The Menopause Conversation Every Woman Deserves to Hear

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to another episode of a line and elevated podcast.
I'm your host, doctor Allison Felt, owner of Body Motion
Physical Therapy, all lover of life, all things health and wellness,
and I'm so excited to be joined with an amazing
guest here today.

Speaker 2 (00:12):
We haven't had a guest on in a while.

Speaker 1 (00:14):
And so I want I really really wanted to dive
into the topic of perimenopause and menopause because my DMS
had been blowing up all about hormmal shifts or who
should I go see to talk about like my hormones
and are my hormones normal?

Speaker 2 (00:28):
Are they not normal? What should I do about it?
And I don't feel equipped to fully answer that question.

Speaker 1 (00:33):
And that's why I really wanted to bring on an expert,
a doctor in the field who works with women.

Speaker 2 (00:38):
In perimenopause and menopause.

Speaker 1 (00:40):
And so I am honored to have a doctor Melissa
Lang today and she is giving us her time to
really break down a lot of what is perimenopause?

Speaker 2 (00:50):
What are the signs? I have a whole list of
questions for you.

Speaker 1 (00:53):
I'm sure, of course, she is a doctor at North
Seattle Natural Medicine right now, and yeah, so you can
check her out and anything else you'd like to say,
not yet.

Speaker 2 (01:03):
Okay, let's start right, let's dive she sees a lot of.

Speaker 1 (01:06):
Patients in this time of life. Yes, and it's becoming
a lot more common. Did not just settle yep anymore.
Absolutely for perimenopause and menopause symptoms. So absolutely, let's dive
into what some of those symptoms are.

Speaker 3 (01:19):
Yeah, there are some of the first signs. I mean,
it's so Perimonopause is such an interesting time of life because,
contrary to what many people might think, actually starts in
your late thirties, and for some people even younger, depending
on where their hormonal shift happens in their lifetime and
what other things might be happening in their bodies. Some

(01:40):
of the first things that often show up for women are,
you know, changes in cognition, changes in sleep, especially those
are gonna be really early signs.

Speaker 2 (01:50):
Sometimes women notice changes.

Speaker 3 (01:52):
In menstrual cycle really early on too, and so kind
of this classic change in mencies that we see over
the gat or cell of perimenopause before we officially hit menopause,
or kind of that last phase before we're an official
menopause is slow, lengthening of time in between mensis and

(02:13):
so we'll see kind of longer cycles. We'll see kind
of these bumpier changes towards the end, and then all
of a sudden they get shorter together and then the
length and right back out and we get to the
point where we hit actual menopause.

Speaker 2 (02:27):
When we are at that one year point after not
having a menstrual cycle. So you know, it's kind of
it's subtle in a lot of ways.

Speaker 3 (02:36):
Every woman, every female bodied individual, feels a little bit
different as they move through perimenopause and beyond. And I
mean this is no different than you know, fertile age
women going through menstrual cycles from puberty to hitting menopause.
So every step of the way, there's gonna be differences
across individuals. And I think, you know, like m we

(03:00):
talk about things like hot flashes and brain fog and
just kind of changes in wait, for example, around perimenopause
and beyond, and I think those are kind of the
click bait phrases, and sure they certainly show up, but
it's more subtle in a.

Speaker 2 (03:16):
Lot of ways than what most people think.

Speaker 1 (03:18):
Yeah, and you drop the definition, which is I think
really important just to note is So menopause is once.

Speaker 2 (03:24):
You've not had your cycle for a period for one year.

Speaker 1 (03:29):
Exactly, and then and then you're quote unquote Ina, You're
in You're the club.

Speaker 2 (03:36):
I like that. But in all reality, like the changes
have been going on for you, yes, corrects and years
and exactly.

Speaker 1 (03:42):
So you talk about some of these cognitive changes, what
are and the sleep changes.

Speaker 2 (03:47):
I want to know what are some of these cognitive changes.
Oh my gosh.

Speaker 3 (03:51):
So sleep is this kind of its own whole category, right, Like,
typically in terms of sleep, we see worsening sleep patterns,
women having a really hard time with sleep, whether that
just be you know, inability to fall asleep, inability to
stay asleep. Certainly some of the other common symptoms of

(04:12):
perimenopause and menopause contribute to that.

Speaker 2 (04:15):
So hot flashing or nice ones.

Speaker 3 (04:17):
Of course, that's gonna wake someone up for sleep when
they're really intent, and especially when they're happening frequently.

Speaker 2 (04:23):
But there's also just kind of.

Speaker 3 (04:25):
A temporary shift in terms of quality of sleep that
happens during this time, and it's because we have foremoo
chaots happening, and that's very normal and natural within the
arc of moving through that time of life as a
female bodied individual in terms of one of the cognitive
side of the life of go ahead, I have to
interact you.

Speaker 1 (04:45):
So, how does someone know that they're not just stressed
out at work or their kids aren't. I mean, so
many of our post part moms are having babies at yeah,
thirty five, yes, you know, or they just had their
babay thirty five, maybe forty maybe forty five, and like
they could already be in perimenopause. So how do you
not just know that you're stressed and tired your good
children and or you're in perimenoclause.

Speaker 3 (05:07):
This is a great question, and I want to kind
of frame my answer with the understanding that none of
us exist within a vacuum, and so all of these things.

Speaker 2 (05:16):
That happen that are kind of labeled as.

Speaker 3 (05:19):
Oh, well, you know, you're in perimenopause or beyond. Like,
let's be clear, there's more complex human beings, and everybody
has multiple factors that are setting them up for success
or failure in different buckets of health. Right, sleep is
a really big one. So it's hard to kind of
undable some of these things. I think more when I'm

(05:42):
sitting with a patient in front of me who is
coming in with a chief complaint of like hormone balancing, right,
which is one of my favorite chief complaints, because I'm like,
what is actually happening here?

Speaker 2 (05:53):
You know?

Speaker 3 (05:54):
But for me, it's really more about like, Okay, what
is that, what does the container look like?

Speaker 2 (06:01):
What are the multiple pieces at play here that.

Speaker 3 (06:04):
Might impact sleep? And then I'm like, where are we
in terms of age? Okay, we're about in that perimenopause age,
so we really start to see this hit the ground
running for a lot of women kind of in mid
forties in terms of when this.

Speaker 2 (06:18):
Becomes very noticeable to them.

Speaker 3 (06:21):
Mid forties up until your early fifties is when this
is like very prominent and it's not quite obvious to
them yet because they haven't hit menopause and maybe they're periods.
They are still fairly regular, but it's more of these
like more subtle things that are coming up for them,
or they've started to hot flash, or suddenly we have

(06:42):
this change in sleep and it's like, WHOA, nothing has
really changed, but now I'm not sleeping well, so you
kind of have It's really about being clever, listening to
what the patient's telling you. There's no real rhyme or
reason in terms of like, well, if A plus B,
then C.

Speaker 2 (06:59):
Yeah. In terms of pursing out this is hormonal.

Speaker 3 (07:02):
Usually what I do as a practitioner is I love
running labs.

Speaker 2 (07:07):
I think data is really important.

Speaker 3 (07:09):
And I, you know, for populations, women included, who have
not been represented well and not fairly.

Speaker 2 (07:17):
In the medical literature historically. For me, I'm like, I want.

Speaker 3 (07:21):
As much information as I can possibly gather about this
person to help me understand them as an individual, because
as a medical profession historically we've done a bad job
of that. So I kind of take it case by case,
and I wouldn't necessarily say there's any key signs aside
from that time of life, right, that's a big clue
for me.

Speaker 2 (07:41):
And then if they're you know, let's say labs come back.

