Did you know that the average person will spend a third of their life in the menopause transition? We invite Certified Sex Therapist Nicole Schroeder this time to talk about ways to get comfortable with this stage of our life; How Generation X is pushing forward the conversation about menopause more than any other generation and, where to go for help when you are struggling with symptoms of perimenopause? Show notes: 00:35 Our Guest Nicole Schroeder – Introduction 02:10 Everyone that has ovaries will go through menopause 06:40 How do you know when you are experiencing perimenopause? 09:20 Generation X are handling menopause differently compared to other generations 15:04 Menopause became a joke in western pop culture 21:53 Stop treating menopause as a mid-life crisis 31:53 Some symptoms can be treated under different methodologies 35:06 Pelvic pain is not all in your head 49:00 Expecting to always have an orgasm at the same time as your partner is similar to expecting to have a Michelin Star style meal every time you cook 54:00 Let’s talk about pelvic floor physiotherapy treatment next time 57:00 Where to find Nicole Schroeder? ---------------------------------------------------------------------------- Nicole Schroeder is a Registered Social Worker with the College of Social Workers in Ontario (OCSWSSW). She is a certified member of BESTCO (Board of Examiners in Sex Therapy and Counselling in Ontario). She currently works in an outpatient gynecology clinic at a downtown Toronto hospital and in private practice, with a focus on individual, relationship, and sex therapy. Nicole also facilitates virtual groups on menopause, a variety of pelvic pain conditions and sexual wellbeing. She runs virtual groups at Bria, a virtual mental health clinic that provides support and treatment for cis-women, non-binary folks, and transgender women experiencing mental health challenges across their reproductive lifecycles. Nicole Schroeder http://www.nicoleschroeder.ca/about.html Instagram: @nicoleschroedertherapy Menopause Support Groups: https://betterbria.janeapp.com/ Book: The Menopause Manifesto https://www.menopause.org/for-women/book-reviews/i-the-menopause-manifesto-own-your-health-with-facts-and-feminism-i If you have questions or topic suggestions for the podcast, submit them here. As well, you can now record your messages for us! Please record your message/question in a quiet room and use your phone’s headphones with a built-in mic if possible. Send your questions or show ideas to Me@getsome.ca Guest Opinion Disclaimer: All opinions expressed by podcast guests / participants are solely their current opinions and do not reflect the opinions of GETSOME Inc. or affiliates or the companies with which the podcast guests / participants are affiliated, and may have been previously disseminated by them. The guests / participants opinions are based upon information they consider reliable, but neither GETSOME Inc. nor its affiliates, nor the companies with which such guests / participants are affiliated, warrant its completeness or accuracy, and it should not be relied upon as such. Follow us on Instagram: getsome_podcast
Did you know that the average person will spend a third of their life in the menopause transition?
We invite Certified Sex Therapist Nicole Schroeder this time to talk about ways to get comfortable with this stage of our life; How Generation X is pushing forward the conversation about menopause more than any other generation and, where to go for help when you are struggling with symptoms of perimenopause?
Show notes:
00:35 Our Guest Nicole Schroeder – Introduction
02:10 Everyone that has ovaries will go through menopause
06:40 How do you know when you are experiencing perimenopause?
09:20 Generation X are handling menopause differently compared to other generations
15:04 Menopause became a joke in western pop culture
21:53 Stop treating menopause as a mid-life crisis
31:53 Some symptoms can be treated under different methodologies
35:06 Pelvic pain is not all in your head
49:00 Expecting to always have an orgasm at the same time as your partner is similar to expecting to have a Michelin Star style meal every time you cook
54:00 Let’s talk about pelvic floor physiotherapy treatment next time
57:00 Where to find Nicole Schroeder?
----------------------------------------------------------------------------
Nicole Schroeder is a Registered Social Worker with the College of Social Workers in Ontario (OCSWSSW). She is a certified member of BESTCO (Board of Examiners in Sex Therapy and Counselling in Ontario). She currently works in an outpatient gynecology clinic at a downtown Toronto hospital and in private practice, with a focus on individual, relationship, and sex therapy. Nicole also facilitates virtual groups on menopause, a variety of pelvic pain conditions and sexual wellbeing. She runs virtual groups at Bria, a virtual mental health clinic that provides support and treatment for cis-women, non-binary folks, and transgender women experiencing mental health challenges across their reproductive lifecycles.
Nicole Schroeder http://www.nicoleschroeder.ca/about.html
Instagram: @nicoleschroedertherapy
Menopause Support Groups: https://betterbria.janeapp.com/
Book: The Menopause Manifesto
If you have questions or topic suggestions for the podcast, submit them here. As well, you can now record your messages for us! Please record your message/question in a quiet room and use your phone’s headphones with a built-in mic if possible. Send your questions or show ideas to Me@getsome.ca
Guest Opinion Disclaimer: All opinions expressed by podcast guests / participants are solely their current opinions and do not reflect the opinions of GETSOME Inc. or affiliates or the companies with which the podcast guests / participants are affiliated, and may have been previously disseminated by them. The guests / participants opinions are based upon information they consider reliable, but neither GETSOME Inc. nor its affiliates, nor the companies with which such guests / participants are affiliated, warrant its completeness or accuracy, and it should not be relied upon as such.
Follow us on Instagram: getsome_podcast
[00:00:00] [Theme music]
[00:00:15] Michelle: Today, that's who we're going to be talking with. Nicole's a registered social worker, a BESTCO certified sex therapist. and we're going to be talking about menopause, not menopause today. So Nicole splits her time between working at an outpatient gynecology clinic at a downtown
[00:00:42] Michelle: Toronto hospital and is also in private practice with a focus on individual relationship and sex therapy. In addition to that, you also facilitate virtual groups on menopause, a variety of pelvic pain conditions, and on sexual well-being. And then also you work with BRIA, which is a new mental health clinic that provides support and treatment to cis women,
[00:01:16] Michelle: non-binary folks, and transgender women experiencing mental health challenges across their reproductive life cycle. Welcome, Nicole. I'm so glad we are seeing each other not only because you are a wealth of information, but also because you're my friend. And I like having conversations with you about lots of different things. And today it just so happens to be menopause and pelvic pain.
