Latest / Clearly Hormonal / Ep 20: When Hormones Change, Relationships Change with Neha Kumar, LMFT

Transcript

Ep 20: When Hormones Change, Relationships Change with Neha Kumar, LMFT · Clearly Hormonal

• 0:01
  Dr. Komal Patil-Sisodia: Welcome to the Reset Recharge podcast with your host, Dr.
• 0:05
  Dr. Komal Patil-Sisodia: Komal Batia, a board certified endocrinologist, internist, and obesity medicine specialist.
• 0:11
  Dr. Komal Patil-Sisodia: This podcast is focused on empowering women's health and aims to help you reset your understanding of your metabolic health.
• 0:18
  Dr. Komal Patil-Sisodia: And recharge the conversations you are having with your healthcare providers.
• 0:22
  Dr. Komal Patil-Sisodia: While I am a physician, this podcast is purely for educational purposes.
• 0:26
  Dr. Komal Patil-Sisodia: No individualized medical advice is being given on this podcast.
• 0:30
  Dr. Komal Patil-Sisodia: If you do find information that is helpful, please discuss it with your healthcare provider at your next visit.
• 0:40
  Dr. Komal Patil-Sisodia: Hi everyone.
• 0:40
  Dr. Komal Patil-Sisodia: Welcome back to Reset Recharge.
• 0:42
  Dr. Komal Patil-Sisodia: Today we have a very special guest with us.
• 0:45
  Dr. Komal Patil-Sisodia: I'm happy to introduce my sister, Neha Kumar, who is a licensed marriage and family therapist.
• 0:51
  Dr. Komal Patil-Sisodia: I've known her her whole life and I'm just excited to be doing this episode with her.
• 0:57
  Dr. Komal Patil-Sisodia: Welcome, Neha.
• 0:58
  Dr. Komal Patil-Sisodia: Thank you.
• 0:59
  Dr. Komal Patil-Sisodia: As we get started, can you talk a little bit about yourself and your background and how you got into marriage, family therapy?
• 1:05
  Dr. Komal Patil-Sisodia: I'd love for our listeners to hear that.
• 1:07
  Neha Kumar, LMFT: Yeah, absolutely.
• 1:08
  Neha Kumar, LMFT: I have been a licensed marriage and family therapist since 2018.
• 1:13
  Neha Kumar, LMFT: However, training starts a couple years before that when you're still doing your masters, and so I have had years of experience working with a variety of people, white demographic and initially fun fact, I thought I would get into.
• 1:28
  Neha Kumar, LMFT: Movies, movie marketing, specifically the business of film.
• 1:31
  Neha Kumar, LMFT: And then I spent a summer in India that was life changing where I spent half the summer interning in the film industry in Bollywood there, and then the second half of the summer volunteering in the slums.
• 1:41
  Neha Kumar, LMFT: And that was really eyeopening.
• 1:42
  Neha Kumar, LMFT: And I came away from that summer, still in love with movies and all things film related.
• 1:47
  Neha Kumar, LMFT: However, I, there was a shift in me and I really wanted to start helping people and I.
• 1:54
  Neha Kumar, LMFT: Ultimately went down that path a couple years after graduation, I was in advertising and then I decided to get my master's in clinical psychology and I've never looked back.
• 2:02
  Neha Kumar, LMFT: Yeah.
• 2:02
  Dr. Komal Patil-Sisodia: This is a second career for you.
• 2:04
  Dr. Komal Patil-Sisodia: Yes.
• 2:04
  Dr. Komal Patil-Sisodia: And I will say for all of our listeners, my sister is probably one of the most talented people I know.
• 2:10
  Dr. Komal Patil-Sisodia: When I say triple threat, I mean it, not just in terms of what she can do on.
• 2:14
  Dr. Komal Patil-Sisodia: Stage or in a production that is, film or television, just in terms of writing, acting, singing, dancing, actually quadruple threat.
• 2:22
  Dr. Komal Patil-Sisodia: But then also just to be such an intelligent, well-read and, educated person in the space of marriage and family therapy.
• 2:31
  Dr. Komal Patil-Sisodia: You really can do it all.
• 2:32
  Dr. Komal Patil-Sisodia: I know you're my baby sister, but I've always just held a deep admiration for everything that you've accomplished so far.
• 2:37
  Neha Kumar, LMFT: Well, thank you.
• 2:38
  Neha Kumar, LMFT: Right back at you.
• 2:39
  Neha Kumar, LMFT: You have been, my role model in addition to our middle sister since day one, but you were definitely, with the six year age difference, I saw a lot more of sort of what you did academically and watched you go off to college and then medical school and all those things.
• 2:52
  Neha Kumar, LMFT: So you have been a, an inspiration for me my whole life.
• 2:55
  Neha Kumar, LMFT: So
• 2:56
  Dr. Komal Patil-Sisodia: well, thank
• 2:56
  Neha Kumar, LMFT: you.
• 2:56
  Neha Kumar, LMFT: Thank you.
• 2:56
  Dr. Komal Patil-Sisodia: I love doing stuff with my sisters, so I know that's the best.
• 2:59
  Dr. Komal Patil-Sisodia: And just as a teaser, I will have an episode with our middle sister coming out around TMJ and how that changes during menopause.
• 3:07
  Dr. Komal Patil-Sisodia: But let's dig into relationships, which is why we're here today.
• 3:10
  Dr. Komal Patil-Sisodia: And you
• 3:10
  absolutely.
• 3:11
  Dr. Komal Patil-Sisodia: You are the expert in that arena in my life.
• 3:14
  Dr. Komal Patil-Sisodia: And I know I talk to a lot of, I talk to you about a lot of patients who are struggling with this.
• 3:19
  Dr. Komal Patil-Sisodia: So in your practice, how often are you seeing couples struggling with relationship issues, especially when the woman is coming into perimenopause and menopause?
• 3:27
  Dr. Komal Patil-Sisodia: How frequent is that?
• 3:28
  Neha Kumar, LMFT: In my clinical practice, I have seen, I would say a good amount of.
• 3:33
  Neha Kumar, LMFT: Patients who come in that are dealing with menopause, the bulk of my experience has been in primary mental health.
• 3:39
  In
• 3:40
  Neha Kumar, LMFT: the recovery field.
• 3:41
  Neha Kumar, LMFT: So most people think recovery.
• 3:42
  Neha Kumar, LMFT: They think substance abuse.
• 3:44
  Neha Kumar, LMFT: Yeah.
• 3:44
  Neha Kumar, LMFT: However, there is a movement that's been happening and it's just getting bigger and bigger for primary mental health issues.
• 3:50
  Neha Kumar, LMFT: Severe depression, severe anxiety, PTSD, maybe substance abuse is secondary and co-occurring.
• 3:56
  Neha Kumar, LMFT: But a lot of the women that I've seen who come in with severe anxiety and depression are dealing with perimenopause or menopause.
• 4:06
  Neha Kumar, LMFT: And even.
• 4:07
  Neha Kumar, LMFT: You know before that there's a lot of postpartum stuff and then that sort of feeds into some of the feelings that they experienced during perimenopause and menopause.
• 4:15
  Dr. Komal Patil-Sisodia: Yeah.
• 4:15
  Dr. Komal Patil-Sisodia: And with women having kids later nowadays Oh yeah.
• 4:19
  Dr. Komal Patil-Sisodia: Perimenopause comes hot on the heels of postpartum.
• 4:21
  Dr. Komal Patil-Sisodia: So I'm sure the, you're seeing the gap become shorter and shorter there.
• 4:25
  Neha Kumar, LMFT: Yes, and it's a lot, it's a lot for women to have to navigate.
• 4:30
  Neha Kumar, LMFT: I think at a baseline, being a woman comes with a lot of different obstacles and things that we have to overcome.
• 4:37
  Neha Kumar, LMFT: And so working with clients who are coming and maybe have had postpartum or are experiencing it currently and don't really know how to deal with it, it has been very interesting.
• 4:46
  Neha Kumar, LMFT: And then on top of that, maybe they've had postpartum.
• 4:49
  Neha Kumar, LMFT: Just 10 years ago and now they're dealing with the perimenopause.
• 4:52
  Neha Kumar, LMFT: 'cause like you said, people are having Yeah.
• 4:54
  Neha Kumar, LMFT: Children later and so they feel like they really can't catch a break.
• 4:58
  Yeah.
• 4:58
  Things
• 4:59
  Neha Kumar, LMFT: just, by the time their kids are old enough to sort of sit back and be like, okay, they're self-sufficient.
