May 28, 2024 • 38 mins
Hey friends, welcome to the podcast. This week I'm interviewing Kim Hefner, a board-certified nurse practitioner specialising in midlife and menopausal women's health.
Kim is a fountain of wisdom, and in this episode, she shares her expertise on critical health issues including cardiovascular disease, osteoporosis, and Alzheimer's disease.
Kim discusses the crucial role of estrogen, hormone replacement therapy, and practical prevention strategies. Discover how understanding and managing menopause symptoms can significantly improve your quality of life and long-term health.
I enjoyed discussing with Kim about taking control of our health in midlife and beyond, the new research available to us, and she also helped to clear up some falsehoods about menopause and HRT.
Understand how estrogen affects various organs and tissues, the impact of its decline, and the benefits of hormone replacement therapy. Learn about early prevention measures and complementary therapies that can help manage symptoms and reduce disease risk.
I think it's important for us to be informed about the benefits and risks of HRT and complementary therapies in menopause, we have access to modern research and studies and can stay up to date with current thinking and protocols - this conversation with Kim serves as a helpful resource in that area.
Join me for this resourcing and super helpful conversation with Kim Heifner board-certified nurse practitioner.
About Kim:
As a board-certified family nurse practitioner, certified menopause practitioner, and host of the popular Midlife Wellness NP Podcast, Kim Heifner, is a pioneering force in midlife women’s health. With over 23 years of diverse experience, Kim’s personal journey inspired her to become a specialist in the menopause space, open her telemedicine practice, Kim Heifner Wellness, and share expert advice and strategies on her podcast to help women thrive in midlife and beyond! Apple Podcasts: https://podcasts.apple.com/us/podcast/midlife-wellness-np/id1517262867 YouTube Channel: https://www.youtube.com/channel/UCP1MLJvcxegZ7Bv7---PUEQ
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Join the waitlist for The Midlife Upgrade Course: https://meegancare.co.nz/course/
Please note: The content of this podcast does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Hey friends, welcome to the podcast. This week I'm interviewing Kim Hefner.
Kim is a board-certified nurse practitioner and she specializes in midlife and
menopausal women's health.
She is an absolute fountain of wisdom and knowledge and on this episode,
Kim is sharing her expertise on critical health issues including cardiovascular
(00:21):
disease, osteoporosis and Alzheimer's.
She discusses the crucial role of estrogen, hormone replacement therapy and
practical prevention strategies that we can all use.
Kim helps us discover how by understanding and managing menopause symptoms,
we can significantly improve our quality of life and our long-term health.
(00:44):
Kia ora. Are you a woman navigating midlife, menopause and beyond?
I'm Megan Keir, your midlife mentor and psychosynthesis counsellor and coach.
Join me as we dive deep into the heart of midlife, Unraveling the Complexities
of Menopause and Exploring Uncharted Territories That Lie Beyond.
Together we'll navigate through self-doubt, bid farewell to people-pleasing,
(01:06):
conquer imposter syndrome and tame those overwhelming feelings.
It's time to celebrate this vibrant second chapter of life, claiming your authentic
confidence and courage along the way.
Midlife is not a time to settle. It is a time to unleash your purpose,
make an impact uniquely your own, all while prioritising your wellbeing.
(01:27):
So buckle up for conversations that resonate with the essence of your midlife
journey. Are you ready? Let's begin.
Kim Hefner, welcome to the podcast. So grateful that you're here.
Tell us about the work that you do and who you help. Well, thank you for having
me. I'm super excited to be here. Super excited to talk about this topic.
I'm a board certified nurse practitioner.
(01:49):
I specialize in the care of the midlife and menopausal woman.
I have a private practice, Kim Hefner Wellness. It's a telemedicine menopause
practice where I help patients during these years.
And I also have a podcast, the Midlife Wellness NP podcast.
So yeah, all about midlife and menopause. We're right on the same page there.
So we know that in midlife and
(02:12):
menopause, it's a time where health issues tend to arise for us as women.
And so today you're going to be speaking with us about the three big diseases of menopause.
Can you explain to us what they are and why these conditions are so relevant
and important for us to know about at this stage of life.
Right. Well, yeah, this is a critical time window of opportunity for women.
(02:36):
And I like to kind of talk about prevention starting years before we hit menopause
because we don't suddenly get to menopause and develop all these diseases.
But yet estrogen, the decline of estrogen does take a sharp nosedive when we
hit menopause and we have a significant increased risk of cardiovascular disease,
(03:01):
osteoporosis, Alzheimer's, and also other diseases like immune disorders can increase in menopause.
So definitely our risks increase at menopause due to the deficiency of estrogen.
I can talk about that a little bit more because...
It's so important to understand that estrogen is a hormone that protects,
(03:23):
that affects all of our organs, all of our tissues.
It's very protective of our heart, our blood vessels, our brain,
neurological system, musculoskeletal system.
So our muscles, our bones, our joints, our skin, our genitourinary system.
So definitely it's amazing when you think about all of the things that estrogen
(03:45):
affects, effects, then you can start to understand why you experience the symptoms
that you do when you understand everything that estrogen affects.
But specifically, I can just kind of run through the specific changes that you
might expect with a decline of estrogen if you want me to.
Yeah, sure. I think that that's really good because there's a lot when I talk
(04:06):
to women and, you know, when we start to understand, oh, that could potentially
be linked with the decline of estrogen, it changes the context of how we can
look after our health. You are so right.
So with that sharp decline in estrogen, our cardiovascular risk rise.
We can develop plaque in our arteries more rapidly. Our blood pressure can rise.
(04:26):
Our cholesterol, our inflammation can rise.
We also have loss of nitric oxide production, which I just talked to an expert yesterday about that.
That is a potent gas produced in our blood vessels.
It helps keep them wide and open so our Our blood can reach all of our areas and our nutrients.
Well, that declines with estrogen loss. We have metabolic changes.
(04:49):
Our glucose can rise. We have fat redistribution. I'm sure you've talked about
that before, that weight gain in the abdomen, increase in insulin resistance.
It's interesting that estrogen affects the way our insulin works.
So therefore, even if we're making enough insulin, it may not work efficiently
(05:09):
like it used to. So insulin resistance can increase.
So with that increases our risk of diabetes type 2, metabolic syndrome.
So we have less carb tolerance. We don't burn glucose for fuel like we used
to. So that can contribute to the weight gain.
And what about those mood changes, sleep disturbances, hot flashes?