[00:01:47] Nicole Schroeder: Thank you so much, Michelle, for having me and hello to everyone wherever you are. I'm so excited to be here and have this important conversation.
[00:01:58] Michelle: Great. Yeah. I wanted to get some clarity just for our listeners when we use terminology throughout this talk today using the terminology of cis women or people who are vulva owners. I wondered if you would be able to just help to define those two so that people can follow along and understand why we're doing that. Yeah.
[00:02:29] Nicole Schroeder: I mean, the way I always sort of make sense of it is particularly when we're talking about in the... in the kind of topic of menopause is that menopause is going to happen to anybody that has ovaries. So that includes, you know, cis women, but it also includes folks who may not consider themselves women or maybe non-binary. And I think the importance of kind of talking about this is because what we want to do is to make this accessible to anybody who might...
[00:03:00] Nicole Schroeder: be having this experience. And I think, you know, when we talk about language mattering, it's because when people see themselves reflected in everyday language, they feel part of it. They feel included. They don't feel ostracized. And so I think that when we're clarifying these things, like it should be what everybody does, frankly.
[00:03:23] Michelle: Right. And I guess cis woman would, what that refers to is somebody who at birth was born and they looked between their legs and they had a vulva. Is that?
[00:03:37] Nicole Schroeder: Yes, that's my sort of understanding. Yeah, it's the biological kind of markers that you were born with, which may not be how you define. Yeah, so that is my understanding. I think you articulated it far better than I am.
[00:03:57] Michelle: I'm all about analogies. Okay, why don't we begin? Because we're going to be talking about menopause today, pelvic pain. I thought it would be helpful if we just for a couple of minutes talk about what exactly menopause is?
[00:04:20] Nicole Schroeder: Sure. I mean, so the most kind of easy definition is that menopause is when the ovaries decrease in function and no longer release eggs. And this process leads to low levels of estrogen in the body. And menopause is diagnosed after 12 consecutive months without a menstrual period. So, you know, menopause is actually diagnosed in retrospect, because you not actually know if you're finished until you've gone 12 months without a menstrual period.
[00:04:53] Nicole Schroeder: But I would say that, you know, Jen Gunter, who is a very well-known kind of OBGYN and superstar author, has written a book called The Menopause Manifesto that I would highly recommend to anyone. And she talks a lot about the menopause transition. So that incorporates, you know, what is traditionally kind of known as perimenopause, which is, you know, in average, kind of starts happening around age 45. And the hormonal sort of fluctuations that are happening
[00:05:24] Nicole Schroeder: from that state until one goes 12 months without menstrual period.
[00:05:29] Michelle: Right. I know that a lot of people are confused. Say you're around 45 and you're not totally sure if you're in perimenopause, but you're having some symptoms. And I know people have said, well, go to your family doctor and get a blood test. and then yeah and I I wondered is that sort of the process
[00:06:00] Michelle: Or do we just kind of assume that when we're 45, that we're probably some things are going on in our bodies?
[00:06:09] Nicole Schroeder: Yeah, so that's a really good question and one that comes up a lot. you know, any of the associations, so the, you know, OBGYN Society of Canada, the North American Menopause Society, all of the kind of, you know, systems that sort of are experts in menopause would say that you do not need a blood test to determine if you're in menopause. And again, to quote Jen Gunter again, she talks about in her book, you know, often like,
[00:06:37] Nicole Schroeder: we don't need a blood test to know that someone is going into puberty. It's based on symptoms or changes that might be happening. You know, there isn't a kind of moment that you are now officially in puberty. And it's very similar to the menopause transition. So the other piece that I think is tricky is that, you know, hormones fluctuate hour to hour. What a blood test reflects at 10 in the morning may be different at 6 p.m. in the evening. And so again, it's the sort of perspective from
[00:07:11] Nicole Schroeder: the clinic I work in that has a menopause kind of speciality in it is that it's based on symptoms, age and kind of symptomology. So yeah, so that's the answer. Does that mean that people aren't getting blood tests all the time? They are.
[00:07:28] Michelle: Yeah, except I guess those blood tests wouldn't necessarily be accurate.
[00:07:34] Nicole Schroeder: Right. And I think that's kind of the key part is that, you know, I've had this conversation with friends where, you know, they have done a blood test that has indicated that they are in, you know, the fluctuations that would indicate kind of menopause or perimenopause. And they found that validating. My concern is that if that becomes the marker of how menopause is, you know, diagnosed, so to speak, then what happens to the people whose hormone levels were fluctuating differently at that time. And what that means is
[00:08:03] Nicole Schroeder: that they may not be recognized and their symptoms may not then be addressed. So I think it's a really important kind of takeaway to be mindful of.
[00:08:14] Michelle: Yeah. I don't know if there is a change or if it's just me now that I'm in those years of, you know, being past 45 and having symptoms of perimenopause, but it feels as if there's a lot more discussion going on than I've ever. I mean, I don't know if it's just because now I'm in that age range or if in fact there is an
[00:08:48] Michelle: an increased amount of people out in the world talking about this. What are you like? What are your thoughts?
[00:08:55] Nicole Schroeder: Yeah, I mean, I have I have thoughts on this. I have a lot of thoughts. And again, like this is anecdotal. This is my perspective. I have no sort of research to back this up. But my sort of take is that, you know, we are kind of firmly in the generational group of Generation X. And my perspective is that Generation X, we are known for talking about things, you know.
[00:09:24] Michelle: And Generation X is like you're born between 1965 and 1980, yeah?
