Menopause is one year and one day without a period. Women can start having perimenopausal symptoms anytime two to ten to even fifteen years before they go through their final menstrual period. So you're menopausal for one day, anything before that with symptoms is perimenopause, then anything after that is postmenopause. I am sitting down with our amazing nurse practitioner, Jen, to answer some of the most common questions that we, as menopause experts, get about menopause every day. We are going to talk about what's actually happening in your body during the transition and why it's more than just hot flashes and how your risk for certain health conditions can shift during this phase of life.
But we're not just going to talk about all the problems. We're also going to talk about solutions. We are giving you our best hacks and solutions and tools to use to get through this menopause transition and beyond, including hormone replacement therapy, but not just that. We're talking about movement, sleep, some supplements, some other practices that you can use to really feel your best. If you've ever felt confused or overwhelmed about menopause, if you feel that you might be going crazy for menopause or perimenopause, this is gonna be a great conversation.
We hope you'll love it. We hope you'll share it. Now please notice that I recorded this episode when I was recovering from a terrible case of laryngitis. So thank you in advance for your patience with listening to my voice. I think there's still a lot of good information, and I think I get it out okay.
But I hope you'll be patient and understanding with me. Please feel free to share these episodes and let us know if there's something that you'd like to hear from us. Otherwise, let's go. Menopause for me is not just replacing hormones. Menopause is a medical milestone that really we need to assess long term health and really the risk factors that you personally are gonna have and and things that you're at risk for.
You know, we're looking beyond just vasomotor symptoms like hot flashes or night sweats and really addressing your health long term and making sure that, you know, you're gonna age well, you're gonna have brain function, you're gonna move well, you're gonna move the way you want to, and we're gonna you can thrive in the second half of your life. That's really important to both of us. Well, Jen, thank you so much for being on here today. As you can tell, my voice is still really struggling to come back. So, I'm recovering from laryngitis, so I'm glad you're here so we can get through this together.
Of course. Thanks for having me. And this episode came from we're talking about menopause and perimenopause a little bit more, and it came from I have seven sisters, and most of them are somewhere in perimenopause or menopause, all of them. And, you know, I feel like I talk about perimenopause and menopause nonstop. Like, people must be so sick of hearing it.
And yet the other day, I had a conversation with my sisters, and they were like, did you know and they brought something up about perimenopause and menopause that they had learned on a different podcast. And I felt so like I had let them down because I was like, I tell people this all day every day. How did you not know this? So we're gonna regroup and talk about some of the basics today, but also some of the things that I think will be news to a lot of people around menopause specifically. And we're gonna start with kind of recapping the basics of perimenopause and menopause, and then we're gonna move into some of the things that people may not know about aging and menopause and sort of keeping themselves healthy long term that's different than hormone replacement therapy.
Sound okay? Sounds great. Well, why don't you start us off and recap just some of the definitions of perimenopause and menopause. I think one of the questions we still get most often is what lab tests can I do to see if I'm in perimenopause and what lab tests can I do to see if I'm in menopause? So walk us through that a little bit.
Yeah. So starting off, I usually do this with all of my patients. Starting off, I say menopause is one year and one day without a period, which sometimes can be helpful and sometimes it's really unhelpful if people have hysterectomies or ablations or IUDs. So it's one year and one day without a period, but there's a kind of little asterisk saying maybe. So, women can start having perimenopausal symptoms anytime two to ten to even fifteen years before they go through their final menstrual period.
So you're menopausal for one day. Anything before that with symptoms is perimenopause. Then anything after that is postmenopause. And talk about the lab testing. I had a patient just yesterday who came in and said, my doctor ordered my estrogen and FSH level and she had a hysterectomy, so no no periods at all.
And he says, I'm postmenopausal. I must be postmenopausal. Tell us how that works with blood levels. Yeah. So when we check blood levels, we're checking FSH.
So FSH is a hormone that comes from your brain and it talks to your ovaries and it tells your ovaries to make hormones. So if that's elevated over 25 or 30, I think I've seen mixed data on which exact number, on two different occasions, then that could be declared postmenopausal along with a low estrogen level, meaning you don't have very much estrogen in your body anymore that's being produced by your ovaries. Yeah. But it's super wishy washy, and I think what I want people to understand is, to some degree, it doesn't really matter what you call it. That's more for medical terminology to say, are you perimenopausal, menopausal, postmenopausal?
I don't really care. I I mean, I do care, but when people are super confused by it and they're like, maybe I should get my IUD out so I can see if I'm perimenopausal or menopausal, I don't know. I mean, I don't I don't think it changes anything. I also like to differentiate to people that there are soft differentiators along the way that don't have any medical terminology and don't have any lab terminology. But in early perimenopause, that's when we're seeing it maybe late thirties, maybe early forties, and especially into the mid forties, typically.
In early perimenopause, the pattern of hormone change and the symptoms can be quite different than in later perimenopause that we're seeing at the late forties and really just we're expecting your period to stop any day. So in early perimenopause, we're really seeing increases in estrogen. Mhmm. People think of perimenopause and menopause as all my hormones are dying. You know?
Yeah. My ovaries are just failing and everything's low. But, actually, that's not true. The first thing we see in early perimenopause is actually that estrogen sometimes shooting up and the progesterone starting to decrease, and then testosterone just does whatever it wants to do. Sometimes it's the same.
Sometimes it can still be a little high if you had PCOS. Sometimes it's tanking. There's no testosterone at all. Tell us how to differentiate the symptoms of that pattern when you have that higher estrogen for a time and then the lower progesterone and maybe that whatever testosterone? So in early perimenopause, usually our vaginal bleeding gets heavier.
So we have heavier periods, maybe periods that are closer together. Maybe people are bleeding for three months straight, which is not really sounds like menopause because menopause is when our periods stop. But it's a little bit confusing because that's when our estrogen is high and our progesterone, as doctor Hickroff mentioned, is low. So our progesterone is low because we really only make that after we ovulate, and we're not ovulating as much as we used to. Either because we don't have enough follicles anymore, our follicles aren't as robust, so we're not making as much progesterone.
So usually, in the early perimenopause, our sleep has changed because progesterone can help with sleep and our bleeding patterns have changed. Usually, for the worse, they're heavier, they're longer, maybe they're more painful. Yeah. And along with that, that that's where a lot of people find PMS and mood swings. The progesterone is really this nice calming, not sedating, but sleepy time hormone.
