Transcript #26. Menopause and work: How menoupause affects your career - interview with Dr Fatima Khan Part 1

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Renata:                So let's start from the beginning for you. What led you to have a career that you have today?

Fatima:                 Okay. So, it's, it's a long story as I'm sure you're familiar with it.

Renata:                That's okay. We like stories here.

Fatima:                 In a nutshell, I've done my training in London, UK at Imperial College and I graduated and did a range of surgical medical, rotations and doing obstetrics and gynaecology. That was my true love. But then I actually went on to go and do general practise, where I saw 80% of my patients are women. And out of those 80%, I think another 80% were related to menstrual cycle, menstrual pain, direct and indirect mental health related to their menstruation. The impact on their relationship, work life, home life.

Fatima:                 And so this impacts not just women going through the menopause. I mean, you start seeing it from puberty in their 20s and their 30s and their forties and 50s. So our hormones, fertility periods, this is something we are faced with and challenged with since, since puberty all the way till in your mid-fifties until you end your menstruation. And so, for me it was, I found that there was a lot of help for people doing the premenstrual syndromes and a general fertility and ovulation. There's a lot of help on the internet. There's lots of apps. But it's the woman in her early forties going onwards there isn't much recognition of the symptoms, much awareness and how to deal with it. And the focus really is in the UK now there's a big movement towards these women are highly experienced, very dynamic and they need to stay in the workforce into their sixties, and a lot of them now are giving up their work in their late forties because they're finding they can't cope. They can't cope with the demands of the work, home life and something has to compromise.

Fatima:                 And so a lot of them get early retirement, some get unfortunately made redundant and a lot of them will not go for that job. A lot of them will come to me at 48, it will be given this job just below, below the executive level. And then they will step down. They wouldn't take up because they can't cope. And primarily is, is to do with not just the disturbance in their menstruation. There's a huge disturbance in their mental health. Anxiety, depression, mood, cognitive function, focus, concentration, memory, decision-making. So I found that I wasn't able to help them because there was a lot of misinformation about how to manage them, what, whether to give them HRT, what should we do? So in the UK they've got a, the British menopause society with the faculty of reproductive sexual health society. They've got a, it's almost like a certification and diploma where you sit in every week and you do a menopause clinic in which you would see the perimenopause premenstrual syndromes, you see kind of all the hormone related disorders.

Fatima:                 But you essentially sit in, for an advanced certificate, which is what I have for a year. And you sit in every week and you see these women who got complex backgrounds and how you manage them essentially with a gynaecologist. So I would have an independent clinic and I've seen, you know, hundreds if not thousands of women and these got complex needs. So these women aren’t just destroyed. They've got strokes, they've got heart disease, they've got family history of breast cancer, family history of endometriosis, heart disease, all the things that the average doctor can't treat, I can treat and manage them because of this multidisciplinary team we had. With an obstetrician, a gynaecologist, a haematologist, and breast cancer specialist. So the training that they give you and at the end you get a certification, the advanced menopause management, which allows me to set up a clinic and also accept referrals and manage these patients because the problem is the average GP, it's beyond their scope to manage these women. And so women that end up Googling, seeing naturopaths, seeing different people, spending hundreds of dollars on lots of supplements and they still don't feel good.

Renata:                Yes. I want to ask you a couple of things, as you know, I'm a career coach Fatima and I see a lot of clients, female clients and they come to me in their early, mid-thirties all the way to their mid-fifties. And, and in, especially in their mid-thirties, I have been getting clients and prospect clients that say, I have changed in my, my leadership style have changed or my confidence levels have changed and I don't know why something has, is happening to me. I also have friends and clients in their forties who are saying that they are getting, they feel depressed. I'm not, wouldn't say that it's clinical or just say that, you know, they feel like they're not themselves anymore. They don't feel as confident and they feel depressed. Do you think that we have all these issues that are going undiagnosed and it would kind of, putting a lot of, sort of weight in ourselves and our self-development when we should be seeing people to help us with those things?

Fatima:                 Yes. So essentially if you go back to the basics again and why did the changes start, mid-thirties is a common time to see it, because mid-thirties is when everyone knows it's when your fertility goes down. And so what tends to happen in your menstrual cycle, which is 30 days, mid cycle, you release the egg and then 10 days or two weeks before you have your period, you would have something called progesterone, which is a hormone that gets released. Now, progesterone is your fertility hormone, but it's also your calming hormone. So what tends to happen is mid 30 onwards, that hormone starts to decline in its level.

Fatima:                 So women tend to experience a lot more anxiety related symptoms. They might get emotional, they might get teary, they might get angry, might lash out. And what I get them to do is, but they know they're not depressed because they're not like this all the time. You know, they do have good days because the true definition of depression is low mood for six weeks. So waking up every day with low mood changes in your appetite, change in your sleep, but it has to be a symptom that's there majority of the time in the last six weeks. That's a screening question we ask for depression. If you ask 10 women who are experiencing these changes, a lot of them would say these are not consistent symptoms. So giving them an antidepressant is not the solution. What the solution is, I get them all to write a journal in which what they need to do is write their thoughts, their feelings, what they're grateful for that day, what are the winds of the day, what would they like to improve in terms of self-development and then set the intention for next day, but in relation to their menstrual cycle.

Fatima:                 So they do it in relation to, because interestingly enough, when you get women to do this, when they're having their periods and the first two weeks of their cycle they’re actually really good. And then when you look at these diaries 10 days before their periods is when these thoughts and feelings and the dark cloud hanging over you starts. But you can only realise that when you track it. And so I normally get them to not just do journaling, I want them to do a journal and then you see the shifts and then women themselves become empowered that actually this is not in my head. There is a physiological change that happens in my body seven to 10 days before my period.