[00:09:31] Nicole Schroeder: Yeah, 1981, I think, is the cutoff or 80, yeah. And so if I'm doing the math right, I think that puts us both being born kind of in the mid-70s. Um, so, you know, it's interesting because our generation, I think what has often been the kind of generation that had more independence than previous generations from a child rearing perspective, um, you know, coming up in sort of the like early eighties. Um, I think we were the
[00:10:01] Nicole Schroeder: first generation that was really kind of affected by, you know, more, more people's, both parents working or being in single parent households. So we had more time to kind of be on our own. And it's funny, I always, you know, when I'm talking about menopause, which I talk about a lot, not just because I am interested in it and teach on it, but also because I'm in it. And most of my friends are too. We often talk about the fact that we've always talked about these things,
[00:10:32] Nicole Schroeder: you know, these sorts of topics, whether we're talking about mental health issues, or, you know, consent or sexual assault or other things that kind of were prevalent and becoming more sort of talked about, I would say in the 80s and 90s, we were the people that were talking about it. So my theory is that, you know, we're just a generation that is used to talking about things that have maybe been less encouraged to talk about. And I think now that generation is fully
[00:11:04] Nicole Schroeder: in the menopause transition. And we're not going to not talk about it.
[00:11:09] Michelle: How many, how many people, because I have listened to one of your talks, and I think you made this, this, you put out a statistic about right now, how many people in the population are actually going through this stage. And it was huge.
[00:11:26] Nicole Schroeder: Yeah, yeah. I mean, it's, it's, It's at any point, I mean, again, it's going to vary, but, you know, probably a good chunk of the population will be in the state at some point. I think the stat that you're referring to, if I'm thinking of it, is that the average person will spend a third of their life in the menopause transition. And yeah, you're nodding. So I'm thinking that is the right one. And that's because, you know, I mean, that's we live longer, you know. So really we're going to.
[00:12:00] Nicole Schroeder: to spend a good chunk of this. And so I feel really passionate about the fact that we have to get comfy in this state. And, and, you know, the kind of previous narratives that this was sort of this like mournful time where life became sad and, you know, kind of to your reference of like sad face menopause, or we're losing some, I don't know, kind of part of ourselves, like, it that's a long time to be miserable if that's going to be the way that we're approaching it
[00:12:34] Michelle: and i and i imagine also even how we you know coined the term menopause and how we saw it and how it was treated um which by the way like i i believe that name was coined by a person with a penis a man um and it was very much focused on the symptoms and the health risks
[00:13:07] Michelle: and versus um just the experience and like the changes that can go on and like the emotional transition and yeah a lot of it was missed and it sounds like now we're getting a better idea because now we have as you said we have a lot more people that are like with strong voices out there that are putting it out and also on like with pop culture right like
[00:13:40] Michelle: we have access to so many people who have views on this and it's not just even like western views right like we're getting kind of input around how in different cultures even that menopause is is viewed but but but going back to just the talking about it I mean even Michelle Obama I I think she has a podcast where she talks about her experience of going through menopause.
[00:14:13] Michelle: And it was like a furnace just turned on inside of her body and why it seems to be so hard for the Western culture to really embrace it versus like really try to dig your heels in and push away something that is not like you can't. You either have to like embrace it and like lean into it because it's going to happen. So you might as well like get comfy.
[00:14:43] Nicole Schroeder: Yeah. Yeah. A hundred percent, you know, and it's I mean, I have other kind of thoughts on this. And I think one of the things, like when you look back on kind of... how menopause has been represented in pop culture or in, you know, advertisements and whatnot. If you look back at the kind of advertising from, you know, the 60s or 70s, you know, people were often, it was like a joke, like that women going through menopause were these kind of shrews
[00:15:17] Nicole Schroeder: and difficult to deal with and we're going to lose our youth and our vitality and...
[00:15:24] Michelle: Our sex drive.
[00:15:25] Nicole Schroeder: Our sex drive, everything. And I think, you know, Again, like, I don't think this is too conspiracy theory. But I mean, again, like, the quickest way to shut a woman up is to, you know, tell her that she's inconsequential or mouthy or crabby or fat or any of these kinds of things.
[00:15:47] Nicole Schroeder: And so, you know, I think that it's not a shock to me that that sort of narrative became developed when actually this is a time in life where people have generally had quite enough of being bossed around. And I think this is something that I talk about with a lot of people is that when kind of female presenting or identifying people get to their mid-40s, they often have kind of less cares to give.
[00:16:20] Nicole Schroeder: And what may have been kind of detrimental to one's sense of self at 20 is quite different for a lot of folks at 45. And so, you know, again, if we look at, you know, how do you kind of exploit people? Will you make them feel inferior? So, you know, I think there's a lot of things that happen.
[00:16:45] Michelle: Yeah, especially I think, within the Western culture, especially how so much is so much value is put on how you look, your sexual desirability, your Yeah, like your weight, all of these things. And so we have, you know, rather than I think challenging some of these ideas, now I think we're starting to think about where some of those ideas came from. Right? Yeah.
[00:17:20] Michelle: 100%. Yeah. And then you're like, well, fuck that. Yeah.
[00:17:25] Nicole Schroeder: Yeah, yeah, yeah. Yeah.
[00:17:28] Michelle: Yeah. Where, you know, in other countries, in other cultures, there's actually when you get to that stage in your life, it's a stage where you like earn respect. Right?
[00:17:48] Nicole Schroeder: Yeah, yeah. I mean, Western or North American culture in particular, I mean, we've always fetishized, sorry, fetishized young, white, thin. in conventionally attractive people, right? I mean, it is incredibly problematic. And menopause is sort of a time where, you know, I think people are having to kind of face up to
[00:18:15] Nicole Schroeder: a different time of life. And again, like that, that can be empowering, or that can be challenging. And most people will have an experience that falls somewhere in the middle,
[00:18:27] Nicole Schroeder: And some days it will be empowering and other days it's challenging. But yeah, I think trying to kind of claim something that people have kind of said has been a bad thing, like being older and, you know, not kind of needing to please people in the same way. I mean, these are positive things. So, you know, yeah, I think lean in.