(05:33):
I like to explain to my patients that hot flashes and night sweats,
they are symptoms, classic symptoms of menopause.
But interestingly, those symptoms are not benign.
They increase our risk of future cardiovascular disease. So,
it's important to manage those hot flashes and night sweats because I say our
(05:54):
symptoms are a risk themselves and they further worsen our mood and our sleep.
So, that's related to the cardiometabolic changes. changes, well,
then you think about our bones.
You know, we have bone loss with the loss of estrogen.
Estrogen is very protective to our bones. It keeps them strong.
It prevents them from breaking down.
(06:15):
The risk of bone loss is rapid in the first five years of menopause.
We can lose 10 to 12% of our bone in the first five years of menopause.
And a hip fracture, when a woman has a a hip fracture, that is a huge mortality
increase, risk of mortality increase with a hip fracture.
(06:35):
So big deal on the bones. And if you can get to it and prevent,
you know, when you're in that weak bone stage,
that osteopenia, before you get to the osteoporosis, that's the ideal time to
prevent further progression of bone loss.
So estrogen can come into play with that. As far as Alzheimer's,
estrogen is protective of our brain cells.
(06:58):
So we have, you know, it protects us against cognitive decline.
And Alzheimer's also is associated with insulin and blood sugar as well.
I'm sure you've heard of Alzheimer's being type 3 diabetes.
So there's a lot that goes into it, but estrogen plays a big role in all of those diseases.
And especially when menopause happens before the age of 45, we have an increased
(07:22):
risk of cardiovascular disease, increased risk of Alzheimer's,
which is all thought to be related to that length of time.
That we're deficient in estrogen. So a lot goes on when we start to lose estrogen and menopause.
Yeah, it's a wild world, isn't it? And at this stage of life,
and when I hear you talk about early menopause, that was exactly my experience.
(07:47):
So going through menopause before 45 and not then understanding how HRT could help me.
And so it's been quite a journey for me. So I'm I'm 53 now and so have been
in menopause for like nine or 10 years.
So super interesting from a personal perspective.
(08:09):
So can you tell me, so what is the role of hormone replacement therapy in managing
our risk around these issues? Yeah, absolutely.
Hormone therapy is, you know, there's a lot of debate about hormone therapy.
I know it's a really hot topic. Some people are there for it.
(08:29):
Some people are against it.
I feel this way about it. Menopause, yes, is a natural phase of life, right?
But hormone therapy, like I talked about the hot flashes and the night sweats.
Giving back some estrogen and progesterone and replacing some of those hormones
that are contributing to all those
symptoms of menopause can significantly improve one's quality of life.
(08:53):
It can in HRT hormone therapy has been associated with a decreased risk of diabetes,
decreased risk of fractures and a decreased risk of all of all cause mortality.
So definitely it can treat menopausal symptoms, improve health outcomes, quality of life.
(09:15):
But the thing with hormone therapy, there's this thing called the timing hypothesis.
So it's interesting. So the Menopause Society is kind of a certifying body of
menopause. It's a collection of all of the evidence surrounding menopause and hormone therapy.
They say that the best time for hormone therapy is within the first 10 years
(09:37):
of menopause or younger than 60.
It is during that time that people...
Have more of a benefit than a risk ratio.
So the earlier we can initiate hormone therapy, the better health outcomes.
It has better effects on cardiovascular and better effects on the brain,
(09:57):
and definitely it can prevent bone loss.
So hormone therapy is a big deal. It can really be a lifesaver,
game changer for those people that are qualified for it. They don't have any.
Contraindications, the earlier you initiate it, the better.
I always get the question, well, I've missed that window. Is it too late for me?
Is it too late for me? And I would say, no, it's not too late for you,
(10:21):
but you want to make sure that you don't have underlying cardiovascular disease
or other contraindications.
So certainly if somebody comes to me of that age, we're going to look a little further.
We're going to make sure there's no underlying line cardiovascular disease because,
you know, depending on the length of time without estrogen, your vessels can
(10:43):
become stiffer, thicker, less elastic without estrogen.
So increased risk for cardiovascular. So you want to make sure there's nothing
underlying, but definitely it's still on the table for people that don't have
any underlying issues contraindicating it.
So good to know so for my for my
friend who's you know 59 and she's you know been post-menopausal for say seven
(11:09):
or eight years and I have talked to women about this they think well my window
is now closed for hormone therapy but you're saying not necessarily but maybe
let's take a deeper look that's right.
That's right. Absolutely. And vaginal estrogen,
vaginal estrogen, the genitourinary syndrome of menopause is something that
(11:32):
happens in our urinary tract, our vaginal, our pelvic muscles,
all of that has estrogen receptors.
So with menopause, those changes can be progressive.
You know, hot flashes and night sweats and menopausal symptoms,
they can improve over time, right?
But the other symptoms, the genitourinary symptoms, they can progressively get worse.
(11:56):
So it's best to start early with that using like vaginal moisturizers and vaginal
estrogen that's proven safe and effective,
even for those women who have a history of breast cancer, because it stays local.
And that's something that you can initiate anytime and you will,
(12:16):
you will have benefits from it so question to that
that i have wondered is if a
woman is on hormone therapy so the patches and the progesterone capsules do
they still need to use external vaginal estrogen as well or is that sort of
(12:36):
taken care of by the patches the hormone mind therapy?
Yeah, that's a great question. Honestly, even people that have the systemic
estrogen, it doesn't always take care of the vaginal symptoms.
So a lot of times women will need systemic estrogen through the patch or however they're taking it.
And also they use vaginal estrogen as well.
(13:00):
So no contraindications for that.
It's certainly acceptable and beneficial even to have both.
Great to know. So in terms of preventative measures that we can do to prevent
our risk for these illnesses,
for these diseases, so we've talked about hormone therapy,
(13:24):
but are there other measures we can take as well as, or for whatever reason,
if a woman doesn't want to or cannot, you know, utilize hormone therapy,
what else can we do? Oh, absolutely.
First of all, I would say, like I mentioned early, the earlier prevention,
you can start in perimenopause that four to 10 years before the final menstrual cycle.
(13:46):
Definitely start then. But the next best time is to start now with preventative things.
It's never too late to improve your health.
So first I would say, know your risks. You know, do you have a high risk for
cardiovascular disease?
Has somebody in your family died young, like under 55?
Know your risk. Does anybody in the family have osteoporosis?
