Femammal
Femammal
Shifting Fertility in Perimenopause
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[00:17] Greer:
Hi, this is Greer, your host for Femammal, the podcast that holds space for women to explore what it means to live well in our bodies and celebrates moving through this world as female mammals. This season, we are listening to women share their stories of how they formed their families, especially when health factors or medical issues impacted their decisions. Women's health matters for its own sake. At the same time, for many women, health issues not only impact their own quality of life, but also their paths to forming families. And many women have wanted to share those stories here, too. For our purposes, forming families means the creation of any home life that generates safety, belonging, connection, and joy. And it doesn't exclusively mean becoming a parent and raising children. I hope you will listen to each story this season with a sense of curiosity and compassion. And if you're going through something in your life right now where you're not in a place to listen to stories like these, I hope that you find compassion and support for what you're going through, and you can return to this podcast when you're ready. Today's guest is Christina Valenzuela. Christina is the owner and creative director of Pearl and Thistle, LLC, where she offers a unique blend of theology and science to bring better body literacy to Catholics. She has been a certified instructor in the Boston Cross Check method of natural family planning since 2013. Her latest book, The Language of Your Body: Embracing God's Design for Your Cycle, is scheduled for release with OSV in 2024. In this conversation, she shares information from her resource called Perimenopause Prep: Navigating NFP with Shifting Fertility and reflects on the dynamics of family planning as our fertile years come to a close. This conversation will be of interest not only to people from a religious background, but to anyone who has curiosity about how perimenopause affects our cycles and how we might think about forming our families. Welcome Christina. I am so excited to have you back. You were one of our very first guests for season one, and here you are joining us again for season four with more information and ideas that I'm sure people are going to be really interested in talking about perimenopause and how that interacts with natural family planning and what we can learn from our bodies during that huge time of change in our lives if we pay attention. So if we could start just for those who are not super confident about the concepts of both perimenopause and also natural family planning, could you help us understand those two concepts?
[03:49] Christina:
Sure. Yeah. So I'll start by breaking down perimenopause because I think this is a very easy term to get confused about, because people do not use the terms the same way. So when you go and you talk to your doctor, your doctor may use the terms perimenopause or pre-menopause, or menopause. They may mean the same thing depending on the context of the conversation. So when we're talking about the menopausal transition, we mean also like pre-menopause and perimenopause. So I like to get really granular with the terms and say, no, I'm going to really dig in my heels and say, like perimenopause, the root "peri" means around, and so the time around menopause. So menopause is your last menstrual period. And so the time around menopause is a time of acute transition, much like puberty, where our cycles are kind of winding down. Our body is preparing for its final menstrual period. And then even after we have that final menstrual period, there's about two to three years of ongoing transition where our hormones are still settling. And so the term perimenopause encompasses the time that's like approximately right before menopause and the couple of years of transition after our last period. And that's all one big transitional time when our hormones shift. So that's what perimenopause is. Natural family planning is a big umbrella term. It could also be called, like, fertility awareness based family planning. And basically what it is is learning how to observe and chart particular biomarkers in our menstrual cycles that would tell us where ovulation is happening in our cycle. So there are things that we can observe: cervical fluid, basal body temperature, urinary metabolites and hormones. These can all be tracked relative to ovulation. And then family planning methods will use that information about ovulation to build out what's called a fertile window so that a couple understands when around ovulation could we potentially conceive. And so it's an approach to family planning that can go whatever direction you want it to go. It can be used to try to avoid pregnancy, it can be used for people who are trying to conceive. And because it contains elements of just monitoring gynecological health, it can be used purely as a health tool as well.
[06:22] Greer:
That was so succinct. And I love that at its best, what it is is sort of a knowledge is power approach.
[06:30] Christina:
Oh, absolutely. That's why I like to say, I mean, I kind of cheekily like to say it's actually like true family planning because it allows you to simply understand what's going on in your body and make an informed decision about what you want to do, regardless of what those intentions are. Nothing about the data collection changes. When you want to switch from trying to postpone pregnancy to trying to conceive, all of the information is already there, and you just change your behavior and that's all you do.
[07:01] Greer:
So I imagine that for people who have been tracking their cycles over time through natural family planning type tools, they get pretty confident about their body and they feel like they understand a lot about what's going on. And then this perimenopause shift comes up where suddenly there's changes, there's flux, there's maybe confusing signals. And I'm wondering how perimenopause impacts our experience of our cycles as our fertile years come to a close. And then what ramifications does that have for people who are trying to make sense of that data, trying to track their cycles using NFP tools?
