Dr Kirstey Holland | This Is Perimenopause

Expanded interview question bank

45 ways to take the conversation deeper

For hosts and producers who would like to take the conversation beyond the Signature Conversations. These questions can be mixed and matched to suit the audience, format and direction of the interview. They are prompts, not a prescribed interview structure.

Hormones, ovulation & progesterone

1. We hear constantly about oestrogen and bone health, but you argue that progesterone belongs in that conversation too. What does progesterone actually do for bone?
2. You've described oestrogen and progesterone as the yin and yang of bone health. What is each hormone doing differently?
3. Progesterone and progestins are often spoken about as though they're interchangeable. Are they actually the same thing?
4. Why does the distinction between body-identical progesterone and a synthetic progestin matter clinically?
5. Can you explain the difference between having a monthly bleed and actually ovulating?
6. Could a woman be having apparently regular periods but still not be getting the progesterone exposure she once did?
7. Why do you describe ovulation as an important health event rather than simply something required to become pregnant?
8. What does progesterone do in the brain, and why might changing progesterone exposure affect sleep, mood or anxiety?
9. What is allopregnanolone, and what does GABA have to do with the way some women feel during hormonal change?
10. Why might progesterone matter for breast health as well as the brain, bones and uterus?

The brain in perimenopause

11. You describe perimenopause as a neurological transition as well as a reproductive one. What is actually changing in the brain?
12. What is the 'brain energy crisis' researchers describe during the menopause transition?
13. Why does the brain use so much of the body's available energy, and what happens when its ability to use glucose changes?
14. Could brain fog, word-finding problems and that feeling of being cognitively slower sometimes be an energy problem rather than evidence that something is wrong with your intelligence?
15. Why can women suddenly experience cravings for quick-energy carbohydrates during perimenopause? Is the brain involved in that signal?
16. What role do mitochondria play in the perimenopausal brain?

Inflammation, energy & the midlife body

17. You've said that perimenopause can create a collision between increasing inflammatory load and decreasing available energy. What's happening physiologically?
18. Why can a woman feel profoundly exhausted even when she's sleeping, eating well and trying to take care of herself?
19. How are inflammation, insulin resistance and mitochondrial function connected?
20. Can inflammation itself affect the brain and contribute to brain fog, mood changes and disturbed sleep?
21. What role does visceral fat play in inflammation? Is body fat actually biologically active?
22. Why might the combination of poor sleep, stress, fluctuating hormones and impaired glucose regulation become self-reinforcing?

The gut really is talking to the brain

23. We hear the gut described as the 'second brain'. Is that just a catchy phrase, or is there real biology behind it?
24. How does the gut actually communicate with the brain?
25. What is the gut-brain axis, and is communication really travelling in both directions?
26. What happens to mood, cognition or stress responses when the gut environment changes?
27. Where does the vagus nerve fit into the gut-brain conversation?
28. We hear that most serotonin is produced in the gut. Does that actually mean gut serotonin controls our mood, or is the story more complicated than that?

Things women were never taught about their bodies

29. Why were so many of us taught about menstruation but almost nothing about ovulation?
30. If ovulation is about much more than fertility, why aren't girls and women taught to recognise it?
31. What's the difference between a contraceptive-pill withdrawal bleed and a physiological menstrual period?
32. What do you mean when you say, 'We shut hormones down at 25 and then turn them back up at 50'?
33. Have we inadvertently taught generations of women to outsource understanding of their own hormonal biology?
34. If you could redesign women's health education from puberty onwards, what would every girl know before she reached adulthood?

The clinical questions nobody seems to ask

35. Why can two women of exactly the same age with apparently similar hormone results feel completely different?
36. Why is 'your blood tests are normal' not necessarily the end of the investigation?
37. What can symptoms tell you that pathology sometimes cannot?
38. Why do you ask women about sleep, relationships, childhood, food and stress when they've come to see you about hormones?
39. When does a symptom stop being something to suppress and become useful information?
40. What does it mean to treat a woman rather than treat a laboratory result?

Five big questions to finish a great conversation

41. After 26 years of listening to women's stories, what do you think medicine still misunderstands about women?
42. What have your patients taught you that no textbook ever could?
43. What's something you believed about women's health 20 years ago that you no longer believe?
44. If a woman could understand just one thing about her body before entering perimenopause, what would you want it to be?
45. What does vitality actually mean to you now?

Body literate. Self-referenced. Sovereign.