• 5:03
  Neha Kumar, LMFT: Then they start experiencing a lot of the stuff that comes with the perimenopause.
• 5:07
  Neha Kumar, LMFT: So it's a lot.
• 5:07
  Dr. Komal Patil-Sisodia: Yeah, it is.
• 5:08
  Dr. Komal Patil-Sisodia: And it can be so overwhelming, I think.
• 5:10
  Dr. Komal Patil-Sisodia: Absolutely.
• 5:11
  Dr. Komal Patil-Sisodia: So Neha, from a psychological standpoint, how do hormonal changes during perimenopause and menopause affect a woman's emotional wellbeing and identity?
• 5:21
  Neha Kumar, LMFT: That is a great question.
• 5:22
  Neha Kumar, LMFT: So as far as emotional wellbeing goes, I think when people, women start to experience perimenopause, they're thrown for a loop.
• 5:31
  Neha Kumar, LMFT: First of all, a lot of people don't know what that is.
• 5:33
  Neha Kumar, LMFT: I think that's fair.
• 5:34
  Neha Kumar, LMFT: That's fair.
• 5:35
  Dr. Komal Patil-Sisodia: Why we're doing
• 5:35
  Neha Kumar, LMFT: this
• 5:35
  Dr. Komal Patil-Sisodia: whole
• 5:35
  Neha Kumar, LMFT: thing, right?
• 5:36
  Neha Kumar, LMFT: Yeah, exactly.
• 5:37
  Neha Kumar, LMFT: And I think this is actually a much larger issue because when it comes to any sort of female reproductive stage, whether that's puberty or prenatal stuff, a pregnancy postpartum.
• 5:49
  Neha Kumar, LMFT: All of that stuff.
• 5:50
  Neha Kumar, LMFT: Women, I feel like we don't really talk about it.
• 5:52
  Neha Kumar, LMFT: I think in this country maybe it's a little bit more than some other cultures around the world, but in general, either it's not talked about or it is glamorized.
• 6:01
  Yes.
• 6:02
  And
• 6:02
  Neha Kumar, LMFT: so people have this.
• 6:04
  Neha Kumar, LMFT: Either they don't know anything about it or they have this perception that, okay, it's gonna be great perimenopause.
• 6:08
  Neha Kumar, LMFT: If you weren't my sister and I wasn't a therapist, I would not have been exposed to that word by now.
• 6:13
  Neha Kumar, LMFT: Yeah.
• 6:13
  Neha Kumar, LMFT: And that's really unfortunate because most women think, okay, I have, I'm gonna have my period, and then it's just gonna stop one day.
• 6:20
  Neha Kumar, LMFT: Boom.
• 6:20
  Neha Kumar, LMFT: And that's it.
• 6:21
  Neha Kumar, LMFT: And that's not true.
• 6:22
  Neha Kumar, LMFT: And perimenopause is the beginning of the end.
• 6:24
  Neha Kumar, LMFT: It's.
• 6:24
  Neha Kumar, LMFT: Like that transitional phase before it does stop.
• 6:27
  Neha Kumar, LMFT: And that comes, as you know, with a lot of hormonal fluctuations, which unfortunately can lead to a lot of lack of emotional regulation or emotional dysregulation.
• 6:37
  Neha Kumar, LMFT: And that's something that I think people need to be a little bit more sensitive and understanding of because it's not something that.
• 6:44
  Neha Kumar, LMFT: A person can necessarily control.
• 6:46
  Neha Kumar, LMFT: And I think there's a huge misconception around that.
• 6:49
  Neha Kumar, LMFT: Whether it's your period or perimenopause or menopause.
• 6:52
  Neha Kumar, LMFT: Just get it together, you know, this is gonna happen.
• 6:54
  Neha Kumar, LMFT: This is a natural thing, so control your emotions.
• 6:57
  Neha Kumar, LMFT: And that is, it's not, it's very difficult.
• 6:59
  Yeah.
• 7:00
  Neha Kumar, LMFT: And then, as far as identity is concerned, you go your whole life for the most part of it, most.
• 7:05
  Neha Kumar, LMFT: People start their period around 12.
• 7:07
  Neha Kumar, LMFT: It's getting younger and younger nowadays, that's a whole other episode because of environmental and whatever considerations there to all of a sudden have that sort of stop.
• 7:17
  Neha Kumar, LMFT: It's a double edged sword because a lot of women are praying for the day that their period ends because it's not fun to have your period.
• 7:24
  Neha Kumar, LMFT: And then on the other hand, it really.
• 7:27
  Neha Kumar, LMFT: Is a part of our biological identity, whether or not you choose to have kids or whether or not you can have kids, whatever, what you choose to do with that reproductive stuff is obviously your own choice, however it is ingrained in you.
• 7:40
  Neha Kumar, LMFT: And so when that stops, it's.
• 7:41
  Neha Kumar, LMFT: Scary.
• 7:42
  Neha Kumar, LMFT: It's saddening, it's disheartening.
• 7:44
  Neha Kumar, LMFT: And so there's a lot that goes on.
• 7:46
  Neha Kumar, LMFT: There's the emotional dysregulation and then there's the fears around losing identity.
• 7:50
  Neha Kumar, LMFT: That's so well put.
• 7:51
  Dr. Komal Patil-Sisodia: And I think to your point, we don't do a great job of educating women around perimenopause and menopause, but really about any of the hormonal changes that are occurring in their lifetime.
• 8:02
  Dr. Komal Patil-Sisodia: I remember going through sex ed when I was a kid, and it was just.
• 8:06
  Dr. Komal Patil-Sisodia: So glossed over.
• 8:07
  Dr. Komal Patil-Sisodia: And that may be a generational thing because what I've seen my son and his classmates go through is very different.
• 8:13
  Dr. Komal Patil-Sisodia: Maybe on the other end of spectrum, like maybe a little, a little much.
• 8:17
  Dr. Komal Patil-Sisodia: Yeah.
• 8:17
  Dr. Komal Patil-Sisodia: A lot of information that I don't know that they're fully equipped to handle.
• 8:20
  Dr. Komal Patil-Sisodia: But I think the one thing that we really don't teach.
• 8:23
  Dr. Komal Patil-Sisodia: Girls and young women.
• 8:25
  Dr. Komal Patil-Sisodia: And women as they age is how many hormonal changes they will go through in their lifetime and how much that affects their emotional wellbeing and identity.
• 8:36
  Dr. Komal Patil-Sisodia: So in your experience, what are some common emotional or psychological challenges that women do face during these transitions?
• 8:42
  Dr. Komal Patil-Sisodia: Because.
• 8:43
  Dr. Komal Patil-Sisodia: Everything is constantly changing.
• 8:45
  Dr. Komal Patil-Sisodia: Really, if we look at it across the lifespan of a woman, to your point, there is, your childhood where things are pretty carefree, puberty, the reproductive years, and decisions around whether or not you want to or can have children.
• 8:59
  Exactly.
• 9:00
  Dr. Komal Patil-Sisodia: And then perimenopause, menopause, and post menopause.
• 9:02
  Dr. Komal Patil-Sisodia: And so it's like constant shifts.
• 9:05
  Dr. Komal Patil-Sisodia: It's.
• 9:06
  Dr. Komal Patil-Sisodia: The only constant that we really have is change as women
• 9:09
  Neha Kumar, LMFT: I know, and yet we live in a society that's so structured and by the book, and it doesn't really matter how you're feeling one day, it's you've gotta get this done and if it doesn't get done, no one else is gonna do it.
• 9:21
  Neha Kumar, LMFT: And so I think it's when you're going through those huge hormonal shifts, sometimes it's just hard to function at a baseline.
• 9:28
  Neha Kumar, LMFT: And then.
• 9:29
  Neha Kumar, LMFT: You have to think about, okay your work outside the home.
• 9:31
  Neha Kumar, LMFT: You work inside the home, your children, whatever it might be.
• 9:34
  Neha Kumar, LMFT: We all have a million different responsibilities.
• 9:36
  Neha Kumar, LMFT: And so from an emotional standpoint, again, that dysregulation comes in.
• 9:40
  Neha Kumar, LMFT: There's just so many stressors.
• 9:42
  Neha Kumar, LMFT: And then the life in general, and then the added anxiety and feelings around my body is changing.
• 9:48
  Neha Kumar, LMFT: My moods are changing.
• 9:50
  Neha Kumar, LMFT: I can't control this.