[07:46] Christina:
Yeah. So I guess what I'm going to preface this all by saying is that I actually have a course that teaches all of this in very high level detail. So I just released a course called Perimenopause Prep: Navigating NFP with Shifting Fertility. And it is like step by step information about all of the questions you just asked, because it is complicated in the sense that when we talk about perimenopause in this time of transition, there are actually different phases or stages that we go through. And so one of the things that makes it confusing is if you've never been taught the difference between early perimenopause and late perimenopause and the cycle signs that you would expect with those two distinct stages in the transition, then you're kind of going to feel like perimenopause is, you know, that show, "Whose Line is it Anyway?" where everything's made up and the points don't matter. That's kind of what perimenopause is going to feel like to you, because you're like, wait, I thought I was supposed to have long cycles, but I'm having short cycles, or I thought the bleeding was supposed to get less, but now I'm having heavy bleeding. The signs that you see with your cycles change throughout the different stages of the perimenopause transition. And so part of my work is like, educating women on, well, what are those stages and what are the particular cycle changes that you see? So, in summary, what we can kind of see is most women expect with perimenopause that they are going to have long cycles. And that is the case when you enter late perimenopause, which is more proximate to the actual menopause event itself. But in the late reproductive years, in the early perimenopause stages, you actually tend to have shorter cycles, and this catches so many people off guard. And this can wreak havoc on your NFP protocols because you kind of expect a certain cycle length, and then all of a sudden, ovulation was like a week sooner than you thought it would be. You're like, what am I doing? And so I like to tell women that if you're age 35 or older, learning the signs and understanding the different changes of perimenopause can really insulate you and prepare you to be ready for some of those changes before they're already on top of you, if that makes sense.
[10:09] Greer:
Sure. In the midst of that flux, if someone was using a particular NFP method, is that NFP method still going to serve them well, or do they maybe need different or additional tools?
[10:21] Christina:
Yeah, I think that varies woman to woman, and it also varies method to method. So let me just give you one example. If your method relies heavily on basal body temperature--so, this is traditionally the way that you take your basal body temperature, is you have to get consistent sleep throughout the night. You have to have a kind of standard wake up time, and then you take your temperature immediately. When you wake up in the morning, when you go through the stages of perimenopause, one of the things that you'll start to notice are these vasomotor symptoms related to shifts in estrogen that cause things like night sweats or a little bit of insomnia or some anxiety at night. And you may find yourself getting up in the middle of the night or tossing and turning in ways that you never did before. And all of a sudden you may find, like, I cannot get a reliable temperature reading anymore. This sign is actually not something that I can track anymore because I don't have consistent sleep. And so if you have something like that interfering with your method, then it's time to reach out to your instructor and say, hey, is there an alternate way that I could take my basal body temperature? Could I switch to a wearable device? If so, would that change in my calculations at all? Or you may say, you know what? I'm just fed up with it, this temperature is not going to work. See if I can switch to a different category of method that doesn't use temperature and get more confident with that. So a lot of it is going to kind of depend on what the individual woman experiences with her biomarkers, the sort of method that she's been relying on, and kind of how flexible that method is to adapting to some of the changes.
[12:01] Greer:
That's really helpful. Thanks. And you highlighted at the beginning that NFP isn't just about your fertility decisions or your family planning decisions. It's also a great indicator of other health conditions that might be underlying your biomarkers. You can get a lot of signals from your body. Fertility is often tied to what's going well or what's not going well in our bodies. So for people who are really keyed into the ways in which NFP has been helpful for attuning them to health conditions that might be presenting, what are some ways in which the signals that we're getting from our bodies can still cue us into underlying health issues that we should explore with a health professional, rather than just dismissing like, oh, I'm in flux because of perimenopause, and writing that off.
[12:57] Christina:
Yeah, well, I guess the first thing I'll say to women is that when I'm working with my clients, I tell them, we never dismiss anything as, oh, that's perimenopause. So when you go into your provider, this is an important time during the perimenopause transition to just go with a list of, here is everything I am experiencing. Like, you just come with your whole big laundry list, and it could be fatigue, and it could be heavier bleeding, and it could be more painful cramps, and it could be shorter cycles, it could be all sorts of things. And we just give it to our provider because a lot of the things that we may associate with perimenopause, we may be tempted to write off as like, oh, it's just part of the flux. They can actually point to other health conditions as well. And so this is why your provider is going to listen to you, hopefully, and be able to notice constellations of symptoms that don't necessarily add up to, oh, this is just perimenopause fluctuations. So, for example, when we enter perimenopause, it's a time when particular cancers, especially reproductive cancers, seem to pop up more frequently, this is a time when certain thyroid conditions may begin to flare up because of the hormonal shifts that are happening. There's a lot of insulin resistance that can also accompany this transition. And so what I always tell my clients is just keep track of everything that you're observing. Some of it is going to make sense in the context of your chart, some of it may not. But bring up everything that you're experiencing with your provider, because we can never dismiss actually anything. There are definitely things that would be, like, definite red flags that your provider would say, okay, we need to dig into this right now, but there are other things that may just be overlapping symptoms with other health conditions. And so I'll just say it again, like, don't dismiss anything. Always bring it to your provider, and don't be ashamed of that.