[00:18:53] Michelle: Yeah. And with the work that you do, let's say in some of the groups that you run, when you talk about leaning in to and sort of giving yourself over to the experience and seeing it as opportunity and growth, growth. Like, what are some of the ways that you talk about it or that you at least,
[00:19:27] Michelle: what's the word, challenge people to do that?
[00:19:30] Nicole Schroeder: Yeah, I mean, I would say that the first step is even just talking about it. And I think, you know, we're friends and both therapists, But so I think we probably are definitely of this ilk. I mean, we talk a lot about things. We talk about sex a lot. We talk about bodies a lot. We talk about feelings. We talk about, I mean, this is going to be in our wheelhouse. But I don't think the majority of people are doing this. I know they aren't.
[00:20:01] Nicole Schroeder: And so, you know, again, like, I also wonder if part of getting comfy in this kind of transition is also around how much you talk and think about these things. But a lot of people, and I think this is the overwhelming feedback I get, is folks will come to these groups and they will say, I didn't know anything about menopause other than it was like going to be a disaster. My family never talked about it. I'm having these symptoms that I don't tell anyone because I'm
[00:20:32] Nicole Schroeder: embarrassed and I feel like I'm on my own. So frankly, I mean, like you, we can't even know what we think about something if, if you've never had any space to talk about it. So I think like the first step of kind of leaning in is just even saying like, Hey, there's this topic. Does, does anybody want to hear, hear some thoughts I have? And I'd like to hear your thoughts. So I think... Yeah, like it's kind of like that's the first step.
[00:21:03] Michelle: It's talking with other people, validating your experience, not feeling alone. And I guess also hearing how other people think about it, right? And seeing what things that maybe they're doing, resources that they're using that could be super helpful.
[00:21:23] Nicole Schroeder: A hundred percent. And that connection. Like, you know, I have an EFT training background, so this will probably make sense as well to you.
[00:21:34] Michelle: Emotion-focused therapy.
[00:21:36] Nicole Schroeder: Emotion-focused therapy. Exactly. Sorry for the annoying acronym. But essentially, you know, if you were going to define what emotion-focused therapy is, it's that like the sort of one of the ideologies is that humans are wired to seek out other humans and have connections. And I think, you know, when I think about the groups, the overwhelming kind of feedback about why it's beneficial is that people say, like, I just didn't know there would be anyone who would care about what I had to say or interested in these things.
[00:22:09] Nicole Schroeder: And I didn't know other people would be willing to share their experiences. And I learned from that. So, so again, like it's, it's kind of, you know, I mean, you can do a presentation and provide people information. but again there has to be a sort of buy-in as to why people are willing to to listen to things or to feel to share so again I think it's all about that kind of like seeking out connectivity yeah
[00:22:35] Michelle: and I I guess also it's once you start to feel feel validated with you know your friends that may be going through the same thing I think ultimately what would be so helpful is if their partners who aren't going through menopause would be able to have a better understanding of the process of it and realize that it's not something that is just happening
[00:23:09] Michelle: to their partner, but it's actually happening to both of them, right? And like find like where It's more of a shared, a shared, I don't know, transition. Yeah. Yeah.
[00:23:22] Nicole Schroeder: I mean, again, you know, I, I, I loved Jen Gunter's comparison about puberty to menopause and I love it. I always keep coming back to it when I'm explaining these things or thinking about them myself, because, you know, it's, it's a bit like for, for people that have children or parenting, you know, when a person that you're a parent of is going through something from a developmental standpoint, the sort of trauma-informed and helpful way to deal with that is approaching it as a sort of family system, right?
[00:23:56] Nicole Schroeder: So how do we kind of like go together to support? someone that's going through a transition. Again, like a transition could be good or it could be bad. And so that's often what I try to also encourage folks in relationships. Like, this is something that's happening to maybe one or more persons in this relationship, but how do we kind of lean in and support one another? And the first way is by education. I mean, because if what you have been telling yourself or what your narrative is, is factually incorrect. That's also going to
[00:24:30] Nicole Schroeder: change the way that you see something. So I think I think part of it is almost about kind of busting some myths or thoughts that people may have around it. And and they can provide that information to their partner as well. And that can be helpful.
[00:24:44] Michelle: Yeah. The story that I've heard more than once, which really, it kind of irks me is I've heard a couple of people say, well, the relationship ended because she was going through menopause and things got really, really bad between us at that stage. And there's like a lot of focus on using menopause as the reason for a relationship
[00:25:16] Michelle: breakdown. And there's the part of me that's just like, you get this, like, you go back into your old sort of way of thinking and what you know of like more traditional ideas of menopause, right? And then you're just like, you know, you feel like I felt like scared inside of me because I'm like, oh fuck like here we go right and then another part is like hold on a second yeah yeah like
[00:25:48] Michelle: where where were you in all of this
[00:25:51] Nicole Schroeder: right right right yeah I mean it's a good point I I think for me I and and maybe again like this is the uh emotion focus therapy lens that I I kind of put on as well is, is like, it's interesting data. When when people describe something in a way that almost seems too simplistic, or there's like a very kind of easy explanation as to what happened.
[00:26:20] Nicole Schroeder: I'm always just looking at that as like important information to explore. Oh, in a way, I kind of think here's another kind of cliche that people will talk about it's that I think is the kind of male equivalent of the menopause. Like, oh, he's had a midlife crisis, you know, like, like, he's bought a Camaro, and he's had a midlife crisis. I mean, what does that actually mean? I mean, again, I think it's one of these like terms that get kind of thrown around and,
[00:26:51] Nicole Schroeder: and what people might think is different from person to person. But there's obviously a few kind of themes. that people are probably similar. So it would be the same if I had a couple who said, you know, the relationship ended after his midlife crisis. I would be curious as to what that looked like.
[00:27:15] Michelle: Exactly. Yeah, for sure. And even when somebody comes in to my office or your office, and they say, well, my desire for sex has like gone down since I started having symptoms of menopause or perimenopause. Like what, what do you say to that?