Fatima:                 And the problem these days is people have the same routine every single day. That's great if you're a guy because you've got just stressor levels which are completely straight. But for a woman you have to change. You have to listen to your body seven to 10 days before and alter what you're eating. It's not uncommon to crave a lot more comfort food and to allow yourself to eat a bit more because your body is actually think preparing for possible pregnancy. Because you've ovulated and you kind of go into this kind of a mode of probably slight, not paranoia is a strong word, but you might be cautious of making decisions. And we know that if you have a major decision to make in life or at work, your decision that you would make seven days prior to your period and after your period would be very different. And if you speak to these women, they'd be like, I was so rational. And then they'll have their bleed. And then after seven, eight days, they'd be like, Oh, I don't know what I was thinking. That wasn't me. That's not likely.

Renata:                Fatima I get that all the time. Clients, female clients that come to me and say exactly that. You know, I don't know why I said what I said, or I did what I did. I look back and I cringe. And it's that, volatility in, I'm assuming your hormone levels, right? That is making people have come ebbs and flows of hormones affecting their ability to perform as a leader in the corporate sector. And as time goes by, their confidence in their leadership skills diminishes because they don't know how they're going to react the next day, you know? Okay.

Fatima:                 And so what happens is this is just the beginning and most women can compensate. But what happens is when you get to your early forties, mid-forties, your estrogen starts to go down as well, not just the progesterone. So it starts with PMS, which is premenstrual syndrome, which is symptoms that occur 7 to 10 days before your period. And that you can kind of get in your twenties as well. They become more pronounced mid-thirties when you're trying to manage home life, relationships, children running around. And that progesterone beforehand, sometimes an imbalance or some woman might get lots of breast tenderness and migraines and get heavy periods. That's not enough progesterone. And they'll suffer a lot with anxiety and irritability. And then the minute the period happens, they feel a lot more relieved. When we go into your late thirties, early forties, all of these get exaggerated.

Fatima:                 But what happens is the lack of estrogen, if you're looking at women in leadership roles, a lot of them are getting to the peak of their creative mid-forties when they've got the three kids at home, they're rushing around, but then their estrogen starts to decline. So their period might become shorter, longer. They might have three days instead of four days or five days. And the thing is they're so busy, because we don't track our periods. And this is when I get them to do a diary, a lot of them do journaling, but they don't journal with their menstrual cycle. And we have to accept that that is a main difference between the men and us and accept it and accept that vulnerability.

Fatima:                 But once you acknowledge it, you can do something about it and feel more empowered about it. Because then you say, you know what, this is seven days before my cycle. I'm going to keep my schedule slightly lighter. I'm not going to do that crazy 30 minute high intensity workout, which is going to wear me out. I'm going to do something like yoga, something more calming. I might do more breathing exercises. I might be not over commit until I get really exhausted, and then I go home and lash out on my kids and my partner then feel guilty about it because we suffer with lots of guilt because we want to perform at work.

Fatima:                 And then having one coffee after another coffee just to get through the day. And then the excessive caffeine feeds into our stress, and our ability to get more overwhelmed. Then it interferes with our sugar levels, so then we want to crave those sweets more. So the hormones, menstrual hormones don’t just stop at our periods, they interact with cortisol, which is our stress hormone. And they interact with insulin, which is a hormone of, to digest the food, but also it dictates our appetite. So progesterone might be low at 10 days before your periods, but it interacts with insulin, which is your appetite, which interacts with cortisol, which is your kind of your stress hormone, which indirectly and directly interacts melatonin, which is a sleep hormone. Now you can see why it's really important to pay attention to where you are in your menstrual cycle to address your mind, body and heart and your soul.

Renata:                Yes, when we were on the phone getting ready for this interview, we discussed the lack of sleep for women from generation X that has been documented, researched, there are lots of books about it, lots of people write about it. And I have always, spoken about it publicly and in with my clients, about the clash of the social structures between, family life and schools, for example, going from in Australia nine to three and work going from 8:30 to 5 and all of that and how that impacts, a woman's life, a family's life, not just women, but, but we feel that for now we can say mostly women are impacted by, by this mostly. That's how I feel with my clients. You know, they have this, the weight on their shoulders to be the one that is, if not the one that picks up the kids, the one that is the organiser of the family affairs, even if it's the husband who is actually going to do the chores, the women feel like they have to be the administrators of that. And just by overthinking all of those, tasks and chores both at work and at home leads to them feeling like they, they have trouble sleeping at home at night and, and, and you know, it's one of the biggest problems that I have found with my, my friends and also my clients. What this, what do you say to your patients when you see them? Do they come to you with problems? Like lack of sleep?

Fatima:                 So I mean everyone is suffering from sleep problems. So other thing, it's just, as you said, it affects people in their twenties, thirties, forties, 50s, 40 plus. It will be due to a decline in the estrogen and progesterone. So a lot of them might get the stub with feeling hot at night, temperature change, and hot flashes. And that's the biggest reason for their lack of sleep and we have to fix it by giving them the correct hormones to replace the deficiency. However, that's not just to do with the hormone decline. Majority of people suffer from sleep disturbance because we don't have a good sleep hygiene. So the average person will have dinner and then go straight onto putting on television or watching something on their screen or watching their favourite Netflix show, which is great because physically you might feel you're relaxed on the couch, but mentally that is stimulating your cortisol.

