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8. Perimenopause: Mental Health with Dr. Danette Conklin, PhD
73 Plays2 months ago
In this episode of Perimenopause: Head to Toe, Dr. Rachel Pope welcomes Dr. Danette Conklin, PhD, a Clinical and Health Psychologist and Assistant Professor at Case Western Reserve University School of Medicine. Dr. Conklin shares her expertise on the intersection of behavioral health, weight management, and midlife transitions, including perimenopause and menopause.
As Director of Behavioral Health Services for both surgical and non-surgical weight management programs at University Hospitals Cleveland Medical Center, Dr. Conklin has a unique perspective on how psychological and biological factors influence health during midlife. She has also contributed to establishing menopause clinics in Cleveland, helping women navigate the physical and emotional changes of this life stage.
We discuss:
- How behavioral health intersects with perimenopause and menopause
- Managing weight, mood, and lifestyle changes during midlife
- The role of psychology in supporting cardiovascular and metabolic health
- Strategies for navigating stress, sleep, and emotional shifts
- How to advocate for yourself and your care during midlife transitions
- Practical ways to support wellness, including the use of non-prescription supplements like MiM, which are designed to help with peri- and post-menopause symptoms
With her extensive experience on national committees and advisory boards, including The Menopause Society and the American Society for Metabolic and Bariatric Surgery, Dr. Conklin provides practical guidance for women seeking to thrive during this transformative stage of life.
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Transcript
Hormonal Influence on Mood
00:00:00
Speaker
When we think about mood changes and perimenopause and menopause, the main driver is hormones, especially estrogen and progesterone. These hormones don't just control your periods, they also talk directly to your brain, and not everybody realizes that, right? So estrogen actually helps to boost the brain chemicals like serotonin and dopamine, which are our natural mood stabilizers. Progesterone works a little bit more in a calming anti-anxiety way. And during perimenopause, estrogen and progesterone don't just go down smoothly. They go up and down like a roller coaster, unpredictably.
00:00:33
Speaker
And that's why sometimes you hear people talk about this as mood swings. But what I notice for myself and for other patients is irritability and also anxiety. And it's from these ups and downs that a person just feels overall unsteady.
00:00:48
Speaker
Over time, as the levels get lower, the brain has less of that natural support for mood, sleep, and stress regulation. On top of that, hot flashes, night sweats, anything that's disrupting your sleep just make it even harder to manage your emotions. you have less reserve, right? Some women are especially sensitive if they've had PMS, PMDD, or postpartum depression before. We know that from research.
00:01:11
Speaker
So in short, biology is real. Hormone changes affect brain chemistry, stress response, and sleep, all of which add up to these emotional ups and downs that many women notice. You don't have to go through it alone.
Expert Insights on Menopause and Mental Health
00:01:23
Speaker
Dr. Danette Conklin, PhD, practices clinical and health psychology and is an assistant professor of psychiatry and reproductive biology at Case Western Reserve University School of Medicine in Cleveland, Ohio.
00:01:35
Speaker
She's the director of behavioral health services in both the bariatric surgery and weight management program and the Fitter of Me non-surgical weight loss program at UH Cleveland Medical Center. She's been part of several multidisciplinary teams that focus on menopause and midlife, and she's been serving nationally and regionally on committees around this area.
00:01:53
Speaker
She is an editorial board member for the Journal of Clinical Psychology and Medical Settings and an associate editor for the Journal of Immigrant and Minority Health. She's on the scientific advisory board for UTI Guard and MIM, a company that I work with as well. and is dedicated to developing non-prescription relief for peri and post-menopausal symptoms.
00:02:13
Speaker
Join me in welcoming Dr. Dana Conklin. Welcome back, Conklin. I'm so happy to have you here. you know, you're an expert in the field of psychology. i hear you and see your papers on menopause and also the intersection of race, menopause, and psychology too. I feel like You're just a whole expert and in many things, but I'd love to chat today about perimenopause, menopause, and psychology and where we see things start to intersect for women.
00:02:41
Speaker
um thank you for being here. yeah well Thank you for inviting me back, Dr. Cope. It's nice to spend my morning with you. Likewise, I know. And I'll be just sipping on my coffee. yeah But yeah, where do you see things start to pop up during perimenopause and menopause from the psychological perspective?