So in that early phase of perimenopause, as the progesterone goes down, just like you said, the sleep is disrupted. But also some people will kinda get anxiety out of the blue. Like, I've never been an anxious person and, like, suddenly I'm worried about everything and it doesn't really make sense. Other people will find their mood goes more irritable because as the estrogen goes up, the high estrogen can make you feel really irritable. Like, why are those people the most annoying people in the world out of the blue?
You're like, oh, that might be me. So that's as our estrogen is going up. And then also PMS goes up as well when you get that big differentiator in the estrogen up and the progesterone down. You don't feel good. A lot of people outside conventional medicine will refer to this period as estrogen dominance.
You can have estrogen dominance for other reasons. Like I said, there's no medical terminology for it. And in our practice, we're not really worried about the labs as much because you can kinda tell if someone says my periods are getting heavy. I have terrible PMS. I can't sleep.
I'm anxious. Oftentimes, you can just say, well, then I think you're in early perimenopause, and so we're gonna start with progesterone. This is important because we see a lot of people who have gone to other med spas or other hormone places that may not specialize in hormones, And they come in and they say, I think my hormones are off. And a lot of these places will grab an estrogen on a random day and then put them on estrogen. And it makes no sense because a lot of people will bleed heavier or their spot or they get worsening mood symptoms Headaches.
Or they get headaches, breast tenderness. Yeah. Because they don't need estrogen. They actually need less estrogen. They need more progesterone.
So really understanding where you're at in that phase, as a practitioner, then we can help say, like, okay. We're gonna really be aggressive with progesterone. We can use lifestyle measures to help you boost your progesterone naturally. We can use lifestyle measures or supplements to help get your estrogen kind of back down temporarily, and then we'll use testosterone if the blood test is abnormal. Yeah.
Anything you wanna add about that perimenopausal, that early perimenopausal transition? The early perimenopausal transition can be a little difficult because some people will start maybe in their late thirties, early forties, and and it's hard to know. Is it perimenopause or maybe is it something else? Because sleep disruptions can be caused by a lot of different things. Anxiety can also be multifactorial as well.
So it's hard to know, okay, is this perimenopause or is it something else? So that's why I like to do a little bit more digging with what symptoms exactly are you experiencing, have your bleeding patterns changed, and then kind of going from there. So it's more than just, oh, I've hit 40 and this is perimenopause. Maybe, maybe not. Such a good point.
I think also because some people hear this, they may be trying to get pregnant in their late thirties or early forties, and they say, oh, shoot. I have no chance now because I'm perimenopausal. They just described early perimenopause. That means my ovaries are not working and I'm not gonna be able to have a baby. But in the early stage of perimenopause, oftentimes, the ovaries have some resilience and they're just taxed.
They're, you know, you're super stressed or you're undernourished or under fueled or you're missing nutrients or you're not sleeping because of other reasons that are taking its toll on your hormone balance. So in that earliest stage of perimenopause, if someone comes to me at 38, I don't even like to call it perimenopause, if they're coming to see me because they have rotten symptoms, then we can certainly start giving hormone support. But if they're coming to me for fertility and wanting to get pregnant, there's so much we can do Mhmm. To bring those ovaries back to life a little bit. And that changes as we age.
Of course, those ovaries become a little less resilient, so harder to bring ovaries back to a state of awesome robustness at 45 or 46. Not always impossible. Mhmm. But it it gets more challenging than when you're 36, 38, 39. Mhmm.
So I would just say, like, I like not putting clear demarcations around this. I like not using clear definitions because bodies are still pliable at this age, and we're gonna talk a little bit more about how to keep your ovaries as young as possible for as long as possible for the sake of fertility, but also smoothing out perimenopause and menopause. So we'll come back to that in a second. Take us now to then what happens as as women transition from that early stage of perimenopause into the later stages of perimenopause. So usually their periods become a little bit further apart.
So our our periods start to march out maybe thirty days, maybe sixty days, maybe ninety days, and then you go six months. With that is usually a lower estrogen state. So our estrogen eventually does decline. And what's important about estrogen is that there's estrogen receptors all over our bodies. So we're gonna feel symptoms pretty widespread when we don't have estrogen on board.
And this is usually more where we get the hot flashes, maybe the night sweats. The more typical menopausal symptoms, we could maybe get some hair changes, some weight changes, joint pain, muscle aches, more of those low estrogen symptoms rather than the perimenopausal early perimenopausal symptoms that you get with not as much of those low estrogen symptoms. Yeah. Exactly. And I think the take home that I would tell people is oftentimes they'll kind of get into 41, 42, 43 and say, I'm early perimenopause.
They get started on their hormones, and then four or five years later, they're like, what happened? I was doing so well. Everything was going so well, and I feel like my body's falling apart. It's just the next phase. So if we can expect it, then you can say, oh, here it is.
So I think I need to adjust my hormones. And the way we do that then is by adding on estrogen. Oftentimes, like we said, if we add estrogen in early perimenopause, people don't do well. In fact, they do worse. But when you get these lower estrogen levels, they do amazing when we add estrogen.
Helps mood, helps energy, ringing in the ears, heart palpitations, and then in addition to the others that you said. So this is why speaking with an experienced practitioner, you can really get an idea of what combo of symptoms are you having. Now I'll say, even when I talk to someone, sometimes it's a little willy nilly. Yeah. You know, sometimes they'll be this for a few months and then over here on this side for a few months.
So it's not a perfect science. And, really, at the end of the day, you're gonna start whatever hormones you think are necessary or helpful and then adjust them based on their experience. I do think we can be guided by lab work sometimes, but this is so important. We've said this before. We say it again.
If you're getting hormone tested, you have to know what day of your cycle you're on. Mhmm. Now if you have no cycles because you are menopausal, then that doesn't matter. Yeah. But if you are if you have no cycles because you have an ablation or have had a hysterectomy, you just have to interpret those levels with a grain of salt.
Because if they show that your hormones are high, that just means they're high that day. And it also means that you could be in the, you know, in the late end of your follicular phase, and maybe you just had an attempted ovulation. So that doesn't necessarily mean your estrogen levels are terrible and you need to be on dim and you need to, like, you could just be having ovulatory cycles still or tempting to. So I would just say if you have periods, you wanna get these labs on day 21 of your cycle or about a week before you anticipate your next cycle, then we can have some accurate idea of if your estrogen is off the chart high or if your estrogen is not anything at all. And then mostly in that case, the progesterone is kinda sluggish, so I don't find progesterone testing to be all that helpful.