• 9:52
  Neha Kumar, LMFT: I think.
• 9:52
  Neha Kumar, LMFT: It goes for anybody that if they feel a lack of control around something that is very anxiety inducing.
• 9:58
  Neha Kumar, LMFT: And so what I have seen in my professional practice is women who are going through perimenopause in particular, where the periods are totally irregular and the hormones are all over the place.
• 10:11
  Neha Kumar, LMFT: Becomes sort of a game of, okay, how do I get through each day?
• 10:14
  Neha Kumar, LMFT: Yeah.
• 10:15
  Neha Kumar, LMFT: And I think we tend to have a very macro view of things of okay, if I accomplish this, this, and this each month, then that's great.
• 10:21
  Neha Kumar, LMFT: But with these changes in our cycles as women, we almost have to look at it as a day-to-day thing.
• 10:26
  Neha Kumar, LMFT: And I think when we do that, we set ourselves up for success as opposed to failure.
• 10:30
  Neha Kumar, LMFT: Because if we look at things from a macro lens, it can be very overwhelming.
• 10:34
  Neha Kumar, LMFT: And so emotionally, the anxiety and then it can also cause just depression just due to the hormonal shift psychologically you might start questioning, when you're really highly vulnerable and sensitive.
• 10:45
  Neha Kumar, LMFT: Yeah.
• 10:45
  Neha Kumar, LMFT: Sometimes you question choices you've made or what you're doing now or it's your life's trajectory.
• 10:50
  Neha Kumar, LMFT: And so it can we, I feel like women, we are reborn.
• 10:54
  Neha Kumar, LMFT: Yeah.
• 10:54
  Neha Kumar, LMFT: Yeah.
• 10:55
  Neha Kumar, LMFT: You know, multiple times throughout our lives.
• 10:57
  Neha Kumar, LMFT: Yes.
• 10:58
  Neha Kumar, LMFT: Slightly that
• 10:59
  Dr. Komal Patil-Sisodia: we counted already.
• 11:00
  Neha Kumar, LMFT: Exactly.
• 11:01
  Neha Kumar, LMFT: Exactly.
• 11:01
  Neha Kumar, LMFT: And so with these rebirths comes, obviously the growth, but growth generally doesn't happen.
• 11:06
  Neha Kumar, LMFT: They call it growing pains for a reason.
• 11:08
  Neha Kumar, LMFT: It's not just physical, it's emotional.
• 11:09
  Neha Kumar, LMFT: And so I would say emotionally and psychologically, there's a wide span of things I have.
• 11:15
  Neha Kumar, LMFT: And that's not to say that everybody who goes through perimenopause is going to be anxious, is going to be depressed, is going to be dysregulated.
• 11:22
  Neha Kumar, LMFT: That is not, that is fairly common.
• 11:24
  Neha Kumar, LMFT: However, I've worked with people who like.
• 11:26
  Neha Kumar, LMFT: I didn't have postpartum.
• 11:28
  Neha Kumar, LMFT: I was, I was blissed out after I had a kid, or, yeah.
• 11:31
  Neha Kumar, LMFT: The transition to menopause was whatever.
• 11:33
  Neha Kumar, LMFT: Yeah.
• 11:33
  Neha Kumar, LMFT: You know, it's kind of all over the board.
• 11:35
  Dr. Komal Patil-Sisodia: Yeah.
• 11:36
  Dr. Komal Patil-Sisodia: And I think that's what makes it so hard too, right?
• 11:38
  Dr. Komal Patil-Sisodia: To find community in these experiences because everybody's experience is so vastly different.
• 11:42
  Dr. Komal Patil-Sisodia: Absolutely.
• 11:43
  Dr. Komal Patil-Sisodia: From one person to another.
• 11:44
  Dr. Komal Patil-Sisodia: One of the things that I see in my practice with other hormonal conditions, I'll use thyroid as an example.
• 11:50
  Dr. Komal Patil-Sisodia: It is a well known fact that when your thyroid function is off, if you have underlying anxiety or depression, it can get significantly worse.
• 11:58
  Dr. Komal Patil-Sisodia: And that becomes.
• 11:59
  Dr. Komal Patil-Sisodia: Part of the workup that we do to check up on those patients.
• 12:03
  Dr. Komal Patil-Sisodia: Yeah.
• 12:03
  Dr. Komal Patil-Sisodia: I imagine it's much the same with perimenopause and menopause.
• 12:06
  Dr. Komal Patil-Sisodia: If there is an existing predisposition to to depression or anxiety, I can imagine that has the potential to get significantly worse.
• 12:17
  Dr. Komal Patil-Sisodia: Yeah, and even if.
• 12:18
  Dr. Komal Patil-Sisodia: You don't have those diagnoses, the hormonal shifts can cause that Absolute, absolutely.
• 12:21
  Dr. Komal Patil-Sisodia: You loved what you were saying about Rebirth.
• 12:24
  Dr. Komal Patil-Sisodia: Did I ever give you a copy of that book?
• 12:26
  Dr. Komal Patil-Sisodia: The School of Essential Ingredients?
• 12:28
  Dr. Komal Patil-Sisodia: Yes.
• 12:29
  Dr. Komal Patil-Sisodia: I loved it.
• 12:29
  Neha Kumar, LMFT: It was so good.
• 12:30
  Dr. Komal Patil-Sisodia: It's such a good book.
• 12:31
  Dr. Komal Patil-Sisodia: Right?
• 12:32
  Dr. Komal Patil-Sisodia: And I think I've talked about this in another podcast episode.
• 12:35
  Dr. Komal Patil-Sisodia: But that one passage where the woman talks about her pregnancy and how she feels everything inside of her shifting, but externally, she looks the same to everybody else in her life.
• 12:47
  Dr. Komal Patil-Sisodia: Yes.
• 12:47
  Dr. Komal Patil-Sisodia: And they expect her to behave the same and act the same and she gives birth and she feels like her former self shatters into a thousand pieces and she has to like quickly put them together'cause she's got this new life to take care of.
• 13:00
  Dr. Komal Patil-Sisodia: To me that is just.
• 13:02
  Dr. Komal Patil-Sisodia: I have not found a better description of what it means to be a woman, especially through all of these different life stages.
• 13:09
  Dr. Komal Patil-Sisodia: So, shout out to Erica Bauermeister.
• 13:11
  Dr. Komal Patil-Sisodia: That was a powerful passage.
• 13:12
  Dr. Komal Patil-Sisodia: I've talked about it for years now.
• 13:14
  Dr. Komal Patil-Sisodia: No, you have,
• 13:14
  Neha Kumar, LMFT: but it helped me.
• 13:15
  Neha Kumar, LMFT: Because you sent that to me when I was going through my postpartum depression with my Leila.
• 13:21
  Neha Kumar, LMFT: Yeah, I remember.
• 13:21
  Neha Kumar, LMFT: And I remember just feeling so hopeless and so, yeah, I mean, hopeless is probably the best word to describe it.
• 13:27
  Neha Kumar, LMFT: I couldn't see the light at the end of the tunnel.
• 13:29
  Neha Kumar, LMFT: And I think when we are talking about all of these rebirths and these hormonal shifts, it can be really hard to feel a sense of comfort if you don't know that there's an end in sight.
• 13:39
  Absolutely,
• 13:40
  Neha Kumar, LMFT: And also because we, like I said, you know, we both agreed, we just, don't talk about these things and it can become this sort of like silent secret that some people know about and some people don't.
• 13:49
  Neha Kumar, LMFT: And then you experience it and then it's just, it can be really difficult.
• 13:52
  Neha Kumar, LMFT: And I'm.
• 13:53
  Neha Kumar, LMFT: I'm also glad that you brought up the testing and how hormonal levels can exacerbate existing depression symptoms.
• 14:00
  Neha Kumar, LMFT: Because a lot of times when I've seen clients who are have TRD, which is treatment resistant depression, there's many different ways to navigate that.
• 14:09
  Neha Kumar, LMFT: Sometimes I've had clients come to me and say, you know, I have tried, eCTI have tried every antidepressant under the sun.
• 14:16
  Neha Kumar, LMFT: I've tried this, I've tried that.
• 14:18
  Neha Kumar, LMFT: I've tried this, I've tried that.
• 14:19
  Neha Kumar, LMFT: One of the things that we do ask them is, medically speaking, have you had, oh, your labs done?
• 14:24
  Neha Kumar, LMFT: Have you checked your hormone levels?
