Perimenopause Panic: Ultimate Guide | Dr. Kelly Culwell | MomCave LIVE

Hold on to your hot flashes, folks! We’ve got the amazing Dr. Kelly Culwell in the MomCave, where the coffee is strong, and sanity is on a coffee break. Dr. Kelly, not just your typical doctor—she’s the OBGYN rockstar with a prescription for laughter and a cure for the chaos that is perimenopause. Buckle up for a rollercoaster of hormones, hilarious anecdotes, and maybe a few tips on how to survive your next family argument. Let the perimenopausal party begin!

The Good Dr. Lady Doctor

Jen: Hi, welcome to MomCave LIVE where we may have lost our minds, but we haven’t lost our sense of humor. Welcome, Dr. Lady Doctor, Kelly Culwell.

Dr. Kelly Culwell: Hello. I love the intro, by the way.

Jen: Oh, thank you. Oh, my real family members really being loud and annoying as they are.

Dr. Kelly Culwell: Wow. Puts you in the mood. Definitely.

An OBGYN Rockstar

Kelly Culwell, MD, Head, Research and Development, Sebela Women’s Health

Jen: I know! Hide in your MomCave; you may hear them at any moment. They were all arguing upstairs just before we went live. So, Kelly, there’s so much to say about you. Kelly is a doctor a real doctor, obviously an OBGYN. But you work. You’re the head of research and development and developing new birth control methods. She teaches, and she made a web series. There are so many things, but we’ve brought her here today because you’re going to help us out with the whole birth control situation. Yes,

Dr. Kelly Culwell:  Yes. Happy to do it.

Jen:  So a lot of people of different ages watch MomCave. When I started doing MomCave a long time ago, my kid was a newborn. So, we were talking about postpartum and when you can have sex again. And what can you do? What kind of birth control can you use? Well, it’s been a few years, and now, a lot of the people who follow here are going into perimenopause. I just got really sad when I said that. I like went off to another land. And so, we’ve got the new moms that find us still, but we’ve also got a lot of us, not-so-new moms, who are going to this other stage of life. So, first of all, what is perimenopause?

So, What is Perimenopause?

Dr. Kelly Culwell: That’s a good question. Yeah. There’s a lot of attention on menopause right now. The question is, you know, what’s the difference between perimenopause and menopause? And, you know, when does all this start? And what does it mean? So, menopause is it’s pretty simple. I mean, it literally means stopping the period like men-no-pause.

Basically, menopause is defined as not having had a period for one year in the absence of any other medical problems that might be causing you not to have a period. That’s menopause. So technically, it’s kind of a moment in time. When you go through menopause, and then before then, you’re Peri menopausal, and after that, you’re postmenopausal. And so, perimenopause just really means the period around the time that you’re going to stop having your menstrual periods. So that time period and it can be up to 10 years.

If you say the average age of menopause is in the early 50s, you know, 51, then women as early as their early 40s can start experiencing and even sometimes even earlier than that and start experiencing symptoms that people usually associate with menopause. So those that you think are hot flashes, night sweats, mood swings, vaginal dryness, you know, those kinds of things, which are the sort of standard menopause symptoms, really started happening in that perimenopausal period or that period leading up to when you stop having menstrual periods. And the other fun little party gift that happens during that time

Jen:  Oh, there is more?

Perimenopause: More Than Meets the Eye

Dr. Kelly Culwell: Yeah, while most women are, you know, people associate menopause with stop bleeding, right? In the perimenopausal period, you might have heavier bleeding, and you might have more frequent bleeding, and you might have irregular bleeding. So that also can be going on, which is very surprising to people because they expect as they get older, periods will get lighter, or less frequent. or something. Sometimes, it’s the opposite of that. It’s sort of like it goes out with a big bang. A big Hurrah.

Jen: And it’s over. Anyone who’s watching, if you have a specific question, feel free to put it in the comments, and Kelly will answer it. Of course, I have many questions. I know some people who have started perimenopause, even in their mid-30s. That stinks. I don’t know when I was growing up until I got to be a certain age. I always thought that it just stopped like, Okay, hi, I’m fertile, I’m fertile, I’m fertile, and then it stops.

Dr. Kelly Culwell: Right.

Perimenopause Hormone Chaos

Jen: And then, as you just explained, that doesn’t happen with a period. Does it happen with your fertility, or are you slightly fertile? Is it fluctuating during this time the fertility?