Mood and Anxiety in Menopause
00:03:01
Speaker
It's pretty broad, you know, and it depends on the person. going to kind of like start with, you know, how physical changes okay and how those physical changes impact women's mood, you know, or anxiety, yes know, and how they just feel about themselves overall.
00:03:21
Speaker
So, you know, a lot of women, would say, come to me because they just do not feel the same because there's so all these hormonal changes. They're like they can't mentally function the way they could function before or can't even physically function the way they used to function. a lot of women talk about low energy.
00:03:40
Speaker
oh that's interesting. yeah but I hear that a lot too. Lack of energy or yeah just not being able to quite keep up with their life the way they usually would. Right. So like all of these things, you know, and I've listened to many of your podcasts. and Oh, thank you. Yes.
00:03:57
Speaker
And a lot of the things that you kind of bring to the table with other people you interview, those things impact a woman's mental health. you know i was goingnna say Like, you know, for instance, you know, sexual health. I know that you're definitely an expert in sexual health and the low desire or no desire, you know, or just physical changes in their bodies. And they just don't feel, you know, um being intimate just doesn't feel the same.
00:04:23
Speaker
Yeah. So that
Physical and Emotional Changes
00:04:25
Speaker
will take a toll on their mental health and relationships and you know, self-esteem. And I would say like, even like attractiveness. I don't know. I'm like but self-image or body image. Okay.
00:04:37
Speaker
Yes. Even like a few gray hairs, wrinkles, lines, you know, right not being as toned or, you know, the weight coming in the midsection. like gosh, how do I get this extra, these extra inches off of my waist? And I can't fit in the clothes I used to fit in and, you know,
00:04:56
Speaker
So I'm just saying it's so complex is what I'm doing. You're right. There's so many things that add on during that time. Whether you're a person who's experienced depression or anxiety or other, you know, mood disorders, anyway, all of those other things just kind of like build up.
00:05:13
Speaker
Build up and affect the women's self-esteem, especially if they don't know what to do and they feel really lost. And, you know, like, gosh, am I ever going to get back to who I used to be? And all like I'm missing that person. I miss, you know, being able to just jump up off the bed in the morning, go walk run or go do this go do that. or you know, I'm an executive at whatever company and, you know, I need to be you know thinking quick on my feet and whatnot.
00:05:41
Speaker
Here I am sitting in a meeting. drenched in hot because hot flashes. Right, right. Or experiencing brain fog, right? This is a thing keep seeing for my patients who do have high performing jobs that the brain fog makes them feel like a ah new sense of, I guess, lack of confidence or worry or anxiety, even over presenting or performing at work that their mind is going to go blank or that they're just going to be thrown off. And then even, yeah, you're right. Like self-worth, that takes a hit.
00:06:11
Speaker
So when you're talking about the presenting, you know, like the the tip of the tongue phenomenon, I don't know that word. can't think of it. You know, I know what I'm trying to say, but can't really pull it together.
00:06:24
Speaker
so there's this sense of embarrassment and maybe, I it hope no one noticed that. Then now we're talking about these things making women anxious. Yeah.
00:06:35
Speaker
Or feeling down, even if they didn't have anxiety before. Right. Or depression before, because I know this kind of like comes up as well. You know, you know I've never been anxious before, but now I seem to be so anxious all the time or i never had depression, but now I feel down.
00:06:54
Speaker
yeah And I don't know what's going on. And it's more like when I see it from that perspective, it's more like an adjustment. You know, there's something in our diagnostic Bible, adjustment disorder, is adjusting to these changes that they're seeing and that they're feeling and knowing that it's not all in their head.
00:07:16
Speaker
Right. And having to deal with that adjustment or this transition, right? Like I have gone through different transitions. If I think about my career or my life, when you move somewhere new or you start a new job and kind of help that feeling of unease or like you don't yet feel secure in your situation because you're still figuring it out.
00:07:35
Speaker
Right. And so the transition of perimenopause and menopause, if you don't feel like yourself or you have these new symptoms that are popping up, like And they're going on for five to 10 years. I mean, i can't imagine that feeling of unease for such a prolonged period.