Speaker 3 (07:44):
Let's say sleep is impacted and we run some labs
and it's like, oh, well, yeah, we've got some nutritional
deficiencies going on or whatever, then I'm going to take
the fruit, the low hanging fruit on the train, kind
of address that for it first, and if nothing shifts,
then I'm like, ah, here's where we are, okay.

Speaker 1 (08:04):
And when you say nutritional deficiencies. Do you mean that's
showing up in the bloodwork?

Speaker 2 (08:08):
Awesome?

Speaker 1 (08:08):
Yes, okay, yeah, so it's not like they're having to
track their meals and you're like.

Speaker 2 (08:11):
Okay, this is what that's happening. Yeah, like you're not
absorbing this nutrient exactly.

Speaker 3 (08:15):
Happening totally. And I mean we could spend a whole
day talking about that alone. Yeah, but oftentimes there's more
than just one player at the table in terms of
like what's contributing. And we'll get into that more, I'm sure,
but for me, time of life is going to be
a really big one. And then kind of gathering some
context clues about Okay, so also tell me, are you

(08:37):
having any changes in body temperature? Like are you noticing
any changes in your mood? Like there's some other clues
that we can kind of gather. But again, most people,
most of the time have multiple contributing factors to their
experience within perimenopause.

Speaker 1 (08:54):
Okay, yeah, scascinating. I'm learning so much and I have questions.
But one random little ti is I had the other week.
You know, I have a hockey right, Okay, so I
was in the locker room, like this is probably like
two months ago. Sure, And I was telling this girl,
I was like, I loved to hair like this long,
I swear out of my chin and I'm like, how
did I miss that? And She's like, welcome to menopause.

(09:15):
And I was like what, Like, no, I'm not selling that. Yeah,
that's like a thing.

Speaker 3 (09:20):
M it is okay, Yeah, you know, like oh, all
all the fun things that come up where you're like, wow,
estrogen was really.

Speaker 2 (09:27):
Doing me a solid for all of these years.

Speaker 3 (09:29):
And you don't realize until estrogen is either completely low
once you hit metopause or it's on your older coaster
during Perry.

Speaker 1 (09:38):
Yeah, I had breast a jula my sport two and
a half years. So I feel like I've just got
my estrogen. Yeah, like yep, you know, like I'm just
returning to normal. She's almost four.

Speaker 3 (09:47):
Yeah, and I'm like, don't lose it, yain not yet,
please give it to me.

Speaker 2 (09:51):
I totally feel that so fun. But I have a
question because like we talkled with two clients a lot
about like, okay, you should know where your blowers app like,
are E gonna know if this is your thyroid or
this menopause?

Speaker 1 (10:01):
Yes, And so a couple questions I do want to know,
like how do you differentiate is the thyroid wakening or
is this more like perimenopause. But also my biggest thing
with like Western medicine, like when I say Google is
sweeted should get your bood drama your physician, it's like
they're taking one glimpse in time and I'm like, but
the menstrual cycles like this, Like yeah, hormones are going

(10:22):
to be different throughout the syle, So how do you
mitigate that or analyzed data like that or do you
collect more data?

Speaker 2 (10:27):
Totally? Okay, So it's a great question.

Speaker 3 (10:30):
So always, always, always, if you are curious about anything
else hormonally that might be off.

Speaker 2 (10:37):
You have to run labs. That is the only way
to be foresure.

Speaker 3 (10:41):
And so when we see some of these symptoms that
have a lot of overlap, because you know, a lot
of the symptoms of perimenopause are so vague and like
we were talking, there's often multiple things kind of plugging
into how severe those symptoms are showing up in different bodies.
Will use thyroid health as an example since brought it up, Like, if.

Speaker 2 (11:01):
I have any reason to believe somebody has a.

Speaker 3 (11:03):
Thyroid disorder going on, we're gonna run some labs. With
that being said, labs in perimenopause pertaining to the reproductive
system are real tricky because there's a lot of fluctuation
during that period of time, and so it's not just
like you turn a light switch off or your Twitter
light switch on. In terms of estrogen, progesterone, FSH, and LH,

(11:27):
all of those things are kind of going through this
bumpy little roller coaster as we kind of like ease
into menopause. So you know, typically what we do clinically
in terms of running form like our traditional hormone labs
that women would expect is estrogen progest your oone FSH, LH.
We typically run them on day twenty one of them

(11:48):
at the current mestral cycle because that shows us.

Speaker 2 (11:52):
What our peak progesterone looks like in the cycle.

Speaker 3 (11:56):
So you know, if you're if you need a little
bit of some brushing on kind of our normal fluctuations
throughout a normal twenty eight day cycle for a female,
what we typically see is, you know, we start our
period and then day fourteen we have this LH surge
where all of a sudden we are ovulating, and as

(12:17):
a result of ovulation, you develop this little kind of
I like to kind of think of it as like
a little flower that's just kind of sitting on top
of the ovary, and that's called the corpus lybium. The
corpus livium then pumps out progesterone because in the event
that we were to get pregnant, that progesterone is what
is going to help maintain the pregnancy in the event

(12:39):
of implantation until.

Speaker 2 (12:42):
The placenta is able to take over for that. And
so day twenty.

Speaker 3 (12:46):
One is when we should really be seeing that peak
progesterone happening.

Speaker 2 (12:50):
Within a twenty eight day cycle.

Speaker 3 (12:51):
So we like to run labs there because it gives
us an accurate viewpoint of what's progesterone doing. Because when
we're entering pering menopausa, especially progesterone is the most important
and the most reliable.

Speaker 2 (13:04):
Thing to look at.

Speaker 3 (13:06):
Interesting because estrogen is gonna be all lack a doodle
for a few multiple years, even around perimenopause, and even
as we're entering that true menopausal period, progesterone typically doesn't
lie and it typically doesn't fluctuate it as much. So
what we would see, for example, is when we run labs.
On day twenty one, when we start to kind of

(13:26):
exit this time of life and enter menopause, progesterone is
going to be chronically low, and we're also conversely going
to see persistently high FSH and LH because they're like
the little knockers at the door of the over So,
if we're thinking of the ovarys as a home with
the front door, f SH and LH gets secreted from

(13:46):
the pituitary gland in the brain that come on down.
LH in particular is going to knock at the door
of the ovary and when nobody answers, in other words,
when progesterone's not answering the door and rising in response
to that, the.

Speaker 2 (14:00):
Brain's like, well, okay, let me knock harder.

Speaker 3 (14:02):
And so we see this transient increase in those pituitary hormones. Meanwhile,
progesterones like, not dog, I'm done.

Speaker 2 (14:09):
And so we like to look at progesterone. Estrogen not as.

Speaker 3 (14:13):
Useful, even though people like to run estrogens, and there's
certainly in a time and a place to run estrogens.
When we're looking at this time of life, it's not
as useful because it's so variable and sickly. It's like
what you were saying, We typically you're right, as we
move through a month, there's hormone fluctuations even on a
twenty four hour cycle for us, and they might be

(14:36):
more subtle than the big, sweepy ones that we typically
see in a twenty eight day cycle.

Speaker 2 (14:41):
But you know, it's you have to kind of take
everything with a grain of salt and look for the
bigger picture trends. Does that make sense? Yeah?

Speaker 1 (14:48):
Absolutely, yeah, yeah, So what are some of these what
are other signs?

Speaker 2 (14:53):
You can go back to the cognitive things, but.

Speaker 1 (14:55):
What are some of the other signs that pogesterone, like
physically clinically, what are you sayingyrogen is giving?

Speaker 3 (15:00):
Okay, so progesterone in part tis sorry, progesterone estrogen, Yeah,
it's all goad. You started with progesterone. Yeah, so progesterone.
Really big picture things here. We're gonna see sleep disruption,
that's one of the main symptoms.

Speaker 2 (15:15):
We're gonna see fluctuations in mood.