(14:09):
Have they broken a hip in the past?
A parental fracture will increase your risk of future fractures.
Do they have a history of Alzheimer's? Are you overweight?
Are you obese? Are you sedentary? Do you smoke? choke. Age in itself is a risk.
Menopause is a risk for disease. So there's that.
And also something that people don't really realize is if you have a history
(14:34):
of gestational diabetes or preeclampsia when you were pregnant,
that is a future risk for cardiovascular disease.
So that's something you would want to talk to your doctor about to see,
do you need to be doing anything extra to prevent future events of cardiovascular disease.
So know your risk factors. I always tell my patients, follow your own circadian rhythm.
(14:56):
It's super important. It modulates everything, your hormones,
your metabolism, everything.
So a consistent sleep and wake schedule, really, really beneficial.
Early morning sunlight, of course, don't smoke Coke, lemon or avoid alcohol.
That doesn't help us in perimenopause. It doesn't help us in menopause.
(15:18):
It worsens our symptoms, increases our breast cancer risk as well.
Definitely want to have a routine exercise, 150 minutes a week.
Do your strength training, which can also help with some of that metabolic issues.
So I always say get rid of the boot camps and that over cardiovascular training
and And definitely keep your cardio.
(15:40):
But focus on that strength training. If you can afford a personal trainer once
or twice a week, my patients have done really well by doing that healthy eating pattern.
I mean, the occasional bad meal is probably not going to hurt anything,
but you want to have an overall healthy eating pattern.
You want to, you know, keep a healthy weight, a BMI under 25.
(16:01):
So definitely if you're overweight, talk to your doctor about what do I need
to do to be proactive to get this weight off?
So there's that blood pressure. You want to keep a healthy blood pressure.
Keep track of that. I typically will have my patients monitor that once or twice a month.
If they have an issue more frequently, I'll have a monitor that in the mornings.
(16:22):
I like it to be under 120, under 80. So 120 over 80. I want that less than that or equal to that.
Blood sugar, making sure you're keeping that under control.
Protein, you know, there's something called a protein leverage,
you know, increasing your protein intake can offset some of that metabolic changes.
(16:42):
You know, definitely you burn more calories, digesting protein,
you want to increase your fiber.
So those are some things that you can do lifestyle wise, prioritizing that sleep. Sleep is huge.
And then consider early initiation of HRT like we talked about.
Yeah. So is there ever a time when it's too early to start with HRT for for
(17:03):
women's in perimenopause?
I think it just depends. Not really.
You know, a lot of times women in perimenopause, they don't realize that those
changes start in the 30s.
So, and often what happens, I know you've probably talked about it on the podcast before.
Initially, estrogen is kind of fluctuating wildly.
It can go really, really high while progesterone's kind of, you know,
(17:26):
leaving the scene there.
So, you kind of have a situation where you have a lot of estrogen,
maybe you're, you know, you ovulate less frequently.
So a lot of times you might not have enough progesterone. So women might start
to experience increased anxiety, they might have increased, they can have some
heart palpitations, they can have sleeplessness.
So a lot of times, early in perimenopause, or wherever they're at early in perimenopause.
(17:52):
Progesterone seems to really be helpful for women to sleep.
And I can just define that for you early perimenopause, this is kind of helpful
for women to understand because I know you probably get this question a lot.
I just want my levels checked. I want to know where I'm at.
But the thing that they probably all hear is your hormones are,
(18:13):
they're going all over the place. There's no point in checking them.
So in early perimenopause, if you keep track of your symptoms and keep track
of your periods, it's really, really helpful because early perimenopause is
when your period starts.
You know, maybe a week off, a seven day cycle off.
So that's the time when usually progesterone can be really helpful. well.
(18:37):
Late perimenopause, typically you may go two months without a period and,
you know, then you start again or maybe even longer.
Now that's the time when now your estrogen is also declining.
Things are, you're really starting to get ready for menopause here.
Your last period may be between one and three years away. It may be sooner.
(18:59):
But the bottom line is now you're going a couple months from cycling and your
estrogen probably is declining as well.
So you might start to experience more hot flashes and night sweats, that type of thing.
So I always say in that late perimenopausal stage, you may want some estrogen.
You may need some progesterone in that perimenopausal stage.
(19:20):
You may be producing some, but it might not be the level that you were in the past.
So you might start to experience symptoms during that perimenopausal stage.
Age, you definitely can benefit from hormone therapy if you're having all those symptoms.
Yeah. And what's your take on complementary or alternative therapies that can
(19:41):
help with symptoms and or reduce risk of developing these diseases as we age,
as we move through menopause?
Yeah. Well, the Menopause Society did all of the research and all of the different
things that might mitigate hot flashes, night sweats.
And they kind of came up with really the main things that were evidence-based
(20:04):
that actually showed benefit were mind-body techniques like cognitive behavioral therapy,
hypnosis, certain things like supplements and all of the things that women try
that may be beneficial for them.
But the evidence just wasn't strong enough to say that this is effective for
hot flashes, night sweats, and menopause.
(20:26):
So just having an understanding that it's not that you can't try those things,
but there's just not a whole lot of evidence that says this is going to work for you.
But definitely yoga, acupuncture, all of those things that you can do can help
you sleep better, decrease stress, and just doing those things improve symptoms a lot of times.
(20:47):
Yeah, good to know. And in terms of stress and how stress and mental health impacts our risk.
Of these diseases of heart disease, osteoarthritis, and Alzheimer's in women
during menopause, how does that or does it even impact that for us?
(21:08):
Right. So there's been a lot of studies, does cortisol, our stress hormone,
does it increase vasomotor symptoms, which are hot flashes and night sweats?
They didn't find a whole lot of correlation specifically with fat,
but yet increased cortisol,
our main stress hormone that's released under times of stress is not helpful
(21:30):
for us because definitely can damage our blood vessels, increase inflammation.
It can increase our blood pressure.
So that can increase our cardiovascular risk, increased cortisol,
it can damage our tissues.
So definitely when you're thinking of osteoarthritis, but also when you're under
a lot of stress, maybe you're not sleeping, your pain perception can be different.
(21:53):
So things can really be magnified when you're not sleeping and you're under
a lot of stress. I always tell my patients that stress kills us slowly.
You know, 80 to 90% of medical visits are related to stress,
whether it's heart palpitations, fast heart rate.
I know in my own experience, the same thing when I was working in the urgent
care in the emergency room, it definitely, I ended up getting sick and burnt out from it.