00:07:50
Speaker
We got to offer some solutions to people. I'm glad you brought that up because, you know, okay, so menopause is this normal transition. So it's a lot of times dismissed because it's a normal transition.
00:08:03
Speaker
But in fact, like you said, if it's affecting someone five to 10 years, yeah we need to offer some type of support. And now I believe, you know, like the Menopause Society has something that they're working on about how to, you know, present to... In a workplace or no?
00:08:20
Speaker
No, how to present like to those at our place of employment who can offer some support for women who are going through menopause, whether it is just a room to just go take a break.
00:08:33
Speaker
and meditate or cool off, you know, just like there's lactation rooms. Yes. Yeah, that's exactly what I was thinking. You know, when you do look at these other big milestones for people or these times of transition, people move into a new house, we throw a housewarming party for them.
00:08:48
Speaker
ah but Like some people are growing their family. we We show up and we help them. But menopause and that sort of transition, what are we doing to support
Workplace Support for Menopausal Women
00:08:56
Speaker
women? You have to have a very, I think, a company who is very aware and sensitive to the needs of women going through perimenopause or still having a hard time postmenopause and to be able to educate them and recognize you know, that these symptoms are impacting their work because there is, and Rachel, I wish I had the numbers for you, but there's a higher percentage of women, you know, retiring earlier yeah leaving the workplace. Absolutely. Yeah, actually i did ah I did an episode on that with a couple of lawyers. And so if anybody wants to listen to it, you can go back and find that. It it is really interesting and it's striking the number of women who just leave the workforce during that time.
00:09:43
Speaker
And, you know, not to mention the other burdens that might be happening. Women going through their midlife tend to be in that sandwich situation, right? With the stress of their aging parents and potentially their children like that also must compound their mental health. Oh, absolutely. Absolutely does.
00:10:00
Speaker
I know we kind of like, you know, talked about if someone never has been anxious or never had. Right. And I don't want to forget about the women who have had this, you know, chronic disease.
00:10:13
Speaker
depression, and even bipolar disorder, yeah or what's called generalized anxiety disorder, which is just a general worry about many different things, hard to shut their mind off.
00:10:25
Speaker
that And then so those symptoms can exacerbate, know, like The anxiety is more intense. The depression is lower. even think that this rage sometimes that women feel. The impact that they feel that that has on their relationships with their families or at work.
00:10:49
Speaker
yeah not being able It's like lower frustration tolerance. Yeah, you're right. Because you are having like lower drops in a way. That's kind of how I explain to my patients. If you're having fluctuations of estrogen, but you're going through menopause or perimenopause and your your baseline is lower than it was ever before. So you're just having these lower drops in hormones, whether it's estrogen or progesterone or even testosterone. And so that you're right, like it creates an intensity.
00:11:17
Speaker
Sometimes I try to reassure my patients that, hey, you know, men are walking around like this all the time. and and these please You know, you this is just, I feel like it's the change from their baseline. Like you said at the beginning, not feeling like yourself or not feeling normal, right? And lots of people kind of just operate at this lower baseline and may not notice the differences, but it's that fluctuation. It's that roller coaster of perimenopause that I think makes it so hard.
00:11:44
Speaker
Oh, absolutely. And then like what contributes to that roller coaster is stress. Yeah. Yeah. And let's say we got a deadline or you got a lot of notes to do, you know, you know, in our field, we got a lot of documentation have to attend to in addition to, you know, taking good care of our patients.
00:12:02
Speaker
But, you know, then you have to run home and do whatever you have to do or, you know, and like you said, if there's a sandwich generation, you're taking care of your. You know, ah parents who may not be doing so well and taking care of your kids, perhaps if your kids are adults, which they most likely are, you may be taking care of your grandkids.
00:12:22
Speaker
right feel a ge Right. Right. And so trying to do it all, get things done, trying to. manage your own health because exercise tends to go out the window.
00:12:34
Speaker
not fun, but for a lot of people it does. And yeah how do I do all of these things? And they balance. Yeah. Take time for yourself, right? It's just not possible.
00:12:44
Speaker
Yeah. Makes it just more challenging. Yeah. And okay. I wanted ask you another thing because do you see patients who come in with like attention deficit or ADHD ADD? I do.