Fatima:                 So when you watch something on a screen, it's got blue light in it and that will stimulate your cortisol. So at some site your cortisol level is meant to go down, which is your stress hormone. It's the hormone that makes you get out of bed, wake up and do the things that we do during the day. And then in the evening after sunset, you will get an increase in melatonin, which is a sleeper. And that's the reason why we sleep at night and wake up during the day is because of these hormones that play a role. But what happens is, because we're all watching screens or watching some form of stimulant programming, we are the, the cortisol is the overriding hormone that would take over melatonin. So we're going into bed where cortisol is at its peak. And so we can't sleep because physically we're exhausted but we're wired but tired.

Fatima:                 So mentally we are still awake where we are kind of rehearsing all the day's events, we’re rehearsing all the things we've seen in the show. So your brain's just not ready to switch off. So people would sleep and wake up the next day and say, I felt like I didn't sleep at all because their mind hasn't switched off. So the way we deal with that, and I give this to everyone, is to have a sleep hygiene from 9:00 PM onwards, at least 90 minutes before bedtime. You have no blue light of any source and no screens, TV, Instagram, telephones, iPads, all technology switched off. And that 90 minutes is really to do something to send your body the message that I'm ready to wind down. In this modern world. We have so much stimulus, we don't realise, screens and noise and the surroundings we have, all stimulate our body and send messages to stay awake or whether to sleep.

Fatima:                 So I normally get them to no screens. Put some relaxing music on, the auditory signalling tells your body it's, it's something, it's time to kind of wind down, calm down, put a nice aromatherapy candle on. So that's a sensory input, which again relaxes your muscles, and your mind, and then read, do something that's relaxing. So either read a book, spend that time connecting to your partner. Try and do your journaling. I find that’s a really effective time to reflect on your day's events. Just a bit of gratitude, reflection of what you did well that day, what you could improve and just set your intentions for the next day. And it just kind of recalibrating back to yourself and just balancing out this kind of high hormones and we're kind of running on this just run, run, run, rush, rush, rush, and just bringing it back to kind of ramping it down to getting you ready for bed.

Fatima:                 And most people find this quite beneficial. You need to also add in a bit of meditation or some breathing exercise or some stretches or something for 15, 20 minutes that will, or mindfulness or something that will really get you ready for bed. And I practise this every day religiously. Maybe not if there's a big party or we're going out or eating out on the weekends, but five out of seven days I'm sleeping by 10:30 and I'm strictly after 9:00 PM I follow this and sleep is really important. So, and I think it has an impact on everything you do because if you sleep well your next day will be great.

Renata:                Yes. Yeah, no, you can definitely manage your hormonal fluctuations better as well if you had a good night's sleep the night before. Now, Fatima, let's go back to the life of a corporate executive, female corporate executive in her forties who is keen to continue to advance her career, is probably now having more time than ever before with the kids a bit more grown up, and a little bit more opportunity to advance, in her career, but now finding herself juggling hormonal changes and perimenopause symptoms. What would you recommend a woman like that should do to make sure that she continues to progress in her career?

Fatima:                 So the early forties I would probably say is the most challenging time because not only they've got young kids, they're also at a point in their career where they need to perform, so they need to be full time executive, full time mummy. And then on top of that, in terms of their hormones, they can start fluctuating, but they're not necessarily ready to have any hormone replacement. So it's the lifestyle. This is very important. The first thing I say to them is, in this case it's what they're eating is very important. So when we're tired we tend to, we might eat a lot more, maybe fast food or make more carbohydrate dense food, which are energy rich but nutrient poor. So lots of processed foods will just end up making you get more sugar slumps and also give you fatigue and the brain fog.

Fatima:                 So the diet's really important. So lots of green vegetables are really important. Replacing the caffeine with green tea, cutting down to one cup of caffeine a day if they can. So those little things help, keeping small snacks so they don't have big sugar slumps. Because what's happening is you're just rushing from one place to another to one place and keeping your energy levels really important. But through nutrient rich food, not energy dense food, with processed foods. The second thing is I always prescribe them some supplements because I find they help you. So magnesium in a powdered form is fantastic because not only is it muscle relaxant, but it also calms you down. What you see is your blood pressure makes you feel a lot more relaxed, that's fantastic. You can get some really good ones now that mixed magnesium with a B complex. And B complex and your B vitamins are really important to manage fatigue because B vitamins are really important in something what we call mitochondria, which is the energy hub of our body.

Fatima:                 So it's essentially the engine of a car. So when the engine is running, running out of gas or oil, you'll find it's not going to be as effective. You can go in fifth gear. It doesn't matter if the engine is not keeping up, you just can't run as fast or drive as fast. Same thing in our body. We need to nourish our mitochondria, which is our energy hub. And to nourish them is essentially B vitamins is really important. And sleep, sleep is essential because when we go to sleep, we need at least 90 there's a 90 minutes cycle, and we need about four of those cycles. If you go to bed at 10:30, you should be waking up at 6:00 AM. And when we sleep, that's when our body's cells generate because it's not trying to keep you safe to make sure you don't, you know, walk onto the street and or burn your hand when you're cooking.

Fatima:                 So that's the time when you're sleeping. The body's like, okay, I'm going to go around and I'm going to recharge yourself and mop up any things that's going out of order. And so we know when we optimise mitochondrial function, we improve, we improve energy levels, but we also prevent against disease. So there's a lot of shift towards sleep, optimising mitochondria function with B vitamins and eating the right foods.