• 14:25
  Neha Kumar, LMFT: Yeah.
• 14:25
  Neha Kumar, LMFT: And sometimes they're like, no.
• 14:28
  Neha Kumar, LMFT: And then they get that taken care of and they're like, oh my God, this was actually like a biological, physiological thing.
• 14:34
  Neha Kumar, LMFT: Sometimes it's not.
• 14:35
  Neha Kumar, LMFT: Sometimes it's a personality disorder, but sometimes it's hormones.
• 14:38
  Dr. Komal Patil-Sisodia: Yeah.
• 14:39
  Dr. Komal Patil-Sisodia: It's funny, I actually just had a patient message me this week and a younger person who, maybe late thirties, maybe around your age, that had been on an antidepressants since their, since giving birth to their child because they were having hot.
• 14:56
  Dr. Komal Patil-Sisodia: Flashes and anxiety and all of these different symptoms and we talked a bit about perimenopause and the fact that they come from an ethnic group that goes through perimenopause and menopause a little earlier.
• 15:06
  Dr. Komal Patil-Sisodia: So we discussed maybe starting a low dose of an estrogen patch because they had an IUD in place and okay, they texted me and said, my gosh, I have not needed.
• 15:17
  Dr. Komal Patil-Sisodia: I tapered off my Effexor and I have not needed to restart it since I started on my estradiol patch, which is right.
• 15:23
  Dr. Komal Patil-Sisodia: So sometimes that can help.
• 15:25
  Dr. Komal Patil-Sisodia: I've had some patients where, they keep escalating the dose of their SSRI, which is a class of depression and anxiety medications.
• 15:33
  Dr. Komal Patil-Sisodia: But then they add the hormone replacement therapy and they can actually come down on those doses.
• 15:38
  Dr. Komal Patil-Sisodia: Because they find that they don't need quite as much that so they can work in tandem together.
• 15:43
  Dr. Komal Patil-Sisodia: Sometimes you can see an improvement where you may not even need some of those meds if there's no underlying history of anxiety or depression already.
• 15:51
  Dr. Komal Patil-Sisodia: So to me, that is just mind blowing that I know we can see that much of a difference for people.
• 15:56
  Dr. Komal Patil-Sisodia: So going back to our earlier conversation about women just not being educated on.
• 16:02
  Dr. Komal Patil-Sisodia: All of these things about themselves and then feeling hopeless, feeling overwhelmed, and not knowing how to navigate it.
• 16:07
  Dr. Komal Patil-Sisodia: If we're not getting educated, our partners are not getting educated.
• 16:12
  Dr. Komal Patil-Sisodia: I mean, that's the big gap that's there.
• 16:14
  Dr. Komal Patil-Sisodia: So how do you see that these changes manifest?
• 16:17
  Dr. Komal Patil-Sisodia: In communication patterns, intimacy or conflict resolution between partners.
• 16:22
  Dr. Komal Patil-Sisodia: Because if the person who's going through it doesn't know, the assumption is that their partner doesn't know, and I can imagine that just is like grounds for miscommunication all over the place.
• 16:31
  Dr. Komal Patil-Sisodia: Yeah.
• 16:32
  Neha Kumar, LMFT: Well, yes, and you're, you hit the nail on the head because what happens with any sort of emotional dysregulation in a relationship is.
• 16:40
  Neha Kumar, LMFT: The other person has to sort of, it kind of balance it out.
• 16:43
  Neha Kumar, LMFT: If you go through periods of, getting along fine, things are great, and then all of a sudden one person becomes sort of volatile or really emotional or really sensitive, the other person is going to.
• 16:52
  Neha Kumar, LMFT: Wonder what happened.
• 16:53
  Neha Kumar, LMFT: The good news is that if you've been with this person for a long time and and you have made it to the stage where you're hitting perimenopause, then chances are you have fairly decent communication.
• 17:04
  Neha Kumar, LMFT: Because that's number one.
• 17:06
  Neha Kumar, LMFT: I would say that is, a huge factor in couples being able to navigate any sort of challenge.
• 17:12
  Neha Kumar, LMFT: But when it comes to perimenopause in particular, there's one person that's going through this intense.
• 17:17
  Neha Kumar, LMFT: Hormonal mood, emotional, psychological shift.
• 17:20
  Neha Kumar, LMFT: The other person needs to be able to step in and be really understanding and be really compassionate and empathetic as opposed to impatient or irritable or, then have a really volatile reaction to their partner's volatility.
• 17:32
  Neha Kumar, LMFT: So I think the biggest thing is communicating, but you're right, if a woman doesn't really know what's going on with her, then her partner's not gonna know.
• 17:40
  Neha Kumar, LMFT: So I would highly recommend that women really start researching.
• 17:45
  Neha Kumar, LMFT: The stages that they're gonna go through.
• 17:47
  Neha Kumar, LMFT: And in addition to that, talking to friends and family, to the extent that they feel comfortable about what their experience has been.
• 17:54
  Neha Kumar, LMFT: Because the more we connect with each other and hear each other's narratives and stories, and this is I'm a huge believer in this, the easier it is.
• 18:03
  Neha Kumar, LMFT: To get through these struggles.
• 18:04
  Neha Kumar, LMFT: One you have a sense of community, you realize you're not alone.
• 18:08
  Neha Kumar, LMFT: Two you learn, you know about, you learn coping skills from other people.
• 18:12
  Neha Kumar, LMFT: And so in doing this research, in connecting with others who have been through this, women can really learn what it's.
• 18:19
  Neha Kumar, LMFT: What that, that stage is going to be like, and they can share that with their partners and say, look, this is coming up.
• 18:24
  Neha Kumar, LMFT: And so if, be prepared, be prepared.
• 18:27
  Neha Kumar, LMFT: You know, preparation is key.
• 18:29
  Neha Kumar, LMFT: And it's so interesting because I was thinking about this.
• 18:32
  Neha Kumar, LMFT: Yeah.
• 18:33
  Neha Kumar, LMFT: And we have like a big recital or a big match or a big anything.
• 18:37
  Neha Kumar, LMFT: Yeah.
• 18:37
  Neha Kumar, LMFT: We know it's coming up and we practice, right?
• 18:40
  Neha Kumar, LMFT: Like we prepare.
• 18:41
  Neha Kumar, LMFT: That's true.
• 18:41
  Neha Kumar, LMFT: Prepare, prepare, prepare.
• 18:43
  Neha Kumar, LMFT: And I think in general when it comes to healthcare, especially in this country, there is, it's a lot of reactionary stuff.
• 18:50
  Neha Kumar, LMFT: Yeah.
• 18:50
  Neha Kumar, LMFT: I think people are really, in the last five, 10 years, people have started getting into the proactive preventative stuff, which I think is wonderful, but we're not quite there yet with women's health.
• 18:59
  Yeah,
• 19:00
  Neha Kumar, LMFT: and I don't think this is due to lack of interest or laziness.
• 19:03
  Neha Kumar, LMFT: I think that we're so busy, and this is another podcast episode, but in reality it's like times have changed.
• 19:09
  Neha Kumar, LMFT: Yeah.
• 19:09
  Neha Kumar, LMFT: We are expected to manage the home and the kids and work outside of the homes.
• 19:13
  Neha Kumar, LMFT: We're so busy.
• 19:14
  Neha Kumar, LMFT: I would imagine somebody who's like.
• 19:15
  Neha Kumar, LMFT: I don't know.
• 19:16
  Neha Kumar, LMFT: 48.
• 19:16
  Neha Kumar, LMFT: They have three kids.
• 19:17
  Neha Kumar, LMFT: They're driving around to games.
• 19:18
  Neha Kumar, LMFT: They're doing the school drop off.
• 19:20
  Neha Kumar, LMFT: They're going to work, they're making sure they're meeting their corporate deadlines.
• 19:22
  Neha Kumar, LMFT: Oh, what's for dinner?
• 19:23
  Neha Kumar, LMFT: Gotta figure that out.
• 19:24
  Neha Kumar, LMFT: Got a meal prep.
• 19:25
  Neha Kumar, LMFT: You skip your period one month and you start feeling slightly irritable.
• 19:27
  Neha Kumar, LMFT: The last thing on your to-do list is go to your doctor.
• 19:31
  Neha Kumar, LMFT: Yeah.
• 19:31
  Neha Kumar, LMFT: Or even make an appoint.
• 19:32
  Neha Kumar, LMFT: Or it's, it might be like a fleeting second of a consideration, and then that's it because you.