I think you can tell when people are low in progesterone. You give it to them and they feel amazing and all is well. So but the estrogen testing, I do it. Sometimes it's helpful, but know where you're at in your cycle. And if you don't know where you're at in your cycle, then just interpret it accordingly.
Let's say, well, maybe this is helpful or not. Yeah. Exactly. I think it is really important to recognize that things are gonna be changing. So we we could add something in and you feel great for a year or two and then things might change and your ovulatory function changes.
And it's just important that you work with someone that understands that and know that it's nothing's gonna stay the same while you're in perimenopause. Like, eventually your ovaries are gonna stop producing hormones altogether. Yeah. And we address that differently. When you're a women's health expert like I am, you get to talk about a lot of taboo topics for women, and that includes periods and how inconvenient they can be among other things.
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Let's get rid of that. Just get them some period underwear. Click the link in our show notes to shop salt and explore all their options, and you'll see why so many of our patients are making the switch. Now back to the episode. The other thing that I see a lot is I'll see people that we started hormones in late perimenopause, so maybe they're 49 or fifty, forty eight.
And then they'll come back about three or four years later and say, I've been doing great for a few years, and suddenly something happened. You know, I my bleeding changed all of a sudden, or I, you know, started waking up again in the middle of the night, or I'm getting hot flashes again. I haven't had those for years. I also see this transition of what probably is just full menopause. It's probably, like you mentioned, that one day where your ovaries give up completely.
Because along this way, even as the hormone levels are going down, your ovaries are still kind of they're still doing a little something in the background. They're still trying to support you. But at some point, the ovaries stop almost completely. And, usually, I'll see that, I don't know, somewhere 51 to 55 when women will say, like, I was doing great. Now I'm not.
And we just need to adjust the hormones up Mhmm. Because they just weren't were getting something from their ovaries, and then suddenly they're getting nothing from their ovaries, and we just make that adjustment. Exactly. What I want to do is to help people listening feel validated and feel heard by hearing what other people are saying that, their experiences like in perimenopause and menopause. One of the things we hear most is people saying, like, I feel like I'm going crazy.
Mhmm. You know? And I love seeing those people because I can say there is nothing crazy about this. Your body is just going through this change. So tell us, what are some of the statements and the descriptions that you hear coming from people as they're going through these transitions that will be helpful for other people to hear?
I would say one of the most common things that I hear is that people, they feel like they're going crazy. They feel like they can't be around their family or their partners anymore because their mood is unstable. Like, they feel really irritable. They're snapping at their children. They've never been like this before.
And that's something that's really new for them and they don't really know how to navigate it. And what's also hard is if they've had had PMS symptoms before, for the most part, it was pretty regular. Like, they would be like, okay, this is the week before my period. I'm I'm a little bit more snappy this time of the month. But in perimenopause, it changes and and it's a little bit more all over the place.
So it it's a little bit unpredictable and then people feel really isolated with that. So maybe they used to lean on their partner for support, but, you know, they just happened in their partner for a week. So they don't feel like they they can really go to that person for support. So I would say that people feel lonely, and they feel like they don't really know how to help or deal with their emotions. Yeah.
I think there's so much fear associated with it too. I'm so glad that people are talking more and more about perimenopause and menopause because I think there's more and more women who are like, oh, here it comes. But imagine now even people who are going through this, like, what is happening to me? Like, nothing has changed. I'm doing the same things that I've always done, and I'm not the same person.
I don't feel like the person I was three years ago. And I I hear lots of things. You know? I felt like I was so vibrant before, and one of my patients said, I'm not as bubbly as I used to be. My hairdresser told me I'm not as bubbly as I used to be.
I get a lot of people who are quite tearful when they talk about intimacy, actually. And I think when we talk about sex drive, I think it's easy to be like, oh, my sex drive's down. And sometimes I get patients who are like, yeah. I couldn't care less about sex. I'd be fine if I never had sex again.
But I get a lot of people who say, like, we had a great level of intimacy between my partner and I, and it's gone. And I'm heartbroken about it because I liked being that for him, and I liked that he was that for me. And it's, like, just a part of our relationship just completely vanished. Mhmm. And I couldn't care less about it, but I want to care about it.
I think the more that we talk about this, the more, hopefully, people recognize, like, I think I might need some help, and this is fixable and doable. But without that, people can feel so alone and so scared and so unclear about what is happening, so out of control, and that feels terrible. Mhmm. Feels really, really bad. So I hope people are learning more and more that they're not minimizing these symptoms.
Yeah. When I was trained in menopause, which was now many, many years ago, it was like, well, hot flashes and night sweats. Well, even that, like, let's not minimize that. There are people who can't go to meetings, you know, because they're gonna have a hot flash, and it's embarrassing because, you know, they're in an office and even have to take their jacket off or they they're getting flushed in the face or they're starting to sweat through their clothes. And it's really embarrassing, you know, to see that, and it can be for some people, they can have hot flashes up to 10 or 20 times a day, and it can be very disruptive.
Some people can take it in stride, and they're at home, and it's annoying, but maybe it's not as big of a deal. But I don't think we should minimize this by being like, oh, yeah. Hot flashes night, so I have to metapause. Yeah. These are really disruptive symptoms to our lives.
And if nothing else, there are people who choose not to do hormone replacement therapy, and that's okay. But I hope that they don't feel I hope they can feel heard and validated as, like, well, I understand this is a transition I'm going through. I don't like it, but I'm not scared about it. Yeah. You know?
Another thing that I think that's really scary for my patients is weight gain. Yeah. Like, I've never I haven't changed a single thing about my life, about my diet, about my exercise routine, and I'm gaining weight. Like, am I gonna gain weight for forever? Like, every decade, am I gonna gain 10 pounds?
Yeah. And I think that that can be really scary as well for people that really work hard, you know, to maintain, their level of activity and to move the way that they wanna move. And and that's something that most of my patients during the menopause transition bring up at some point. Well, I think that's the perfect transition because what we wanna shift to talk about is all the bad things that happen in Metabas, but with hope, like Yeah. What we can do about it.
We do see a lot of people develop medical problems as they go through this hormonal transition, and I wanna explain that a little bit. So I call perimenopause and menopause the great revealer. It's kind of a stupid name, but I think it explains a lot. Hormones insulate our bodies, our minds, our moods. Hormones are really great insulators.