Renata:                Okay. That's early forties?

Fatima:                 Early forties. The other things I add to the early forties in particular is their periods tend to become a bit heavier, but they're just putting up with it. And when you become, and that’s just a sign again of your progesterone declining, which means you will have more anxiety, you will lash out more at your kids and your partner, you are just exhausted. And so by the time you get home, you just don't necessarily have the same reserve that you would have normally had.

Fatima:                 So two things I need to do managing that, there are few hubs that they can take like vitex is one of the hubs that you can get, which helps produce more progesterone and it helps with the bleeding, but more particularly just balance of progesterone and your mood. And then all should also be taking an iron supplement because when you have heavy bleeding, they tend to become, they might not be anaemic, but that ferritin level, which is the iron level drops. And so it might be in a normal range, but the lower range still makes them quite fatigued and exhausted. So I get them to have iron, to give them the energy and get them to make sure they're taking hubs as well. So in the perimenopause, essentially B vitamins, magnesium hubs, and also fish oil. Fish oil is fantastic. Like an Omega three is fantastic to balance our hormones because our hormones are made out of steroids.

Fatima:                 It also helps with brain function and joints and other anti-inflammatory processes. So those are kind of my hubs and supplements I give them. Then sleep iron supplements on top. But I also get them seven to 10 days before their period to really cut out any excessive exercise because you will find that they exercise is a form of stress. So when I go for a run on the tunnel or a jogging track, you getting a stress response, cortisol is released. But when you already burnt out from all the things you're going through in life, that reserve you, if you go out for that run, you've taken all that reserves. So by the time you want that bit of coping mechanism at home, you don't have that energy. So I'm finding that already you’re burnt out and then you're going and running every single day. It's not helping your stress levels.

Fatima:                 So you need to do what we like, call, fine I know some people love their running great, but at least 7 to 10 days before their period, I actually tell them, you are not allowed to go running. They don't thank me for that, but they need to really be strict and not do anything that pushes them up and get them really overwhelmed because we already know you're going to have disturbance in your mood with a lack of progesterone and heavy periods. So you need to do daily 30 minutes either yoga, change it to reform Pilates a great way to tone your body. Turn your pelvic floor.  They can do 15, 20 minute hit workouts. That's fine because they tend to be more repetitive exercises, but just long distance running, can be exhausting for your body.

Renata:                Interesting you mentioned that because I was talking to a friend this weekend. She said every time I try to do heavy gym work I get sick.

Fatima:                 They’re not getting nauseous? You find that there might get nauseous or they might get headaches?

Renata:                No, she said she physically gets unwell. I think she will get a cold. I think probably she probably tries too hard during that, periods. Menstrual periods that you said you, you know, before the, the, uh, the periods, seven to 10 days. I'll make sure that she watches and she listens to this podcast and understands a little bit better how to manage her exercise routine. Now, Fatima, what about women in their late forties, usually women in their late forties, if they are in the corporate sector, they might have a leadership role. They might, you know, be, you know, fully employed or working as consultants. Some of them might be moving into board positions, which means making important decisions that affect not only their careers but others. Right? Managing large projects. What would you recommend to them in addition to what you just said or some changes to what you just said?

Fatima:                 So this is the main cohort of women that I see now. And it's because, no, I'm a feminist, but the amount of women I see in their late forties who end up giving up their careers is astonishing. It's a taboo that we don't talk about. Because we think it's a sign of weakness and, it's not openly spoken about because it's because of all the stigma attached to it. So I get two cohorts of women. I get the one cohort of woman take, for example, could be a barrister and say, hang on, I'm forgetting my lines and I can't afford to do this because I need to perform. They're very aware, very pragmatic. They'll go see someone like me, I'll give them their hormones and address all the other issues to balance them and they'll continue performing and working.

Fatima:                 Then you'll see the other cohort of women who aren't necessarily as aware of the symptoms. They don't recognise the symptoms. That's what's happening. So they'll fall victim to this, impression that they are not performing well. And that's the problem because what tends to happen is 45, age 45 onwards you might not get your hot flushes, you might get regular periods, but what you're going to start noticing is changes in your mood, depression, anxiety and cognitive function. So difficulty making decision, focus, concentration, self-doubt. And those women will go see the GP in 50% of perimenopause women get put on antidepressants. So you're already starting off on a wrong foot because the real fundamental problem is it's the, it's the decline in hormones, but they're not fluctuating yet. And because the estrogen is still there to give you your periods and not to give you hot flashes, but you're still getting all the other symptoms and mood and cognitive function.

Fatima:                 No one puts two and two together and says, hang on, this is perimenopause. So they get labelled as depressed or anxiety or adjustment disorder. They start having relationship issues. So they blame the relationship they're going through. They have demanding roles as a mother. So that's, you know, blame that. So this is the fundamental, 70% of women fall into this trap. And then what happens is you get into 48, 49 when they could have that CEO job or top executive, but they will step down. They will come and say to me, I'm deciding to go part time because I cannot cope until they get given HRT. And they go back to feeling like they were in their thirties but I would say if I see 10 women in a clinic, only about three or four would seek help at the right age because there is no awareness.