(22:17):
So definitely it impacts your health, your mental health, but also chronic stress
can increase Alzheimer's risk as well because it can increase a protein called
beta amyloid in our brain, which has been shown to increase Alzheimer's risk.
So no, definitely stress is a big deal. In perimenopause and menopause,
we can be less tolerant to stress as our hormones decline.
(22:40):
So definitely mind-body techniques yoga
changing the way you perceive stress you
know seeing it as more as an obstacle to overcome can be really helpful prioritizing
sleep getting on hormone therapy if it's interrupting your life all of those
things are so important for sleep for stress reduction yeah and i think it's
(23:00):
good to note for us as women and perimenopause and menopause where
what might have worked prior in terms of stress reduction no longer is as effective.
And so we might need to look at what are we doing?
Do we need to change things? Do we need to bring in more support in terms of reducing stress?
(23:22):
Would you say that's true for the patients and clients that you work with?
Oh, absolutely. I think just in general, midlife, it's hard because Because
it's a stressful time of life, right?
Many of us are raising, yeah, we're raising kids, we're working full time.
Maybe we have parents we're taking care of.
So definitely, it is a time of life where you're going to have to realize that,
(23:46):
Nothing is worth my health. I have to prioritize these things.
I have to make time for sleep. I have to make time for exercise.
I need to maybe go outside and get some nature to lower my cortisol levels.
I have to prioritize myself during this time. Absolutely.
Yeah. And what would you say to a woman who is, you know, she's listening to
(24:09):
us talk and she's going, yep, I can see me there, there, there.
All of this is going on for me. my sleep is
in in the garbage it's like i'm waking up all
the time you know that usual pattern but i
don't i just don't know where to start what would you say to somebody who had
that going on for them i think in general you know there's some supplements
(24:32):
that can help with sleep like magnesium glycine a lot of women want to start
with supplements which you know is not a a bad thing.
Magnesium, 80% of Americans are deficient in magnesium and magnesium glycinate
particularly is good for mood and sleep.
So that's kind of a thing that's easy to try.
Definitely avoiding artificial light in the evening that can disrupt our melatonin production.
(24:57):
Melatonin in itself for a short term is not a bad thing. Many people take it for years.
The menopause society recommends kind of the delayed release that acts more
like our own circadian rhythm.
So that's something that people can do. There's also things like adaptogens
that many women like to try under stressful situations that can kind of blunt that stress response.
(25:18):
I always say, you know, just make sure that it's safe for you,
check interactions, but also journaling, you know, doing a brain dump before
you go to bed, writing out your things you need to get done so it doesn't distract your sleep.
And then consider progesterone, consider that that micronized progesterone that really...
So progesterone is, I think of it as our calming hormone. It calms us down.
(25:43):
It interacts with the GABA receptors in our brain that, that kind of,
you know, modulates our stress response or anxiety.
So sometimes just adding a little progesterone and perimenopause can be so beneficial
for our mood and sleep and, and dealing with some of that anxiety.
That's really a game changer. Now there's an herb called Vitex that many women
(26:04):
try to do for progesterone support.
Support again not you know it's
not evidence like in medical guidelines but it doesn't
mean you can't try that if for some reason you don't
want to do progesterone but oral micronized progesterone is structurally like
our body produces so it's really beneficial so that's an option yeah so really
(26:28):
good places to start yeah nice yeah i think it's a big deal say again sleep sleep is a big deal Oh,
look, I've always been such a great sleeper.
And then when I was in perimenopause, I was waking, you know,
the usual three in the morning, couldn't get back to sleep till 5.30.
I was always running on not enough sleep.
(26:48):
It was a massive deal. And I did all the natural therapy things that I could possibly do.
And it wasn't until I started on HRT and melatonin at the same time and my sleep
came back pretty much straight away.
Yeah. Yeah. And another thing is don't, alcohol will keep you awake.
(27:12):
It will disrupt your sleep.
So alcohol, I always say, it's not really our friend right now,
maybe an occasional one, but when you're trying to get sleep,
it's just going to make everything worse, your symptoms worse, your sleep worse.
So to me, it's just not worth it. Really good to know, isn't it?
Because I think alcohol, a glass of wine, a glass of whatever lever is something that we go to.
(27:33):
We're tired at the end of the day. I just want something to help me relax.
But actually, I don't understand what it's doing in our body,
but I certainly saw it for myself that it was very irritating,
became very irritating for my system. That's right.
I wear something called an aura ring. I'm sure you've heard of that. It's interesting.
(27:54):
Occasionally, we go out for dinner. If I have wine, it's so interesting because
the next day, you know, I hadn't slept well, it will tell me my heart rate was
elevated above its resting. So it's definitely making an impact.
It's just something to think of it as a treat. If you're going to have it,
it doesn't, it doesn't, it doesn't make your symptoms better.
It doesn't help you cope with stress better.
(28:14):
It really just makes everything worse. So I would, I definitely say limit it
and it doesn't help with our sugar regulation.
It doesn't help with the weight gain issues. So, definitely something to kind of, you know, put aside.
Yeah. That's right. That's right.
Really good to think about. So, are there any recent advancements or research
(28:36):
related to prevention and treatment of these diseases that you've been talking about today?
Is there anything sort of on the horizon that you can speak to?
Well, I think really what's up that's been in the news lately is the recent
research on hormone therapy, actually, for benefits in women 65 and over.
(28:57):
So that was really good news. Because if you remember, at some point,
they said women need to stop it at some point, get off their hormone therapy.
But the research shows, no, women do better, live longer, have better health
outcomes when they don't stop hormone therapy.
So that was really great news. And the news was that they tend to do better
(29:20):
when the hormone therapy doses are kind of in the low to moderate doses.
You don't need high doses of hormone therapy to have those benefits.
So I found that really, really helpful.
Then they did some re-evaluations of the re-analysis of the Women's Health Initiative studies.
So you remember back in the day, the studies where it scared all of the women
(29:41):
off of their hormone therapy because it said it caused breast cancer.
Well, they did some re-analysis of that and found that, honestly,
no, women that just did estrogen only actually had a reduction in breast cancer.
But the overall risk of breast cancer in general was very insignificant.
There was not a significant increased risk of breast cancer.
(30:04):
So I found that really, really reassuring for us that, you know,
are on hormone therapy or want to do hormone therapy, just knowing that maybe
that those studies were overblown. So that's that.