• 19:37
  Neha Kumar, LMFT: Because you're too busy and we do tend to put ourselves last.
• 19:41
  Dr. Komal Patil-Sisodia: Yeah.
• 19:41
  Dr. Komal Patil-Sisodia: And there's an access issue in healthcare.
• 19:43
  Dr. Komal Patil-Sisodia: Right, exactly.
• 19:43
  Dr. Komal Patil-Sisodia: So it's not even like you're gonna get that appointment as quickly as you want it.
• 19:47
  Dr. Komal Patil-Sisodia: Absolutely.
• 19:48
  Dr. Komal Patil-Sisodia: That is really tough.
• 19:49
  Dr. Komal Patil-Sisodia: Let's move on to some other questions that I've had, as women are experiencing changes in libido, physical changes like vaginal dryness or pain with intercourse.
• 20:00
  Dr. Komal Patil-Sisodia: During menopause, how can couples navigate this while still maintaining a fulfilling, intimate relationship?
• 20:06
  Dr. Komal Patil-Sisodia: Yeah, because they're already having difficulty communicating on this other front and so that the advice of preparation is great.
• 20:12
  Dr. Komal Patil-Sisodia: This is a whole other ball of wax, I think it is.
• 20:15
  Neha Kumar, LMFT: Yeah.
• 20:15
  Neha Kumar, LMFT: Absolutely.
• 20:16
  Neha Kumar, LMFT: And that's a really good question.
• 20:18
  Neha Kumar, LMFT: I think a lot of it is reframing,
• 20:21
  mm-hmm.
• 20:21
  Neha Kumar, LMFT: Intimacy.
• 20:22
  Neha Kumar, LMFT: And I'm not saying that you need to just not have sex and be okay with it, I think, but you have to be okay with there being a period of time while you're figuring things out.
• 20:31
  Neha Kumar, LMFT: There's vaginal dryness and then there's like emotional dryness, right?
• 20:34
  Neha Kumar, LMFT: Like some women might not just be psychologically or emotionally wanna get down.
• 20:39
  Neha Kumar, LMFT: Yeah.
• 20:39
  Neha Kumar, LMFT: You know, it's like, I don't feel well.
• 20:42
  Neha Kumar, LMFT: I feel like I wanna rip your head off and you're.
• 20:44
  Neha Kumar, LMFT: Trying to be, sexually intimate.
• 20:46
  Neha Kumar, LMFT: There's the physiological, like, I literally can't do this.
• 20:49
  Neha Kumar, LMFT: My body is not primed.
• 20:51
  Neha Kumar, LMFT: And yeah, ready for you.
• 20:52
  Neha Kumar, LMFT: But then there's also the emotional side of it.
• 20:54
  Neha Kumar, LMFT: So I think whether it's one of those or both of those, the communication is key in.
• 20:59
  Neha Kumar, LMFT: Spouses talking to each other and saying, look, this is, excuse the pun, a little bit of a dry spell, and we need to figure that out.
• 21:06
  Neha Kumar, LMFT: It doesn't mean that it's going to last forever, but when you are in a healthy relationship, that shouldn't be a make or break.
• 21:13
  Neha Kumar, LMFT: But if it's something that's very important to each of you, then to be able to go to a doctor and support each other in that.
• 21:21
  Neha Kumar, LMFT: I think is key for a husband to say, why don't we go see, you can see a sex therapist, you can see a doctor such as yourself if you're trying to get medication to help with your sex life for your, physiological issues.
• 21:33
  Neha Kumar, LMFT: But I think reframing intimacy and finding other ways to be intimate until you guys can figure out how you can get back to what your sexual baseline was.
• 21:42
  Dr. Komal Patil-Sisodia: That's great.
• 21:43
  Dr. Komal Patil-Sisodia: You did talk about the misconceptions a little bit, right?
• 21:46
  Dr. Komal Patil-Sisodia: The misconceptions around sex has to happen x number of times a week or Yeah.
• 21:50
  Dr. Komal Patil-Sisodia: Whatever, in order for it to be fulfilling.
• 21:53
  Dr. Komal Patil-Sisodia: Yeah.
• 21:53
  Dr. Komal Patil-Sisodia: I love the concept that that baseline is different for everyone.
• 21:57
  Dr. Komal Patil-Sisodia: Totally.
• 21:58
  Dr. Komal Patil-Sisodia: I.
• 21:58
  Dr. Komal Patil-Sisodia: How do you encourage people to talk to their partners about that?
• 22:01
  Neha Kumar, LMFT: I think just very openly and honestly, and setting aside time for it, no partner wants to feel like, okay, after a full day of work and dinner and bedtime and all of the things that they're, being bombarded with this, but say, Hey, this is something that's going on.
• 22:15
  Neha Kumar, LMFT: I would really love to be able to talk about it openly, maybe after the kids go to bed and sit down and just be very honest and even a lot of times I've found that mentioning the elephant in the room at the beginning of the conversation in terms of.
• 22:27
  Neha Kumar, LMFT: What the issue is or how they might react.
• 22:30
  Neha Kumar, LMFT: Like, I don't know if you're gonna get upset or if you're gonna get defensive or whatever it might be, but actually that lowers their chances of getting upset and defensive if you just sort of call out.
• 22:38
  Neha Kumar, LMFT: That's try to
• 22:38
  do.
• 22:39
  Neha Kumar, LMFT: Yeah.
• 22:39
  Neha Kumar, LMFT: If you just say, it would be nice if we could have this conversation, without, too many emotions, so setting aside time, setting a framework for the conversation in terms of what it's about and being able to communicate effectively is really huge.
• 22:51
  Dr. Komal Patil-Sisodia: That's really great.
• 22:52
  Dr. Komal Patil-Sisodia: So in your experience, what are some of the biggest sources of conflict in marriages or partnerships that you see related to menopause?
• 23:00
  Dr. Komal Patil-Sisodia: I
• 23:00
  Neha Kumar, LMFT: would say first and foremost it's the emotional dysregulation.
• 23:04
  Neha Kumar, LMFT: All marriages go through dry spells when it comes to sex, and so it's, I've, I have never met a couple that's just got married at 25 and they've just been going at it ever since.
• 23:13
  Neha Kumar, LMFT: Irrespective of kids or whatever, I don't think that exists.
• 23:15
  Neha Kumar, LMFT: That's like a unicorn that, that, you know, just, it's not real.
• 23:19
  Neha Kumar, LMFT: That's like the romance book relationships, right.
• 23:21
  Neha Kumar, LMFT: Yeah, exactly.
• 23:22
  Neha Kumar, LMFT: Right, exactly.
• 23:23
  Neha Kumar, LMFT: Especially the Regency romance, you know?
• 23:25
  Neha Kumar, LMFT: Bridgeton.
• 23:25
  Neha Kumar, LMFT: Yeah.
• 23:26
  Neha Kumar, LMFT: But, I think, most couples that have reached that point in their marriage can get through a sexual dry spell.
• 23:32
  Neha Kumar, LMFT: I think it's the emotional side.
• 23:33
  Neha Kumar, LMFT: Most, most, like I said, since most couples have already experienced that, they tend to lean on their partner emotionally more so, and like for the companionship and the emotional intimacy.
• 23:44
  Neha Kumar, LMFT: And the friendship and the laughter.
• 23:46
  Neha Kumar, LMFT: And then when one partner is all of a sudden really emotional or sensitive or sad or angry or whatever it might be, it can be really hard for the other partner to, okay.
• 23:57
  Neha Kumar, LMFT: It's like, well, this is what our anchor was, right?
• 23:59
  Neha Kumar, LMFT: Yeah.
• 24:00
  Neha Kumar, LMFT: And then that anchor is gone and they just feel like they're drifting off and drifting apart.
• 24:04
  Neha Kumar, LMFT: And so that is probably one of the biggest challenges.
• 24:08
  Yeah.
• 24:09
  The emotional dry spell and all this is
• 24:11
  Neha Kumar, LMFT: the emotional dry spell of one person feeling like the other one is just flying off the handle and they're being pushed away.
• 24:17
  Neha Kumar, LMFT: Or they're not being pushed away, but they're like, I don't wanna be around you at all.
• 24:22
  Neha Kumar, LMFT: Have you seen that?
• 24:23
  Neha Kumar, LMFT: Everybody loves Raymond episode.
• 24:25
  Neha Kumar, LMFT: It's where deborah's on her period, and Ray just does not know how to handle it.