Fatima:                 We've accepted at 45 to feel essentially crap and at 50 we accepted that we feel old, so we're not going to moan about it, we're not going to whinge about it. And so when I get women coming and seeing me, I'm like, Oh, I've just got hot flushes and that's it. And I asked him 15 other questions, which is, do you have joint aches? Do you have headaches? Are you forgetful? Are you feeling lack of confidence? And they’re like, well yeah, that's just age. I'm like, well no, you're only 51 you're not supposed to be getting these. Then they put two and two together because the message is still in perimenopause is still hot flushes and regular periods. But if you go on to any information site, and we have information in our website as well, there is about 15 questions I asked them and they all look at me shocked thinking, hang on, is this part of menopause? Is this part of my hormone change? And then when we, when we help them, these women can go onto, I've got women in their eighties who are much sharper than me in certain things because they feel like, they can function cognitively and emotionally and physically they're balanced.

Renata:                Yeah, that's, that's really amazing. Ah, this is fantastic. The other group of women that I wanted to ask you about, and you mentioned, you know, they don't come to me at the right age. And because I see quite a few of them, you know, the women in their thirties and I will tell you a little bit about the sort of issues that they have. They may be at the point in their careers where they're so anxious about not having achieved what they wanted to achieve in their careers, but also they haven't really started a family yet. So they're in that kind of in between situation. And that making that is banking them so stressed and so anxious. So they seek coaching support to reach that next level in their career so that they can then have kids. And it's a hard one for me because having done that myself, I know how hard it is to actually be in a lead in a new leadership role and then having to go out on a maternity leave and then come back, you know? So I tried to navigate that with them and, and then develop a long-term career plan, a plan that is not about the next five years, but it's about the next 30 years so that they can have a better helicopter view of their lives and put things into perspective a little bit more because that's short termism, is really stressing them out. What would you recommend women of that age to do for their wellbeing? And is there any sort of, opportunity for them to get support from you as a practitioner as well for them to see you?


Fatima:                 So, I mean, I think in, in generally in this age group, it's, I mean, I understand a lot of them necessarily don't have, haven't met that tick box list, you know, which was have, get married, have the kids, and that's not in 30 now that's really happening in women, in women who are in their late thirties, and early forties. Which is actually a good thing in terms of career progression because they can really focus on their career and get to the post and a stage where they want to get to and then focus on finding that partner and having children. But the problem, I find these women, a lot of them, they come to me with two things, either with premenstrual tension, which is again, they don't recognise it. I'm giving it a diagnosis, but in their mind, they're not coping. In their mind they're being overwhelmed. In their mind they're not performing, they're making wrong decisions. They're being irrational or being called aggressive by some of their male colleagues. And it's because they're not really, journaling where they are in their cycle. So if that's the first thing they can do, that's really important to know how to manage your mood, your emotional and mental wellbeing, which is directly linked to your performance at work. And vice versa. So if you're, if you're stressed at work that impacts your hormones and if you, if you're not aware of what's going on your cycle that will impact your work performance. And the women who do really well are those women who are very mindful, who are very connected because they understand what my body's needs are and they will reshape the environment to meet those needs. And similarly, when they know what their work needs are, they will be able to work around and adjust their mental and physical health to kind of mould around their work needs. In terms of, advice for fertility. Did you want to ask or…             

Renata:                No, it's really managing stress levels and managing their pain because the fact that they're so stressed, is impacting their career progression. You know, I, I'm not a counsellor or a life coach, I'm a career coach, but I can see how stressful that whole conundrum that they find themselves in is impacting their career progression because they want career progression so badly and so quickly. But they're also so stressed that their narrative and their body language and their behaviour is, and it is not really helping them perform well at work.

Fatima:                 So I mean I could always go back to that framework of, they all need to journal daily, which I've already gone through the framework cause otherwise they don't recognise and become aware. The first step, I bet you if you took 10 women, eight of them, eight of them don't even recognise that they're suffering from stress and they’re just compensating by, it's their partners who notice it. It's their children who notice it. It's their friends who notice it. So the first step is awareness and conscious awareness. Bringing your attention with journaling is fantastic and linking it to menstruation is even better. The second thing I get these women to do also is to take the supplements, especially if they’re not taking them throughout, magnesium, hubs, fish oil and a B complex is very good for your body's stress response. So it helps build your body's resilience. It helps build your kind of focus and concentration so you're not having to work as hard when you're feeling exhausted and then the exercise again needs to be altered.

Fatima:                 I think we're all going to the gym, which is great or exercising, but when these aren't what I call rehabilitative exercises, they're actually stealing away your kind of stress reserve. So when times are hard, your body can't cope. So I tend to say to them great, do cardio twice a week, but you need to do weight training, you need to do yoga, especially if you're stressed, you need to do more rehabilitative, Pilates, yoga, and if you really want to go to the gym, then I want you to do a hit workout or do weights. Changing the workout is really important because a lot of the younger generation are really doing lots of excessive high intensity workouts, which depletes them of this energy. So we've talked about supplements, we talked about changing the exercises and journaling.

Fatima:                 Finally, I think a lot of people, as you talked about having perspective, they've lost that connection and purpose and meaning to their life in terms of it's not just about work. Life is more than just turning up to work, taking a check pay and getting that, you know, medal that you got to that executive. Life is about having a meaning and purpose, which is outside of work. And we all know that comes from things like connection. And that connection is for doing something for someone in the community, someone in the family. Because when we focus on trying to connect and doing things as an act of kindness, the focus becomes on something else. It's not being me because being me and focusing on me is actually quite a lot of hard work and it doesn't give you a sense of satisfaction. And then we become quite critical and judgmental. And that's the problem now there's this, there's this expectation of constantly performing and we're not meant to do that. Okay? It's a very corporate view about we're all about production, productivity, performance, consumption, and as humans, those are not our needs.

