss  10:32

Yeah, good question. So again, that comes back to that ovulation Pease so sometimes we're going to be having cycles where we're not ovulating. And so then you're not going to be getting that rise and progesterone consistently. Some cycles. You might though, but I do would say like you, as you alluded to, it kind of it does have a calming sensation to us. It's like a relaxing hormone and helps our sleep. And so you know, stalking that like missing ovulation. So missing out on the progesterone plus these huge swings in estrogen. That's where we just really see, like you said, a, like a toxic soup situation happening where we just feel like garbage, because we're missing one thing. And then like having these giant swings and another and so it just really, it doesn't create a very nice time for people. And that's where we see some of those like sleep disturbances too, right?

Jenn Huber  11:25

Yeah, it is not good times. For anybody who's been through that. It is definitely not good times. Yeah. And so sleep is kind of like, it's the thing that gets stacked on top of it. And so I think most people, certainly the people that I know, and I know from the research, you know, sleep is one of those top three symptoms next to the vasomotor symptoms, it's right up there in terms of disturbances, and sleep, not sleeping makes everything worse. Everybody knows that. But it doesn't seem to be the cause of most mood changes, right? Now it does, listening, and you're so focused on trying to fix your sleep to fix your mood. Please hear that it's not always cause and effect, they both contribute. I don't think anybody's arguing it that but you know, fixing your sleep isn't going to magically fix everything else. Am I right? Yes,

Stephanie Bayliss  12:12

you're very right. And they've actually researched that, right. So women who, like their sleep gets improved, or their sleep is more stable and less inconsistent. That doesn't like it doesn't necessarily mean that they're less likely to then have a depressive symptoms, like maybe, but not always. And so it's not this like complete cause and effect. I always think of it like, is it the chicken or the egg, like what came first because when you're experiencing depression, just a symptom of depression is poor sleep, regardless of the time of life that you're in. And so it's obviously helpful to support sleep, but you likely need Mood Support just beyond treating your sleep disturbances.

Jenn Huber  12:48

Yeah. So let's talk a bit about PMS and PMDD. And I'd also like to see if we can kind of slot in a conversation around that term mental rage. That when I think I'm gonna make an assumption that I think you're too young to know what I'm talking about, but

Stephanie Bayliss  13:08

yes, I am. Yeah. Okay.

Jenn Huber  13:11

I never want to assume but. But yeah, it really is a very unique experience. And it's not it's not funny, but you know, it's certainly I think it's unique in that it feels like this like moment of rage that like a boils out of you. And it feels very uncomfortable. Because it's not, it's not who we think we are. Right? And it's like you snap, like, truly snap in ways that like, have the people around, you just look at you like what the hell just happened? And then by the time it's done, you think what just happened? What did I just do? And that's like a universal description of it. So to me, I think it really needs to be its own like recognized symptom, not just like a mood swing, because it's a distinct feeling. Now, I don't think that it has a cause any different than any of the other mood changes. But it does seem to happen, like in the like, really in the thick of perimenopause. And at the same time, I think there's a lot of people who are also kind of experiencing PMS into PMDD. Right, where like that crossover maybe is happening because of those hormone changes. So tell us a little bit about that. Because I'm sure that some people don't even know what PMDD is. Yeah,

Stephanie Bayliss  14:27

that's a great question. So PMS, like premenstrual symptoms experienced by like, let's say the large majority of women to some extent, PMDD, premenstrual dysphoric disorder, like endorsed by maybe somewhere around five to 7% of women. And so it's not extremely common, but it is something that we do see. And it's really characterized by severe depressive symptoms. Sometimes things like suicidal ideation, that really intense irritability, maybe rage, anger, and that it's very characterized from after ovulation. So mid cycle through till when you get your next period. And like really one of the key characteristics is that the symptoms resolve a few days into your period. And then like the kind of the veil lifts and you're like, Okay, what just happened for the last two weeks and then you might get a good 1014 days, and then it kind of happens again. And I think what you're alluding to Jen, is that that mirrors what happens in the, you know, like middle perimenopause is like that estrogen is increasing. And so one of the pieces that happens in PMDD, is it's they're sensitive to those hormonal fluctuations. It's not like the level of hormone it's the fluctuation in the sensitivity to those hormone changes.