• 24:29
  Neha Kumar, LMFT: It's so funny.
• 24:30
  Neha Kumar, LMFT: Yeah.
• 24:30
  Neha Kumar, LMFT: That show.
• 24:31
  Neha Kumar, LMFT: That show is a classic.
• 24:32
  Neha Kumar, LMFT: I love that show.
• 24:32
  Neha Kumar, LMFT: Yeah.
• 24:33
  Dr. Komal Patil-Sisodia: But yes, it's very difficult to work through some of that.
• 24:36
  Dr. Komal Patil-Sisodia: I was actually reading an interesting stat
• 24:39
  mm-hmm.
• 24:39
  Dr. Komal Patil-Sisodia: When I was putting together one of my prior podcast episodes that I.
• 24:43
  Dr. Komal Patil-Sisodia: I think up to 50 to 60% of divorces in the age range past 40 Yeah.
• 24:50
  Dr. Komal Patil-Sisodia: Are initiated by women.
• 24:52
  Neha Kumar, LMFT: Isn't that crazy?
• 24:53
  Neha Kumar, LMFT: That's so interesting.
• 24:54
  Dr. Komal Patil-Sisodia: Yeah.
• 24:55
  Dr. Komal Patil-Sisodia: And the data was.
• 24:56
  Dr. Komal Patil-Sisodia: Basically inferring that this perimenopause, menopause period, because it's causing so much emotional dysregulation and probably leading to, the, both the emotional and sexual dry spells, right?
• 25:08
  Dr. Komal Patil-Sisodia: I how many relationships become untenable because people cannot necessarily communicate that and it leads to the dissolution of these marriages or these partnerships.
• 25:19
  Dr. Komal Patil-Sisodia: Absolutely.
• 25:19
  Dr. Komal Patil-Sisodia: Yeah.
• 25:20
  Dr. Komal Patil-Sisodia: It's higher than we think it is.
• 25:21
  Neha Kumar, LMFT: Yeah, I think there's also a.
• 25:23
  Neha Kumar, LMFT: Probably like a more in depth conversation there too, because there's the untenable side of one person becoming emotionally dysregulated.
• 25:31
  Neha Kumar, LMFT: Yeah.
• 25:31
  Neha Kumar, LMFT: But then I think from a biological perspective, if I remember, the first thing I learned in biology is we are here to procreate, right?
• 25:39
  Neha Kumar, LMFT: Yes.
• 25:39
  Neha Kumar, LMFT: And so if a woman is done with that era of her life, she's having all of these emotions, she's probably also having a lot of.
• 25:46
  Neha Kumar, LMFT: Epiphanies.
• 25:47
  Neha Kumar, LMFT: Yeah.
• 25:47
  Neha Kumar, LMFT: I'm not gonna call it a midlife crisis because I, this is part of our cycle.
• 25:51
  Neha Kumar, LMFT: This is part of who we are naturally, and I don't think we're meant to be in crisis, but I think a lot of women probably start questioning choices like, well, I've had my kids, clearly I can no longer have kids.
• 26:00
  Neha Kumar, LMFT: Maybe this marriage has served its purpose.
• 26:02
  Neha Kumar, LMFT: You know, and the reason I'm saying that is'cause I've worked with clients who are like, we had our kids and we get along great, but.
• 26:09
  Neha Kumar, LMFT: We're kind of just friends.
• 26:10
  Neha Kumar, LMFT: He doesn't really do it for me anymore.
• 26:12
  Neha Kumar, LMFT: And the kids are older and so it's a very interesting how those are some of the things that I've seen is like the emotional distance that happens as a result.
• 26:21
  Neha Kumar, LMFT: Yeah.
• 26:21
  Neha Kumar, LMFT: And then whether or not they can work.
• 26:23
  Neha Kumar, LMFT: Them their way back.
• 26:24
  Dr. Komal Patil-Sisodia: Yeah.
• 26:24
  Dr. Komal Patil-Sisodia: To
• 26:24
  Neha Kumar, LMFT: Growing together.
• 26:25
  Dr. Komal Patil-Sisodia: Yeah.
• 26:26
  Dr. Komal Patil-Sisodia: And so I guess, this leads to the next few questions, which are, how can partners better support each other through this transition?
• 26:34
  Dr. Komal Patil-Sisodia: Even when, they're not really fully aware of what's happening.
• 26:37
  Dr. Komal Patil-Sisodia: Yeah.
• 26:37
  Dr. Komal Patil-Sisodia: And then do you specifically have some strategies for improving communication when these symptoms are rearing their head and people are going through, maybe not midlife crises, but midlife awakenings to what it is they may really want?
• 26:49
  Neha Kumar, LMFT: Yes.
• 26:50
  Neha Kumar, LMFT: It's so interesting.
• 26:51
  Neha Kumar, LMFT: I would say that communication is huge, right?
• 26:54
  Neha Kumar, LMFT: Yeah.
• 26:54
  Neha Kumar, LMFT: And then educating oneself, whether that's through research or talking to people or talking to your medical professionals and letting your partner know this is what's coming up or this is what's happening now.
• 27:03
  Neha Kumar, LMFT: I think the onus lies on both people.
• 27:05
  Neha Kumar, LMFT: I think, there's a reason that when you get married in some traditions you say, for better or for worse, this is one of those situations that's for worse.
• 27:13
  Neha Kumar, LMFT: But that doesn't mean that it needs to necessarily end things, but I think, or pay worse.
• 27:17
  Neha Kumar, LMFT: Spouses and significant others.
• 27:19
  Neha Kumar, LMFT: The onus is on them to really go out of their way, to be more patient, more empathetic, and if it's really affecting them emotionally recognizing, you know what, maybe I need to talk to someone too, and knowing not to personalize it, getting their own help, their own self-care, making sure that that's on track.
• 27:36
  Yeah.
• 27:36
  Neha Kumar, LMFT: And then also educating themself and, being there for their spouse.
• 27:40
  Neha Kumar, LMFT: And I think women, a key part of this is insight, because I think, yes, when you are having huge hormonal shifts that are life changing, making you question your identity, making your emotions go up and down, there's.
• 27:50
  Neha Kumar, LMFT: Yeah, there's a huge aspect of that might be uncontrollable, but when you have insight into the fact that you are going through something that's making you a little bit more all over the place, then yeah, I do think the onus is on you to really take a look at your triggers.
• 28:04
  Neha Kumar, LMFT: Yeah.
• 28:05
  Neha Kumar, LMFT: Really think about, okay, what's ticking me off?
• 28:07
  Neha Kumar, LMFT: What's and resetting and what I mean by resetting.
• 28:09
  Neha Kumar, LMFT: And I think the relationship reset is huge because something I've noticed with couples and also personally is I feel like every six months.
• 28:17
  Neha Kumar, LMFT: Things sort of like shift a little as your kids get older or as maybe your finances change a little bit or just there's always like some weird shift and it's like what comes with that is like you have, you end up having different needs or like different asks of your partner in terms of like, okay, I know this was our routine for the last 6, 8, 10 months or year.
• 28:35
  Yeah.
• 28:35
  Neha Kumar, LMFT: But now that this has changed, can you maybe step in and do this and I can do that, or can you lift this load a little bit?
• 28:41
  Neha Kumar, LMFT: Like whatever it might be.
• 28:42
  Neha Kumar, LMFT: And so.
• 28:42
  Neha Kumar, LMFT: In this case, I think you have to have that reset as well and sit down with your partner and say, this is how.
• 28:48
  Neha Kumar, LMFT: Things are shifting for me.
• 28:50
  Neha Kumar, LMFT: So how can we navigate this where we both feel like it's fair for both of us in terms of whether that's like communication or responsibilities in the house or with the children or whatever it might be.
• 29:01
  Neha Kumar, LMFT: So knowing what your triggers are, and then also being very communicative and having that reset and sitting down and saying, okay, now that this is another phase, this is another season of our relationship, how are we gonna navigate it?
• 29:13
  Neha Kumar, LMFT: And then coming up with some sort of plan.
• 29:15
  Neha Kumar, LMFT: So I would say that that's my biggest.
• 29:17
  Neha Kumar, LMFT: Communication suggestion is not just saying.
• 29:20
  Neha Kumar, LMFT: Honey, I might be really mean the next couple months or the next 10 months.
• 29:25
  Neha Kumar, LMFT: I would be horrible for the next week.
• 29:26
  Neha Kumar, LMFT: Yeah.
• 29:26
  Neha Kumar, LMFT: I would be horrible to you.