00:12:56
Speaker
Okay, so I have kind of been thinking through this because I had a patient who had pre-existing ADHD and is going through perimenopause. And she said, you know, i hadn't really been taking the medications for a while, i wasn't really needing them just for day-to-day functioning.
00:13:12
Speaker
But then I noticed as I'm going through perimenopause that if I take my medications, my brain fog is gone. And she said for her, brain fog is the same as ADHD. And this is the the first time I really thought about that because I'm like, is it that the brain is being distracted by other things or is it the stress that's distracting the brain?
00:13:33
Speaker
i mean, I don't know the science behind it to be totally transparent, but it did kind of change my mind. And maybe I should be offering him treatment for ADHD for women who are really struggling with brain fog.
00:13:45
Speaker
Or is it, I don't know, or are they different? I'm not sure. i wondered i just
Managing Brain Fog and Anxiety
00:13:49
Speaker
wondered your perspective. No, that's a good question. And not the first time I've ever been asked this question. And so when a woman has, you know, let's say she does not have, you know, this ADHD diagnosis, but it's this brain fog, hard to concentrate, you know, but it's also, you know, partly language, having a hard time recalling certain names, words, maybe. I'm not knowing why he what I in there. Right. How did I get here? You know, in an ADHD, you know, it's a bit ah different. I mean, they're still both having a hard time with concentration, you know, but maybe for different reasons.
00:14:27
Speaker
So, but it's still something to kind of think about yeah that will help with brain fog or not. I think maybe that's something, you know. you're a researcher, you read, you tried another recent jack you know, this is the thing I learned so much from my patients. And I get my research ideas from my patients, because you start to see patterns or certain phenomena that we haven't quite explained. And I feel like brain fog is the is one of the trickiest things, because I do have many patients who feel better once they are using hormones, because then they might be getting sleep better, they're feeling more alert during the day. And so I think their memory is firing a little bit better. But I have plenty of patients who are on hormones and still experience brain fog.
00:15:10
Speaker
it's tricky to figure out what to offer them. Well, I can tell you just from my perspective, other things that will affect brain fog, you know, and this is like a pretty standard in terms of this memory in general, it would be more anxiety.
00:15:24
Speaker
for things if you're highly anxious, um kind depression, significant stress, or especially if it's chronic, or as you were saying, you know, um just poor quality sleep, all of those things impact, I think, of you know, the the memory, the forgetfulness. So even like, let's say they're taking something for the anxiety or depression, or even just managing it using coping skills,
00:15:49
Speaker
That's going to help them to manage the brain fog. It's not going to make it go away. Right, right. But they can get a little more control. Yes, great. I have some patience to you for that reason too, because I feel like if but my patient whose mind is blanking when she's about to give a presentation, if you can teach her a coping skill of kind of what to do in that scenario, so then she doesn't just unravel and, you know, become more upset and then not be able to kind find her bearing, then yeah, that should be ah hugely helpful for her.
00:16:23
Speaker
Absolutely. And, you know, there's so many other things out there that can help with anxiety. And yeah especially if women are real sensitive to medication, to some women who yeah are, you know, or just don't flat out, know, want them.
00:16:37
Speaker
Well, you and I work together on the supplement, ma'am. I think it's totally fine for us to talk about it because, you know, i it's it's different from a prescription medication and, you know, full disclaimer. So Dana and I are clinical experts in a supplement company. And one of the supplements is ashwagandha, which helps a lot of women, right, with their anxiety, whether it's during the day or at night.
00:17:00
Speaker
And I think we we have a lot to learn from other cultures. People have been using that in India for a very long time. And so i think you're right, if especially if someone does not quite need a prescription or might be sensitive to a prescription. it is There are some good things out there. The other ingredient that I love, I don't mention this necessarily to my patients because of the conflict of interest, but in general, i feel like the mango leaf extract that we put in the daytime formulation that stuff. I have taken that myself by itself, just the Zynomite.
00:17:33
Speaker
And it's been used and throughout Asia for centuries as a tea. It's like a non-stimulant stimulant. So just kind of like helps you feel awake without making you feel wiry. So yeah, you're absolutely right. There are other things too that we should be looking into and researching and and trying to figure out if that could help.
00:17:52
Speaker
Absolutely. like you said, staying awake without wiry. So Yes. You're awake and you're alert, but you're not worried. That means you can focus better. Right. Exactly. You know, and then you can get things done because I know what, if I'm worried.