Jenn Huber  15:48

Yeah, and I mean, it really like I didn't get a diagnosis of PMDD. In hindsight, I think it might have been there for sure. But I think that it really is something that I want listeners who are experiencing it to know like, it's not something that you have to tough out, you know, it, it really, really affects people's quality of life and affects their relationships that affects their jobs. Like when I hear these, when I see these news headlines of like women quitting their jobs, because of menopause, I think how many of them might be in that state half of the month? Right? Where they just can't deal with people shit. Right. So, so I think that, you know, everything that you're saying is going to be so valuable for people listening, because we talk about mood swings, but we don't actually break it down in the we break it down in the literature, it's there for anybody who, you know, has the interest and ability to read that. But when we're talking about like the, you know, the individual's experience of like scrolling through Instagram, or like reading an article from the newspaper, it talks about, like, mood swings, and like, lumped them all together. But what we're really talking about is anxiety, depression, you know, this PMS slash PMDD, that, you know, this worsening PMS? And there's also I think, something that is a little bit less tangible or less kind of label level, if that's a word, is that a word? I'm making that up? But that like just this loss of interest that isn't quite depression? isn't quite, you know, anything else? But it's just kind of like, blah. Yeah.

Stephanie Bayliss  17:28

And when I was gonna use, yeah.

Jenn Huber  17:32

What are your thoughts on the blahs that lots of women in their 40s and 50s hit?

Stephanie Bayliss  17:38

I think that you're right, it and it can be characterized to by like, just lowered motivation, like loss of interest in things that were previously enjoyable. And I do think of it, you know, I would say, like, clinically, what I see is, because of those big hormonal swings that are happening, it's exhausting. And you feel like you have lost control of like, some aspects of your health. And it's very confusing for people. And I think then, you know, you're also fatigued and tired at the same time, who knows what other like major life transitions and stresses are going on for women at that time of life. And I think it's just, yeah, all of that together, I really feel like it creates that situation like you're describing the blah,

Jenn Huber  18:21

blah. There's also this theory of the U shaped curve of life. I don't know if you've ever seen that reference, but that like people are happiest at the like, beginning and ends of their life. And that, you know, statistically people say that their 40s and 50s suck more. And so I kind of wonder, like, how much of that is crashed landing into it, too. It's just like, you know, we are at a pretty busy time, you know, we're like, like, the sandwich generation thing happening. We're often like, and it really busy points in our careers if we work outside the home. You know, it's just really, I think, yeah, I think it's just a really interesting intersection of all the things that are happening. And, I mean, with the other thing with mood is, you know, we have so many women who experienced body dissatisfaction, right, so we're seeing this like second peak in body dissatisfaction that happens. There's a new study that just came out the other day that body dissatisfaction is like the driver of eating disorders for people in their 40s. So I think it's talking about mood, and how you feel about yourself and how you feel about your life. If you're carrying any of that or if that is new. That is absolutely going to be a really huge piece of that, too. That it's not just perimenopause, although that is likely a route for a lot of things. It's not it's not just all of it. Yeah. So it was sorry. Go ahead.

Stephanie Bayliss  19:44

No, I was just going to agree with you completely. And I think that that is going to it's just a vicious cycle because then that worsens. You know, like when there's obviously which is what you've talked about probably a whole lot on the podcast is like restriction under fueling and, and that's obviously going worsen symptoms and it just kind of goes round and round and round.

Jenn Huber  20:03

Yep, there was an episode from season one called food, mood and menopause. I think it might be 12 or 14 that talks about how when we spend so much of our time and energy thinking about food all the time, it really takes away our capacity to kind of manage the rest of life. So another good reason to get off the dieting roller coaster. Yeah, so let's admit it about treatment. Because one of the big, I think dilemmas that clinicians for sure, but also patients have is, do I treat this like a mood disorder? Or do I treat this like a hormonal problem? And I'm sure your answer is going to be, you know, probably a bit of both is going to be my guess. But, you know, what are? What are the considerations in that decision? For women who are in midlife?