Speaker 3 (15:18):
So I progesterone and estrogen in a lot of ways
are counterparts. I would liken progesterone to more of a
yin like very female energy, very cool, calm and collected.
It keeps things easy, breezy and cool. Estrogen very opposite.
Estrogen is fiery, vibrant, like kind of keeping us up here.

Speaker 2 (15:39):
We need both of them.

Speaker 3 (15:40):
So some of the symptoms that pop up when progesterone
is going down is we're seeing almost this.

Speaker 2 (15:46):
Unopposed estrogen picture.

Speaker 3 (15:48):
Especially when estrogen's doing this wave of activity during that
time period, we get an amplification of estrogen's loud voice,
whereas progesterone is no longer speaking as loudly, and that
can kind of lead to more of these like irritability,
not sleeping as well.

Speaker 2 (16:08):
Those are really the big two that I see clinically
in patients.

Speaker 1 (16:12):
Interesting, is there a difference between patients that you see,
like people that sustain the effects, like they really feel
these effects versus.

Speaker 2 (16:20):
Those who don't? And what are those differences? Difference? Is that?
Like so in terms of symptom picture that well, like
why do some people get such bad symptoms and other stuff?
This is a great quay, So this was actually kind
of a loaded question.

Speaker 3 (16:33):
One of my favorite women's health specialists, she's kind of
like a nationally what's your friend?

Speaker 2 (16:39):
Her name is doctor Aviva rom Oh love her. She's
very smart. So she started as a as.

Speaker 3 (16:46):
A midwife, okay, and then ended up going to get
her MD and now practices women's health.

Speaker 2 (16:53):
She's very smart and very well educated.

Speaker 3 (16:56):
She I was listening to one of her podcasts when
I was still in medical school, and I remember her
making this comment about how the research indicates that if
you look anywhere outside of the United States or anywhere
that has like supersaturated Western culture, women have different experiences

(17:19):
in menopause and across the board.

Speaker 2 (17:21):
Bumpy menopause is a Western phenomenon. Really, Yeah, why is this?
I think it's I think it's multifactorial.

Speaker 3 (17:32):
I think a lot of it comes down to the
societal perception of women as we move throughout our normal
and natural life span. I think a lot of that
is internalized by a lot of female bodied individuals. There's
some stress, there's some anxiety about hitting menopause. There is,

(17:53):
you know, for lack of a better term, I think
that there's kind of this silencing and this looking away
of women when they're no longer fertile in Western society,
which is extremely unfortunate and thankfully changing. Like our societal
views on women and their value throughout the lifespan are changing.

(18:14):
Women are more integrated in society in different cultures, and
they're seen as valuable, and they're seen as matriarchal, and
they're seen as kind of the wisdom holders in other cultures.
And so it's celebrated to move throughout the lifespan and
to get older and to go through these normal transitions.
And so there's a lot of theoretical talk about you know,

(18:36):
this is just a.

Speaker 1 (18:37):
Cultural thing that is beautiful and absolutely not even freaking
close to what I thought you're gonna say.

Speaker 2 (18:43):
I thought you're gonna be like, this is because.

Speaker 1 (18:45):
Our nutrition, our process food are I mean high levels
of our environment, Like I think there's by surprise, Yeah,
there's definitely aspects of that, don't get me wrong.

Speaker 3 (18:59):
Like we do have a lot of environmental exposures. A
lot of them are hormone disrupting forever chemicals, and that's
an unfortunate reality that we get to continue to live
with and our children get to live with and deal
with as well. You know, the food system in the
United States is no shocker. It's not great. Like do
we have an abundance of caloric intake? Absolutely not. Many

(19:23):
people are truly starving in the US. There are certainly some,
but I mean, we have an abundance here and yet
the quality of it is garbage in a lot of ways.

Speaker 2 (19:34):
There's a lot of contamination, so a lot of pollution.

Speaker 3 (19:38):
There's a lot of practices here that if you were
to go to somewhere like Europe where they have high
food standards, we don't see a lot of the long
term lifestyle diseases that we see in the US because
of our nutrition alone. So yes, absolutely to all of that.

Speaker 2 (19:54):
And also there's more to it, Like there's deeper pieces.

Speaker 3 (20:00):
To it that I think are just you know, we're
we're still trying to wash some of this chronic sexism agism,
I guess for lack of a better term, that's phenomenal,
and how it impacts women through the lifespan.

Speaker 2 (20:15):
Yeah, just something I have not thought of. Yeah, so
that's fascinating.

Speaker 1 (20:20):
But I think deep like subconsciously, like like.

Speaker 2 (20:25):
Oh I'm what am I scared of? No absolu And
you know it like it reflects clinically too.

Speaker 3 (20:31):
When I have patients sitting in front of me, kind
they're like almost precipice of like this next shift, right,
this is the next major hormonal shift for a female
bodied individual after puberty, and so it's a really big deal.
And for many of us, gosh, we've lived a whole
lifetime in between puberty and hitting menopause, and so it's

(20:51):
kind of sometimes it can be really hard to touch
face with that space of like, ah, I've been through
a transition hormonally before. A lot of us just kind
of lost that aspect of ourselves. But also I think,
you know, menopause is unfortunately just poo pooed, and it's
a really beautiful part of life that I think more
and more we're starting to embrace and celebrate for women.

(21:14):
And I think that's shifting the internal narratives for people too,
because patients in front of me, they're scared. They're like,
oh my god, I don't want to feel a single thing,
like I don't want any bumps, shakes, whatever. I'm really
afraid about aging and this, that and the other. I mean,
a lot of it is, you know, just hot topics
in health and wellness right now, but a lot of

(21:35):
it is unfortunately deeply ingrained societal beliefs that many of
us have continued to carry as.

Speaker 2 (21:41):
A burden, whether or not it belongs to us or not. Yeah,
you know, yeah, that's beautiful, thank you. Yeah, of course,
I wonder we all know the research is lacking.

Speaker 1 (21:52):
Yeah, female health has never been prioritized then, I mean,
a rectal dysfunction has been like, you know, research for
years and years and years, and the fact that we've
never even talked about female you know, female reproduction or
into facy or any of that.

Speaker 2 (22:08):
You know, I think it's coming maybe a little bit
in full circle now.

Speaker 1 (22:12):
But it's so fascinating to hear you say this aspect
because I think about it, and I do think, like
a lot of the reason research needs to increase is
our life expectancy has increasing great so much so we
had to see what's happening, and so there was probably
a big aspect of when the life expectancy sixty years
ago was in the fifties and now it's in the eighties.

(22:32):
It's like that's a huge shift, you know. So I
wonder how much well, I wonder when.

Speaker 2 (22:37):
Research will keep up. We'll probably be having one hundred.
We'll probably live to one.

Speaker 1 (22:41):
Hundred by the time that research picks up to like
what's happening in our sixties. But yeah, it's just fascinating
to start to think about. So I love you shedding
light on that. Can we jump to what what are
the options?

Speaker 2 (22:54):
Then? What are your options for women?

Speaker 1 (22:57):
And I would love to talk a little bit about
hormonal spent therapy at some point.

Speaker 2 (23:01):
Of course, when I was in PT.

Speaker 1 (23:03):
School and I had just started in PT school it
was two thousand and nine, I was interested in women's
health and I went to a lecture with a bunch
of top level physicians in the area.

Speaker 2 (23:12):
And this is when they were saying hormonal pacement therapy.

Speaker 1 (23:16):
Most people were saying it causes cancers, so bad for you.

Speaker 2 (23:18):
Everyone got off of their hormonal pacements.

Speaker 1 (23:21):
But these physicians were like they were trying to break
the mold, and they were like that research was flawed.

Speaker 2 (23:25):
This is why it's so important that we have this
is an option. And that was in two thousand and nine. Yeah,
we are in twenty twenty five.

