Episode 12: Difficult Women, Hot Flushes & Perimenopause

In this episode Kate Thomas, an AHPRA-registered pharmacist with 25 years of clinical experience, covers:

• Why the word difficult follows women who stop being agreeable and what that has to do with midlife
• Anxiety, rage and emotional sensitivity in your 40s and the hormonal biology behind it
• Painful sex and vaginal dryness as perimenopause symptoms
• Why abdominal weight gain happens during perimenopause even without dietary changes
• Waking at 3am during perimenopause and the hormonal drivers behind it
• Veoza (fezolinetant): a new non-hormonal treatment for menopausal hot flushes
• How fluctuating estrogen affects serotonin, dopamine and GABA

Episode 12 opens with a reflection on the word difficult, prompted by the public labelling of Grace Tame following her political advocacy. Kate is not interested in the politics, but she is very interested in the word itself and the way women everywhere recognise it instantly. The word that appears when women stop being agreeable. Kate shares her own experience of rage-quitting a senior hospital pharmacy leadership role at 45, asking honestly whether she was difficult or simply done. It is a powerful opening that sets up the broader theme of the episode: what happens when women in midlife stop shrinking to fit. 

One of the most compelling features of Episode 12 is Kate's answers to listener questions submitted from around the world, a reminder that menopause does not care what passport you hold. The questions cover some of the most commonly searched perimenopause topics:

Anxiety, rage and crying at emails in your 40s is one of the most googled perimenopause experiences, and Kate explains the biological mechanism behind it clearly, connecting fluctuating estrogen to the neurotransmitter systems that regulate mood, stress response and emotional processing.

Painful sex and vaginal dryness are covered as perimenopause symptoms, with Kate pointing listeners toward the treatment options discussed in more detail in Episode 11.

Abdominal weight gain during perimenopause, even without changes to diet or exercise, is driven by the shift in how the body stores fat as estrogen declines. Kate explains why this happens and what it means for women's health long term.

Waking at 3am fully alert is a classic perimenopause sleep pattern driven by hormonal fluctuations affecting temperature regulation and stress hormones. Kate explains the biology and what options are available.

One of the most important insights Kate shares in Episode 12 is the connection between fluctuating estrogen and the brain's key neurotransmitter systems. Estrogen interacts with serotonin, dopamine and GABA, the chemicals responsible for mood regulation, motivation, reward and the brain's ability to slow down and feel calm. As estrogen fluctuates unpredictably during perimenopause, these systems become destabilised, which is why life in your 40s can suddenly feel harder, more emotional and more overwhelming than it used to. Understanding this biology is the first step in getting the right support. 

Veoza, known generically as fezolinetant, is a new non-hormonal treatment for menopausal hot flushes that works through a completely different mechanism to HRT. Rather than replacing estrogen, it targets the neurokinin B pathway in the brain, which is responsible for triggering the temperature dysregulation that causes hot flushes. In Episode 12, Kate breaks down how fezolinetant works, what the clinical evidence shows, and where it fits for women who cannot or choose not to use hormone therapy. This is an important addition to the menopause treatment toolkit and one that many women and their GPs are only just becoming aware of. 

If this episode has raised questions about hot flushes, perimenopause symptoms, Veoza or your hormone therapy options, a telehealth pharmacist consultation with Kate is a great next step. In a dedicated one-on-one session you can go through your symptoms, your current medications and your treatment options in plain language, without rushing. 

Kate Thomas offers a range of in-depth telehealth medication consultation and medication review services to help you understand your body and your medications.

You can view the transcript for this episode below