Stephanie Bayliss  20:53

Yeah, I first off, I agree, it needs to, like both is would be my answer. And then, you know, working with a really great clinician who can like view it as both, I think is really important, because they sometimes, well, not sometimes I see this all the time, patients come to me and there's they've been prescribed an antidepressant, which very well might be indicated. But there hasn't been any discussion of like, all the hormonal implications of how that's playing into their symptoms. And it can be really disempowering to not be educated on that. 

So I think getting some really good knowledge and assessment. Also, equally as important is a good assessment to kind of figure out where you fall in. If we're talking about depression, like, are we talking a mild depression? Are we talking a moderate to severe with like, some suicidal ideation, those need to be treated very differently. And I would say the standard of care kind of across the board is antidepressant therapy, we know that it's effective. And we know that it does play a really important role in supporting women in midlife, if there is like a moderate to severe mood disorder happening. But at the same time, there's also like all the lifestyle pieces, right, so moving, sleep, nutrition, you know, investigating other things, like another hugely common thing at this time of life is low iron or being anemic. And so like, because of like the heavy periods that come along, and we know iron deficiency worsens, yeah, health. 

So if you're listening to this, and you have mood disorder, please get your iron jacked looks like public service announcement number one. And then like, obviously, all the other, you know, lifestyle factors. And I would say, I don't know if this is where you're going with it, but to hormone therapy, may be a part of the conversation. And there is some research suggesting that initiating estrogen during this time of life and perimenopause, if you have a history of a mood disorder, maybe will prevent or reduce the risk of a depressive episode it through the menopause transition. So but again, it's got to be very individualized. And we've got to take into account all the symptoms that are happening and making sure you're being well supported from all angles.

Jenn Huber  23:02

Yeah, yeah. So you read my mind. And that is absolutely where I was going with that. But especially, I don't know how you did it. But you really kind of highlighted what I wanted to talk about, which is that the research for hormone therapy is stronger, if I recall correctly from from your lecture is stronger in perimenopause, and it is for menopause. Which if anyone is listening, because I feel like I've had this conversation a lot, a lot of people will go to their primary care provider and you know, say, Hey, I'm in perimenopause, this is going on. Can I try? You know, can we try hormones and they'll say, Oh, you're still having regular periods, or you haven't stopped having a period yet. We're not you're too young to start hormones. And then they come back and tell me and then my head blows up. And then I like, them all the information because it feels like such a, it's, it's just wrong, like, you know, you it is symptoms that guide whether or not symptoms plus age, essentially, really, that guide whether or not you should try hormones, right. Obviously, it's more more complex than that. But it has nothing to do with whether you're having a period or not right

Stephanie Bayliss  24:09

100%. And so like when we're talking about depression, specifically, there's actually no positive evidence on initiating HRT after menopause or a year after your last menstrual period to support mental health. We don't have good data, maybe we'll we'll get there. But right now, we don't. It's actually while you're still menstruating. And so I have those conversations with patients all the time to and it's also very, it's a lack of education and knowledge. And I think I'm hoping as the years progress, there will be some more trickle down and more education that it's not based on if you're still having a regular menstrual period.

Jenn Huber  24:44

Yeah. And I mean, my my own end of one experience, is that my Peri menopausal years, were by far more challenging on my mental health than the last 12 months like the last six months, I've said So many times has been the best six months of the last decade. I'm sleeping, my mood is stable. I've got my mental mojo back, the brain fog is gone. Like it's a new normal, but it's like, stable, you know, it's not swinging, it's not swinging. So I can totally see why research doesn't support a benefit to starting HRT when you're past this. Right. 