I know they're coming out. They're trying to target some Alzheimer's drugs.
So those are in process and research.
And then talking to Dr. Nathan Bryan, they are working on some nitric oxide
(30:29):
type supplementation that can help women because that is a really big deal for
sexual function, cardiovascular, Alzheimer's prevention.
So that's really exciting as well. So that's really, I think,
what's up and coming as far as disease prevention and hormone therapy.
Yeah, really good to know. And I think because I went through menopause earlier
(30:50):
than my peers and because then I probably started hormone therapy earlier or
a lot of them haven't yet or don't want to,
I get a lot of questions around, well, how long are you going to be on it for? When do you have to stop?
And I just kind of make a joke and say, you know, they can bury me in the patch.
I'm not coming off it unless there's good evidence to do just that.
(31:17):
Yeah, so, yeah, really helpful to know.
And I think it's important for women to know that all of the benefits that they
were receiving while they were on hormone therapy can quickly decline once they came off of it.
So bone loss, think of that, you know, the effects on your blood vessels.
So those things can significantly decline when you come off of your hormone therapy.
(31:41):
So research shows you don't need to come off it. The menopause society says
there's no time that you have to stop it.
So I think that's good news. I don't think you have to come off of it as long as it's benefiting you.
As long as it's still benefiting you, you're not having any issues, then you're good to go.
That's really good to know. And something I've heard from a friend,
(32:05):
and she said she was talking to a practitioner that was helping her with menopause symptoms.
And the practitioner said well if
you take HRT and then you
stop you're just delaying menopause you're going
to have to go through it at some time and my
internal flags came out I was like that doesn't make sense to
(32:27):
me at all but I don't have a science brain so can you sort of speak to that
absolutely so before we're even born the amount of eggs that we're ever going
to have or is already predetermined and we lose them along the way, right?
So as we ovulate, some of them are just lost.
(32:47):
You know, they don't all ovulate. Some of them are lost to atresia,
it's called, or apoptosis.
So they don't make it. They don't survive the ovulatory cycle, right?
Our menopause is kind of predetermined. I mean, no, nothing is really going,
you know, birth control pills is not going to delay it. that nothing's really
going to delay menopause because like I said, you have so many eggs that are gonna be ovulated.
(33:10):
So no, nothing's going to change it.
Now, things can make it happen earlier because we can have things happen to our eggs, right?
So take for example, smoking.
It said, the research shows that a smoker may experience a menopause one to two years earlier.
Surgical menopause, obviously. Those are some things that can cause it,
(33:33):
but no, you're not going to delay menopause.
And yes, every woman will go through it. There's been some posts and different
things saying that women don't have to go through menopause.
And, and I say, that's not true.
If you're a woman at some point, you're going to experience menopause typically
between the ages of 45 and 55.
The average age in the U S I don't know about where you're at is 51.
(33:56):
So, but yeah, I don't, I don't necessarily agree with that.
Yeah, good to hear from you around that. Yeah, the research I've looked at,
I think it's 51 to 52 is the average age here.
So very similar. Yeah. In the same ballpark.
And so I really want to thank you for sharing your wisdom and your knowledge today.
(34:18):
That's been like this incredibly inspiring information gathering exercise for me.
So I know it's really going to help women that are listening to the podcast.
So what would you like as
we start to wrap things up what's the sort of final nugget
you would be really thrilled if women walked away
with what what sort of advice would you leave them i
(34:40):
think first of all i would say kind of ignore the social media noise you're
going to have people that are for hormone therapy yeah against hormone therapy
i think this is a personal decision you have you You have personal medical history
and things that affect you personally. So it's a personal decision.
(35:00):
I would say advocate for your own health. Make appointment with somebody that
understands the risks associated with menopause. And they want to be proactive.
They don't want to wait till you have all these things going on to initiate hormone therapy.
Or they may not, if they say they don't prescribe hormone therapy,
then I would find somebody different because there's definitely medical guidelines
(35:24):
for hormone therapy that every physician should know about.
And it's an indication for hormone therapy, but also know your own risk.
Like we talked about earlier, what are your risks?
You know, if you're at risk for early cardiovascular events,
then your prevention strategy needs to be greater than if you have no risks, right?
(35:45):
Know your preferences for menopause. Do you want to try to do it natural with
lifestyle changes and supplements?
Do you want non-hormonal therapies, hormonal therapies?
Those are things that you can kind of think before you ever meet your practitioner.
How do you wanna manage your menopause? This is your time, right?
I would say perimenopausal women, definitely track your cycles,
(36:07):
track your symptoms that can help guide your treatment.
You know, like we talked about earlier, early menopause, perimenopause versus late.
Know where you're at so that that will help guide your hormone therapy if you
decide to, or your supplementation or whatever you're working on.
Lastly, I think I would just want to say, I want women to embrace the opportunity to age.
(36:30):
Don't get caught up in societal standards of women. Just enjoy your life.
Age stronger, not harder.
Take care of those muscles and your bones and your body so that you can live
happy, healthy, and long.
So I think that's what I would say. What a beautiful way to wrap up our conversation.
Thank you so much, Kim. How can people connect with you if they want to learn more from you?
(36:56):
Absolutely. So my website is kimhefnerwellness.com. On social media,
I'm just Kim Hefner or Kim Hefner Wellness.
My podcast is the Midlife Wellness NP podcast. So it's on YouTube and podcast
platforms everywhere. I would love for you to subscribe.
I interview all kinds of authors and experts on the podcast.
And we talk about all different kinds of things.
(37:17):
So yeah, I would love it if you would follow me, subscribe, connect with me.
Happy to have you. Thank you so much, Kim.
No problem. I'm happy to be here. Thank you so much for having me.
Hey, thanks for joining me on the podcast.
Really appreciate you. Check out my course where we just go so much deeper than
I can ever do on a podcast over an eight-week period.
(37:38):
The Midlife Upgrade course is a blend of video and learning modules and weekly
live calls where you will discover a roadmap for psychological freedom freedom in midlife.
Check out all the details on my website. I really, really would love to have you join the course.
MeganKier.co.nz forward slash course.
Hey friends, welcome to the podcast. This week I'm interviewing Kim Hefner.
Kim is a board-certified nurse practitioner and she specializes in midlife and
menopausal women's health.
She is an absolute fountain of wisdom and knowledge and on this episode,
Kim is sharing her expertise on critical health issues including cardiovascular
(00:21):
disease, osteoporosis and Alzheimer's.