Fatima:                 As humans, we need to focus on our physical, emotional, but our heart, and heart  and the sense of contentment, fulfilment, the sense of release comes from when we're trying to connect with ourselves, but also people in the community and doing an act of kindness. You know, kindness is almost contagious when you try and do things for other people, without thinking of gain for our self and actually is food for the soul. It makes you, it gives the sense of satisfaction from it. You know what? I've done something great today, which has no materialistic value for me, but it's essential to treat that sense of stress and that sense of purpose and meaning to your life. And I feel like that's the problem. They're under so much pressure of their existence and validating their existence to tangible, materialistic things. The picture, the house, the nice car, the nice bag or whatever things they need to do. But there is more to life than just this. And if you speak to all the people who are much more mature and older, work was one aspect of their life. That contentment comes from connecting and giving because that's when we feel almost relaxed and we've got a sense of purpose in life.

Fatima:                 And the narrative has to change as well and I think that's the main thing we need to learn to evolve. But you can only evolve when you self-reflect and self-reflection is hard. You know? No one wants to, it's hard work because you need to think and you need to look at what you can do better and how you can do, how what you can improve. And you know.

Renata:                That's the hardest thing I do because I have a seven step framework that I use with my clients. I've been using the same framework for years and the self-reflection is the first week and I tried to move that to let's say the third week because they are so reluctant to do that self-reflection right at the beginning of the programme. And I have feared that I would lose my clients. But you know what happens, once they actually complete the programme and I asked for the, I asked for their feedback. That's the, that's the part that they liked. You know, looking back, you know, when they can look back then they see the value of it. But getting them into it is like pulling teeth.

Fatima:                 That's probably the most fundamental thing. Because the reason why they can't get that job or the reason why they can't, their relationship's not working is because they're not self-reflecting. Because when you self-reflect, we're able to have better perspective and evolve on a daily basis and be like, okay well you know what, I was slightly out of order, that was my fault. Maybe I need to change. And we don't, you know, I think people are evolving because mindsets are changing. But until we look inwards and not look outwards for help because you know, we can all help ourselves, we just need to start by looking inwards, helping ourselves. Help has always opportunities out there, everything's always there, you need to change your perception and the lens you're using to look at these things and see actually what is it that I can do to change and evolve. And I’m a completely different person too, in my twenties and my thirties and now in forties and I'm completely different through this process of self-reflection. Which I've only really started in the last five to six years, and apart from that, I thought I knew everything and there was nothing wrong with me.

Renata:                But Fatima, we've been forced into self-reflection mode now. Like the, the whole structure of our world has completely collapsed. And this is the time when we can self-reflect. I still have been getting prospect clients calling me and asking me to help them just write a resume and I don't do that. You know, I only write resumes if you are a CEO of A and you want to be a CEO of B. Or if you are a, you know, up and coming, your a financial controller and you want to be a CFO, that's if you, that means you already know what you want. I don't do resume writing services for people that are completely lost, you know, and not, not having any direction because I can't promise that they will have any results from it. Right. So what's the point of charging people money to do something that's quite expensive if it's not going to get them a job or an interview?

Renata:                So I say no to that and I said, I say to them, this is not the time nobody's actually going to be looking at this properly. The only jobs that are advertised right now are fruit pickers, you know, shop fitters, people to work in, you know, urgent, emerging, areas. This is not for you. My clientele is usually a middle managers to senior managers, and I am asking them stay still for the next two to three weeks, you know, and do some grieving, some self-reflection and then some analysis and learning of where the world's is going because your career might need to change and adjust before you start networking. Every company is actually transformed and readjusting to working from home. They're not advertising roles at the moment. Just wait a couple of weeks if not a month or two before you get your narrative right. For this new world of work that we're moving into.

Fatima:                 But I think it's also for your patients I was going to say, for your audience, I think this is also the time to manage the anxiety and stress with doing things for kindness. So saying, actually, you know what, I'm going to go and help my grandmother and those people and I'm going to dedicate two evenings to going and supplying some grocery for my neighbours. Diverting the attention from self and lack of self, lack of achievement, lack of this. I'm not good enough. I haven't got a job. How am I going to pay my bills, to actually doing something which they can control, which is acts of kindness. And at this point, and in England, they've got a big volunteer service signing up. So, so many people I know are signing up as volunteers to go and deliver food or help some other lady who helps someone else because they need lots of people to just help up for the people who are in isolation.

Fatima:                 So there are things that they can do to keep themselves occupied. And they feel like there's a sense of need for them in this world and they'll feel a lot more, slightly more content, I guess.

Renata:                And more connected as well to what’s, more grounded.

Fatima:                 And I think going back, majority of my patients from 20 to 35 are on anxiety, I really didn't even know what anxiety, depression was at that age. That's because they haven’t got any sense of purpose. Like I had a huge connection to family community. My mom made us volunteer for free and, and give things and help people out and cook for people and cook for your neighbours and do all of this stuff and now, you know, in this materialistic world where we have to justify every single thing we're doing and we're not going to do anything on this way remunerated for it. That's not how humans thrive. You might have all the success in the world, but you will be really unhappy. And I see that all the time with people with fancy, like you know, I have, I've had a huge wealthy clientele in London and they're just missing that soul, that thing in their life, which is a purpose to really doing things to make a difference in other people's life that gives us ultimate fulfilment in life.