• 29:27
  Neha Kumar, LMFT: Just
• 29:27
  Dr. Komal Patil-Sisodia: beware.
• 29:28
  Neha Kumar, LMFT: Yeah, exactly.
• 29:29
  Neha Kumar, LMFT: So maybe we come home, it goes Yeah, I know, right?
• 29:32
  Neha Kumar, LMFT: But it goes a lot deeper than that.
• 29:33
  Neha Kumar, LMFT: So I think being able to sit down and say, okay, what are our goals?
• 29:36
  Neha Kumar, LMFT: What do we still need to, what are we still responsible for?
• 29:39
  Neha Kumar, LMFT: If I am not wanting to have sex, if I am irritable.
• 29:42
  Neha Kumar, LMFT: What do you like?
• 29:43
  Neha Kumar, LMFT: What do you need?
• 29:44
  Neha Kumar, LMFT: What do you need?
• 29:44
  Neha Kumar, LMFT: Do you want more?
• 29:45
  Neha Kumar, LMFT: Do you want a night out with your guy friends?
• 29:46
  Neha Kumar, LMFT: Do you want like us to at least watch a movie together and cuddle like once?
• 29:50
  Neha Kumar, LMFT: Like what do we both need?
• 29:52
  Neha Kumar, LMFT: Do I need space?
• 29:53
  Neha Kumar, LMFT: Like you have to be able to advocate for your needs, but then also really listen to your partner's needs and come to sort of.
• 29:58
  Neha Kumar, LMFT: A happy medium so that you don't end up just fighting all the time.
• 30:02
  Dr. Komal Patil-Sisodia: Yeah.
• 30:02
  Dr. Komal Patil-Sisodia: So at what point do you recommend, because we focused a lot on self-care and understanding what you need for yourself in order to be successful in this.
• 30:10
  Dr. Komal Patil-Sisodia: When do you recommend that couples actually go seek professional help?
• 30:13
  Dr. Komal Patil-Sisodia: Like, couples therapy, marriage counseling, seeing a sex therapist, you can see a therapist individually, right?
• 30:19
  Dr. Komal Patil-Sisodia: Yeah.
• 30:19
  Dr. Komal Patil-Sisodia: But at what point do you know to pull the trigger to go to couples therapy?
• 30:23
  Dr. Komal Patil-Sisodia: What does that look like?
• 30:24
  Neha Kumar, LMFT: That's, yeah, that's a question I think with therapy and with couples therapy, with any sort of therapy or psychological mental health help.
• 30:32
  Neha Kumar, LMFT: We always say, just like with substance abuse, there's like a survey that people take to basically figure out whether they have an alcohol problem or they have a substance problem.
• 30:40
  Neha Kumar, LMFT: And so ultimately you have an issue with substances if it is getting in the way of your ability to.
• 30:47
  Neha Kumar, LMFT: Function and thrive.
• 30:49
  Okay.
• 30:49
  Neha Kumar, LMFT: And it's affecting, and there's other, obviously other criteria, DSM five, whatever but if it's, there's something in your life that's a problem to the extent that you can't function either personally Yeah.
• 30:58
  Neha Kumar, LMFT: Socially, professionally, emotionally, whatever it might be, then that, that's when you need to get help.
• 31:04
  Neha Kumar, LMFT: So if I have a client who's ha going through perimenopause or if I have a male client whose wife is going through perimenopause and they're saying, our marriage is really shifting, and I give suggestions to that individual and they come back and they're like, it's still bad.
• 31:17
  Neha Kumar, LMFT: Or It's getting worse, it's getting worse.
• 31:19
  Neha Kumar, LMFT: If it, if you, if there's a constant pattern of a breakdown of the marriage or a lack of marriage functioning, I'm gonna say you guys should see somebody jointly.
• 31:27
  Yeah.
• 31:28
  Neha Kumar, LMFT: And then that, I would say that the couple's therapist would probably be the one to suggest the sex therapy if I was seeing the couple and I felt like they just weren't getting on the same page.
• 31:37
  Neha Kumar, LMFT: Yeah.
• 31:37
  Neha Kumar, LMFT: Or they weren't hearing each other.
• 31:39
  Neha Kumar, LMFT: I think I would really try to build insight.
• 31:41
  Dr. Komal Patil-Sisodia: So I have a question.
• 31:42
  Dr. Komal Patil-Sisodia: You talked about a scale that you can use to measure whether you're having a substance issue.
• 31:49
  Dr. Komal Patil-Sisodia: Affect your ability to thrive.
• 31:51
  Dr. Komal Patil-Sisodia: Is there something like that that people can take for themselves when it comes to a relationship, or are you just trying to look for the signs?
• 31:59
  Dr. Komal Patil-Sisodia: That's
• 31:59
  Neha Kumar, LMFT: a great question.
• 32:00
  Neha Kumar, LMFT: I.
• 32:01
  Neha Kumar, LMFT: There has been nothing that I have seen used in my clinical practice.
• 32:05
  Neha Kumar, LMFT: Okay.
• 32:05
  Neha Kumar, LMFT: Or even in my training.
• 32:06
  Yeah.
• 32:06
  Neha Kumar, LMFT: And maybe that's something that I'm sure there, that they exist, but there's no standard of standards.
• 32:11
  Neha Kumar, LMFT: Yeah.
• 32:11
  Neha Kumar, LMFT: There's no, yeah, exactly.
• 32:12
  Neha Kumar, LMFT: So there's no standard survey there.
• 32:14
  Neha Kumar, LMFT: Generally people you should create it.
• 32:15
  Neha Kumar, LMFT: Nay.
• 32:15
  Neha Kumar, LMFT: Yeah, I know right.
• 32:16
  Neha Kumar, LMFT: To you.
• 32:17
  Neha Kumar, LMFT: I would take it.
• 32:18
  Neha Kumar, LMFT: I
• 32:18
  Dr. Komal Patil-Sisodia: mean, I'm kind of curious from, yeah.
• 32:20
  Dr. Komal Patil-Sisodia: A therapist or mental health professional's perspective, like what are the key points that, because I can, yeah, I can figure it out based on hormone levels or symptoms that people are telling me.
• 32:30
  Dr. Komal Patil-Sisodia: It would be interesting to see it from that perspective.
• 32:32
  Neha Kumar, LMFT: Yeah, absolutely.
• 32:33
  Dr. Komal Patil-Sisodia: Have you ever seen cases where menopause actually strengthens relationships?
• 32:37
  Neha Kumar, LMFT: That's a really good question.
• 32:39
  Neha Kumar, LMFT: You know, a lot of times, most of the people that come to me are dealing with some sort of like major stressor.
• 32:44
  Neha Kumar, LMFT: Yeah.
• 32:46
  Neha Kumar, LMFT: Yeah.
• 32:46
  Neha Kumar, LMFT: But sometimes some of those stressors are not their marriage or they're not their relationship.
• 32:50
  Neha Kumar, LMFT: Yeah.
• 32:50
  Neha Kumar, LMFT: I'm thinking of one case.
• 32:51
  Neha Kumar, LMFT: I haven't seen that a lot to answer your question, but I have seen Yeah.
• 32:54
  Neha Kumar, LMFT: Which is fair.
• 32:55
  Neha Kumar, LMFT: Where I think what happened was she was more sexual.
• 32:59
  Neha Kumar, LMFT: And the husband was less so.
• 33:01
  Neha Kumar, LMFT: Yeah, I think he had some ED issues and yeah, so it was an issue for them'cause she wanted it more initially and then he just didn't over the years and he was very comfortable with just cuddling and he loved her.
• 33:11
  Neha Kumar, LMFT: There was no emotional Lack, there.
• 33:13
  Neha Kumar, LMFT: But then I think once she started menopause, she, her libido went down and he was like, this is great.
• 33:19
  Neha Kumar, LMFT: Yeah, this is wonderful because okay, so so they matched.
• 33:23
  Neha Kumar, LMFT: They matched basically.
• 33:24
  Neha Kumar, LMFT: Yeah, they matched and yeah and that's another thing, right?
• 33:26
  Neha Kumar, LMFT: Because I think oftentimes we think, oh, you know, in any marriage the man wants it and the woman doesn't.
• 33:31
  Neha Kumar, LMFT: And that's not necessarily the case.
• 33:32
  Neha Kumar, LMFT: No, it's not.
• 33:32
  Neha Kumar, LMFT: And there's a huge spectrum of everything in between, not just there's some people that.