Speaker 1 (23:31):
We're still trying to pull back that recutfort and people
are still so scared.

Speaker 2 (23:37):
The conversation is shifted. You have social media and influencers
being like I'm on.

Speaker 1 (23:41):
HRT, you know, like yes, oli yah, yes, but I
think there's you know, so I do think it's shifting
quite a bit, Yes, but I would love for you
to dive into what are some options, maybe natural options
or you know, HRT, whatever you feel like.

Speaker 2 (23:56):
Absolutely what we went to.

Speaker 3 (23:57):
Yeah, so I used again framing this around my individual
patients in front of me, because it definitely varies from
patient to patient. I have some patients for whom they
are suffering, they cannot fill their buckets of health because
they're not sleeping, They're hot flashing all day long. For them,
I'm like, yep, we're reaching top shelf. We're doing some

(24:18):
HRT right away. Absolutely, I am here for women feeling
good in their bodies.

Speaker 2 (24:23):
That is the foundation of what I do. I want
women to feel empowered.

Speaker 3 (24:28):
And sometimes that empowerment looks like just hopping straight to HRT.
Sometimes it's like, hey, let's spend some time with this,
let's set some better foundations, right and cause a lot
of times it does come down to foundations in terms
of what you're working with and how severe your symptoms
may or may not be.

Speaker 2 (24:44):
Okay, And so you know, if let's say we.

Speaker 3 (24:47):
Have a patient in front of us who is in
their early forties, they're just starting to kind of really
notice some changes over time, very beginnings of like noticeable
early peri menopause, kay, like for them, and I would
say even earlier, Like gosh, if you can start setting
up your diet and lifestyle from a place of it

(25:10):
um intelligence, using your diet and lifestyle more intelligently to
help support an easier transition over a place of er
or over a period of time, ideally that's starting in
your thirties, like just kind of setting the stage having
really solid nutrition. And we'll talk more about nutrition within
the context of perimenopause and menopause. But like exercise so important,

(25:34):
Oh my gosh, just especially aerobic exercise. It could not
be more important in terms of hormone health and helping
to regulate some of these symptoms that can come up,
including the mood and the sleep in walking count Absolutely
it does, yes, does whatever. Definitely anytime that you're getting
your heart rate up, you're breaking a sweat a little

(25:55):
bit from it, fantastic.

Speaker 2 (25:57):
We love to see it.

Speaker 3 (25:59):
You know, there's some other things we could be doing here, Gosh,
there's so many. There's so many things that like I
help women with in terms of like setting up good
foundations for health. But you know, some of the first
things that I'm thinking about when we just have really
mild symptoms.

Speaker 2 (26:14):
If symptoms are.

Speaker 3 (26:15):
Mild and women are cool with like, alright, this is
probably gonna take a couple of months to really fine tune.
I prefer to do nutritional and botanical interventions first, yep,
cause for those who are like kind of in that
mild early moderate symptom range, I found, I find we
get really great clinical results.

Speaker 2 (26:35):
Find botanical medicine.

Speaker 3 (26:36):
In particular, we have some really awesome tools at our
fingertips that you know, m medical doctors doos don't necessarily
have the education to use in a way that's going
to be therapeutic or helpful. And so you know, with
my education being a naturopathic physician, I'm really grateful to
have that knowledge base available to me. Whereas maybe things

(26:59):
like way more on the line in terms of like
hierarchy of care, sure like surgery, that sort of thing
is not in my toolbox. But I've got something a
little bit further down the line here on the spectrum
of care that's like great, we can work with nature.
We have hundreds and thousands of years of data from
traditional societies about how these things work, how they've helped people.

(27:20):
We're starting to see this kind of catch up in
the literature as well, which is really exciting, and so
I like to start there when I can, because I
find it to be the most helpful.

Speaker 1 (27:30):
Could did you give us an example of what like
one of those botanicas?

Speaker 2 (27:33):
Yes?

Speaker 3 (27:34):
So, And I'm gonna put a big fat asterisk next
to this because some of these recommendations, while it's safe
for most people, it's not safe for all.

Speaker 2 (27:43):
So people for whom.

Speaker 3 (27:45):
Estrogen receptor positive cancer breast cancer is a family history
or a personal history, then I would kind of pause
on some of this. Something that can be done early on.
And this is nutritional and also so botanical is including
phyto estrogens. Phytoestrogens similar to HRT, have the history of

(28:07):
getting really unfortunate bad rapport because one or two negative
studies that were like, oh my god, the red clover
caused cancer, Like, no, it didn't.

Speaker 2 (28:17):
Let's be clear. The by and large, the.

Speaker 3 (28:20):
Meta analyzes, which are the most important pieces of literature
because they're taking the conclusions and the data from everything
within kind of the focused parameters, lumping all of this
data together and then coming up with like no, This
is the definitive answer of the data indicate that phytoestrogens

(28:41):
are protective against breast cancer. In particular, they actually have
a net inhibitory effect on estrogen receptors in the body, which.

Speaker 2 (28:51):
Is part of the mechanism of action there. And so
when we.

Speaker 3 (28:54):
Can include those earlier we start to it helps eat
out especially the estrogen piece, cause estrogen is responsible for most.

Speaker 2 (29:04):
Of the kind of fiery.

Speaker 3 (29:05):
Symptoms that come up during perimenoplausm beyond when we are
in taking through the diet or through herbs. Phytoestrogens on
a daily basis that evens this out. So instead of
like the crazy ups and downs, we're seeing like a
little bumpy hill and that feels better in most bodies.
And so just kind of backtrack a little bit of
phytoest Estrogen is an estrogen type molecule that's created by

(29:29):
a plant. They can m many of them can interact
with the estrogen receptors in our bodies. It's a very
weak bind though, so they have less affinity for the
estrogen receptors in our bodies than the estrogens that we make,
for example, which makes sense.

Speaker 2 (29:47):
We're making our own estrogen. They better bind well so
they do compete though, which is the important piece.

Speaker 3 (29:54):
When you are in taking phytoestrogens and this lock and
key is bound up with that weekly bound phyto estrogen,
our normal estrogen store can't go there because it's already
taken up. And so what we see is, like I said,
this net inhibitory effect. Where this is gonna be weekly bound,
there's gonna be less potent effects downstream in terms of

(30:16):
like what that estrogen receptor triggers in terms of symptoms potentially,
or how the organ systems are responding to it, and
then our own estrogen and so it helps to quiet
things over a period of time.

Speaker 2 (30:30):
Does that make sense? That makes total sense. Yeah.

Speaker 1 (30:32):
So what are some natural phytoestrogens that we can put
in our diet?

Speaker 2 (30:37):
Yes?

Speaker 3 (30:37):
Absolutely, So there's kind of three categories because each of
them are through phyto estrogen that works slightly differently. Number one, soy,
oh my gosh, soy is so wonderful, and it gets
such a bad such a bad rap. Okay, it fairly
gets a bad rap in the US because much of
our soy.

Speaker 2 (30:54):
Is GML, non organic.

Speaker 3 (30:56):
It's garbage, like it's not great to put in our
bodies and cause problems.

Speaker 2 (31:00):
So if you go jump on the soy train they.

Speaker 3 (31:02):
Share to organic non GMO, it needs to be really
high quality soy okay, but oh my gosh, soy phenomenal
for so many reasons above and beyond that for this
transition period too. Soy has an incredible amount of protein
in it, and so what we see, and especially when
we're thinking about this through the lens of like brain

(31:23):
health and cognition and sleep deprivation, oftentimes we can get
a little bit of some traction in terms of mood, sleep, brain.

Speaker 2 (31:33):
Health with adequate protein on board.