She discusses the crucial role of estrogen, hormone replacement therapy and
practical prevention strategies that we can all use.
Kim helps us discover how by understanding and managing menopause symptoms,
we can significantly improve our quality of life and our long-term health.
(00:44):
Kia ora. Are you a woman navigating midlife, menopause and beyond?
I'm Megan Keir, your midlife mentor and psychosynthesis counsellor and coach.
Join me as we dive deep into the heart of midlife, Unraveling the Complexities
of Menopause and Exploring Uncharted Territories That Lie Beyond.
Together we'll navigate through self-doubt, bid farewell to people-pleasing,
(01:06):
conquer imposter syndrome and tame those overwhelming feelings.
It's time to celebrate this vibrant second chapter of life, claiming your authentic
confidence and courage along the way.
Midlife is not a time to settle. It is a time to unleash your purpose,
make an impact uniquely your own, all while prioritising your wellbeing.
(01:27):
So buckle up for conversations that resonate with the essence of your midlife
journey. Are you ready? Let's begin.
Kim Hefner, welcome to the podcast. So grateful that you're here.
Tell us about the work that you do and who you help. Well, thank you for having
me. I'm super excited to be here. Super excited to talk about this topic.
I'm a board certified nurse practitioner.
(01:49):
I specialize in the care of the midlife and menopausal woman.
I have a private practice, Kim Hefner Wellness. It's a telemedicine menopause
practice where I help patients during these years.
And I also have a podcast, the Midlife Wellness NP podcast.
So yeah, all about midlife and menopause. We're right on the same page there.
So we know that in midlife and
(02:12):
menopause, it's a time where health issues tend to arise for us as women.
And so today you're going to be speaking with us about the three big diseases of menopause.
Can you explain to us what they are and why these conditions are so relevant
and important for us to know about at this stage of life.
Right. Well, yeah, this is a critical time window of opportunity for women.
(02:36):
And I like to kind of talk about prevention starting years before we hit menopause
because we don't suddenly get to menopause and develop all these diseases.
But yet estrogen, the decline of estrogen does take a sharp nosedive when we
hit menopause and we have a significant increased risk of cardiovascular disease,
(03:01):
osteoporosis, Alzheimer's, and also other diseases like immune disorders can increase in menopause.
So definitely our risks increase at menopause due to the deficiency of estrogen.
I can talk about that a little bit more because...
It's so important to understand that estrogen is a hormone that protects,
(03:23):
that affects all of our organs, all of our tissues.
It's very protective of our heart, our blood vessels, our brain,
neurological system, musculoskeletal system.
So our muscles, our bones, our joints, our skin, our genitourinary system.
So definitely it's amazing when you think about all of the things that estrogen
(03:45):
affects, effects, then you can start to understand why you experience the symptoms
that you do when you understand everything that estrogen affects.
But specifically, I can just kind of run through the specific changes that you
might expect with a decline of estrogen if you want me to.
Yeah, sure. I think that that's really good because there's a lot when I talk
(04:06):
to women and, you know, when we start to understand, oh, that could potentially
be linked with the decline of estrogen, it changes the context of how we can
look after our health. You are so right.
So with that sharp decline in estrogen, our cardiovascular risk rise.
We can develop plaque in our arteries more rapidly. Our blood pressure can rise.
(04:26):
Our cholesterol, our inflammation can rise.
We also have loss of nitric oxide production, which I just talked to an expert yesterday about that.
That is a potent gas produced in our blood vessels.
It helps keep them wide and open so our Our blood can reach all of our areas and our nutrients.
Well, that declines with estrogen loss. We have metabolic changes.
(04:49):
Our glucose can rise. We have fat redistribution. I'm sure you've talked about
that before, that weight gain in the abdomen, increase in insulin resistance.
It's interesting that estrogen affects the way our insulin works.
So therefore, even if we're making enough insulin, it may not work efficiently
(05:09):
like it used to. So insulin resistance can increase.
So with that increases our risk of diabetes type 2, metabolic syndrome.
So we have less carb tolerance. We don't burn glucose for fuel like we used
to. So that can contribute to the weight gain.
And what about those mood changes, sleep disturbances, hot flashes?
(05:33):
I like to explain to my patients that hot flashes and night sweats,
they are symptoms, classic symptoms of menopause.
But interestingly, those symptoms are not benign.
They increase our risk of future cardiovascular disease. So,
it's important to manage those hot flashes and night sweats because I say our
(05:54):
symptoms are a risk themselves and they further worsen our mood and our sleep.
So, that's related to the cardiometabolic changes. changes, well,
then you think about our bones.
You know, we have bone loss with the loss of estrogen.
Estrogen is very protective to our bones. It keeps them strong.
It prevents them from breaking down.
(06:15):
The risk of bone loss is rapid in the first five years of menopause.
We can lose 10 to 12% of our bone in the first five years of menopause.
And a hip fracture, when a woman has a a hip fracture, that is a huge mortality
increase, risk of mortality increase with a hip fracture.
(06:35):
So big deal on the bones. And if you can get to it and prevent,
you know, when you're in that weak bone stage,
that osteopenia, before you get to the osteoporosis, that's the ideal time to
prevent further progression of bone loss.
So estrogen can come into play with that. As far as Alzheimer's,
estrogen is protective of our brain cells.
(06:58):
So we have, you know, it protects us against cognitive decline.
And Alzheimer's also is associated with insulin and blood sugar as well.
I'm sure you've heard of Alzheimer's being type 3 diabetes.
So there's a lot that goes into it, but estrogen plays a big role in all of those diseases.
And especially when menopause happens before the age of 45, we have an increased
(07:22):
risk of cardiovascular disease, increased risk of Alzheimer's,
which is all thought to be related to that length of time.
That we're deficient in estrogen. So a lot goes on when we start to lose estrogen and menopause.
Yeah, it's a wild world, isn't it? And at this stage of life,
and when I hear you talk about early menopause, that was exactly my experience.
(07:47):
So going through menopause before 45 and not then understanding how HRT could help me.
And so it's been quite a journey for me. So I'm I'm 53 now and so have been
in menopause for like nine or 10 years.
So super interesting from a personal perspective.
(08:09):
So can you tell me, so what is the role of hormone replacement therapy in managing
our risk around these issues? Yeah, absolutely.
Hormone therapy is, you know, there's a lot of debate about hormone therapy.