[00:27:40] Nicole Schroeder: Yeah. I mean, the, the, the first question that I all, I always ask is, you know, how do you feel about that? Right? Like Like, how do you, are you distressed by this? Like, that's always my first question. And I think this is an interesting part, and I'm sure that this is something familiar to you, but like, when we look at sort of like sexual challenges in the DSM-5, so that is the Diagnostic and Statistical Manual of...
[00:28:07] Michelle: It's like where we get diagnoses from.
[00:28:09] Nicole Schroeder: It's where we get diagnoses from, yeah, American Psychiatric Association. Yeah. And again, you know, I'm sure we could do an entire other podcast on on that as a concept. But but I think the interesting piece and this is something I talk about in all of my groups, whether we're talking about pelvic pain, we're talking about, you know, quote unquote, sexual dysfunction or we're talking about menopause. I want to understand what what the level of distress is around these.
[00:28:38] Nicole Schroeder: And so going back to the point about the DSM-5, so even when we're looking at certain, quote unquote, again, sexual disorders like low desire, which is not, it has a much longer name that I can't blanking on right now. But when we're looking at that, the criteria in order to meet the diagnosis has to include the person themselves being distressed by the situation. and and this is an important part right because again you know there's these like facts and you
[00:29:11] Nicole Schroeder: can't see me in this podcast but I'm doing quotes
[00:29:14] Michelle: well there's a video there's a video but so yeah yes that it could yes there might be a video to this so you'll be able to see the air quotes
[00:29:24] Nicole Schroeder: okay perfect air quotes um that uh you know oh gosh sorry I've just now lost my train of thought
[00:29:32] Michelle: I totally just lost your train of thought because I told you it was like being videotaped.
[00:29:37] Nicole Schroeder: Oh, yeah, yeah, yeah. No, I got you. I got you. Okay. So you have to be distressed by the symptoms. And I think that that is a very important part of it because, oh, sorry, I know where I was going with this. Yes, talking about the kind of facts of society. So it's kind of like, you know, people will say, well, I understand that the average couple has sex three times. a week. And first off, I don't know where that stat comes from. I have no idea where that stat comes from. We don't think it's a real stat.
[00:30:08] Michelle: And who are they asking?
[00:30:10] Nicole Schroeder: Right? Once you start to ask questions, this whole thing falls apart very quickly.
[00:30:16] Michelle: It blows up.
[00:30:16] Nicole Schroeder: Totally. So it's kind of like these interesting things around like people will say, you know, I don't feel desire in a normal way. And again, if it's kind of like, well, what is normal? So when people are talking about either symptoms of menopause, or they're talking about, you know, desire around the menopause transition, like, my first question is, like, how do you feel about this? Are you bothered by this? Because they're, that's going to determine a, you know, what the treatments are going to be.
[00:30:49] Nicole Schroeder: If a person says, well, no, I'm not bothered in the least, I have noticed a change in my desire, but I actually don't care. Then, you know, again, that's going to be a different situation. Right. So so that is always my first kind of my first question. And then the second question is always around symptoms. Like, like, when you say that you kind of correlate or connect this to being, you know, secondary to menopause, like, tell me what your symptoms are like. And I want to know
[00:31:21] Nicole Schroeder: that kind of information because, you know, there are very pronounced symptoms that can affect sexuality. And those are what kind of fall under the genitourinary syndrome of menopause. GSM is often what it's abbreviated to. But, you know, that can include sort of urinary tract infections that can include dryness, burning, kind of pain with penetrative sex, if people are having that. And this can be easily treatable or treatable. I don't want to say easily necessarily,
[00:31:52] Nicole Schroeder: but, you know, so those are the questions that I would be wanting to know a little bit more about. And again, like desire is complicated.
[00:32:01] Michelle: It's so complicated, right? You don't, yeah, as you said, is desire, low desire related to you going, having menopause, perimenopause symptoms? or have there been other things going on in your life? Big changes, relationship stressors, a pandemic. Yeah, exactly, right? I mean, it's like you pretty much have to tease out a lot. It's not cut and dry.
[00:32:33] Michelle: Although some people find it a relief to be able to say, well, I think it's because I'm going through perimenopause.
[00:32:43] Nicole Schroeder: Yeah, for sure. and again like for some people having an explanation or context that makes sense to them is helpful right because it it gives them a kind of um map if you will to to try and navigate and again like that's kind of what I strive to do when I'm talking about sexuality in these groups is, is we can provide the evidence that we know, we do know that, you know, from from a kind of research perspective, there is a there is a correlation between the menopause transition
[00:33:18] Nicole Schroeder: and lowering of desire. But again, it's too easy to say what is because of menopause, it could be because of symptoms, it could be because you haven't slept well in six months, It could be because your mood is being impacted by hormonal fluctuations.
[00:33:34] Michelle: Totally. And yeah, if you say we're having sex, and let's say that sex included intercourse, and it was feeling painful, chances are when you think about sex, you're going to start to connect it to feeling painful, which then kind of blocks your ability to be open to it.
[00:33:58] Nicole Schroeder: A hundred percent. And this is something that often, you know, comes up in pelvic pain when we're talking about kind of conditions that can cause either pelvic or vulvar pain. And this is one of the things that happens if people try to kind of like grit their teeth and force themselves to engage in things that are causing them physical pain. you know the brain is going to remember that and and you know there's going to be an automatic
[00:34:27] Nicole Schroeder: kind of activation of the the parasympathetic nervous system when when sex is kind of on the table so again
[00:34:36] Michelle: yeah because your your brain is pretty much telling you to not let what is causing you pain in like protecting you like creating a wall right so i mean it completely makes sense
[00:34:49] Nicole Schroeder: Yeah, yeah. So it's, it's, again, like, it, it, it's important to address that, right? Like, and I think, you know, one of the, one of the conditions that I do see a lot of when I'm working in, in the clinic that I work in, are conditions like vulvodynia, which is a sort of vulvar condition that involves nerve pain in the vulvar region, or in the vestibule, which is the entrance kind of to the vagina.