00:18:06
Speaker
Yes. I'm bouncing all over the plate, you know, like the Winnie the Pooh Tigger and Winnie the Pooh Tigger. Boing, boing, boing. Exactly. Things are getting done a little bit here and there, but I'm really not completing
Supplements for Mental Clarity
00:18:18
Speaker
anything. yes And I'm just all revved up and it' the en energy's there, but it's really hard to get things done that way. You know, like you said, some of the MIM products, you know, what we have in the MIM products, if we can help people stay alert, give them a little more energy, bring a sense of calm.
00:18:39
Speaker
Right. The sense of calm is really huge because let's say like we're talking about with stress and that increases hot flash frequency or hot flash bother, it can actually help them to be able to implement these coping skills.
00:18:53
Speaker
And I think that's kind of like where the compliment comes in. Right. you Having a supplement in coping skills or having a medication and coping skills. don't know what coping skills is a good idea.
00:19:05
Speaker
Yeah, it's a very good idea. Absolutely. And I love that there are psychologists like you that teach those, right? I think for people who don't live in the Cleveland area and don't have access to you what kind of psychologists should they be looking for? like where should women be looking for, for help?
00:19:23
Speaker
going to the first thing I would suggest, and and I have suggested this because i have I'm in a clinic where people travel and come to the hospital. I give them the information to the Menopause Society website. Nice. Okay.
00:19:35
Speaker
And I say look to see if there is a provider in your area because there's psychologists on that site too. And even if there's not a psychologist, say that, you know, there's someone like yourself in whatever state they're in, then you could say, oh, I know someone.
00:19:49
Speaker
Right. That's right. We do have kind of our networks of people that we rely on and trust. Yeah, I suggest women start there. But let's say they're in an area where it's just not, the access is just not that great.
00:20:04
Speaker
Just find somebody who can just help you manage to stress the anxiety, the depression or the mood swings. And just in general, you know, they may or may not have a lot of information about menopause itself.
00:20:17
Speaker
Yeah. But, you know, at least if they can help you manage the symptoms, that's still a bonus, I think. Okay. My last question for you, because I know we could talk all day. My last question for you is
Recognizing Early Signs of Perimenopause
00:20:29
Speaker
about perimenopause, because I do think that mental health issues sneak up on women during perimenopause.
00:20:37
Speaker
And sometimes... Whether it's the person herself or her healthcare care providers or whatnot, the dots are not always connected. And I just wanted to hear from you, like, what are some early signs that, okay, this might actually be influenced by perimenopause or here's where you should be kind of thinking, do you need to adjust both the perimenopause and the mental health concerns? Yeah.
00:20:59
Speaker
I just want to make sure I'm understanding the question, like what are some initial symptoms or signs that that I see or that I could tell a woman to look for? Yeah, exactly.
00:21:10
Speaker
Okay. Well, I would say the first thing would be, know, if there's any significant changes in mood compared to their baseline. Okay. no And if it's someone who already has depression or another mood disorder, does it feel a little bit different than it did before? Okay.
00:21:29
Speaker
Also, if there's any sensitivity to if their ah menstrual cycles are longer or shorter or heavier, or if they skip, so if they're noticing any changes in how they're functioning mentally, you know, or emotionally, then those would be the, then would say, you know, just go talk to somebody so you know what to expect and know how to maybe even, you know, start to manage these things so you don't start to feel way out of control.
00:21:59
Speaker
yeah no, that's a really good point. And you kind of made me think of something in order to recognize those changes People have to be tuned in with themselves. And i feel like to be in tune to your mental health, you kind of have to quiet all the noise around us, right? Like there's so much noise, there's so much distraction.
00:22:18
Speaker
And so to help people even recognize what a change is happening, like you have to then be able to tune in to your own self. Or have a very trusted partner who can let you know without offending you.
00:22:32
Speaker
You know, things feel different to me. That's a good point. Because a lot of times, like you said, there's so many multiple things going on and there's so many distractions. I mean, just the phone.
00:22:43
Speaker
Yes. That maybe we're not as ah tuned into ourselves as usual. So let's say, you know, for instance, if they're already seeing a therapist or seeing someone like myself, I mean, I can certainly ask, has there been any significant changes in how you've been functioning since we met last time.