Speaker 3 (31:35):
And quite frankly, most people are not getting enough protein
in their day to day and so you're getting your
phytoestrogen benefit from the soy and you're getting your protein
benefit from soy as well. So for me, I'm always
trying to feed a couple birds with one scone clinically
with patients, because patients don't want to be taking five

(31:55):
thousand things. They don't want to have a huge laundry
list of a treatment plan in front of them. It's like,
how can we make this as easy as possible and
accomplish a couple of things at once. Right, So soy
is kind of like way up here for me and
cool organic none.

Speaker 2 (32:09):
I'm not gonna feel guilty about soy anymore. No girl,
every day in my life, I don't feel guilty.

Speaker 3 (32:17):
Another kind of category with a slightly different physiological mechanism
of action, but still phido estrogenic is like the brassy
Casia family of est or of vegetables, which is also
the cruciferous veggies. So we're looking at like kale, cabbage, broccoli,
Brussels sprouts, kind of that family that's like pungent a.

(32:38):
I mean, there's so many health benefits to that alone,
the pungency aspect of that family, but they contain phytoestrogens,
and that can be really helpful in terms of adequate
metabolism of estrogens, which we can.

Speaker 2 (32:51):
Talk about more too.

Speaker 3 (32:52):
Finally, things like flax, Oh my gosh, flax is wonderful. Also,
phytoestrogenic has a slight different mechanism of action in terms
of how it's kind of helping us around hormones and
establishing hormone balance in the body. But some of the
additional benefits of flax, which also come into play within
the context of perimenopause, menopause and beyond is in addition

(33:16):
to having these bytoestrogenic compounds, we also have Mega three
fatty acids, which are wonderfully anti inflammatory.

Speaker 2 (33:23):
And you know, any time.

Speaker 3 (33:25):
That we are seeing kind of this atrophy, whether it
be you know, a structural atrophy or even just a
functional atrophy, which is really what's happening in menopause, we
want a good inflammatory profile because atrophy oftentimes kind of
couples with a little bit of similar level inflammation over time.

(33:45):
And so when we have that nice inflammatory profile from
having adequate Omega three fatty acids in the diet, we
kind of set the stage for a.

Speaker 2 (33:53):
Smoother transition overall. Does that make sense? I love that.

Speaker 1 (33:56):
Yeah, And I'm just sitting here super hypes because yeaviage
is my thing in the whole world every single day.

Speaker 3 (34:04):
So I'm like, okay, yes, this is great exactly. And
so like that family of vegetables in particular, the active
compounds are called glucosinolates, and so there are sulfur containing compounds.
They help your liver do what they need to do
to properly metabolize and then also enhance excretion of estrogen
metabolites in particular. Interesting, so real important because estrogen's a

(34:27):
tricky one and we can talk about it a little
more too.

Speaker 1 (34:29):
Yeah, I might have to just bring you back because like,
even as you're saying this, and this is totally not
what this episode is about, but I feel like if
I'm thinking this, other moms are thinking, it's like, Chloe,
my daughter, she's going to be ten, you know this week,
And I'm and Natalie, we didn't even tell the listeners,
but can I.

Speaker 2 (34:47):
Say, of course, Okay, Melissa has an amazing daughter.

Speaker 1 (34:50):
Natalie and Chloe and her are like the youngest on
the soccer team as they play up a year and
so Chloe and Natalie are the same age. So and Chloe,
I'm just thrown around here her dirt laundry. She hasn't
started her period yet or anything, but yeah, you can
start see little changes.

Speaker 2 (35:06):
Happening in her body. Absolutely.

Speaker 1 (35:08):
And all I can think about is as you're talking
about estraden, and I'm like, I need to make sure
that she's getting like adequate levels of these vito estrogens.

Speaker 2 (35:15):
Yes, And so I mean I'm like, Okay, I got
the story.

Speaker 1 (35:17):
I gotta get flaxied, I gotta get she loves russels
sproutes all this, keep doing the russels browns like you know.

Speaker 2 (35:22):
And exactly what was the first one? So I food and.

Speaker 1 (35:26):
So yeah, so and I haven't dappled this so because
I've been I've been sold the wrong thing about.

Speaker 2 (35:32):
So many of us have. And you know, here's the thing.

Speaker 3 (35:35):
Nutrition, like clinical nutrition is relatively new science if we're
looking at the full scope of how long different like
ologies have been around, right, And unfortunately, the birth of
clinical nutrition and when it really picked up in the
last few decades, has coincided with social media and having
so much access just so much information at any given time,

(35:58):
Like there's a lot of miss information out there, and
you know, somebody can cherry pick something from a study
and then be like, mmmm, this is it right here?

Speaker 2 (36:07):
And unfortunately that's what happens a lot, especially.

Speaker 3 (36:10):
When it comes to things that impact women's health, and
it's pe you know, many of us aren't trained how
to critically evaluate the information that we're getting, where it's
coming from, whether or not it's a good source, whether
or not the data from a good source is even
valuable data. And so I usually like when I have
people come in and be like, well, have you heard

(36:31):
about this book from so and so blah blah blah.
Like this person I follow on Instagram says X Y
and Z. I'm like, oh, and like I'll hear them
out and be like that's really interesting, like you know,
but at the same time also helping them better.

Speaker 2 (36:45):
Understand, like hey, you know, like.

Speaker 3 (36:48):
I'm concerned about this piece of information you've gotten and
now you're making changes on it that are potentially dangerous,
and it's ultimately.

Speaker 2 (36:57):
Coming from somebody who's not credentialed to be giving you
the advice that they're giving you. Right.

Speaker 3 (37:02):
It's so there's a lot of intersections in terms of
a timeframe for this.

Speaker 2 (37:06):
I mean I feel the same way and the feeling
for industry and like what you're doing what exactly and
you're doing how long? It's how much time do I
have to undo this? Yes?

Speaker 3 (37:14):
You know?

Speaker 2 (37:14):
Or like yeah, you know you're doing that because of this,
Yes you know.

Speaker 1 (37:18):
It is that it is scary, it is take advice
for people, but also I feel like that's why it's
so important to have someone like you in their back
pocket exactly. And also like your practice is a little different, right,
Like you get to sit with the client and like
here it sounds like you talk about their lifestyle, whereas
like anyone who's been to like a normal medical office
in the last few years, like you can't get in

(37:40):
a b You're only getting prescriptions for whatever you need.
There's no lifestyle modification, and now there's even less because
you can.

Speaker 2 (37:50):
Just go get ooze and like exactly.

Speaker 3 (37:53):
It's and it's really interesting for me as a provider too,
because at my core, I consider myself to.

Speaker 2 (37:59):
Be a primary care that's what I do.

Speaker 3 (38:01):
I just happen to have pockets of populations that land
with me often. And you know, on average a normal
doctor's appointment, you are seeing the doctor for seven then
it's total and being a doctor myself, that's not enough
time to really ask all the questions you need to
be asking and make some sound.

Speaker 2 (38:22):
Decision making it around it.

Speaker 3 (38:23):
And gosh, I have so much empathy for my colleagues,
for whom that is their truth and that is.

Speaker 2 (38:27):
Their day to day for whatever reason. And it's a lot.
And also this is why we exist on.

Speaker 3 (38:33):
A spectrum in terms of healthcare, and we got to like,
you know, communicate with each other and like where one
of us doesn't shine in terms of our skill.

Speaker 2 (38:41):
Set or our knowledge base more importantly the other woe, and.

Speaker 3 (38:44):
So just working together as a care team becomes important
in terms of helping these patients kind of get better
care overall.

Speaker 2 (38:51):
Yeah.

Speaker 1 (38:51):
No, I love that, And I love that you have
the toolbox to not just go straight to the farmers
of the bills, although I think they have a place exactly.
It's just like we we have to be able to
explore what else is out there, especially like what if
we didn't have that, you know exactly. And every pharmaceutical,
as you know, has a side effect. Yes, it's like
are we willing to sign up for that?