[14:59] Greer:
Right. That's really helpful. And then even if it does just wind up being perimenopause, you deserve to get whatever relief there is available for any of those symptoms that are interfering with your life.
[15:11] Christina:
Yes, that too. Yeah, I think a lot of times we can--well, maybe this goes into a different tangent of the conversation--but it's so easy to want to hide or to be ashamed of the experiences that our bodies are going through. But literally, your doctor is there to listen to the stuff that your body is going. You should be telling your doctor absolutely everything with no shame. Right. Because that's what your doctor is there for. So I just want to encourage women to never dismiss or to belittle anything that you're experiencing, because that is worthy and deserving of attention, both from you and from your medical provider.
[15:52] Greer:
Thank you. So I'm thinking about maybe someone being interested in diving into natural family planning for the first time when they're already over 35, already kind of approaching perimenopause, and that could be for a lot of reasons. Maybe they used a different family planning method for a lot of their life and didn't want to be on that anymore. Maybe they had hoped for a family for a long time and then didn't get the opportunity to pursue that until they're already in their latter fertile years. They're hoping that natural family planning could assist. So how should someone approach it? Can you still get good information about your body if you don't have data from earlier in your life? Can you start natural family planning with no data and just start from scratch when you're already in perimenopause? Sounds like there might be some curveballs, but what are the opportunities there?
[16:52] Christina:
Yeah, and I actually have clients who are in this situation for some of the various reasons that you listed before. Perimenopause is a time when cycles are shifting. But until we hit the late stages of perimenopause, when ovulation is kind of few and far between with the cycles, you are still ovulating, you are still having cycles. And so it is entirely possible to learn a natural family planning method. If this is the very first time that you're diving in, there's going to be specific protocols, probably, and particular things that you would be looking at. So, I mean, I'm just always going to hang my hat on, especially with times of transition, please invest in working with somebody. Do not try and self teach, because when you're in a time of transition, this would be perimenopause or postpartum or post medical diagnosis, that's going to change a lot of things for you. You really need somebody who can walk you through how protocols may be personalized and tailored to your situation and to your goals. I think that that's just so important to have somebody in your corner. So number one, find an instructor, and number two, be open to the possibility that if this is the first time you're coming into natural family planning, it may be a little bit more likely that you might have to try a couple of methods before you really find something that you feel is comfortable for you. And then you may have to kind of adapt those protocols as you go through. So it's just going to be a time where you're probably not going to find one method and just sit on it for a while. You're going to have to just be adaptable. But again, that's how having an instructor can really benefit you during this time, because they'll know exactly how to coach you on how to do that.
[18:44] Greer:
That's helpful. Is there a good way to look up instructors in your area, or, I imagine there's people online now who do virtual assistance as well?
[18:53] Christina:
Oh, yeah. I mean, honestly, Greer, I would say easily 98% of the instructors that I know are online and maybe even exclusively online. It's so easy to do from your home. So there are a couple of directories that I really like to point people towards. There's one directory called the Fertility Awareness Educators directory, and it's run through Read Your Body, which is a collective from the UK that has a charting app, which I absolutely adore and is my top recommendation for anyone who would want to be charting NFP with an app, Read Your Body. It's great. So they have a provider's directory, and what I love about their directory is it encompasses all different methods, including ones that are not common to find in the United States. You can filter people by your price range, you can filter people by whether or not you want somebody who's going to be teaching from a religious context. So it's a really user-friendly directory to be able to sift through. And if you have particular concerns, like if you're a Catholic woman, you're like, okay, well, I want to make sure that somebody's teaching in line with Catholic moral teaching. You can filter for that. It's so easy. There's another directory called the Fertility Science Institute directory. They share a directory with Natural Womanhood, that's another website. And then Facts about Fertility is another educational website. So FSI directory has a number of people who can work online with you as well, and you can filter by method.
[20:25] Greer:
Cool. I will make sure that links to those resources get into the show notes if anyone wants to look them up and didn't catch it while you were just saying it out loud.
[20:34] Christina:
Yeah, that's great.
[20:35] Greer:
Yeah. So I am over 35, and more and more of my friends are in that position of wanting to start having children when they're already kind of in their latter fertile years and where perimenopause might be a contributing factor to fertility issues. What are some ways that practicing NFP during perimenopause could offer some hope to women who are trying to conceive later in life?