Dr. Kelly Culwell: It absolutely is, yes. Part of the reason why some people in perimenopause will have irregular bleeding is because they’re not ovulating regularly. One of the most common reasons for having irregular periods at any point in your in your reproductive life or is to not ovulate so the ovulation is what really triggers the hormonal cascade that makes those periods kind of come and go in a regular fashion.

So you ovulate in the middle of your menstrual cycle, and then approximately two weeks later, that’s when you have your period. It’s because of the hormones that get kicked into effect. Once that egg pops out. In the perimenopausal period, you’re not having an egg pop out every month. And in fact, you could go several months with no ovulation. Also, the eggs that are being produced are not necessarily as easily fertilized.

And they, you know, everything about the sort of reproductive system gets a little bit slower. So your fertility does kind of wax and wane. The important thing is that someone might have no period for three or four months thinks I must be good. Stop using birth control. Then that next month, they can put an egg out, and all of a sudden, you have an unexpected pregnancy and your late 40s. In fact, the two most common times for unexpected pregnancy are teenage years and mid to late 40s.

Jen: Wow.

Ups and Downs

Dr. Kelly Culwell: Because people are not expecting that they have much fertility left. In fact, it’s this sort of like up and down cycle, which is also why it’s very hard to check hormones during this time. So a lot of people say, well, how do you diagnose this, right? You do a blood test. The problem is, is they’re going like this, you know, you’re having these hormones. So, if you catch them on a day, it could look like you’re menopausal. But if you catch them on another day, it might not. That’s why it’s a little bit difficult to tell someone, okay, you don’t need birth control anymore. Right? Because next month, you might. So it’s definitely a challenge in that sort of, yeah, the late 30s to early 50s. Time Period.

Jen: Yeah.  Would you say that there is an age where it’s just too risky to risk getting pregnant?

Dr. Kelly Culwell: No, I don’t think so. I think, you know, obviously, the risks of pregnancy go up with age. But more importantly, they are related to your health. So, I have seen many very healthy pregnancies in women in their 40s, and even in their early 50s. I have seen healthy pregnancies. I think all of us who have been through a pregnancy and are now in our 40s or 50s. Recognized we might not have the stamina we had when we when we were pregnant. So you have to think about that. I mean, you know, it is

Jen: You already feel tired and gross and pregnant.

It’s a Burden

Dr. Kelly Culwell: Yeah, it is a huge burden. Pregnancy is a huge burden on the body. There’s no question about that. That’s why, I mean, it definitely puts people at pregnancy is a health, it’s risky. You are risking your life when you get pregnant, actually, and that does increase with age, but I would not say there’s an absolute cutoff where you absolutely should not get pregnant because it really depends on your health. Each person’s sort of individual situation.

Jen: Stephanie on Instagram says, yeah, that’s why I have an IUD at 39. Because I don’t want any surprise pregnancies.

Dr. Kelly Culwell: Yes.

Jen: Yes, she has. She has that. So now that we’ve we’re going to talk about some specific methods. What do you think is the best method for perimenopause?

The best method is what works for you

Dr. Kelly Culwell: Well, what we always say is the best method is actually the best method for you. So, the most effective method for any individual person is the one that they can use consistently and correctly. IUDs can be a great option at any age, because they’re sort of a set-it-and-forget-it type method. So, there are two different kinds of IUDs on the market. Right now, there’s the nonhormonal, which is a copper IUD.

There’s only a single copper IUD right now. Then there’s the hormonal, which is kind of a group of IUDs that have the same hormone, just a variety of different doses. They’re good for different periods of time. Both of them have some advantages in the perimenopausal period. So the non-hormonal one, obviously, no hormones, you’ll continue to have your menstrual cycle. So that will sort of monitor your own kind of cycle and see how things change. You’ll have a sense that if you stop having periods, that’s more likely to be related to menopause rather than any birth control that you’re taking.

Hormone vs Copper IUD for Perimenopause Periods

So you can kind of continue to monitor that the downside with the copper IUD is that sometimes, especially the one that’s currently available, can cause heavier menstrual bleeding and more painful menstrual bleeding and, in the perimenopause when you’re already kind of are having some of those months that are a little heavy. That can be a challenge. The hormonal IUDs there are some real advantages to those in the perimenopause. One thing that people will sometimes talk about is hormone therapy in menopause.