Speaker 3 (39:11):
You know?

Speaker 1 (39:11):
And when you're getting stuff from your food or from
your tables or from how you know, it's like that's
normal digestion, that's normal concession that nutrients is yes, you're
just fueling your body in the guards, so you're not
looking at these kind of side effects that we have.

Speaker 2 (39:26):
Absolutely. Yes.

Speaker 1 (39:27):
Is there anything else that you feel like you should say,
like from a botanical.

Speaker 2 (39:30):
Standpoint, Mmm.

Speaker 3 (39:32):
The one thing that I will say about botanicals, you know,
like while they are typically well tolerated by people, it's
important to not just kind of dive in without expert
advice on them because they are not all indicated for
everybody in every situation, and you know, they are potent medicine,
and so especially with people who are taking pharmaceuticals for

(39:53):
any reason, legitimate or not, like, we need to make
sure that anything that's being added in from a therapeutic standpoint,
they all play well together, because then we can get
into too kind of a deeper hole when they're not
playing well together, and it becomes very sticky to kind
of entangle like, oh, what's contributing to what?

Speaker 2 (40:12):
Like what here isn't fitting. I can't even tell you
how many patients first time I.

Speaker 3 (40:17):
See them come in with this like twenty bullet point
list of like I'm taking this in this and this
and this and this and there are all supplements, many
of which are self prescribed, many of which were recommended
by somebody on social media, many of which were like
prescribed and then not managed by a different provider. And
it's just like, you know, it's good to have some

(40:38):
sound expert advice and do a good medication supplement clean
up before adding anything new. And it should always be
added by somebody who knows how to use it therapeutically.

Speaker 2 (40:48):
Yeah, and knows what else you're on exactly. Yeah, yeah,
and you can do that for somebody. Yes, I love it.
I do this all the time.

Speaker 1 (40:54):
Yeah, okay, got so retouch to doctor Melissa and doctor
Melissa Lang. I keep saying your first saying that's totally fine,
and yeah, that's awesome.

Speaker 2 (41:03):
I appreciationing that is there. I guess I don't even
know where I wanted to take this. There's so much
I want to ask, too many questions.

Speaker 3 (41:14):
Well, since you wanted to make sure we touched on it,
let's talk about HRT. Let's do that because that's such
a big topic. And I have a lot of women
who come in and are like my friends.

Speaker 2 (41:23):
Are on HRT, like should I be on it?

Speaker 3 (41:26):
Or people who are like, no, I know, I want
to be on it, or I'm inheriting somebody else's patient
who's been on HRT for many years and is like, oh,
you know, so HRT is like a really interesting focus
in terms of women's health because it can be incredibly helpful,
but gosh, with caution, so because at the end of

(41:47):
the day, it is pharmaceutical treatment of symptoms, right, and
that's totally reasonable.

Speaker 2 (41:52):
Again, kind of.

Speaker 3 (41:53):
Rooting myself always in a place of I want women
to feel empowered and I want them to feel good
in their bodies so that they can tell, right, And
so hormone replacement therapy looks a little different for everybody,
but like you know, some common things is we have
women coming in with like hot flashing, irritability, mood swings,

(42:14):
waking up with night sweats, kind of the whole gambit
of especially the baso motor symptoms.

Speaker 2 (42:20):
Low libido is a really big one that we.

Speaker 3 (42:23):
See that I often actually will treat with hormone replacement
therapy right away because you know, as with many things
in women's health, sexual health is so important and it's
kind of been tabooed historically, and so I'm trying to like,
we don't need to taboo that anymore.

Speaker 2 (42:39):
It's a normal part of human life.

Speaker 3 (42:41):
So we can definitely address especially more high, moderate to
severe symptoms right away with some hormone replacement therapy. Given
there's no frank contrat indications on board, right, okay, And
I screen all of my patients for Frank contra indications
before we do anything, So you know, we do estrogen

(43:03):
progesterone if there's a uterus intact still estrogen always needs
to be paired with progesterone to help lower the risk
of uterine cancer that can come with reintroducing estrogen.

Speaker 2 (43:15):
Beyond its normal shelf life in the body.

Speaker 3 (43:18):
So just there's some things that have to happen clinically
from like a safety standpoint. Also, something that I've been
seeing more often recently, which is kind of interesting to me,
is like when we're kind of like doing we're plugging
some things in, whether it be HRT or fine tuning
lifetile lifestyle things or this, that and the other patients

(43:38):
are like a plus in terms of adhering to their
treatment plan, and they're still feeling like weakness, muscular fatigue,
like resist like they're feeling like they can't get into
their workouts, they're not recovering as fast as they usually do.

Speaker 2 (43:53):
Obviously, there's some.

Speaker 3 (43:54):
Additional workup that can happen around that in terms of
nutritional status. But I've been finding that there's actually a
lot of androgen deficiency in women or it's insufficiency, and
so something that I've actually been treating more often lately
in terms of HRT is plugging in a little bit
of testosterone or.

Speaker 2 (44:11):
Plugging you is going to ask you about that, So
I'm fascinated to hear.

Speaker 3 (44:14):
You say that yeah, or plugging in a little bit
of some data, which is kind of like a weak form.
It's not testosterone, but it's a weak androgen that gets
kicked out from the adrenal plans. And so what I'm
finding is like women who kind of have those chronic
fatigue picture and there's not really a rhyme or reason
why they're on board. I'll run some testosterone and some
DAGA labs and I'm like, whoa shit, no, wonder they're

(44:37):
not feeling well, you know, And then they do really
really really low dose always for women, And I do
this across the board for any HRT that I'm bringing
on board. I would rather start too low and need
to ramp up than start too high and be like,
oh shoot and have to kind of skirt back a
little bit, you know, especially with testosterone, because even though gosh.

Speaker 2 (44:56):
It can make you feel like strong and.

Speaker 3 (44:58):
Invigorated and like it can definitely help with more of
that fatigue side of the symptoms. It's kind of the
muscle weakness side of the symptoms. It can cause things
like hair loss, which you know, women are already we
don't want that, Like, we're already dealing with that as
we move throughout the lifetime and.

Speaker 2 (45:12):
Under normal circumstances.

Speaker 3 (45:14):
And so I just like anytime I bring it on
board really important that we're doing some good informed consent
around potential side effects because they do exist at low doses.

Speaker 2 (45:25):
Are they likely?

Speaker 3 (45:26):
No?

Speaker 2 (45:26):
But they do exist, And so.

Speaker 3 (45:28):
There's kind of a couple of different things that we
can play with here in terms of estrogen and progesterone.
Everybody kind of has a different approach in terms of practitioners,
I personally like aside from progesterone, because progesterone typically comes
as oral micronized that's usually very well tolerated by patients.
It's an oral capsule that you take before bed. Most

(45:51):
patients tolerate that really, really well. And sometimes that's where
all start in terms of HRT, is just plugging in
a little progesterone again to get you sleeping, to get
feeling a little more settled in your body, because if
you're not sleeping, anything else that you try to do
up here on top of the foundation is not going
to have as good of efficacy over a period of time.

(46:13):
So foundations of health is kind of where we're starting,
even if we need to support it.

Speaker 2 (46:17):
With a little HRT.

Speaker 3 (46:18):
Now, then progesterones on board, we'll see what that can
buy us, because sometimes it ad buys you a lot
more than what you would expect. Sometimes progesterone alone can
help with hot flashing, which I think is really interesting.
And I think again, it's just like meeting this chaos
of estrogen where it's at and helping to kind.

Speaker 2 (46:37):
Of level some of that out a little bit interesting.

Speaker 3 (46:39):
Now when we have progesterone on board and the patient
is like, oh, I'm still having like these basomotor symptoms, especially,
then yeah, let's plug in some estrogen.