[21:05] Christina:
Yeah, well, I mean, so anytime you understand your biology and you understand where ovulation is actually happening in your cycle, you boost your chances significantly. So there are plenty of studies that show that couples who understand their fertility and are able to engage in what's called fertility focused intercourse, right. Meaning that they know what they're doing relative to timing, they can improve their chances of conceiving in any given particular cycle and actually expedite the process and cut the time in about half. So people who don't understand where their fertility is in their cycle, it takes approximately one year to reach about a 90% conception rate. With otherwise healthy fertility, you can cut that in half to six months. If you are somebody who understands where ovulation is happening. And why this can be important in perimenopause is because even if you had totally regular cycles, for the vast majority of your life, you're going to be seeing shifts in the timing of ovulation, either earlier if you're in the late reproductive stage, or the early perimenopause stage, or ovulation can be significantly delayed when you have longer cycles. And so really, the entire concept is understanding where ovulation is and how timing of intercourse relative to ovulation can positively impact your chances for conception. That's hugely empowering. The other thing about NFP is that it puts you more in tune with your body, and it is possible to find things like potential hormonal imbalances or irregularities in your cycle that you may have been unaware of before. So I've had clients who have cycles who are in what would be considered a very, very typical range, maybe about 30 days long on a fairly predictable schedule. But when they start charting their cycles, they find out that within that cycle, they're actually ovulating very, very late. And so they aren't producing enough progesterone to be able to sustain a pregnancy. And so what they're able to do is to understand, okay, well, I have late ovulation, so what I'm going to do is I'm going to actually get on progesterone supplementation after I ovulate to boost the chances that if I conceive, I'll be able to maintain the early stages of that pregnancy and boost my chances that I'd be able to carry full term.
[23:30] Greer:
Wow. Yeah. That's a real knowledge is power kind of moment. Yeah, I know it's not a miracle worker. Some people aren't going to be able to get pregnant even if they want to, but it definitely could help certain situations.
[23:45] Christina:
Yeah, and that's good to reiterate that NFP is not some sort of magic wand where you can wave and all of a sudden I understand my fertility and I'll be able to conceive. It doesn't work that way. But if you are ovulating and you do understand some of these concepts, it makes it more likely that you'll be able to maximize whatever natural potential that you do have for conception.
[24:08] Greer:
So I'm now thinking of maybe a different group of people, maybe couples who have been using NFP over decades together, and now they're heading into those perimenopausal years, and maybe they have some anxiety about sticking with NFP during perimenopause. Maybe the shifting fertility is intimidating, especially if they've discerned that they don't have the capacity to care for more children. What are some things you might say to couples who are in that position and not sure if they really want to stick with NFP at this point?
[24:46] Christina:
Yeah, that is a great question, and I hesitate to give any resounding answers because anxieties and things can come from so many different places, and I want to tread carefully because sometimes anxieties are actual, real trauma based things that couples have been through, and other times the anxiety flares up, honestly, because the woman is going through these hormonal changes, and anxiety is one of the things that we can experience in the stages of perimenopause. And so kind of understanding that even our mental state shifts during this time is something that I think couples should really understand about how they may need to change their conversation strategies when it comes to navigating this time. That's a little bit of a side point. The practical stuff that I might offer would be, especially if you're working with an instructor and you have anxieties, there are always ways to make protocols more conservative if you want to. Right. So there are always ways that you can talk to your instructor and say, you know what, I'm feeling a little nervous about this. Are there modifications we could make or that you could talk me through that would decrease some of those anxieties for me? The other thing I might say is that it's entirely possible that the method that you were using before is not going to work in perimenopause. And so keeping that kind of mental space open. I have one colleague who loves to say, you are married to your spouse, not your NFP method. And I think that's so true, especially in perimenopause. You have to find a strategy that you feel comfortable with. You don't owe your instructor or you don't owe your method any loyalty beyond just a thank you for your service, and you can move on. So there definitely are strategies that couples can utilize because you never want anybody to feel anxious, because you feel stuck, like there's nothing that we can do, nothing that we can do to make this better, no way that we can improve the situation.
[26:50] Greer:
So that second point you made, it sounds like even though NFP is sort of set up to try to identify the tightest fertile window there is, you could kind of artificially introduce a broader potential fertile window so that folks can bring risk for conceiving down if that's what they're invested in at the moment.
[27:14] Christina:
Yeah, well, and I would also say, understand how your method is built. So, for example, when you say methods are built to find the tightest fertile window possible, that's actually not true for the method that I teach. We are built to be a method that is inherently a little bit more conservative because some people just want that from a method. And so we actually build out a slightly larger fertile window. I'm talking about a difference of like maybe 36 to 48 hours in any given cycle. But even that added boost gives people a lot of confidence in the method and whether or not the method can be flexible to kind of absorb some of the changes that may happen with premenopause. So it's important to understand whether your method is built to be kind of something that identifies the smallest fertile window possible or is already bordering on being a little bit more conservative than that.