When you’re having those hot flashes, night sweats, and mood swings, one of the best ways to treat those, as you know, especially in the short term, is hormone therapy, and what we, for women who have uteruses, we need to use both estrogen and progestin. So estrogen is really what’s helping your symptoms. A low estrogen situation that’s causing your hot flashes, your vaginal dryness, some of your mood swings, even muscle, muscle aches, you know, difficulty sleeping. But you can’t just take estrogen if you have a uterus because estrogen actually causes growth of the lining of the uterus. And so you need to take progestin, which counters that estrogen to keep that lining from overgrowing and becoming precancerous.

Jen: Wow.

Progestin is Your Friend

Dr. Kelly Culwell: The nice thing about the hormonal IUDs is they are progestin-based. So you can actually have that hormonal IUD and take your estrogen, either orally or by a patch or even a vaginal ring. You can take your estrogen and not have to take a separate progestin because you already have it in your IUD. Your IUD is protecting your uterine lining. That’s a nice benefit of it also, the hormonal IUDs also decrease menstrual flow.

So again, in the menopausal period, where sometimes you’re having very heavy bleeding from month to month, these hormonal IUDs can help decrease that. So, both types of IUDs are highly effective, and they’re sort of set it and forget it. If your life is crazy, in this period of our lives, most of our lives are crazy between work and parents and kids. An IUD is a thing you don’t have to remember to do something every single day.

Jen: Yeah, that’s great not having to worry about it. What if you don’t want to put an IUD inside your body? What are some other options?

Everyone is Different

Dr. Kelly Culwell: Yeah, absolutely. That’s the thing; it’s not one size fits all. There are some people that an IUD is never going to be appealing. Some people just can’t tolerate it. They just can’t tolerate either the insertion or having it in or anything like that. There are basically many options that are available that are totally appropriate for perimenopausal women. The only exception is if you’re a smoker or you have some health conditions like high blood pressure or heart conditions.

If you don’t have those conditions, or migraines are another one, if you don’t have those conditions or any other sort of health risk factors, you’re pretty much open to taking any method. One method that can be good in the perimenopausal period because it can help ease the transition is birth control pills. Either the pills, the patch, or the ring, because all three of those methods have both estrogen and progesterone in them, and so what they do is they actually regulate your cycles.

Keeping it Regular

So when you’re having all these crazy up and down cycles, they help to keep your cycle regular, not too heavy. They also provide about three times as strong as menopausal hormone therapy. So if you’re having hot flashes, night sweats, etc, they’re going to treat those and also provide you with contraception. So if you’re someone who can tolerate hormonal birth control, and you don’t have any health risks that make it not safe for you, that can be a very good option in perimenopause as well.

Jen: I did not know that, so that’s very good. So then, why I’m getting very basic here. People are gonna think I’m dumb. But I’m trying to be very basic about everything.

Dr. Kelly Culwell: That’s good.

Why can’t we just take it forever?

Jen: Why don’t we just take birth control forever, then? Why don’t we just take it into our old age?

Dr. Kelly Culwell: Yeah, it is a very high dose, and it’s more than you need. So when you talk about sort of, if you were going to take menopausal hormone therapy just to sort of, you know, replace what is falling during menopause. As I said, the dose would be about a third of what it is in a birth control pill. So, you would be overdosing yourself if you continued to take birth control. Birth control is not without its risks.

So, hormonal birth control. There are risks even for any woman of any age, so it does increase your risk for blood clots. It can increase your risk for heart conditions as well. In some women, it might increase the risk of breast cancer, although that risk is extremely low compared to its benefits, so it actually decreases your risk of uterine cancer, decreases your risk of ovarian cancer, and decreases your risk of colon cancer. So it definitely has a lot of positives. However it is a medication that does have side effects and does have some risks. So we wouldn’t keep someone on it forever. As you get older, those risks are only going to increase. So if you still need it, then yeah, go ahead.

When will it stop?

Jen: Because of your body, does there come a time when your body figures this out? And it’s like, Okay, I’m done. I’m old now. I’m going to be healthy and stop doing this whole hormone thing and torturing the woman. Is there a time does it ever level off?

Dr. Kelly Culwell: It does. So when you get through the sort of the menopausal transition, those big symptoms like the hot flashes, the night sweats, the mood swings, those things start to ease off. Once you get past that sort of roller coaster of hormones. However, once you get into the true menopausal postmenopausal period, you still don’t really have much-circulating estrogen, if any, so you’re gonna things that will continue will be like vaginal dryness, pain with intercourse, those kinds of things will definitely continue.