• 33:37
  Neha Kumar, LMFT: Would like to, be intimate occasionally or all the time, or not at all, or, and so that's just something in general that I think most couples navigate.
• 33:44
  Neha Kumar, LMFT: Yeah.
• 33:44
  Neha Kumar, LMFT: Whether or not perimenopause or menopause is at play.
• 33:47
  Dr. Komal Patil-Sisodia: Yeah.
• 33:47
  Dr. Komal Patil-Sisodia: I think that's fair.
• 33:48
  Neha Kumar, LMFT: I think that's fair.
• 33:49
  Dr. Komal Patil-Sisodia: Yeah.
• 33:49
  Dr. Komal Patil-Sisodia: So if you could give one key piece of advice.
• 33:52
  Dr. Komal Patil-Sisodia: To couples navigating menopause together, what would it be?
• 33:55
  Dr. Komal Patil-Sisodia: Great question.
• 33:56
  Dr. Komal Patil-Sisodia: Or a list, right?
• 33:57
  Dr. Komal Patil-Sisodia: Like if you have a list of things that you know, to your point, what is your preparation recommendation list?
• 34:03
  Neha Kumar, LMFT: That's a great question.
• 34:05
  Neha Kumar, LMFT: I would say that there are a number of things that you can do to prepare.
• 34:09
  Neha Kumar, LMFT: The first again, is the education piece.
• 34:11
  Neha Kumar, LMFT: Yeah, educate yourselves, ladies, because unfortunately, the way the system is now is nobody's going outta your out of their way to educate you at all.
• 34:19
  Neha Kumar, LMFT: I'm gonna say that again.
• 34:20
  Neha Kumar, LMFT: Nobody is going out of their way to educate you about what will come to pass.
• 34:25
  Neha Kumar, LMFT: Yeah.
• 34:25
  Neha Kumar, LMFT: The way that healthcare works today is that people unfortunately dealing with end up dealing with things and then going to the doctor and then trying to get something for something that has already happened.
• 34:36
  And
• 34:37
  Neha Kumar, LMFT: there's such a shortage in terms of healthcare workers and access to healthcare that the people who are being seen are largely being seen because it's like emergent situations or acute situations.
• 34:47
  Neha Kumar, LMFT: And so if you're just like, I would like to prepare myself for something that'll happen in 10 years, people are gonna be like, go to the library.
• 34:53
  Neha Kumar, LMFT: You know, unfortunately.
• 34:54
  Neha Kumar, LMFT: And I think that there's a shift that needs to happen with that, but till that shift happens.
• 34:58
  Neha Kumar, LMFT: Yeah, educate yourselves.
• 35:00
  Neha Kumar, LMFT: Do some research talk, talk, talk.
• 35:02
  Neha Kumar, LMFT: Share your stories, share your narratives, ask your family.
• 35:05
  Neha Kumar, LMFT: 'Cause that can also give you some sort of like.
• 35:08
  Neha Kumar, LMFT: Indication as to what you might be inheriting in terms of certain things, especially if there's like a pattern that exists in your family.
• 35:14
  Neha Kumar, LMFT: So educate yourself in various ways.
• 35:16
  Neha Kumar, LMFT: Educate your partner.
• 35:17
  Neha Kumar, LMFT: I would say this also can affect how you, interact with children, educate your children, and just be prepared in that way.
• 35:25
  Neha Kumar, LMFT: But in addition to that, and in addition to the communication piece of once you have received that education and talking to those.
• 35:33
  Neha Kumar, LMFT: That are closest to you is taking care of yourself first and foremost, we find, and I'm sure medically speaking and behaviorally speaking, in terms of behavioral health, things are always exacerbated.
• 35:44
  Neha Kumar, LMFT: Any sort of condition is exacerbated.
• 35:46
  Neha Kumar, LMFT: If you're not getting good sleep, you're not eating well.
• 35:48
  Neha Kumar, LMFT: If you're not getting moderate exercise, no one's telling you to run a marathon, movement, you know all of those things.
• 35:54
  Neha Kumar, LMFT: Nutrition, exercise, sleep.
• 35:57
  Neha Kumar, LMFT: Self care.
• 35:58
  Neha Kumar, LMFT: I'm a huge proponent of that.
• 35:59
  Neha Kumar, LMFT: Infusing your life with moments of joy.
• 36:01
  Neha Kumar, LMFT: If you aren't doing those things on a fairly regular basis to keep yourself at, a fairly healthy baseline, then when you do have these huge hormonal, transitional phases, yeah, it's going to be that much more difficult because you have, you're not utilizing some of the best.
• 36:17
  Neha Kumar, LMFT: Coping skills available to you, which is just taking care of yourself, in a great way.
• 36:21
  Neha Kumar, LMFT: So there's the education, there's the communication, and then there's really just taking care of yourself.
• 36:27
  Neha Kumar, LMFT: And also acceptance.
• 36:28
  Neha Kumar, LMFT: I think accepting.
• 36:30
  Dr. Komal Patil-Sisodia: That's really hard,
• 36:30
  Neha Kumar, LMFT: isn't
• 36:31
  Dr. Komal Patil-Sisodia: it?
• 36:31
  Dr. Komal Patil-Sisodia: Because it's very hard, especially in the society when we're taught that as women, we have to juggle everything perfectly.
• 36:37
  Dr. Komal Patil-Sisodia: All the time.
• 36:38
  Dr. Komal Patil-Sisodia: Yeah.
• 36:38
  Dr. Komal Patil-Sisodia: And that we can't age while we're doing it.
• 36:40
  Neha Kumar, LMFT: Yeah.
• 36:41
  Neha Kumar, LMFT: Oh yeah.
• 36:41
  Neha Kumar, LMFT: We have to look a certain way and be a certain way and present a certain way and speak a certain way.
• 36:46
  Neha Kumar, LMFT: And Lord knows I don't follow that one.
• 36:48
  Neha Kumar, LMFT: So
• 36:49
  Dr. Komal Patil-Sisodia: neither do I.
• 36:51
  Neha Kumar, LMFT: So I think that's part of our charm.
• 36:53
  Neha Kumar, LMFT: Exactly, exactly.
• 36:54
  Neha Kumar, LMFT: But I think acceptance is huge.
• 36:56
  Neha Kumar, LMFT: But acceptance can only come if you educate yourself, if you don't, if you don't know what's to come, then accepting it when it happens is very difficult.
• 37:03
  Dr. Komal Patil-Sisodia: Thank you so much.
• 37:04
  Dr. Komal Patil-Sisodia: This has just been such a great conversation about how people can start navigating all of these changes and figuring out a strategy for self-care and building a stronger partnership.
• 37:15
  Dr. Komal Patil-Sisodia: Where can listeners find you if they want to learn more about your work?
• 37:18
  Neha Kumar, LMFT: That's a great question.
• 37:19
  Neha Kumar, LMFT: I am currently working actually on my website, but it is pros and psyche.com or prose and underscore psyche.
• 37:28
  Neha Kumar, LMFT: That's my Instagram handle.
• 37:29
  Neha Kumar, LMFT: I'm not super active on it.
• 37:31
  Neha Kumar, LMFT: I'm hoping that will change in the near future, but as a working mom, you get to things when you can.
• 37:36
  Neha Kumar, LMFT: Absolutely.
• 37:37
  Neha Kumar, LMFT: Yeah, absolutely.
• 37:37
  Neha Kumar, LMFT: So give yourself grace.
• 37:39
  Neha Kumar, LMFT: Right?
• 37:39
  Neha Kumar, LMFT: Absolutely.
• 37:40
  Neha Kumar, LMFT: I am.
• 37:40
  Neha Kumar, LMFT: That's closing words.
• 37:41
  Neha Kumar, LMFT: I'm not gonna stress, I'm accepting
• 37:44
  Dr. Komal Patil-Sisodia: my busyness.
• 37:44
  Dr. Komal Patil-Sisodia: That is wonderful.
• 37:45
  Dr. Komal Patil-Sisodia: Thank you so much.
• 37:47
  Dr. Komal Patil-Sisodia: I hope everybody enjoyed this episode.
• 37:48
  Dr. Komal Patil-Sisodia: You can find Neha at the website and the social media handle.
• 37:52
  Dr. Komal Patil-Sisodia: She said we'll go ahead and link them in the show notes and thank you all for listening.
• 37:56
  Neha Kumar, LMFT: Thank you.
• 37:57
  Neha Kumar, LMFT: Thanks so much for having me.