[28:06] Greer:
That's helpful for sure. And I'm also wondering for couples who are trying to discern together: are we going to stick with NFP? Are we going to try something different? Especially if they've just got a lot of anxiety about the potential for falling pregnant during period menopause, are there any aspects that you feel like folks would really miss out on if they walked away from NFP that you'd want to kind of shine a light?
[28:38] Christina:
Oh, that's an interesting and very fun way to reword that thought. I mean, I'm not a healthcare professional, so you have to take everything that I say here with a grain of salt. But there are plenty of doctors who are coming round to understanding that women's menstrual cycles are actually a vital part of our health, and our bodies are made to function optimally when we have this flux in hormones, this shift in estrogen and progesterone and the balance of those things throughout our cycles. And so the concept of maintaining natural hormone levels for as long as humanly possible is something that a lot of practitioners are kind of opening their eyes to as a way that we can help women transition into the post menopausal time with fewer long term adverse health effects. And so if couples are thinking about, maybe I want to go like an artificial hormones route at this point, I have to just hit the pause button when I hear people say that, because I'm like, well, but we're kind of changing our tune in medicine a little bit. And I'm seeing more and more practitioners who are advocating for maintaining natural cycles because we're beginning to understand that this could be essentially putting a deposit into your long term health bank.
[30:06] Greer:
Wow. Okay. That's a very helpful way to think about it because, of course, women have to make the best choices for themselves, and you know, couples should talk through these things together. But it's really helpful to get a sense of what you might miss out on if you walk away from NFP at that stage, because we are paying more attention now as a society to the ways in which women's health can be impacted by what their experience of perimenopause and menopause was like for years to come.
[30:41] Christina:
Yeah. And I just want to reiterate and say that if your symptoms are so severe, for example, that you're like, my practitioner says that I need to get on birth control to control some of these things. I mean, that's a conversation that you need to have, and you need to weigh the costs and the benefits of that. But there are ways that you can alleviate symptoms of perimenopause if they are kind of that severe. And you need to go in and you need to do some hormone supplementation that are more cooperative with your cycle, that can keep that ovulation intact, so that as long as possible, you are producing the higher levels of estrogen, you're producing the progesterone that you can. You're supplementing with hormones where appropriate. And some of those things can actually even out some of the kind of bumps in the road that come with cycle changes and can kind of ease some of the variations that you see with cycles that might make you a little more frustrated with the practice of NFP. So there's also that added consideration there, that natural hormonal supplementation could also be a way that could potentially decrease experience of symptoms and potentially increase confidence because it smooths out some of the issues that you might otherwise see.
[31:54] Greer:
Okay, that's really helpful. It sounds like everything you've just mentioned opens the door to more conversation with your partner, more conversation with your healthcare provider, more conversation with your NFP practitioner, if you have one.
[32:08] Christina:
Yeah. Oh, I'm all about talking to everyone. And in an ideal world, your NFP provider and your doctor could be like pals and know, hey, we have a whole cooperative plan for you. It's not always the way that that works, but it definitely is important for couples to understand what their options are, because the things that you are experiencing and the goals that you have are more important than whatever goals your instructor or your doctor may have.
[32:40] Greer:
I'm just wondering, are there any myths about perimenopause that you want to dispel right now?
[32:47] Christina:
Any myths about perimenopause? I think all of the myths that I want to dispel about perimenopause are just myths that we have about women's cycles in general. We have all of these stereotypes of women who are just like these raging maniacs in perimenopause. And I have to laugh because it is true that we can have emotional changes that we go through in perimenopause, but we're not monsters, and we're not slaves to our emotional changes either. And when women have emotional changes that are actually that severe, that's a sign that their body is communicating that something is off and needs attention. It's not something that we just accept as, like, a normal part, that all women are just awful in perimenopause. So I think any stereotype that we have about perimenopause or menopause turning women into these crazy other beings, I think we need to nip that in the bud because we need to understand that, yes, there are going to be shifts that happen, and there are definitely normal ranges of changes that we will see with those things. But anything that's that severe should never be written off as like, oh, it's just perimenopause. That's just how women are. That's just how the change is. We shouldn't dismiss it because it's a change. We should be saying, oh, no, if it really is that severe, that just means that we need to pay attention and maybe spend a little more time nurturing ourselves in that place.
[34:18] Greer:
I think one of the things that feels daunting thinking about this coming up in my future is simply that when we went through puberty, we were sort of in a very specific, somewhat protective context. We were around our peers constantly, so our peers were also going through this. And at a time of life where our parents and our elders sort of expected us to be somewhat erratic, still trying to get a handle on things maturing developmentally anyway. So the sort of mood swings aspect of puberty was sort of socially acceptable to a degree. And when you go through perimenopause, you're just out there in the world, like in your workplace, you might not necessarily have a lot of peers. You're in mixed gender environments constantly. You're living your life just in a very public--the context is so different, and I wonder if you have any reflections on that and how to sort of navigate that dynamic.