[00:35:17] Nicole Schroeder: Um, and you know, this is a diagnosis that is, is very impactful for people with vulvas and, you know, yet most people have never heard of it. So again, like it's a little bit going back to the point of like, if you can name it, you have a better chance of, of creating some new narratives or understanding around it. Um, because more, you know, you can actually talk about it and,
[00:35:47] Nicole Schroeder: And for people, especially I would say with conditions like vulvodynia or vaginismus, vaginismus is the contracting of the vaginal muscles where then penetration can't happen. And these are conditions that people are really struggling often to talk about it.
[00:36:06] Michelle: Yeah, well, because I also think that sometimes when they have talked about it and sometimes it is having talked about it with even a medical professional are being told it's all in your head. Right. Which which I mean, can really it makes you not be able to trust what it is that you are actually experiencing.
[00:36:35] Michelle: Look, I'm not saying that there isn't a connection between, yeah, when you imagine and you're afraid of a painful sexual encounter, yeah, like your body is going to tense up and it's going to be uncomfortable if you try to have penetration during that time. So I'm not saying that there is no connection, but it does nobody any favors when people say it's all in your head because it's there.
[00:37:09] Michelle: You feel it. Like you feel pain. It's happening.
[00:37:13] Nicole Schroeder: A hundred percent. And I think, you know, one of the things it's in your head in so far is that the brain is connected to pain. Yeah. But that's the only bit. And when people say it's in your head, that's not what they're referring to. I mean, what people's experience is often is that they're being told that they are unwell and that they are psychologically damaged. And that is not true. And pain, nerve pain, this kind of pain is very real.
[00:37:42] Nicole Schroeder: And I think what we often, you know, what we do know is that the average person for a condition like vulvodynia has gone to three different medical professionals looking for a diagnosis and being diagnosed incorrectly.
[00:37:58] Michelle: Why? Why do you think this is happening? Like, just, and look, I'm just saying, I'm not saying that we know why because this has been documented. Like, what do you, because I have my thoughts, but I'm curious what your thoughts are. And I'll say my thoughts too.
[00:38:15] Nicole Schroeder: Yeah, I mean, I think I'm probably not shattering anybody's brain with the information that I view this, the medical system as well as our society through a feminist lens. Um, so, you know, for me, we know that kind of vulvar health is, is underfunded. And, you know, again, like is there's less of these doctors who have expertise in these areas. Um, I don't think it's a coincidence that the people who are often attached to vulvas
[00:38:49] Nicole Schroeder: are, are people who identify as women. So, you know, again, like we have a long history of, of inequality in many ways. So, you know, I think. I think it's complicated. And but yeah, and I also think there is an inherent kind of shame in in patriarchal societies around female presenting bodies. And, you know, the shame
[00:39:16] Nicole Schroeder: that people often feel talking about their vagina or their vulva. And I think that that is huge. And If they feel comfortable, not comfortable, sorry, talking about their genitals, they're going to have a harder time explaining the situation or finding an appropriate healthcare practitioner. So I think the problems are multilayered.
[00:39:42] Michelle: Oh, for sure. And I mean, how I view it is regardless, I mean, even medical professionals, they grow up with their own values around sex and sexuality.
[00:39:59] Nicole Schroeder: Yeah, we all drink the Kool-Aid.
[00:40:00] Michelle: We all drink the Kool-Aid. And so even though, yeah, you're going to see somebody who's, let's say, a GP, it doesn't necessarily mean that they've done all of the work to challenge their own shame, their own conflicts around sex and sexuality, which, I mean, I think is just, and this isn't news to you.
[00:40:30] Michelle: But it's not their fault. It's the training that goes in to their program that is lacking time to really learn about sex and sexuality.
[00:40:44] Nicole Schroeder: yeah I mean a hundred percent it's it's really complicated I and really really awful right because I think you know when I think about the things like the most common thing that people will will tell me is that they you know again and this is not to kind of just have a go at GPs because like this is problematic in in many ways um for many different people across all different kinds of careers. Yes, 100%. But I think it's interesting because people will say, you know,
[00:41:19] Nicole Schroeder: I talked to my doctor, I tried to explain what was happening. And, you know, they said, you know, just try and relax, like have a glass of wine, just relax, which is pretty patronizing.
[00:41:31] Michelle: I mean, maybe that's what they do. Right, right. Yeah.
[00:41:35] Nicole Schroeder: I don't know. Again, it kind of makes people feel like, okay, well, I'm just nervous or they feel invalidated when actually what they're talking about is kind of nerve pain at specific points or like specific parts on the vulva. So I think people feel very, by the time I often get to see them in the gynecology clinic, they have... really been through the ringer. And the fact that now they're being seen by a team that is,
[00:42:05] Nicole Schroeder: has expertise in this area and, you know, they may receive a diagnosis, they may receive clarification and information. You know, I think people are just beyond exhausted.
[00:42:17] Michelle: Yeah. And, and also there are a lot, and I think more and more family doctors that are having these conversations with their patients around perimenopause, and they have the correct referrals when they are having vulva pain, which is wonderful. And I'm hearing it more and more where my clients are saying, oh, yeah, they asked about this, and it gives me so much
[00:42:50] Michelle: hope. How, I guess, how would somebody know if it's a good fit, right? Like if they're having some either pain or some symptoms that are related, you know, to the vulva area, how, what can they do if, like, how do they know if in fact their GP, what do they trust? Do they trust their gut? Like, and if it's not a good fit, like, what are the
[00:43:24] Michelle: options?
[00:43:26] Nicole Schroeder: I mean, I think this is sort of the way that I operate. When I go to my GP, who I adore, by the way.
[00:43:35] Michelle: Yeah, I adore mine too.