I know it's a really hot topic. Some people are there for it.
(08:29):
Some people are against it.
I feel this way about it. Menopause, yes, is a natural phase of life, right?
But hormone therapy, like I talked about the hot flashes and the night sweats.
Giving back some estrogen and progesterone and replacing some of those hormones
that are contributing to all those
symptoms of menopause can significantly improve one's quality of life.
(08:53):
It can in HRT hormone therapy has been associated with a decreased risk of diabetes,
decreased risk of fractures and a decreased risk of all of all cause mortality.
So definitely it can treat menopausal symptoms, improve health outcomes, quality of life.
(09:15):
But the thing with hormone therapy, there's this thing called the timing hypothesis.
So it's interesting. So the Menopause Society is kind of a certifying body of
menopause. It's a collection of all of the evidence surrounding menopause and hormone therapy.
They say that the best time for hormone therapy is within the first 10 years
(09:37):
of menopause or younger than 60.
It is during that time that people...
Have more of a benefit than a risk ratio.
So the earlier we can initiate hormone therapy, the better health outcomes.
It has better effects on cardiovascular and better effects on the brain,
(09:57):
and definitely it can prevent bone loss.
So hormone therapy is a big deal. It can really be a lifesaver,
game changer for those people that are qualified for it. They don't have any.
Contraindications, the earlier you initiate it, the better.
I always get the question, well, I've missed that window. Is it too late for me?
Is it too late for me? And I would say, no, it's not too late for you,
(10:21):
but you want to make sure that you don't have underlying cardiovascular disease
or other contraindications.
So certainly if somebody comes to me of that age, we're going to look a little further.
We're going to make sure there's no underlying line cardiovascular disease because,
you know, depending on the length of time without estrogen, your vessels can
(10:43):
become stiffer, thicker, less elastic without estrogen.
So increased risk for cardiovascular. So you want to make sure there's nothing
underlying, but definitely it's still on the table for people that don't have
any underlying issues contraindicating it.
So good to know so for my for my
friend who's you know 59 and she's you know been post-menopausal for say seven
(11:09):
or eight years and I have talked to women about this they think well my window
is now closed for hormone therapy but you're saying not necessarily but maybe
let's take a deeper look that's right.
That's right. Absolutely. And vaginal estrogen,
vaginal estrogen, the genitourinary syndrome of menopause is something that
(11:32):
happens in our urinary tract, our vaginal, our pelvic muscles,
all of that has estrogen receptors.
So with menopause, those changes can be progressive.
You know, hot flashes and night sweats and menopausal symptoms,
they can improve over time, right?
But the other symptoms, the genitourinary symptoms, they can progressively get worse.
(11:56):
So it's best to start early with that using like vaginal moisturizers and vaginal
estrogen that's proven safe and effective,
even for those women who have a history of breast cancer, because it stays local.
And that's something that you can initiate anytime and you will,
(12:16):
you will have benefits from it so question to that
that i have wondered is if a
woman is on hormone therapy so the patches and the progesterone capsules do
they still need to use external vaginal estrogen as well or is that sort of
(12:36):
taken care of by the patches the hormone mind therapy?
Yeah, that's a great question. Honestly, even people that have the systemic
estrogen, it doesn't always take care of the vaginal symptoms.
So a lot of times women will need systemic estrogen through the patch or however they're taking it.
And also they use vaginal estrogen as well.
(13:00):
So no contraindications for that.
It's certainly acceptable and beneficial even to have both.
Great to know. So in terms of preventative measures that we can do to prevent
our risk for these illnesses,
for these diseases, so we've talked about hormone therapy,
(13:24):
but are there other measures we can take as well as, or for whatever reason,
if a woman doesn't want to or cannot, you know, utilize hormone therapy,
what else can we do? Oh, absolutely.
First of all, I would say, like I mentioned early, the earlier prevention,
you can start in perimenopause that four to 10 years before the final menstrual cycle.
(13:46):
Definitely start then. But the next best time is to start now with preventative things.
It's never too late to improve your health.
So first I would say, know your risks. You know, do you have a high risk for
cardiovascular disease?
Has somebody in your family died young, like under 55?
Know your risk. Does anybody in the family have osteoporosis?
(14:09):
Have they broken a hip in the past?
A parental fracture will increase your risk of future fractures.
Do they have a history of Alzheimer's? Are you overweight?
Are you obese? Are you sedentary? Do you smoke? choke. Age in itself is a risk.
Menopause is a risk for disease. So there's that.
And also something that people don't really realize is if you have a history
(14:34):
of gestational diabetes or preeclampsia when you were pregnant,
that is a future risk for cardiovascular disease.
So that's something you would want to talk to your doctor about to see,
do you need to be doing anything extra to prevent future events of cardiovascular disease.
So know your risk factors. I always tell my patients, follow your own circadian rhythm.
(14:56):
It's super important. It modulates everything, your hormones,
your metabolism, everything.
So a consistent sleep and wake schedule, really, really beneficial.
Early morning sunlight, of course, don't smoke Coke, lemon or avoid alcohol.
That doesn't help us in perimenopause. It doesn't help us in menopause.
(15:18):
It worsens our symptoms, increases our breast cancer risk as well.
Definitely want to have a routine exercise, 150 minutes a week.
Do your strength training, which can also help with some of that metabolic issues.
So I always say get rid of the boot camps and that over cardiovascular training
and And definitely keep your cardio.
(15:40):
But focus on that strength training. If you can afford a personal trainer once
or twice a week, my patients have done really well by doing that healthy eating pattern.
I mean, the occasional bad meal is probably not going to hurt anything,
but you want to have an overall healthy eating pattern.
You want to, you know, keep a healthy weight, a BMI under 25.
(16:01):
So definitely if you're overweight, talk to your doctor about what do I need
to do to be proactive to get this weight off?
So there's that blood pressure. You want to keep a healthy blood pressure.
Keep track of that. I typically will have my patients monitor that once or twice a month.
If they have an issue more frequently, I'll have a monitor that in the mornings.
(16:22):
I like it to be under 120, under 80. So 120 over 80. I want that less than that or equal to that.
Blood sugar, making sure you're keeping that under control.
Protein, you know, there's something called a protein leverage,
you know, increasing your protein intake can offset some of that metabolic changes.
(16:42):
You know, definitely you burn more calories, digesting protein,
you want to increase your fiber.