[35:30] Christina:
Yes. So I actually have an upcoming book with Our Sunday Visitor, and I'm going to have to paraphrase, because I don't remember how I said it in the book. In the book, I was talking about transitions, transitional times with cycles. And I reflect on the fact that the woman going through perimenopause is just a much more complicated human being than the girl who's going through puberty, which isn't to belittle puberty because it's rife with its own issues. But when we're in perimenopause, it is, as you say, a time that can be isolating if we don't have somebody else who's going through it with us. But it's also a time when we are usually sandwiched between care for children, potentially, and care for aging parents. It's at a time of transition in our work when maybe there's some changes happening in our work life balance. There's just a lot of complicated human things that are happening at this time in life. And so I encourage women, number one, to make these connections during this time and to not be afraid. This is a time when, if you are a part of a book club, or if you are a part of a Bible study, or if you have like a Wednesday morning coffee date, these are things that I think we should give ourselves more permission to bring up and to start conversations with our friends about. Because there can be this idea that we need to kind of suffer in silence, in silos and isolation. And sometimes all it takes is one little comment to let everybody else know that this is a safe space and that we can talk about this. So, number one, I would say be proactive as best you can about making sure that whatever contact you have with the other women in your life, they know that you're a safe space to talk about these things. That's going to nurture an environment for you and for them, and that's going to help everybody. The other thing that I want to say about this time is that it's okay to grieve in a way that we don't grieve in puberty. Exiting our reproductive years can be a time of grief, whether we have like, ten children or whether we have no children, either by choice or just by happenstance. Exiting our reproductive years means saying goodbye to something. It's entirely good to grieve that. And it's also a time when, for a lot of women, we're going through a change that we don't have a lot of direction from our mothers either, because our mothers have already passed on. And this is the first life change we're going through without them. And that's hard and that sucks. Or because in many cases, our mothers didn't naturally go through this transition of menopause on their own anyway. A lot of women have had to have hysterectomies. Many women have gone through kind of chemically induced menopause because of chemotherapy or something like that. And so we don't always have the guidance and the handholding that we would like to have and that we need to have in this time. And it's okay to grieve that and to name that as well as part of the transition that you're going through.
[38:59] Greer:
Yeah, there's so much there. I want to throw in another scenario. I mean, most of our mothers weren't socialized to talk openly about these things either. So when you were maybe a teenager, maybe a 20 something, and your mother was going through perimenopause, she probably didn't share that information with you. And I often hear, oh, well, you will likely go through perimenopause around the same time frame as your mother went through that. Well, that's not helpful information if you--
[39:31] Christina:
--don't know, if you have no idea. Right.
[39:34] Greer:
So there's just so many aspects there. There is a grief for the fact that our mother's generation and many generations before that didn't have that opportunity for openness, didn't feel as free as we do now to discuss these things and the grief that we still struggle to discuss these things. These things aren't all that openly discussed yet.
[40:00] Christina:
Yeah.
[40:01] Greer:
This season is about how women form their families and what family means. And so often we think about that in a forward facing way, thinking about younger generations coming up, coming forward, coming into being. But there's also that looking backward direction, that looking up to the generations ahead of us and still hoping to get wisdom from them, also seeing how much has changed from one generation to another and maybe an opportunity as you enter perimenopause and menopause to find a new sense of kinship with generations ahead of you.
[40:45] Christina:
Yeah, I was just meeting with a client very recently, and she was sharing aspects of her cycle that we were talking about in the context of perimenopause. And she said, you know, I always had a suspicion that maybe my mom experienced the same things, but she's like, we never talked about it, and I didn't feel comfortable asking her. I felt if she wanted to share with me, she'd let me know. But she said, I'm really struggling right now in this moment because I'm just realizing she passed away last year, and I will never have the opportunity to ask her. I got choked up about that because this is a space where when we take the time to listen to our bodies and to try to understand what's going on and to try to contextualize it and make sense of it, we can very suddenly come to this realization that, oh, I missed out on these conversations sometimes. And so what I want to encourage women to do who are listening is to maybe think about that. And even if you're not nearing perimenopause right now, maybe to start some of those conversations with the women in your life who are still around because you don't know when you'll have the chance to really absorb their wisdom and to hear what they have to say, and maybe they won't want to talk about it, and that's fine, but at least you make that attempt and that connection and understanding. So maybe that's just a little thing that I want to throw out for consideration for all of us as we think about kind of entering this time of life, no matter how far out that may be.