They sort of soften things. They they give us leeway for a lot of things. So, oftentimes, we'll see, like we'll hear just what you said. I've been doing all the same things that I've always done, but suddenly, I'm getting a different outcome. And that's because hormones allow us a lot of leeway.
And as those hormones go away, that leeway goes away as well, and we start seeing exposed anything that may have been percolating beneath the surface. If you're kind of a a high revving person that's a little bit type a, oftentimes that can switch into full blown anxiety. If you're kind of a low person, like, you do okay. You don't have depression, but you're kind of, you know, you're kinda down in the dumps easily. Then as your hormones go away, you fall into depression.
If you are someone who borders on fatigue, like, you've never had the best energy, your hormones go away and that fatigue can come rearing to the surface. And then we see this with medical problems as well with cholesterol worsening as you your hormones change, high blood pressure creeping up as as hormones change, osteoporosis, dementia, heart disease, thyroid disease. All of these things increase in frequency, breast disease. Right? All of these things increase in frequency as our hormones go away, which is sounds like really terrible news, and I don't wanna dwell there.
But I do want people to know so they can feel empowered to do something about it and also so they don't feel so out of control and questioning everything. Like, what is happening to my body? Like, I've we hear this all the time. Right? I've never had high cholesterol.
I've never had high blood pressure. I've never struggled with my weight, and suddenly these numbers just look terrible. I don't wanna hammer that in like we're all doomed because women can age well, and women can have really wonderful second halves of their lives, but there are things that we need to know about it to do it well. Yeah. Absolutely.
And that's a really big part of our practice is is really making sure that people age well, women age well, but also hormones aren't the only fix for menopause. It's it's more important to look at what is your lifestyle like and how are we gonna prevent disease in the long term? Hormones are a really big part of that. Yes. But it's not the only thing.
So I I do think it's quite important to see someone that's actually focused on health promotion as well when it comes to the menopause transition. Because we can patch all we want with hormones, but you can't just keep going up on your dose for forever Yeah. To to improve your symptoms or to lower your cholesterol levels. It doesn't necessarily work that way. It's really important to me and that's kinda really what I hammer in with my patients is the hormones are kind of an easier fix.
It's more so how are you gonna age well and how are we gonna prevent all these diseases that usually creep up in midlife in the long run? Yeah. Exactly. It's both. Mhmm.
There are definitely some medical conditions that improve with estrogen replacement therapy and with other other hormone replacement therapy, but we don't wanna stop there. We wanna do better than that. We wanna do more. So maybe we start by talking about I mentioned earlier this idea of fertility in the late thirties and early forties. I'm an old mom, so I have I have kids in my late thirties and early forties.
And so this has been something that's really important to me to help patients understand. I get patients who come to me all the time and say, you know, is it safe for me to have a baby at 38? And I say, I don't know. You're talking to the wrong person because I had two babies after 38. So but but the idea is with all of this is that what we do to maintain fertility into our late thirties and early forties is the same thing we do to age gracefully.
Fertility is one of the best markers that we have of aging gracefully. And I'm not saying you have to go have a baby to see if you're aging gracefully. But if you're having really nice, healthy cycles, really good rhythm cycles, and good periods, and not a lot of PMS, that's a really good sign. And that's something that we can all deal with at at any age to try to optimize so that we know that things are are aging well. There are some specifics that we deal with with that.
Why don't you start and tell us a little bit about the nutrients and the food that we need to begin this aging gracefully process, both as we're, you know, in our late thirties and early forties. But it's the same answer if you talk about any decade along the way. Mhmm. It's the same answer. How do we age gracefully?
So tell us a little bit about food and nutrition as we're aging. I love to think of food as medicine. In the first place where we usually always start is protein. We need raw protein honestly as we age because we're not maintaining our muscle mass if we are not getting the amino acids from the protein, that we're eating. And it's important that we also are eating just real whole foods is kind of where we always go back to is making sure you're getting enough of everything.
And I often find that people are undernourished. We look at we look at labs, we can check certain vitamins and minerals and we see, you're undernourished. And I have the same treatment for my my 20 year olds who are having irregular periods to my 45 year olds who are also having irregular periods, usually for two completely different reasons. But we have to make sure that we're nourished. Otherwise, our body just kinda shuts everything down and and you do use the the term, the canary in the coal mine for our ovaries.
And I love that because I think it's really important to see. We should be having regular, pretty non painful, easy part of our lives periods. And that's where we should go. And usually the first place that we start is nutrients. Yeah.
So along with that, also fiber, but I'll let you take over on fiber. No. Yeah. I think nutrients is so key. And I have said this before, but I think of nutrients as, like, ingredients in a recipe.
Right? If you don't have the ingredients, you're not making that recipe. There's just no other way around it. And the same is true in our body. If we are lacking ingredients, we're not doing stuff in our body.
There are things that will not happen. The body needs all the nutrients. It uses all of them. Mhmm. It's not like, well, for you, you don't need b twelve.
I'll use, you know, d, vitamin d. Like, no. We all need all of the vitamins. And the only place the only place we get any of these nutrients is through food Mhmm. Except for vitamin d, which we get through sun.
But, otherwise, the only place we're getting these is through our food. So food matters so much, and it makes me so frustrated because there's so many influencers out there talking about macro counting. I'm not frustrated by that. That's fine. But so many people talking about protein, fiber and nutrients count too.
Yeah. So it's not just about protein. And I'll have patients come in, and they're trying so hard to lose weight, and they're trying so hard to do these things. So they're eating their 100 to a 130 grams of protein a day, but then they're deficient Yeah. In other nutrients or they're deficient in fiber.
And the body needs stuff. So more important than weight loss, more important than having that be perfect with the perfect amount of protein. Yes. Protein is important, but so are all the other nutrients. So just like you said, eating those whole foods, getting your levels tested.
One of the questions I get from people is, like, can you test my nutrients? Like, which nutrients? All of them. I wanna know where all of them are, and I do too. You know, I really would like to do that.
There are some fancy functional nutrient tests that can get a better look, but what we typically do to start with that's very accessible is just test the main ones that are somewhat more reliable at a regular old lab. So whether you're going to your hospital or lab, Coroquest, or anything like that. Some key performers are your iron levels. So iron and ferritin, vitamin b twelve. Zinc is a really easy one to sort of get an idea of, although it's a little less reliable.