[00:43:37] Nicole Schroeder: Yeah. I think, okay, do I have a sufficient explanation? Do I have an understanding of why this is happening? It is not enough to just sort of say, well, we don't know. Like, again, you know, there's often more to that. And sometimes in medicine, we don't know, you know, like science hasn't caught up with everything yet. We don't know everything. um but I think what I would often say you know I I if I'm gonna get my car fixed like I'm gonna go
[00:44:09] Nicole Schroeder: to a mechanic I'm not going to like just take my googling opinion for that so what I would say to people is if you are having any sort of pain in the vulva or vagina areas um talk to your GP if you are not if you don't have an understanding of why this may be happening and it's continuing on ask for a referral to a gynecologist. That is your best bet. They are experts in understanding kind of vulvar and vagina pain, vaginal pain, and other parts of kind of what is called the
[00:44:41] Nicole Schroeder: more reproductive kind of system. So again, like I, it's kind of like with menopause, right? I, I would like my kind of hot takes on menopause from the North American Menopause Society that are experts in it. So, you know, again, I think getting referred to the correct practitioner is important. And education, right? I mean, you know, again, I promise I don't know Jen Gunter, and I'm plugging her constantly. She's not asked me to. I don't know her. But her book, which is called The Vagina Bible,
[00:45:17] Nicole Schroeder: is an excellent resource for anyone with a vulvar vagina or anyone who knows anyone with one. because it talks a lot about, you know, just different conditions, how things work, and really provides a lot of food for thought on good questions to ask.
[00:45:36] Michelle: And also she wrote The Menopause Manifesto.
[00:45:39] Nicole Schroeder: Yes, exactly.
[00:45:40] Michelle: Which is amazing. And every time I give it to somebody, they're like so grateful that they have the opportunity to read that book. tell me like how did you get into this specific area of interest like when it comes to let's say pelvic pain like what what is it about this piece that feels super important to you and that where you want to be able to educate the people out there
[00:46:09] Nicole Schroeder: I think it's really important because I Again, this is just my experience, but I think that female presenting people or people with vulvas and vaginas carry a lot of shame in that area to begin with. And I again, like, I hope that not everyone does. But, you know, when you have kind of lived your life with the narratives that we have around kind of vulvas and vaginas and just being an owner of one of those.
[00:46:42] Nicole Schroeder: like I think it's it's really silenced. And I think that, you know, again, like talking about pain in that area of the body is different than talking about arm pain or knee pain. Like we, North American culture is strange, because we are saturated in sex. And yet we have a really difficult time talking about it in a factual way or an educational way. So I think, you know, part of the reason that I feel so passionate about this is because I'm a crabby Gen Xer.
[00:47:16] Nicole Schroeder: Like, and now I'm in menopause myself. So I'm going through all of this. I just think that we're really sold a bad bill of goods about this kind of information. And I'm going to give you an example. I mean, one of one of the most common kind of questions that that I get or that people will raise is around like, you know, having an orgasm from penetrative sex. And and this comes
[00:47:46] Nicole Schroeder: up time and time again, I'm sure it does for you. I mean, people think there is something wrong with them if they are not able to have an orgasm from penetrative sex with a penis. And, you know, again, And like the stats, I mean, there are not that many people who are able to do that.
[00:48:06] Michelle: No, and I think that people have talked to the few people that can. Right. And they've taken that seed and planted it somewhere in their head that that is like the goal to work towards. And hey, look, I think there are people out there who not just have one orgasm from penetrative sex, but multiple and all like it's wonderful. And I think that's great.
[00:48:34] Nicole Schroeder: More power to them.
[00:48:34] Michelle: All the power to you. OMG, right?
[00:48:38] Nicole Schroeder: A hundred percent. Right? This is not to shame those few people who can. It's great.
[00:48:44] Michelle: I think it just has to do with like how their bodies are, right?
[00:48:47] Nicole Schroeder: A hundred percent. Like that's it. But it's, you know, this myth or this idea that all these people are having these orgasms, it isn't just being created by people in their mind. It's reinforced in every rom-com or every show we watch. You know, I was watching it yesterday. I can't even remember what it was now.
[00:49:10] Nicole Schroeder: But literally, it's a cis-heterocouple that kisses for, you know, sort of 15 seconds, and then their clothes come off, and then they're having penetrative sex, and then they both have an orgasm at the same time. Yeah. It is what we see over and over again. And that sends the message to people that this is what everybody is doing.
[00:49:33] Michelle: And if you're not doing it, it's wrong.
[00:49:35] Nicole Schroeder: Yeah, exactly.
[00:49:36] Michelle: What they do for pleasure is wrong, and you need to be doing it this way. And man, how many people do you see? Because I see a lot where they're just like, but it's so much better when we come together. And like, good. Like, I'm so, that's amazing. And when that happens, like, awesome. But the fact of the matter is, is that the majority of people and our bodies were different humans, were different people in that exact moment of the day, depending even how our
[00:50:05] Michelle: day was, that you can't have that to be the gold standard.
[00:50:11] Nicole Schroeder: Right. I mean, it just sets up again, this like perfectionism and this certain way of being. And again, like, it all comes back to capitalism. Like you keep people wanting to purchase things, right? It's, you know, buy this, buy this outfit, use this toy. I mean, again, like there's money to be made on these things. And, you know, when you can kind of portray sexuality repeatedly in this one way, it really, it makes people feel inferior.
[00:50:46] Nicole Schroeder: I mean, again, representation matters. Like, if the only people you see having sex on television are kind of thin white people who are always having orgasms at the same time, like, what does that say? Um, and I just don't like, I just, I just don't like being taken for a ride. So I think that's part of it, right?
[00:51:08] Michelle: And not like the good ride.
[00:51:10] Nicole Schroeder: No, no, no. Emotionally, emotionally tricked. Um, yeah, you know, I think, I think again, like it's, it's just, it's just not factual. And, and that, that is what I find frustrating. So if we can actually look at the stats on things, and we can say, you know what, this is what the majority of people are doing. And this is what the majority of people's experiences are. Like there's, there's going to be different ones and that's great. But again, like it's, it's normalizing people's experience. It's, it's
[00:51:41] Nicole Schroeder: allowing people to kind of say, you know what, like I've never had that experience and maybe it is what I'd like to have, but it's actually perfectly normal that I haven't. I mean, I'm thinking about your, your kind of couple with the idea of like, oh, it's best when we do this together at the same time. But I mean, imagine if that's the way you approach to like every meal you made. I mean, you would be exhausted. Like every meal must be a Michelin star grade.