Speaker 2 (46:50):
How long do you leave them on this progesterone before
you let it?

Speaker 1 (46:54):
Like?

Speaker 2 (46:54):
What hell on does it take? That's a great question.

Speaker 3 (46:56):
So if we're in paerimenopause and we haven't met the
tech definition of menopause yet, I'm not gonna bring estrogen
on at all because estrogen is too chaotic during that
period of time and it's like chasing wild horses a
little bit. Okay, so you can, and also I don't
like to because it fluctuates so much. Now when we're

(47:18):
in menopause and we're hot flashing still, absolutely we can
do that. And you know, so what I like to
do is see how progesterone goes for a couple of weeks,
but maybe even a whole month if we're still really suffering,
and even a week later, if my patient is like,
we're not feeling great, then yeah, we can get something

(47:39):
else on board.

Speaker 2 (47:40):
Estrogen. You can do oral forms.

Speaker 3 (47:43):
I don't like to because oral forms come with really
big boy side effects, and so we're looking at increased risk.

Speaker 2 (47:49):
Of blood clots.

Speaker 3 (47:50):
This includes pulmonary embolism, deeping with the rombosis, and then
also stroke, which you know, not great.

Speaker 2 (47:58):
We also see.

Speaker 3 (47:59):
Increase risk of things like breast cancer and uterine cancer
with oral So I really hesitate to bring an oral
estrogen on board at all, unless it's birth control at
a younger age, and even then I would need like
a pretty good at this point, with how many options
we have available.

Speaker 2 (48:18):
To us, I would need a really good reason to
do that.

Speaker 3 (48:21):
What we do often though, is we can do patches
for estrogen. We can do creams, there's so many like
you can do hormone pellets, which is really great. Topical
form is better in terms of overall safety and side
effect profile because number one dosage is gonna be down
because we don't have to go through first past metabolism

(48:44):
of the liver, and.

Speaker 2 (48:45):
So already we're maintaining more.

Speaker 3 (48:47):
Of that dose that we're taking in we don't see
the same side effects. We don't see as much risk
in terms of cancer and cardiovascular risk with topical forms.

Speaker 2 (48:57):
So for me as a provider, that's usually where I'm
going to go.

Speaker 3 (49:00):
I'm going to bring estrogen on it all and again,
if there's a uterus intact, we have to pair it
with progesterone to prevent that uterine cancer.

Speaker 4 (49:07):
So it's even topical estrogen needs to be a pair
of pogesterone ethics theaters for me, yes, that's so good
to know, just because we have so many clients that
will do beyond a topical or vaginal estrogen.

Speaker 3 (49:17):
Yeah, that's a separate well okay, let's talk about kyah. Yeah,
vaginal estrogen, which is an interesting Oneeah. That is, so
we usually implement that clinically more for a localized symptoms.
So we're thinking like vaginal join us, we're thinking low libido,
we're thinking increased UTIs, which Yeah, that's a sign and
the symptom of perimenopause and beyond.

Speaker 2 (49:40):
And a lot of that is because of what we
talked about earlier.

Speaker 3 (49:42):
There's this structural and functional atrophy that's happening as we
kind of go through this hormonal shift. Topical estrogen vaginally
is wonderful for those symptoms. Oftentimes, it is not absorbed
systemically and at least not in height enough amounts.

Speaker 2 (49:59):
To really contribute to any risks or anything this that
or the other.

Speaker 3 (50:02):
So if I have a patient who's like, my only
concern is I get more UTIs and I'm having pain
with sex, I'm just gonna do topical vaginal estrogen.

Speaker 2 (50:12):
We don't need to do anything else there. Yeah.

Speaker 1 (50:15):
Interesting, that's so good to know because, first off, from
a clinical perspective, asset and help me four pt we
absolutely see the difference that the natural estroudent can make
to the tissue. But on a side note, one of
the things like when our clients come postpartum or kind
of in that.

Speaker 2 (50:29):
Perimenopause before menopause phase, we.

Speaker 1 (50:32):
Are always like, you need to do this now exactly
when we have clients do this work before they go
through menopause, Yes, we can change their tissue so quickly.

Speaker 2 (50:40):
It's incredible. So quickly.

Speaker 1 (50:42):
Yeah, when we have clients that come after menopause, that
tissue takes double maybe triple the time to change.

Speaker 2 (50:50):
So if you were thinking.

Speaker 1 (50:50):
You were gonna have pain before pain with sex before
you had went through menopause, that is.

Speaker 2 (50:55):
About to amplify.

Speaker 1 (50:56):
Yeah, and like because it doesn't get better, and so
like it's like if you're peeing your hands before menopause,
it's gonna good person like and we always like and
so to hear you like say, like the localized changes
of the tissue absolutely, like we see that time and
time and time agains, and like the healthier we can
get your tissue, more blood flows, everything, we can get

(51:17):
to your tissue before our hand, before you go through menopause.
I always use the analogy. And like it's like because
we'll have people that come, you know, five years after
they have babies, they still scar tissue in there. Ten
years after, their tissue is so tight it just feels
like beef jerky. And then the minute we can start
hydrating that tissue, just doing manual therapy, stretching and getting
that mobile exactly, we can change that to like a

(51:39):
chicken breast exactly. But once they're menopausal, it's like we're
fighting that beef jerky and like to get blood flow
delivered to this tissue that's been chronically tight and compensated
for twenty years exactly. It's like, oh, it's just yeah,
it's you just wish everyone knew this after they had babies.

Speaker 2 (51:55):
It's so true. You know, it's so true.

Speaker 1 (51:57):
Even people that don't have babies. It's like, you just
wish that that was, like, you know, just more common.

Speaker 2 (52:02):
I had to shout out there because like hearing you
say it, it was like, yes, it's so true. It's so true.
And it's because like estrogen's mechanism of action, like estrogen
is very like m I like.

Speaker 3 (52:12):
To think of it as anabolic in a lot of ways,
which means it's building, it's hydrating, it plumps local tissues,
like you know when we think about like anti aging,
and like sure, of course estrogen is going to kind
of appear to have some of those effects because it's
mechanism of action is fullness. Like I kind of I

(52:33):
like to think about women's health through the lens of
arabtic medicine too. That's something that I am well versed
in and have certification in as well, and I often
find that I can't help but bring some of the
irabatic principles into how I view especially like.

Speaker 2 (52:48):
Women's transitions through the lifespan.

Speaker 3 (52:51):
So like when I'm thinking about perimenopause and beyond as
just like, okay, how would I categorize this from like
an irratic perspective. And it's a very dry and hot
time of life. So that dry heat, like I like
to think about like a forest fire where there's Santa
Ana winds just kind of blowing on it. So it's

(53:13):
very dry. It can be very hot, very irritating. And
so when we think about this through the lens of
io beta, you want to address those that symptom picture
with its opposite to balance it out.

Speaker 2 (53:27):
And so we want.

Speaker 3 (53:28):
Hydrating things, we want cooling things like estrogen is very hydrating,
and it's very like for me when I like, you know,
there's the medical side of it, but then there's also
this other piece of it.

Speaker 2 (53:39):
I love that this is a piece of how you
treat And I like.

Speaker 1 (53:43):
Everybody's gonna see you right now cleaning myself because that
is I mean.

Speaker 2 (53:49):
It's yeah, speaking my language. Yeah, I love it. And
you know, the more holistically.

Speaker 3 (53:53):
We can approach something to you, like I For me
as a practitioner, I find that I am better able
to serve my patients the more lenses that I can look.

Speaker 2 (54:02):
At something through, And like ir veta is.

Speaker 3 (54:05):
One of my favorite lenses that I've collected over the
years in terms of my ability to look at things through,
because I find that like when you can look at
something as like, Okay, well.