Vitamin d, from our perspective, if there's one nutrient low, then we can deal with that. But if all of them are low, then we know that you are not getting enough nutrients, and then we can really work on that. We also think about gut health and, you know, maybe you're not absorbing. So it's not getting in trouble if they're low. It's just saying you need more.
A lot of people theorize and there's some studies to suggest that our food is just not as nourishing as it used to be. Even the whole foods that may be from depleted soil practices were not getting those same minerals from the soil. So I just think get your nutrients in, and people will say, should I take a multivitamin? Honestly, the data is not great with multivitamins, but I don't think it's a bad thing to air on the side of. I think taking something like an organ complex or eating organ meat, not very appealing to most people.
But getting in the wide variety of foods like nuts and seeds is how we make sure that we're getting all of those nutrient needs met, which going back is how we age gracefully. Mhmm. That's how we make sure our skin has what it needs. Our eyeballs have what they need. Our hormones have what they need.
Our adrenals have what they need. They rely on things like magnesium and zinc and vitamin a for our skin, and, you know, we just need all the vitamins. Mhmm. So I'm sorry. I beat that beat that horse just dead.
But I I do think it is really important. It's really important because so many people are deficient and they don't and they don't think they are. So it Yeah. We hammer it in because it's probably the most common thing that we see on people's labs pop up is nutrient deficiencies. And sadly, it takes a fair bit of work.
I will say, like, I'm not happy about it. There are shortcuts. I do a big green drink in the morning, then I get as much in one fell swoop as I can get so I don't have to worry about it. But you wanna be eating multiple different foods, whole foods through the day. You wanna be snacking on foods that you may not get in your meals, like seeds and nuts and things like that.
One of the other big things that you mentioned is fiber. Fiber, fiber, fiber. Fiber is so important for our gut and our digestive tract, but it's also really good because a lot of fiber comes paired up with really great nutrients. So if you think about, like, fiber that comes in nuts and seeds, that's usually paired with our minerals like magnesium and zinc. If you look at fiber from colorful fruits and vegetables, that fiber is paired up with antioxidants and with phytonutrients.
That's the things that make foods really colorful, and those things that make foods really colorful are one of the very best things you can do for antiaging that there is. So making sure you're getting beets and cranberries and blueberries and acai berries and carrots and bell peppers. And, really, when they say eat the rainbow, it is eating, you know, looking at your plate and saying how many different colors do I have and experimenting with getting them in. If you're not a big fan of diverse foods, then looking at things like beet powder or, you know, things that you can add in that way. I think just along with nutrients also is hydration.
Yeah. You know, we have so many people don't drink enough water, and that's okay to to add in different types of water, like sparkling water or electrolytes or I'm okay with that. But getting plenty of good liquids in, I think, is really important as well, especially for aging. Good. Now, we're gonna move along here because we can just sit and talk all day, but we have some things we really wanna cover.
So what are a couple other things that come up just in terms of this, like, just basic antiaging? I would say always movement. Yeah. Moving your body in a way that feels good for you, joyful movement. But the biggest thing that we love is walking.
Yeah. You know, it's the number one thing we can decrease overall mortality if walking is probably the best medicine, that we can do for longevity. Along with that, I think really good quality sleep. This is not news to anyone, but literally, it ages you faster than just about anything else if you're getting crap quality sleep. This is my heart goes out to people who were graveyard and things as I did for a decade because it really takes its toll on your body.
And I'm I just hope that they get, you know, cosmic blessings because it's it's rough, but it is rough on your body. So if you can, you know, pay your dues and and get out of that graveyard shift, it is it's better that way. But really addressing sleep and making sure that's good quality is one of the best things we can do to slow down aging. Another really great thing is decreasing stress where we can. And I think that sounds a lot easier than it is, but really being intentional about recovering from our stress and completing the stress cycle and and doing little things every single day that help wind you down to not allow little microstructure to build up and build up and build up.
For me, it's walking or breathing or mindfulness. You know, it can be anything that winds you down, doing a puzzle. Doesn't really matter to me what it is. Yeah. This is really, really big.
I mean, if we're just talking even science, there are so many studies showing that adding some sort of mindfulness routine decreases the risk of disease. Just about every disease state there is, heart attack, stroke, cancer, high blood pressure Yeah. Yeah. Every condition you can think of, depression, anxiety, mindfulness decreases that evidence based. This is not a question.
This is a you need to figure out how to get it into your life, not a is it good for me or not. Like, this should be when we think about, like, we all know we probably should not be smokers. Not probably. We should stop smoking. Right?
That's an easy guideline. Adding some sort of mindfulness routine should be just as easy. I'm gonna keep working to get that in because I know it's so good for me. And kind of as an offshoot of that, there are some really good studies looking also at people who live longer lives typically have higher purpose, higher life enjoyment, higher meaning. Like, when they serve survey people, there was one study showing as they surveyed people, people who scored higher in terms of higher life enjoyment had a thirty five percent lower risk of dying over the next eight years.
That's that's good data. Like, this isn't just fluffy nonsense. This is good data that says, if you wanna age well, look for purpose, look for meaning, get a therapist, get a life coach, figure out how to put down the crap that's keeping you stuck, that's keeping you anxious, that's keeping you stressed, and find ways to live a life that is more in line with your authentic self and that's gonna give you more meaning and purpose. Not too far from that is social connections, you know, making sure this has been well studied, that people who maintain social connections live longer and live better, and that people who age into isolation don't age well Mhmm. And don't live as long.
So really keeping up whatever social connections, it doesn't matter. Make friends that when you're out on a walk, make friends in an art group, you know, reach out to your grandkids, reach out to your your own aging parents. Like, it does not matter who you're connecting with. Reach out at the lady at the grocery store. Right?
Like but having those social connections. Yeah. I think that's wonderful. I have a lot of patients that all play tennis, so I think that's the route I'm gonna go. Yeah.
Foraging. That's right. I think that's great. Another really important, just kind of surrogate marker that's really fascinating, but has reasonable data behind it is grip strength. So grip strength is measured like it sounds like you grab onto something with your hand, and they have meters that you can measure how tightly can you squeeze this.