You know, when I think back 234 years ago, you know, it would have been, I think it would have been helpful. Now, that being said, I've said this before, so I'm not I'm not sharing anything I haven't before, but I'm one of those really hormone sensitive people that I just can't I can't take it. I would, if I could. And I have tried, it is not for lack of trying, but I'm one of those people that I just feel like garbage. So you know, yeah. But antidepressant therapy was a lifesaver four years ago for me,

Stephanie Bayliss  25:54

you know, and it can be for lots of and it also, the fun fact is, I mean, antidepressants have actually been shown to help things like hot flashes, and like some other symptoms related to menopause. So there you go.

Jenn Huber  26:07

Yeah. Now, people listening might be surprised that we're to naturopathic doctors, and we're talking antidepressants and hormones. But, you know, I think that, I think that we would be we'd be remiss if we didn't at least kind of touch on, maybe kind of what are some of the non pharmacological options that people have, like, you know, thinking about things like fish oil, and vitamin D, like, Are there are there any things that people can explore with their primary care providers that would fall outside of, you know, prescription medications?

Stephanie Bayliss  26:41

Definitely. So I can't talk about mental health without talking about like mindfulness and meditation, I think that's also super important. I also think moving your body is very important. And obviously nutrition, which you've talked a whole bunch about, when we're thinking about, you know, nutraceuticals or herbals, omega threes, there's some good evidence that that can potentially be helpful. In some situations, same with like, getting your vitamin D tested, and treating it to sufficiency would be very key. And then beyond that, we're thinking about, like, an herb that's coming out as being probably pretty effective in this mid lifetime is actually saffron, which you probably knew I was gonna say. Yeah, both like adjunctively wish with medication, but also on its own for supporting mood. And it might actually help some other symptoms like vasomotor, hot flashes, too, but but primarily mood and maybe sleep and some women. So again, like obviously speaking with your primary care provider, but that potentially is like a non pharmaceutical option in situations where the depression is more like a mild, moderate situation.

Jenn Huber  27:49

Yeah. And the really exciting thing is that, you know, this is still I mean, all of women's health and menopause, I would say is like a, you know, a newer field of research in that we're really focusing on it now. And not just on things like breast cancer and osteoporosis, we're looking on, like quality of life, and in our earlier stages, so the research is changing all the time. You know, there's interesting research, even looking at phyto estrogens because they cross the blood brain barrier. Right. And that, you know, there may be there may be implications there in terms of, you know, food that can be included. But at the end of the day, it's just important, and I want people to know that there are options, right? That it's not something that you have to like, just suffer through, Grin and Bear, wait for it to be over. Wait for your period to end like it was. You don't have to do that. There are so many evidence based well researched, accessible options pretty much anywhere you are on the planet that can just help make this a little bit more comfortable.

Stephanie Bayliss  28:48

Yes, you don't have to suffer.

Jenn Huber  28:51

Yeah. Thank you so much for sharing your wisdom and experience. I can already tell I think this is going to be a well loved episode. So thank you very much. Awesome. Now, I always ask my guests, what do you think is the missing ingredient in midlife, you're not in midlife, so you can make something up but just

Stephanie Bayliss  29:10

Well, I treat primarily women in midlife. So I would say the primary thing would be support as though women in midlife are supporting everyone else. And so I think that they themselves that's the missing piece is like more support, I think could go a really long way.

Jenn Huber  29:27

Absolutely, I agree. And if people want to learn more about you or from you, what's the best place for them to find you? I'll have all this in the show notes. But

Stephanie Bayliss  29:36

yeah, probably I'm the most active on Instagram as Dr. Stephanie Bayless and yeah, sharing lots of fun updates on midlife and hormones and mood.

Jenn Huber  29:46

Yes, I love your Instagram. I always learn something from it. I feel like I like save every other post. That's awesome. Yeah, no, I really appreciate your time. I appreciate your expertise and thank you You so much for sharing that with our listeners.

Stephanie Bayliss  30:04

Thanks for having me. I really appreciate it. Thanks for

Jenn Huber  30:07

tuning in to this week's episode of the midlife feast. For more non diet health hormone and general midlife support. Click the link in the show notes to learn how you can work and learn from me. And if you enjoyed this episode and found it helpful, please consider leaving a review or subscribing because it helps other women just like you find us and feel supported in midlife.