[00:52:05] Michelle: Or we need to, we need to be full at exactly the same time.
[00:52:09] Nicole Schroeder: I mean, it would be exhausting. So like, again, I think there's, there's this some natural sort of like we, but we hold sex in this pedestal. Yeah. That it's different, right. It's somehow different. And it's, so again, like I always think, you know, like apply the same logic to something a little bit more mundane, like making dinner. Do you expect this kind of gourmet dinner every single night?
[00:52:41] Michelle: Or like be okay with having two separate dishes, but really enjoying the experience. Right? Right? You don't both have to have chicken.
[00:52:50] Nicole Schroeder: No, at the same time.
[00:52:53] Michelle: At the same time. um yeah so i think for you with with the talking about pelvic health talking about menopause a lot of it is also debunking a lot of the myths that are out there that are i think causing a lot of people to stress and like making them not feel air quotes normal
[00:53:14] Nicole Schroeder: yeah yeah a hundred percent a hundred percent and and not knowing like again that there are options like there are treatments for different conditions, right? Like, it's important. Life can be changed.
[00:53:32] Michelle: You don't have to grin and bear it. If you are struggling with the symptoms of perimenopause, if you are struggling with pelvic pain, you can first, you can speak with either friends, family, but also to your GP. If they're not quite getting it, you can be referred to or asked to be referred to a gynecologist.
[00:54:00] Nicole Schroeder: Yeah, 100%.
[00:54:02] Michelle: You could see a sex therapist who would likely set you on that same path. That's a lot of, I think, the work that I do, especially when it comes to pain. Pelvic pain is like, I'm like, here, go see your GP. Gynecologist, pelvic pain physio.
[00:54:23] Nicole Schroeder: Yeah, I was just going to say, and we have to give a shout out to the pelvic floor physio world. Oh my gosh. Yes. You know, and I think if there was one thing that if before I die, I would like to see changed, it would be that OHIP covers pelvic floor physiotherapy for pelvic pain.
[00:54:44] Michelle: I agree. I agree. Actually, I'm going to be at one of my episodes and it's probably going to be right after this one. I'm interviewing Michiko Caringal, who is a pelvic floor physiotherapist. She was in Toronto now. She's in Victoria, BC. And she is awesome. And we're going to talk a lot about pelvic health in both female presenting people and male presenting people.
[00:55:13] Nicole Schroeder: Yeah. Amazing. That's going to be so good. Yeah. I mean, and again, like if you have benefits or you can afford it, like pelvic floor physiotherapy is one of the kind of multi-pronged treatment recommendations for any kind of pelvic pain condition, also for the genitourinary syndromes, symptoms of menopause.
[00:55:35] Michelle: Even like going to the just the first session, even to just learn about what is actually helping or what is happening, I should say, is so helpful and therapeutic and makes sense. I'm so on board with you with that for sure. Sure. Nicole, is there anything else that I haven't asked you about that you think would be important for me to say?
[00:56:10] Nicole Schroeder: No, I don't think so. I think you've asked everything and I've really enjoyed this conversation. I just, I think, you know, it is so important for people to, like, again, educate yourself, get comfortable, advocate for yourselves around kind of vulvar health, whatever that looks like, and know that you are not alone in this. And again, like, this is a powerful, powerful time of life. I feel very strongly about this, as I like to say,
[00:56:44] Nicole Schroeder: as was just sort of Gen X joke. Not only am I the president, I'm also a member, is how I kind of think of menopause at this point. If anyone remembers that hair club
[00:56:56] Michelle: I did. Oh my God, Nicole, you're hilarious. Okay, Nicole, where can people find you? What like, yeah, what are your details?
[00:57:10] Nicole Schroeder: Yeah, yeah, yeah. So the best way to find me is probably just to have a look at my website. Or you can email me directly at therapy@nicoleschroeder.ca. I'm sure there'll be you can spell it down it'll be
[00:57:27] Michelle: I will put everything down for contact information
[00:57:32] Nicole Schroeder: yeah and if you're also interested in in kind of menopause groups that I do run they are accessible for people if they would like to join BRIA which is a virtual mental health clinic in Toronto, Ontario. Um, B R I A. Yeah. Better is, uh, is the way you could find it. It's a, on a Jane app. So you do have to be a member of the clinic to, to access groups, but, um, yeah, I'll put running those too.
[00:58:03] Michelle: I'll put those details there as well, Nicole. And for all of you. I am now newly on Instagram at getsome_podcast. I'm pretty new. So like pretty lonely. And I maybe have like 32 followers at this point. And I need company because I think you'll find it interesting. I think it's going to be some informative content. And it's probably also me being silly once in a while.
[00:58:33] Nicole Schroeder: I'm definitely going to follow it. I also have an Instagram account.
[00:58:37] Michelle: Oh, you do?
[00:58:38] Nicole Schroeder: Yeah, yeah. It's Nicole Schroeder Therapy.
[00:58:42] Michelle: Yay.
[00:58:43] Nicole Schroeder: I believe.
[00:58:43] Michelle: Oh, good. Okay. So now I'm going to have 33 followers. Woo!
[00:58:49] Nicole Schroeder: I'll be doing it quickly.
[00:58:51] Michelle: Thank you so much, Nicole. It was such a wonderful interview with you. I always enjoy talking to you. Take care.
[00:58:58] Nicole Schroeder: Thank you so much as well. Thank you.
[00:59:03] Michelle: If you have a question, a confession, or an inspirational story, send me an email to the confession booth at michelle@getsome.ca and you just might hear it on the air. I hope you enjoyed GETSOME. If you'd like to listen to more episodes, Subscribe to wherever you like to listen to podcasts. And until then, be kind to yourself, be curious, and when you're ready, your sexual journey will unfold.