And they've found that the tighter you can squeeze with your hand, the better the longer you'll live. And that seems really odd. And I think it's more of a surrogate marker is that people who are active and people who are strength training and people who have more muscle have higher grip strength, but they actually showed there was one study that showed for every five kilos of decrease in grip strength, so you you couldn't grip as strong, there was a sixteen percent increase in all cause mortality. You died of everything sixteen percent more people did when they lost that grip strength. So just a argument for carrying in your groceries and, you know, staying active and dancing and hiking and just doing all the things that we can do to move our bodies and build muscle.
I just wanna mention quickly in functional medicine, when we take this a layer deeper to say, how do we age well? We're looking at some of those culprits that get hidden inside of us. So chronic infection or chronic inflammation or toxins, these are all kind of buzzwords that'll get a lot of flack. But the fact is, if you are burdening your body, it's not going to age as well. Mhmm.
Right? Smoking is one of the most obvious toxins there is. And we know that when we are smoking, we die of just about everything more. Mhmm. It's just tremendous burden.
It gets in, and it interferes with cellular health and cellular healing. And from every avenue, it's just really bad for us. And so as we look at other toxins, alcohol is one, honestly, that the body can handle better a small amount. But if you drink more alcohol than your liver can handle, things don't go well. Higher rates of breast cancer, higher rates of heart attack and stroke, higher rates of blood pressure, higher rates of other types of cancers.
You don't want to burden the body. The body is really good at getting rid of certain levels of stuff. Mhmm. But if you overburden that system, things don't end well. Mhmm.
The body ages very poorly. And so in functional medicine, we go about that from two ways. We say, how do we expose ourselves to less badness, and how do we boost our body's capacity to deal with that badness. Mhmm. Anyone can do the increasing capacity.
You can eat more green leafy vegetables, eating fiber, keeping a healthy gut, making sure that you're pausing between meals, making sure that you're getting a really good night's sleep. All of those things help us detoxify, but there are some things in functional medicine. If you're not doing well, if you're aging more quickly than you feel like you should, that we can really get in and help detoxify the body and then set you up for better aging and longevity. I love that. It's important.
Have you ever tried red light therapy? At Uplift for Her, we are big fans, and we and I use it ourselves regularly. Red light therapy helps support energy, healing, reduce inflammation, and improve skin health, And there's more and more data to support that. One of my favorite at home options is the LoomBox, a powerful clinical grade device that combines red light with near infrared light so you're getting both surface level and deeper tissue support. It's easy to use and makes consistent red light therapy actually doable.
One of the things that I love about the Loom box is how easy it is and how compact it is. So you can grab it out really quickly, use it while you're in bed getting ready to go to sleep, and then put it away and not have to unpack a big complicated device. I use it most nights as I'm going to bed mostly just for relaxation. I find I feel very calm and wake up with good energy, so it is one of my favorite wellness add ons. If you're thinking about adding it to your wellness routine, we have a link in the show notes that will save you $250 off of a Loom box.
You can also find it on our favorite products page at upliftforher.com. Now back to the show. I'll throw sauna into that. Yeah. Sauna has great data looking at people who are using sauna regularly, have less dementia, less cardiovascular disease, and a big part of that is probably because of detoxifying.
Mhmm. There's some temperature regulation things that are probably beneficial as well, but really just sweating and sweating out stuff that shouldn't be there is really beneficial. Let's transition now for the last bit of this to talk about a few of the specific medical conditions that that we mentioned before the pop up that I think people are gonna be like, could you go back to that? Like, I have a strong family history of that. What can I do now specifically to that disease state to decrease my risk, to age well, and and hopefully not deal with this?
I think let's start with heart disease. Will you talk about what are some things we can do in terms of aging gracefully, going through menopause to decrease the risk of heart disease? The first thing you can do is keep estrogen on board. So Yeah. That estrogen can be preventative for cardiovascular disease.
And then next thing is keep moving and keep eating your fiber. Keep eating colorful fruits and vegetables and then keep moving your body. And it's and it's stressing your body a little bit when you when you're exercising, you know, doing some sprint interval training, doing box jumps, doing things that are really pushing your body that make your heart work, which is important. Absolutely. And then when you're done doing all of that, then go have more fiber.
Exactly. I would add to that too stress is stress is one of the biggest predictors we have of cardiovascular disease, heart attack, stroke, high blood pressure. Stress is handled in the body in certain ways, and the way that the body handles stress is exactly counter to heart disease and metabolic health because stress ramps you up. It says, I am gonna die if this tiger catches me, so I'm gonna switch all of my body's mechanisms into get away from this tiger. That means that it's looking at keep me alive for a short time.
We don't want that. We want to stay alive for a long time, and so those are counteropposites to each other. If we're doing things that say, keep me alive right now, the body will say, okay, but it comes at a cost. Yeah. It has to borrow from keeping us healthy for a long time.
Mhmm. So really figuring out how do we decrease our stress levels. And for those stress levels, we can't decrease, like, bad things that happen to us or losing a job or having a family member with cancer or having a difficult marriage or parenting challenges, you know, all of these things that are that are going to be stressful, how do we recover from them? So it's twofold. Decrease stress where you can.
Don't worry about don't perseverate about the guy who flipped you off on the freeway because he's a jerk. Like, let that go. You don't have room in your health to worry about those types of things. Mhmm. You don't have room in your health to worry about that woman who looks like she was giving you a bad glare.
What was she thinking? Was it my outfit? Was it something? You don't have time to worry about that. Mhmm.
Focus on recovering from stress and managing the stress that you do have for especially for cardiovascular health. And it's so important because the number one killer of both males and females is heart disease. So we've you've spoken on other episodes the importance of of heart health, but more than anything, that's this is something that we have to take pretty seriously because it it comes for us all eventually. Yeah. Exactly.
Exactly. And I will draw people's attention. We have two great episodes on heart health. Yeah. That you can find.
We'll put them in the show notes, but they really go into it in more detail. Mhmm. And one of the things that they go into in detail is looking at doing advanced cardiovascular testing. I think this is so underutilized. As an OB GYN, for years, people came to me as their only doctor through perimenopause and menopause even and saying, I'm here for my annual checkup.
What can you do for me, doctor, to make sure that I'm in optimal health? And you know what I did for them? I checked their cholesterol level. I checked their blood pressure, and I checked their hemoglobin a one c. And then do you know what I did for them?