00:23:00
Speaker
That could be of help. And if there's a good relationship, a good bond, you know, someone like myself can bring it up without the person being offended. But kids would bring it up. Yeah. Oh, okay. That's good to know. You have to be like, mom, what's wrong with you?
00:23:19
Speaker
That's so funny. I've heard some of my patients talk about that too. That's so funny. Or noticing that they just don't have the same tolerance or the patience with their kids that they used to. And they're like, Yeah, that's so interesting. But, you know, we have such few moments without the distraction of a phone or something happening. i feel like I'm trying to think of, you know, all these times where maybe 20 years ago it would have been just like sitting and waiting for someone, you know, where you have these five minutes where you're waiting for someone to jump on.
00:23:50
Speaker
or not even jump on. See, my brain has changed. Say you're meeting in person with someone and they're running five minutes late and you don't know because you don't have a phone to know what's happening. And you're just waiting, right? And you just start thinking about things and you have this brain space or being in the car and all the radio stations are playing music that you don't like. So you turn the radio off. You don't, you can't select what you want to listen to or put on a podcast.
00:24:15
Speaker
You know, there's all these sort of liminal spaces that we don't have anymore because we just fill it with noise or with distraction. And I don't know, i feel like for mental health providers, I'm sure can see the difference between the worlds then and and now and and how people um know themselves or don't know themselves.
00:24:36
Speaker
I think, you know, one of the things that I kind of I would say typically suggests is the self-care
Importance of Self-Care During Menopause
00:24:42
Speaker
time. And I would say the response is normally, i don't have time. i don't have time.
00:24:49
Speaker
Okay. Well, you know, and this is pretty standard. This is not just, you know, late to ah menopausal women, but just kind of look at their schedule, really take a hard look. What can you cut out that's not necessary and you can pencil yourself.
00:25:03
Speaker
And I think to help, you know, women to take time out, they really literally have to pencil themselves in their schedule yeah whether it's you know meditation taking a walk some type of ah exercise or even just kind of like going hanging out with their friends yeah whichever it is that brings a sense of groundedness and peace yeah and stillness because stillness is really important because if you have that stillness then you can tune in yeah that's a great point yeah we need more stillness
00:25:36
Speaker
My last point I want to mention on that is, you know, I am actually having her on the podcast soon Sunday Schneider Bean has been my longtime life coach, career coach. She's amazing. And one of the things that she says when you're scheduling your month or your block of time that you should schedule in what your priority sort of self-care stuff is, whether that's exercising, meeting up with a friend, whatnot, and put that on the calendar first because everything else is going to get done.
00:26:04
Speaker
Yeah. Or not. Or not. Yeah. Right. Or it's not as important. It'll fall off. But if you don't schedule that in first, then you won't be able to find the time to squeeze it in. So you just kind of like put these blocks of time. Okay. I'm not, I'm not professing to be good at this.
00:26:18
Speaker
i still have to work with her, but I do think it's a really good recommendation to put these priorities into your calendar before putting everything else in. Otherwise it's not going to fit. Oh, absolutely.
00:26:30
Speaker
can go to any store that sells journals and gets you a little journal. And, you know, if you have to do it that way, put it on a whiteboard, put it on your phone. If you like it that way, there's so many ways now to remind us yeah that, oh, appointment at 9 a.m.
00:26:50
Speaker
for me. but That's awesome. I would start doing that. Yeah. and then you like you don't join on to everything or you don't do all the other things that people ask you to do at the last moment because you're busy you got a conflict don't let go out and sit in my lounge chair with my you know glass of you know i don't know whatever you like exactly try pull Exactly.
00:27:13
Speaker
I know. we need more of that in our lives. Okay. Well, I'm taking that from an expert mental health provider. We need a scheduled self-care and time for ourselves and time to think and time to tune in, especially during these times of transition of perimenopause and menopause. Absolutely.
00:27:28
Speaker
Thank you, Dr. Conklin. As always, it's a pleasure. It's so i good to talk to you You're welcome, Dr. Pope. I hope you have a good day and I hope you put yourself on your schedule. If not, I hope that's the next thing you do. i know yeah