[42:29] Greer:
I think that's helpful. And if it helps you take the risk, the mother or auntie or grandmother who mothered you through puberty is not the same as the person who's providing that presence for you now, as you enter perimenopause. That's a person who's had another 20 or 30 years of development and growth and life experience herself. So if she is still around in your life, maybe there's an opening there.
[42:58] Christina:
Well, and even this is one of my favorite things. So I'm just going to throw out there. There's a fabulous book called The Hormone Repair Manual by Lara Briden, and she talks a lot about the changes that we go through in menopause and one of the results of going through the menopause transition. She says women losing their filter is a very real thing. There's a neurobiological explanation for this. There's all sorts of reasons why getting rid of these fluctuating hormones, gets rid of some of our filters and some of the restraints that we've put on ourselves. So she's like, women who have gone through menopause are a lot freer with what they feel comfortable talking about and sharing their mind on. And so just to kind of echo that there is actually a change that we go through with our brains, that your mother may surprise you is all I guess I'm saying that's cool.
[43:53] Greer:
I do also want to honor that sense of grief that you mentioned in relation to as women exit their fertile years, looking back on their lives, regardless of whether they've had children or whether they've not had children, you might have sad or conflicting feelings about those fertile years being over. I'm sort of thinking of that shift from during that long stretch of fertile years, there's sort of a hint that there's always a possibility there's something that might be on the table. And then as your fertile years come to an end, even if you are happy with the decisions you made during that time, suddenly there isn't that sort of seed of potentiality always buried in you. And that might be sort of a jarring transition for anybody.
[44:47] Christina:
Yeah, I would agree with that. I would also say it's been interesting to me because I've talked with women in many different vocational states of life. Right. So the vast majority of women that I work with are married women, and they may or may not have children. And so what they're going through with perimenopause may be particularly acute in some ways. But I've also coached some women who are consecrated virgins who don't regret their vocational path at all. But they even sense that there's something apart from the fact that, okay, the biological window is closing, which they understand. They effectively closed the biological window by choice many years prior. But there's also a sense that losing their cycles and losing the potential for biological fruitfulness may also somehow impact their understanding of what it means to be spiritually fruitful as well. That there's an anxiety or there's a fear that my living out of motherhood, whether that's a biological motherhood or a spiritual motherhood, is going to be impacted. And I don't know what that's going to look like. And so I think that embracing this as a very poignant, liminal time in our lives, that this is a time of transition in a way that men just don't go through. I think that this is a part of grappling with womanhood and the seasons that we go through in ways that men, as much as they may love us and be with us and be alongside us, just they don't go through the same thing themselves. And so I think that, again, either if you're unmarried, grappling with this on your own, or if you're married, grappling with this as a spouse, I think that both the biological and the spiritual dimensions of this transition are perfectly good things to wrestle with, to talk about, and to really be intentional about trying to navigate positively as best you can.
[47:06] Greer:
I really appreciate the lens that you address that through because it's bringing me back to the interview we did in season one where we were talking about energy and mood through that menstrual cycle. So when you think about energy and mood throughout the menstrual cycle, if you really keyed into that and really learned your cycle and learned to ride those waves, there could be a sense of loss when those waves recede and you're entering into a whole new terrain of experiencing energy and mood without those same waves that you learn to surf.
[47:43] Christina:
Absolutely. Yeah. And you can imagine that couples are going to go through very different dynamic shifts during that time as well.
[47:53] Greer:
Yeah, sure. I'm wondering if you could share at all about what you've learned about fertility and perimenopause and how that might have shaped your own outlook as you get closer to perimenopause yourself.
[48:07] Christina:
Well, I think one of the things that I have simply learned through this process of just really digging in and having to understand how this change works is I really have experienced the fact that knowledge does empower you in so many ways and that we have tons of research which shows that when girls are adequately prepared with information and affirmed in their body changes prior to puberty, they actually navigate the transition with significantly less anxiety. They have a much more positive experience. And so I have no doubt that the same thing would apply to perimenopausal women as well. If we take the time to actually understand what are the changes, what should we be expecting? What's normal? When do we talk to the doctor? Just equipping ourselves with that knowledge and taking the time to sit and to think about how am I going to affirm myself in this change? How can I help my husband affirm me in this change? Or how could I build an environment where even my kids or my coworkers could help affirm me in this change? My sense is that that's just going to decrease a lot of anxiety, and I haven't been through the transition yet, so I can't say whether it has worked. But at least, as I'm kind of, like, thinking about entering the threshold of perimenopause, I think I do have a lot less anxiety about it now than I did a few years ago, before I was particularly attuned to some of the nuances of this transition.
[49:46] Greer:
Yeah, that's great. I'm curious if you could wave a wand and make lifelong cycle education look like what you want it to look like, what would that perimenopause education look like? Because there isn't really a built in venue for that in our society right now.