Speaker 2 (54:16):
Does this is this balanced or not? And if not?

Speaker 3 (54:18):
Why, like what needs what aspect of it is unbalanced?
What are the characteristics of it? And then what's the
opposite of that? Like how I plug something into help
even it out?

Speaker 2 (54:27):
And I find that to.

Speaker 3 (54:28):
Be really potent medicine clinically, and people get a lot
from it.

Speaker 2 (54:32):
So like when we're thinking like the lens of kind
of this dry hot heat period.

Speaker 3 (54:38):
Of time that eventually just kind of goes off into
like more of a dry cold picture after official menopause
has hit, we really are kind of the continuous thread
there is we need to be treating the dry on
a long term basis, this drying effect that comes, so
like to back up a little bit, there's kind of

(54:59):
these threat dosha because we've got Kafa which is like
earth element, water element, very grounded, like I think like
goddess energy. When I think about Kafa dosha, we've got
pitta which is fire and water working together. And so
when I think about pintadosha, I think about like the
movers and the shakers, like people who are really active,

(55:20):
like really sharply just like into having a full, busy life.
And then when I think about the last one, which
is Vata doosha.

Speaker 2 (55:30):
We're thinking more air and ether elements.

Speaker 3 (55:32):
And so this is like creatives like spending time up
in the mind space, lots of movement. Vata's governed by movement,
and oftentimes when Vota's out of balance, we see this
drying happening. So we apply the doshes over the lifespan.
And so when you're a kid and you're in childhood
before you hit puberty, that's your coffa time of life.

Speaker 2 (55:52):
It's very anabolic. You're building, you're.

Speaker 3 (55:55):
Leaning into earth element because we need structure, right, like
we need to set that structural foundation to be able
to enter into pitta time of life, which if we're
framing it within a female bodied physiological lifespan. Pitta is
kind of puberty to menopause where we're like living it
out right, We're doing all the things, and then when
you hit menopause, you enter your bata time of life,

(56:17):
and it's this really beautiful time where everything kind of convalesces,
you can you spend more time kind of up in
your creative centers. There's definitely some things that come along
with it, and that drying aspect is one of them.
So we're moving from like really grounded, umptuous, like nurtured
into kind of this fiery time of life that comes

(56:38):
with its whole own bucket of fun, and then you
kind of even it out with this drying.

Speaker 2 (56:43):
And I like to think of it as just kind of.

Speaker 3 (56:45):
Like you know, the spirit, Like the spirit kind of
takes hold because it's more of that air either element,
and so all of the changes that are happening in
the body intuitively just kind of makes sense with like
that that last transition that we're getting ready to go
through at the end of life, right, And so when
I look at menopause and parimenopause, I try to think about, like, Okay,

(57:06):
if we're going to plug things in therapeutically here I
know that my common thread is like dry. There's definitely
going to be a strong vawta aspect to all of
this because we're transitioning into that time of life, and
so you know, I'll use nutrition as an example here.
I think, like women get kind of freaked out by
this temporary waking that happens during that pari menopause menopause bump.

Speaker 2 (57:32):
For most people it's transient, for some it's not.

Speaker 3 (57:35):
And you know that's another aspect of like society and
viewpoints on women that we could probably spend a whole
episode on.

Speaker 2 (57:41):
This is so normal, and you know.

Speaker 3 (57:45):
I think a lot of the tendency around this is
to address it with we need more heat, we need
to do more crisp white drying things, and that's actually
the opposite of what we want to be doing there
because it exacerbates all the problems. And so we want
to meet this vata dry just kind of like more
expansive time of life with grounding things. And so women

(58:07):
can really set themselves up for success by instead of
reaching for like a crunchy raw green salad for example,
which sure is super healthy, lots of nutritional value there,
but is it healthy for the body and the time
of life, not necessarily because it's drying and it's making
that dry.

Speaker 2 (58:24):
Aspect of what's happening worse.

Speaker 3 (58:26):
And so we actually want to kind of plug in Goddess,
Like we want the gray yogurts, we want the honey,
we want the cooked, warm foods that have a lot
of nutrition. But there's a little bit of some I
hate to say it this way, but like predigestion happening
from it being in a slow cooker all day because
those are grounding and they're healthy, just kind of balance

(58:47):
out that air element. That's just kind of part. It's
just part of how it goes, you know. And so
the way that we oftentimes address this of like, oh
I'm doing all the things, it's just adding more vota
to the bucket, making it worse. And so we kind
of have to flip the script of like where can
we slow down? How can you ground like instead of
doing like high intensity intervolved training, how about some like

(59:10):
chill yoga. You know, like your body wants that right now,
your body needs to round to kind of help balancing
what's happening out or what's happening normally out.

Speaker 2 (59:19):
That's kind of finating. Yeah. So are these conversations that
you're having at your friends it's my favorite conversations. Yeah. Yeah,
and lo and behold when we.

Speaker 3 (59:28):
When we can really get behind the lifestyle side of
this and help people understand.

Speaker 2 (59:32):
What's happening in their body.

Speaker 3 (59:34):
Yeah, on educating, because this happens during female lifespan from
start to finish. Yeah, there is a lack of education
around anatomical structures. There's a lack of education about what
to expect with anything, literally, a lack of education around
what's normal and what's not normal, and then a lack
of education around how to talk about it instead of

(59:56):
treating it like m that's TMI blah blah blah.

Speaker 2 (59:59):
No, no, no, no, this is fifty percent of the planet.

Speaker 3 (01:00:01):
We need to be having these open conversations about women's
health so that we can have shared experiences and then
also so that women feel comfortable asking for help and
guidance when they need it, because this is information that.

Speaker 2 (01:00:14):
Belongs to us.

Speaker 3 (01:00:15):
Unfortunately many of us don't currently have access to it,
but it belongs to us. And so my job, other
doctor's jobs who are treating women on a regular basis
for women's concerns it's our job to pass that knowledge
back to the hands that belongs into you, because then
you're empowered. Then you can make more informed decisions about

(01:00:37):
your day to day, your lifestyle, diet, whatever it's again
always comes back to helping women feel empowered and feel
good in their bodies.

Speaker 2 (01:00:46):
And a lot of that's just you know, re educating.
Oh this was so so good.

Speaker 1 (01:00:53):
Thank you so much for sharing all this information with
us and taking time out of your busy schedule to
like come and give us this information because it is lacking.

Speaker 2 (01:01:01):
It is.

Speaker 1 (01:01:01):
I learned so much today and the fact that you've
thread this into things that we can implement.

Speaker 2 (01:01:08):
Yeah, you spoke on so much that we need to
come back to and like talk me back on.

Speaker 1 (01:01:13):
And I have a feeling that we're gonna get a
ton of requests to have you back on with like
sleuzive questions, so whatever you are willing to give us,
and we will absolutely love to talk about.

Speaker 2 (01:01:22):
Yeah, but this is amazing. I learned so much.

Speaker 1 (01:01:26):
I love that people now have a resource for you locally.

Speaker 2 (01:01:28):
I don't know if you do any virtual care at all,
but I do. I do tell the medicine Oh you do, Okay, Yeah,
I sure do. I do. I like to make it accessible,
like one reasonable right. Yeah, yeah, we have listeners from
all over. Can you do out of state or I wish?

Speaker 3 (01:01:43):
I'm only licensed to practice medicine at Washington, okay, but
I can do telehealth.

Speaker 2 (01:01:48):
Yes, everyone, this patient is in Washington, Okay. Love that? Yeah? Well,
thank you for doing this, Thank you for being here.
Please like and subscribe to share with your friends.

Speaker 1 (01:01:55):
This podcast will be available anywhere on YouTube with Spotify, Apple,
you name it.

Speaker 2 (01:02:00):
Thank you,

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