Renata:                Oh Fatima, I'm so glad you mentioned this because I have two questions that I want to finish off, but you know, I think they are going to be, I really want to know what you have to say about these two things that have a lot to do with kindness and having purpose outside of work. One of them has to do with this situation that we find ourselves now in the middle of a covid pandemic and most of us in lockdown mode around the world, not just in Australia, but everywhere. By the time this podcast is out, this episode is out, I am assuming we will still be in that same situation. And I feel in my friend's voice, in my client's voice, the stress and anxiety that they're feeling. I also have a lot of clients that have just lost their jobs recently, immediately before the pandemic or because of the situation that we find ourselves in. And I want you to tell me if you have any advice or any kind of knowledge of what that does to your stress. I'm assuming it would be equivalent to being in a war situation, right? Where you're, its complete uncertainty and volatility and ambiguity and you're feeling threatened and stressed. What does that do to your hormones in your body?

Fatima:                 So, I mean, number one, it's important to reassure people that feeling anxious is a normal reaction. So it's important to acknowledge that than to numb that emotion because that shows that your body is doing its job and our body's job is to protect us. So when we are hearing that we might lose our job or we might not have a job and might in future for the next few months, not be able to get a job or pay the bills. Those thoughts create fear in our body and fear is telling our body that there is imminent danger. So the response that we get from a negative news is the same thing as running away from a tiger. So we haven't evolved evolutionary, we are still in caveman days where if I'm scared, my body thinks I'm going to get eaten by a lion. So I go into fight or flight mode, which basically means cortisol, which is a stress hormone pumped up throughout your body.

Fatima:                 Pupils dilated, blood pressure goes up, blood gets diverted to your muscles, away from your gut. Immune system is deprived. Digestion is again slowed down. So at the moment with the covid crisis, we're all living in fight or flight, but we're in this state constantly. So you can imagine that constant state of fear and result in anxiety is suppressing your main function further. Because of course when you're trying to run away from a tiger, you don't care about immune system. You know the aim is to survive. The aim is to run away. You're going to get bloated and indigestion because you're not worried about that. You just want to run. And save your life. And it's difficult because our mind has a habit and also is designed to do this, to have a negative bias. So when things are negative in your favour, it will pick on anything that's negative.

Fatima:                 So you will exaggerate the smallest negative things. So if there's no food or there's no toilet paper, people start panicking. That’s a sign that there's not enough food. And then it's like, Oh my God, we're in danger and people are stockpiling. And that's a normal reaction and we will start focusing on the doom and gloom and the catastrophe of this crisis. And the reality is if you breathe, stop, disconnect to the news, that's the first thing you need to do. Only look at the news once a day. You’re back to your basic routine of getting up in the morning, doing all the things you did. Get ready, take your shower, sitting from the laptop, start working from home. Do the things that you would do. And you watch the news once a day because you can do all the right things. But if you're watching news every hour, that is programming your brain that were in imminent danger. And that's the worst thing we can do in this crisis because we want our immune system to be stronger and immune system is most optimal when we're in a rest or repair, which is a parasympathetic which comes from when we're just completely relaxed.

Fatima:                 So how do we make yourself relax? Lots of mindfulness, lots of breathing exercises and also when we are doing things that again connect to us, give us purpose, give us meaning. So if there's something you enjoy dancing, putting on the music, if you like cooking, cooking, cause these are activities where your brain switches off and starts focusing on these moments because this is something you enjoy and it's a task that you have to focus on. Puzzle making. I have lots of puzzles now with my daughter. I'm planning to do a Lego is fantastic for mindfulness. All these things to try and get you to rest or pair because the reality is that we're coming to the flu season and majority of our going to, majority of us are going to get a flu like illness and which was, we'll get a mild covid like illness. How do we prepare for that and prepare for that is to be in this, in this kind of rest repair state, which is moving away from anxiety.

Fatima:                 So all those things that I mentioned, but again, you need to be taking your magnesium, your B complex and a vitamin C is really important in the winter season. We know vitamin C really, really helps. So 1000 milligrams a day is fantastic and if you’re finding you're getting a bit sick, you can take up to three times a day. And I've seen so many people say to me, my sore throat went after two days. But it needs to be a liposomal vitamin C, because vitamin C otherwise is water soluble and you pee it out. So that's about it. I don't know if that answered your question.

Renata:                No, it does. No, I think it was very good to hear that. And it's really interesting because even though I know I can rationalise and understand that I need to manage this rationally, my body still reacts, the way that it wants to react. So I'm actually quite good at mindfulness and meditation and keeping up a routine, but I have felt really bloated recently and my diet hasn't changed and you just mentioned that and I'm like, Oh yes, that makes sense. That’s the reason why. Wow. Okay.

Fatima:                 It's interesting you say that. So this is where I'm going to conflict and give some conflicting advice. So I think normally I would say don't do running, but I found that I was getting, and I'm someone who's not very worried because I know we are going to get through this crisis. Nothing in life is permanent. Okay. We in a few months are going to come out back to being normal because that's the way life is, it's dynamic and we are, we have ups and downs and this is a phase that we're just slightly going and the roller coaster and plummeting down. But we're going to get back up. But it's important to have the optimistic view. But what I found myself was looking in the news because I’ve got lots of family back in the UK and getting completely overworked and I realised this isn't me and I sit on a desk most of the day and I normally do Pilates or yoga. But what I've started doing now is because my body I feel is so tense and tight. I actually started going for a bit of a run.

Renata:                Yeah. Yeah. I'd feel the same. I feel the same. I need to release the energy sometimes. Yeah.