That’s why in the postmenopausal period, even if you’re not taking oral, or transdermal or the patch for menopausal hormone therapy, sometimes you can just take vaginal estrogen, which actually doesn’t have any of the risks that the oral estrogen or transdermal estrogen or birth control have. It really is just a local effect. So for postmenopausal women who are still having problems with vaginal dryness, pain with intercourse, and frequent urinary tract infections, which sometimes come from a lack of estrogen. Just using vaginal estrogen is something that and that’s something you can use forever. You can use vaginal estrogen for the rest of your life if you need to.

Perimenopause Rage

Jen: Great. Good to know. I have a very, this is obviously a personal issue I’m having, so let’s just put it on the internet. What about these mood swings and, like, rage? Is that part of perimenopause?

Dr. Kelly Culwell: It absolutely is irritability, rage? Yes, mood swings? Absolutely. It’s the hormonal fluctuations that are going on. Now, in addition to that, obviously, we are also in a period of our life where there’s a lot of stressors

Jen: So much going on.

Dr. Kelly Culwell: Yeah, there’s a lot going on. It’s sort of like someone described it. As you know, I don’t know about you, but my kid. My one child is in adolescence, and then I’ve got my elderly parents, so I’m hitting perimenopause, my son’s hitting adolescence, and it’s also usually the peak of our careers and our earning potential. So, like, we’re busy at work, we’ve got crazy pubertal kids, and our parents need a lot of assistance. And then our hormones are going all over the place. So yes, irritability is very, very common during this time period. It is related to hormones, and it can be helped with hormone therapy. There are also other options that you can look into that are not hormonal

Jen:  Like moving out and like ignoring your family

It’s Not in Your Head

Dr. Kelly Culwell: Actually, moving to Bali, I think is one that’s recommended. Write a prescription for that. Things that, a lot of times people don’t like to hear. Things are in your head or anything like that. And it’s really not, it’s not in your head, it’s just that your mind and your body are really connected, right?

Jen: Yes.

Dr. Kelly Culwell: This irritability has a biological cause, but it’s got sort of a mental effect, right? This is all connected. So, working on things like meditation, yoga, relaxation practices, and acupuncture actually can be extremely helpful for a lot of symptoms in perimenopause, including this sort of irritability situation. Then, there are other prescription medications as well. So, there are some antidepressant medications that have been successfully used in the perimenopausal period to help with some of this irritability, but also some of the symptoms of depression that we experience during this time as well. So, you know, there’s a lot of options. But that’s very common, and it’s very normal. And I think all of us are experiencing at one level or another that are in this age.

Jen:  My oldest is 13, and I had him in my mid to late 30s. Cause you have a kid when you’re in your 30s, and you can like start shaping together. Yes. All these wonderful things as we get older

Perimenopause Acne

Dr. Kelly Culwell: Yes. So, then the acne comes back. So, you’re perimenopausal acne, so you can share acne washes.

Jen: It’s actually quite convenient in that way. It’s not great for your relationship.

Dr. Kelly Culwell: Right

Jen: When you’re angry all the time, and you’ve got an angry teenager. So, I don’t want to give away any trade secrets. But I hear you’re working on some new forms of birth control in your research. Is there anything you have been working on? Can you tell me about birth control in the future?

Research and Development

Dr. Kelly Culwell: I will say that more and more companies that are working on developing birth control methods are trying to develop non-hormonal methods. So, we have a lot of hormonal methods right now. And they’re great for what they’re for.

They can provide a lot of relief, like we were just talking about, from different symptoms, even outside of perimenopause. Some people I know want to stay on their pill. Mainly because they regulate their periods, they decrease their acne, and they stop their menstrual headaches. So they’re happy with it. But there are a lot of people who want to avoid hormones, either because they’ve had bad side effects, they’re worried about the health risks, or they just don’t like the idea of it. They’re living a sort of natural lifestyle, and they’re trying to keep the hormones out.

So, most advancement right now is happening in the non-hormonal space. The product that my company is working on it’s actually a new version of the copper IUD. It will have a lower dose of copper, and it comes on a different type of frame that is more amenable to different sizes and shapes of uteruses. We’re looking forward to maybe having that product out as early as next year, which will be kind of exciting because it will be the first time that a new copper IUD has been introduced. The one that we have now was approved in 1984.

Look at it in a New Way

There haven’t been any advancements with the copper IUD since then. Some other options that there’s some other kind of on demand options that are being looked at to work with sort of the cervical mucus. One thing that we know is if you’ve ever done any sort of fertility awareness, kind of monitoring your cervical mucus, you know that your cervical mucus changes right around the time that you ovulate. You can imagine if you could sort of harness the cervical mucus to make it thick and inhospitable at any time of the cycle, then you could potentially prevent sperm from making their way up. So, there are companies that are working on that.