[50:04] Christina:
We don't have a model for it. I know. I mean, at least for puberty education, I mean, maybe you can opt out of that, or maybe you didn't quite have a great experience, but at least it's kind of standard that you can find a class to go and learn, or you're stuck in a class at school. I'm not entirely sure. Part of me says we should have a class. Maybe local community centers or parish centers should actually host a program that's like my Perimenopause Prep program, or they should bring in a nurse, or they should bring in a well trained OBGYN to talk about these things and to just do big group classes. I'm not entirely sure that that model holds up because women are just in such different places in our lives with perimenopause. But at a minimum, having a class, that's just like the basics of, like, here are the biological changes I think would just be so helpful, but I don't know effectively how that could happen. And I also think that a lot of the things that we experience in the workplace, a lot of the fears that we have, they're not going to change until men are well versed in this, too. So I don't know. Can we have men's classes on perimenopause, too? What would that look like? I don't know. Yeah.
[51:28] Greer:
You're making me wish that the HR lady would do perimenopause classes in the workplace for both genders. All genders. Because, yeah, it's information that we could all use.
[51:41] Christina:
I love that. Or, like, maybe it's part of your annual physical. You get to age 35 and both men and women, the doctor's like, here's a pamphlet on perimenopause. You need to understand this. I don't know. I don't know how it would work.
[51:57] Greer:
Anything would be better than nothing at this point.
[52:00] Christina:
That's exactly right.
[52:03] Greer:
I just have one last question. I'm wondering if you have an insight you could share with us into how we as women can listen well to our bodies and our hearts as we move through making family formation choices in our lives.
[52:19] Christina:
Oh, goodness. The term that is always the one that I come back to, which is more familiar for people in a religious context, would be discernment. And I think it's very easy to misunderstand what discernment is. A lot of times we think that discernment is us just getting really quiet and waiting for God to tell us exactly what to do. And I think when it comes to family planning, as much as we want to plan, there's also this element of, like, well, can somebody just tell me what to do? Can somebody just take some of these decisions away from me? Or could I just not feel this burden so much? And so what I would say is, when it comes to discernment, it's all about God will always bring peace, and it will not always be in the places and in the paths that you expect it. So we have visions of what we want our family life to look like, and those are good, and those are nice things. I'm not saying we shouldn't have an idea, but we should never hold too tightly to those things and we should always be open and receptive to, if those things don't come, what are the other gifts? If my hands are empty, if they're not holding the thing I wanted them to hold, then what are they open to receive? That's something that I have particularly struggled with in my own family planning discernment because I struggle immensely with pregnancies. I get incredibly sick and it's pretty severe. And so one of the things that I'm concerned about is approaching perimenopause. How am I going to handle this knowing that I've been deciding not to get pregnant for this whole time? Because it's probably not good for me, not good for the family. There are plenty of very compelling reasons why it would be a grave hardship for us. Am I going to feel differently? I don't know. If I feel differently, would we even be able to have another baby? We don't know. We don't know. And so the only advice I can give is to have a vision, but to never cling too tightly to it and to see what openness you can find in other areas if your vision doesn't come to fruition. And if it does, how are you stewarding that well?
[55:08] Greer:
I truly appreciate the vulnerability of what you just shared and that instance from your own life, and I do think that's a very helpful way to put things into perspective. So thank you.
[55:20] Christina:
It's tricky. It's a tricky thing, this concept of planning families when ultimately we have very little control.
[55:31] Greer:
Yeah. I wish we would just throw out the term family planning to begin with. It's such a misnomer. It is such a misnomer.
[55:38] Christina:
Yeah. Well, you've been using a different term, though. You've been using forming your family, and that carries all sorts of different resonances for me as well. So I appreciate that term in so many ways.
[55:53] Greer:
Well, thank you so much. I'm so excited about this resource that you have to offer, the Perimenopause Prep: Navigating NFP with Shifting Fertility. So I'll link to that in the show notes as well. If people's interest was piqued by everything you said today, they can dig into a lot more information there and any of your other courses. You just have a wealth of resources to share at this point. So thanks for everything you've shared here today and also through your career.
[56:21] Christina:
Oh, thank you, Greer. Thank you for having me. And congratulations on season four. This is such a great effort and I'm so happy to be a small part of it.
[56:28] Greer:
Thank you. If today's episode resonated with you, I'd love to hear from you. You can email me at femammalpodcast@gmail.com. That's femammalpodcast@gmail.com you can also follow this podcast on Facebook. Just search for Femammal Podcast and you will find a community of people who are interested in living well in our bodies. And of course, I'd love for you to rate this podcast and leave a review wherever you download your podcasts. Until next time, be well.