Fatima:                 Yeah. And so when I go for that little bit of run, I'm not going for an hour run. I'm going for 20 minutes sprint, trot and I come back. I actually feel amazing. My body feels exhausted. It feels relaxed because you're storing all that cortisol as I said to you, it all, everything gets ready to run. Yeah. So your muscles are really, really tight. So when you go for that run, you expense that energy, you feel better. And I actually am not a runner, but I'm loving my run this week. Because I find it's making me feel really calm and it gives you that serotonin rush. So serotonin is a happy hormone. So in the evening, while most people are feeling gloomy and dead and tired. I'm like, I feel relaxed in my body because I've got rid of all the stress and I feel my serotonins I'm going on a high note to bed. I follow my sleep hygiene routine and so I'm actually feeling good and sleeping better than I've ever done despite all of this going on.

Renata:                Oh, I'll try that. I haven't been running but I've been walking really fast, but I really need to possibly try that. Look, I know we're going to go over time, but I want to ask you this last question because it's such a controversial question Fatima. And I wanted to get your views, from, you know, like a clinician in a medical practitioner to see if, there is any, thing we can add to this discussion. In the corporate sector, women often, discuss this a lot, and it's the fact that some women find that female bosses are not as good mentors and coaches to them as they would have hoped. And quite the contrary, they might be even hindering their careers by, creating barriers along the way for women coming up the corporate sector. And that's an ongoing discussion and there are two, two polarising views on this. Some women think that this is not going to, that that doesn't happen at all. And others that truly believe that this is part of the psychic of being a female and it's part of kind of our instincts to protect our, ourselves. And, I wanted to kind of ask you if you have a view on that or it is what it is. We will never know.

Fatima:                 Yeah, I think it's really important to have some compassion. I'm going to come at it from a different angle because I see these women, so these women are really struggling in the 48 plus, the ones are even ex-CEOs and executives because they're going through what they call reverse puberty. Okay. They're going through menopause, which is really, really challenging. It's not just insomnia and hot flushes. They have, every single part of their body has an impact due to the hormone transition they're going through. This has an impact on their relationships at home. So we don't know when we see someone at work, we see some executive turn up or actually we need to, we don't understand. Why don’t we try and put ourselves in their shoes. But the thing is a 35 year old cannot do that, because you don't, you cannot comprehend what they're going through.

Fatima:                 And if I just started seeing you, the symptoms other than hot flushes, but imagine waking up with a brain fog, you can't remember where you put your keys, you can't remember what day of the week it is. You can't focus and with all the multiple symptoms. So they, I find the women who are going through it at that age lose perspective of the people around them and how to manage them. Their ability does get affected. That's because they're going through a really difficult time. And you've got to understand if you took a, you know our senior executive team, there's only like 2 in 10 women who get to that. So I think it's exaggerated. If all the executive team was a woman, I'm sure how half of them would be great leaders if they were managing their menopausal symptoms. But what happens in the executive team at the moment is, you have 10 members of the board, two would be females or one might be female who's having hot flushes and gets bullied in the board room because you know, she can't remember her presentation.

Fatima:                 She's flustered, she knows she's trying to look for that USB cable and all those things. So they are going through a really difficult time. And I think that one woman not for stereotype will stay with us until we get more women in the executive position number one, to balance that one woman out. Because that one woman who's made up there, is probably not being looking after her symptoms very well, and soon she won't even make it to see it because she would have left her job. So that's my perspective on it because that one woman's is to stereotype of this monster because there's only one of them. But if you had 10 woman going through those things, we actually possibly could have a workplace which is more suitable for women going through the change and tailor make it to their needs and also make it more aware. And if we talked about it, there was no taboo about it, then we would, we would say, you know, we'd be more understanding and more compassionate.

Renata:                Well that's a wonderful way to finish off. I love it. Thank you Fatima. Thank you so much for your time. And I want us to, in the episode show notes, put a link to help women find you and come to you if they need help. If they're in Melbourne, they can come to you. Right?

Fatima:                 Mhmm, so we, so I work at Agora centre. You can find us on, it's a specialist centre at Epworth hospital. We work in a multidisciplinary team. So I work with gynaecologists and other colleagues of mine, because that just makes it more convenient for patients if we need to get other kinds of advice. I've also started an Instagram account, which is quite interesting.

Renata:                Oh we will definitely put the link on the episode show notes then.

Fatima:                 Yeah, so you can follow me on, that and with the current crisis we have got the ability to do telehealth and Medicare is now giving rebates. So a lot of people might be suffering, especially with a lot of anxiety and mood disorders. Which again, antidepressants aren't going to help and you might need some specialist hormonal advice. You can all have rebates available, as of Monday, I understand that you can do a telehealth for all of them. And at the moment, currently we're doing it for a certain select number of patients.

Renata:                Wonderful. And if it's telehealth, then they can be all over Australia basically.

Fatima:                 Yes. And we're doing video consultations so it's not just telephone. I think initial consultation is quite nice to have a video consultation. So we're available and open for video consultation and the more important thing is, you know, they get a rebate for that for Medicare, which is really important.

Renata:                Of course. Wonderful. Fatima, thank you so much for talking to me. It's been a pleasure having you.

Fatima:                 Thank you for having us and I hope that your audience found this useful.

Renata:                Oh I have!

Fatima:                 And then yes, I look forward to possibly doing more of these again if there's any specific topic that you need me to talk on.

Renata:                Oh, absolutely. We'll have you over again for sure. Thanks Fatima.

Fatima:                 Wonderful. Take care of yourself and keep safe.


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