I said either it's good enough or I gave them flat, boring advice, usually through my nurse in one line because I didn't have time to actually Mhmm. Review these guidelines with them. And I would say, you know, keep working on a healthy diet and move your body more. And then if that if it was really bad, I would say, go to your primary care, and they'll start you on a medication. Mhmm.
This is a vast disservice. There is so much more that we can do in terms of functional medicine testing to really evaluate what is your baseline risk that you inherited from your family. We call that LP little a. What are your cholesterol molecules look like? Are they kind of non worrisome cholesterol particles or less worrisome cholesterol particles?
Are they big bad cholesterol particles? We can look at that with something called APOB, or we can look at it by, looking at things that make your cholesterol particles unhealthy, like insulin resistance and blood sugar. And I'll stop there because it goes on and on and on. But there are so many things we can do to give you a clear and accurate perspective on your cardiovascular risk. Mhmm.
So if you are one of those that your cholesterol is in like, your LDL is in the, like, one thirties or one fifties, and your doctor says, it's not time for a statin yet, but your blood pressure's a little high. Your blood sugars are fine, but you know, maybe work on diet and exercise do more. Yeah. Do better because it will pay off for you tenfold as you try to improve your health and improve your longevity, prevent heart attack and stroke. With a lot of this too, when people are interested in doing hormones and maybe they're beyond the window of opportunity, beyond 60, beyond, 10 from the last period, the biggest thing that we're looking at is your heart disease risk because adding an estrogen may or may not be beneficial when you're beyond those ten years because estrogen is really important for our heart health.
So this is something we're really diving into. If people are are beyond that ten years, they feel like, oh, I didn't know I should have been on estrogen or I didn't wasn't able to go on estrogen before this. This is really what we're digging into. So it's it's pretty important. To optimize health in every other way since you can't have the advantage of the estrogen.
And, also, on the flip side of that, if people are at high risk for cardiovascular health to say, maybe consider that estrogen. Mhmm. And and this is counter, by the way, to what I was trained ten years ago. Yeah. It's not just functional medicine.
The North American Menopause Society, they agree, so it's not just me. But when I was trained, we learned that estrogen might be bad for cardiovascular health, and now it's kind of the opposite that we're seeing estrogen is good for cardiovascular health. So there are some doctors who are a little bit old school still who may say like, oh, you have a heart attack risk. Don't do estrogen. That increases the risk of clot, and transdermal estrogen can be actually quite beneficial.
Yep. Let's move on now to genital urinary syndrome of menopause. Mhmm. It's a mouthful and it's a it's a newer term, but will you tell us what that is and and what do we do about it? This is one of the easier things Yeah.
To deal with, but also really affects your life. Yeah. Absolutely. So the genital urinary syndrome of menopause can be vaginal dryness. It can be vaginal itching, maybe an increase in UTIs, maybe pain with sex because of the dryness.
I've even had bladder leakage, so maybe a little bit more of incontinence. And the solution usually is quite simple. It's just vaginal estrogen and most I would say most women can take vaginal estrogen. Like, it's very safe even for women with breast cancer a lot of the time because it's not systemically absorbed. That being said, vaginal estrogen is very safe, but some people do have a reaction to it.
So we'll we'll we can compound it because it does have some additives like propylene glycol in it. So if vaginal estrogen didn't work for someone, we usually try compounding it with a little bit less of the additives in it and just a an HRT, cream base, and usually women tolerate it very well. So if you've had it before and it didn't work for you, there's a little bit more digging that we could do. Exactly. And estrogen is really the only part of that that actually decreases the risk of urinary tract infection.
Mhmm. There are, though, some other solutions that can be really helpful just for some of the symptoms. Sometimes we'll talk about adding DHEA Yeah. Or hyaluronic acid. There are a couple name brands out there that people are familiar with.
Reverie is a common hyaluronic acid. Yeah. Intrarosa is a common DHEA, prescription that we can do. So there are definitely some other things that we can do to add to the estrogen. Sometimes we even do testosterone can help some women.
And then there's some other measures that we can take that just make a lot of sense. I think the skin, as it thins through the genital urinary syndrome of menopause, can just be more sensitive. So using increased sexual lubricants, one of them that I really like is Kokanoo because it is very clean. It doesn't have a lot of preservatives in it. And as women age, they can be more sensitive.
So if they're still using the same old, you know, stuff they've had in their drawer from when they were younger and find that, like, gosh, this is burning now or this is causing a lot of sensitivity. The Coconu can be really well tolerated because it is just a couple ingredients that that can work really well to improve that, itching or burning or dryness associated with sex. And then, also, sometimes we'll do a vaginal probiotic. Yeah. When we say vaginal probiotic, it doesn't always mean in the vagina.
You can do a probiotic for vaginal health. So especially as you're transitioning or if you've been off of estrogen for a long time, it changes the vaginal microbiome, those good bacteria that are in the vagina. And, usually, just adding estrogen will take care of it. A lot of women come to us, and they've already been wrestling with it for a while. They've had yeast infections and bacterial vaginosis and, bladder infections, and they've been on antibiotics and antifungals and all of these different things.
And then we add the vaginal estrogen and it does help, but they're still, like, feeling imbalanced or getting easy yeast infections or easy UTIs. A vaginal probiotic for a time can be really helpful. And there's lots of them out there. We want specifically l rhamnosus, l reuteri, or the bacterial strains that we want in there. So, and like I said, you can take it by mouth.
Mhmm. But that can help kind of even things out if they've been out of whack from lack of estrogen for a little while. Let's move on to osteoporosis. This is kind of a big deal. Will you tell us why it's a big deal and tell us a little more about it?
Yeah. So osteoporosis is something that really skyrockets for postmenopausal woman. So osteoporosis is basically low bone density. So you your bones are no longer as strong as they used to be. And it's really important because about twenty to thirty percent of women who suffer hip fracture will die within one year.
Yeah. That is a very well known terrible statistic. Yes. Very well known. And it's really important to not only prevent osteoporosis, but make sure that we're doing all the things to support our bodies in general and and making sure we're not losing muscle mass, we're not losing this bone density.
So there are a couple ways that we can do this. Nothing that we can give you can replace lifestyle, your lifestyle measures. So what you're eating and how you're moving your body. I love jump training. Tell me what what do you think about it?
I think it's good. Tell us more about what it is. So with jump training, I like box jumping. I like skipping. It could be jump rope.