Jen: As if my anger isn’t making it inhospitable.

Male Contraceptives

Dr. Kelly Culwell: Exactly. The irritability is a good form of birth control. Most people are in, and then people always ask me, “What about male contraception”? Because we’ve been waiting, what’s happening with that, and it is a real challenge to develop a male contraceptive for multiple reasons. As you may have heard, there was a study that was being done on a male contraceptive pill, and they stopped it early, because of some of the side effects that men were having.

And they were having, I know, exactly, that’s what everybody was like. They had side effects, like mood swings, and you know, and in depression and irritability, and people roll their eyes, which, we’ve been dealing with this for, you know, 60 years, but thank you. The big problem with when you study a birth control method in men, men don’t have the risk of pregnancy as much as they would like to participate in the whole thing.

They don’t have the physical risk of pregnancy, right? Because of that, their risk-benefit ratio is a bit different, from just from a from a medical perspective, not you know, not whether or not they’re weenies or whatever, that’s one thing. You know, from a medical perspective, we do have a different perspective because any birth control method that we take is safer than pregnancy. Without question.

Jen: I never thought about it that way,

Calculated Risks

Dr. Kelly Culwell: The risks that you think about with hormonal birth control, like blood clots, and heart disease and stroke and things like that. It’s multiplied tenfold in pregnancy. So that’s why, in addition to the fact that I think women are just sort of, we’ve learned to just suck it up. From a medical perspective, we can accept a fair amount of risk because the alternative is pregnancy, whereas, for men, that’s not their alternative. So, it has been somewhat challenging.

There are some studies right now. There’s a gel contraceptive for men that is pretty advanced in clinical studies, and it’s a hormonal contraceptive that has shown real promise. It’s currently being studied in the US, which is kind of critical. There is just one method that keeps coming up. It’s a kind of reversible vasectomy that was developed in India.

It has great clinical data in India. But the problem is that if you don’t have clinical data in the US, it’s never going to get approved here. It’s very expensive to do those studies. So, that’s been a challenge. But I do think that I think we’re not as far off from a male birth control method as we have been in the past, which I usually just said, I don’t know. But I think we’re getting closer.

Jen: That will be very interesting for us all.

Dr. Kelly Culwell: It will. Yeah.

Will New Technology Fix Old Problems?

Jen: Jessica says, “Will the new copper IUD still have the possibility of heavy flow and more painful periods?”

Dr. Kelly Culwell: Yeah, so the data that we’ve seen thus far shows that it should be less than the current copper IUD. But the women in the study still, had side effects. Some women did experience heavier menstrual bleeding or menstrual cramps with it, particularly in the first three to six months. But what we see is fewer than half the women that we expected discontinued because of that. They were really pretty satisfied with the study, and we had a pretty high continuation rate. So, we’re still finalizing the analysis, the data, and getting the review through the FDA and all of that stuff. We expect that the side effects will be lower, you know, not zero, but lower.

Jen: Lower is always better.

Dr. Kelly Culwell: Yeah.

Where to go after here if you have more questions?

Jen: Wow. So, I could keep you all night because I have many questions about perimenopause, but I know that we have to get to it. Everybody, Kelly is so accessible. She’s about to relaunch her website, where she writes blogs that teach us all of these things and is willing to answer questions, so you can send her questions on social media or through the blog or comment on these videos. If you have a particular question about perimenopause or anything we talked about tonight, you can have the good Dr Lady Doctor answer your question. Can you tell everyone where to find you, Kelly?

Dr. Kelly Culwell: Yes, so my website is DrLadyDoctor.com. So, it’s just Dr. and then Lady Doctor dot com. There, you can actually sign up for my newsletter, which I usually send out about once a month. You can send me questions that are actually used potentially as topics for my newsletter as well if it’s something that I think a lot of people would be interested in. And then I’m also on Instagram and Facebook @DrLadyDoctor, so just Dr. L A D Y D O C T E R, so you can reach me there as well.

Jen: We are going to keep in touch because I’m sure there will be many questions for me and everyone else here and thank you for sharing your knowledge.

Dr. Kelly Culwell: Thank you.

Jen: It was wonderful being with you. Have a great night. Thank you

If you would like any more information about Perimenopause or Menopause, You can contact Dr. Lady Doctor:

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