But, of course, we're working our way up to these things. If you have pretty advanced osteoporosis and maybe you're in your seventies, like, you wanna just start with small step ups. And really, we're focusing also on eccentric movements. And eccentric movements are you kind of lowering down. So lowering down slowly in a squat, lowering off of a step really slowly, lowering off of a curb slowly because those are times when we'll fall if we don't have a great stability and that's when we break our hip and then things really kind of go haywire from there.
So box jumping and then weight bearing exercises. That's why we see so much of the weighted vests, which is amazing, and really making sure that we're we're putting some strain on our bones to make them stronger. And on the flip side of that, I think it can go too far. Mhmm. So you really wanna understand where your bone health is.
Because if you are already osteoporotic, this is not something that you do without help. You don't just go say, like, I'm gonna start box jumping. Because if you fall, you break something, then it's like, well, that was worse. You know? So you really wanna know where your state of bone health is.
If you know that your bones are healthy, then these are great things to keep your bones healthy. If you don't know, then find out. Estrogen too is hugely helpful for bone health. We hear a lot about calcium for bone health. It's important, but most of us actually get enough calcium through any sort of reasonable diet at all.
But vitamin d is actually, much more likely to be deficient and probably more important. So when I see people taking calcium, that's actually not quite the recommendation anymore. You do want a normal calcium level, but whether you need additional calcium or not really depends on where your nutritional status is. Yeah. You can get too much calcium, but vitamin d is easy to test.
Make sure that if you are at risk for osteoporosis, meaning that your your mother had osteoporosis or your sister or you've been on long term steroids or you went through menopause or had your ovaries removed early, those are all risk factors for menopause. And you would want to make sure that your vitamin d is on the upper end of normal, not sufficient, which is about thirty. You want good vitamin d. I would say even fifty to 70, even up to eighty for osteoporosis of getting making sure that that vitamin d is is a sturdy amount of vitamin d in there. Yeah.
And I think this osteoporosis often kinda gets pushed to the wayside until someone's diagnosed with osteoporosis. Like, we'll ask about family history and then I'm like, oh, any family history of osteoporosis? Like, oh, yeah. I think my mom. Probably my grandma.
Maybe my aunt. And I'm like, oh, that's a that's a pretty significant history of osteoporosis. And that's something that we we absolutely can prevent and wanna prevent. And estrogen can really help prevent, osteoporosis. It can reduce vertebral fractures, those fractures in our spine, by fifty to seventy percent, and then hip fractures by thirty to fifty percent.
So estrogen, movement, eating a well balanced diet are all really important for osteoporosis, and also the knowledge that osteoporosis runs in your family is is really important as well. I think that our screening for osteoporosis is pretty inadequate. Mhmm. Currently, the guidelines say no osteoporosis screening until 65 unless you have a reason to screen earlier. And insurance actually does a good job at paying for it to screen earlier, but I I think there are a lot of women who aren't being asked Yes.
If they have increased risk. So I'd encourage people to take it into their own hands. This is actually a pretty easy thing to Google and say, you know, there's scores online. One of them is called Frax, f r a x, that will calculate your risk of osteoporotic fracture. And we mentioned some of the risk factors, but Google it.
Yeah. And if you have early menopause, if you have estrogen deficiency, if you have, a family history, you can bring it up to your doctor in case no one's asking. Annual exams, like I said, as an OB GYN, sadly, I was not routinely asking people until 65. And then I would say, 65, you're due for your bone scan. Go get it.
By the time you're 65, if you haven't been keeping up these routines and you have osteoporosis, it's gonna be way harder for you to go start doing some of these mobility exercises, and you're gonna be at higher risk of falling and having a fracture. So 65 is not old, but but you can be screened earlier, especially if you need to be screened earlier. So look it up, see if you're at risk, go to your doctor and say, I think I might be at increased risk for osteoporosis. Do you think it's okay if I get a DXA scan earlier? Mhmm.
And like I said, insurance usually pays for it well. It's just we were not very good at asking the questions to put the diagnosis code on the order to go get that early DEXA scan to find out your bone health. Another good point too is, medications. So SSRIs can thin our bones, omeprazole, like PPI, so things that people can be on for really a long time, decades. Those can thin your bones.
And then, of course, steroids, smoking, moderate alcohol use. So I think more than two drinks a day can thin your bones. So looking also at those types of risk factors, but really medications, because those can be a little bit sneaky when you've been on them for decades. For sure. And we do have medications that treat osteoporosis, and they do a decent job.
But if you don't have to be on them, none of them rebuild bone health as well as you build your own bone health. So taking steps to build your own bone health now with the steps you mentioned is great. And then as you also mentioned, doing what you can just to avoid a fall. Yeah. So doing balance exercises, staying flexible, reaching down and picking stuff up on the ground off the ground, getting down onto the floor and getting back up off the floor.
If you're not good at getting off the floor right now because of whatever is the case, practice practice getting up off the floor because that is one of the biggest predictors of falls, is not being able to do that. Well, I think we'll wrap up there. This has been so important, and, of course, there's lots that we didn't talk about. But is there any last thing that you wanna bring up in terms of just menopause and aging well? Yeah.
Menopause for me is not just replacing hormones. Menopause is a medical milestone that really we need to assess long term health and really the risk factors that you personally are gonna have and and things that you're at risk for. So in our functional and integrative clinic that we have here, you know, we're looking beyond just vasomotor symptoms like hot flashes or night sweats and really addressing your health long term and making sure that, you know, you're gonna age well, you're gonna have brain function, you're gonna move well, you're gonna move the way you want to, and we're gonna you can thrive in the second half of your life. That's really important to both of us. I love that you said that.
I love that you called it a medical milestone. And we do every once in a while get patients who are like, why are there so many questions on this questionnaire? But it matters. It matters to us and it matters. It should matter to you to say, are you taking care of these basics that are gonna change the quality of your life?
I think we talk a lot about a lot of medicine up through, like, age 50 and 60, and then there's this whole group of women who are like, so now what do I do? And they're like, well, just keep keep enjoying these last few years. And you're like, it's thirty years. Like, that's a huge chunk of my life. Like, I don't wanna just fade off into the distance.
I wanna thrive and I wanna be strong. And certainly, that's how I hope to see the women who are aging in my life, and it's how I hope you and I will age. And it's what I want my patients to be able to age that way as well. And it's so possible. It's so doable.
So thank you for all of your wisdom and expertise today. Thank you. It's been a fun conversation Yeah. As always. Yeah.
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