So those are some things that you can do lifestyle wise, prioritizing that sleep. Sleep is huge.
And then consider early initiation of HRT like we talked about.
Yeah. So is there ever a time when it's too early to start with HRT for for
(17:03):
women's in perimenopause?
I think it just depends. Not really.
You know, a lot of times women in perimenopause, they don't realize that those
changes start in the 30s.
So, and often what happens, I know you've probably talked about it on the podcast before.
Initially, estrogen is kind of fluctuating wildly.
It can go really, really high while progesterone's kind of, you know,
(17:26):
leaving the scene there.
So, you kind of have a situation where you have a lot of estrogen,
maybe you're, you know, you ovulate less frequently.
So a lot of times you might not have enough progesterone. So women might start
to experience increased anxiety, they might have increased, they can have some
heart palpitations, they can have sleeplessness.
So a lot of times, early in perimenopause, or wherever they're at early in perimenopause.
(17:52):
Progesterone seems to really be helpful for women to sleep.
And I can just define that for you early perimenopause, this is kind of helpful
for women to understand because I know you probably get this question a lot.
I just want my levels checked. I want to know where I'm at.
But the thing that they probably all hear is your hormones are,
(18:13):
they're going all over the place. There's no point in checking them.
So in early perimenopause, if you keep track of your symptoms and keep track
of your periods, it's really, really helpful because early perimenopause is
when your period starts.
You know, maybe a week off, a seven day cycle off.
So that's the time when usually progesterone can be really helpful. well.
(18:37):
Late perimenopause, typically you may go two months without a period and,
you know, then you start again or maybe even longer.
Now that's the time when now your estrogen is also declining.
Things are, you're really starting to get ready for menopause here.
Your last period may be between one and three years away. It may be sooner.
(18:59):
But the bottom line is now you're going a couple months from cycling and your
estrogen probably is declining as well.
So you might start to experience more hot flashes and night sweats, that type of thing.
So I always say in that late perimenopausal stage, you may want some estrogen.
You may need some progesterone in that perimenopausal stage.
(19:20):
You may be producing some, but it might not be the level that you were in the past.
So you might start to experience symptoms during that perimenopausal stage.
Age, you definitely can benefit from hormone therapy if you're having all those symptoms.
Yeah. And what's your take on complementary or alternative therapies that can
(19:41):
help with symptoms and or reduce risk of developing these diseases as we age,
as we move through menopause?
Yeah. Well, the Menopause Society did all of the research and all of the different
things that might mitigate hot flashes, night sweats.
And they kind of came up with really the main things that were evidence-based
(20:04):
that actually showed benefit were mind-body techniques like cognitive behavioral therapy,
hypnosis, certain things like supplements and all of the things that women try
that may be beneficial for them.
But the evidence just wasn't strong enough to say that this is effective for
hot flashes, night sweats, and menopause.
(20:26):
So just having an understanding that it's not that you can't try those things,
but there's just not a whole lot of evidence that says this is going to work for you.
But definitely yoga, acupuncture, all of those things that you can do can help
you sleep better, decrease stress, and just doing those things improve symptoms a lot of times.
(20:47):
Yeah, good to know. And in terms of stress and how stress and mental health impacts our risk.
Of these diseases of heart disease, osteoarthritis, and Alzheimer's in women
during menopause, how does that or does it even impact that for us?
(21:08):
Right. So there's been a lot of studies, does cortisol, our stress hormone,
does it increase vasomotor symptoms, which are hot flashes and night sweats?
They didn't find a whole lot of correlation specifically with fat,
but yet increased cortisol,
our main stress hormone that's released under times of stress is not helpful
(21:30):
for us because definitely can damage our blood vessels, increase inflammation.
It can increase our blood pressure.
So that can increase our cardiovascular risk, increased cortisol,
it can damage our tissues.
So definitely when you're thinking of osteoarthritis, but also when you're under
a lot of stress, maybe you're not sleeping, your pain perception can be different.
(21:53):
So things can really be magnified when you're not sleeping and you're under
a lot of stress. I always tell my patients that stress kills us slowly.
You know, 80 to 90% of medical visits are related to stress,
whether it's heart palpitations, fast heart rate.
I know in my own experience, the same thing when I was working in the urgent
care in the emergency room, it definitely, I ended up getting sick and burnt out from it.
(22:17):
So definitely it impacts your health, your mental health, but also chronic stress
can increase Alzheimer's risk as well because it can increase a protein called
beta amyloid in our brain, which has been shown to increase Alzheimer's risk.
So no, definitely stress is a big deal. In perimenopause and menopause,
we can be less tolerant to stress as our hormones decline.
(22:40):
So definitely mind-body techniques yoga
changing the way you perceive stress you
know seeing it as more as an obstacle to overcome can be really helpful prioritizing
sleep getting on hormone therapy if it's interrupting your life all of those
things are so important for sleep for stress reduction yeah and i think it's
(23:00):
good to note for us as women and perimenopause and menopause where
what might have worked prior in terms of stress reduction no longer is as effective.
And so we might need to look at what are we doing?
Do we need to change things? Do we need to bring in more support in terms of reducing stress?
(23:22):
Would you say that's true for the patients and clients that you work with?
Oh, absolutely. I think just in general, midlife, it's hard because Because
it's a stressful time of life, right?
Many of us are raising, yeah, we're raising kids, we're working full time.
Maybe we have parents we're taking care of.
So definitely, it is a time of life where you're going to have to realize that,
(23:46):
Nothing is worth my health. I have to prioritize these things.
I have to make time for sleep. I have to make time for exercise.
I need to maybe go outside and get some nature to lower my cortisol levels.
I have to prioritize myself during this time. Absolutely.
Yeah. And what would you say to a woman who is, you know, she's listening to
(24:09):
us talk and she's going, yep, I can see me there, there, there.
All of this is going on for me. my sleep is
in in the garbage it's like i'm waking up all
the time you know that usual pattern but i
don't i just don't know where to start what would you say to somebody who had
that going on for them i think in general you know there's some supplements
(24:32):
that can help with sleep like magnesium glycine a lot of women want to start
with supplements which you know is not a a bad thing.
Magnesium, 80% of Americans are deficient in magnesium and magnesium glycinate
particularly is good for mood and sleep.
So that's kind of a thing that's easy to try.
Definitely avoiding artificial light in the evening that can disrupt our melatonin production.
(24:57):
Melatonin in itself for a short term is not a bad thing. Many people take it for years.
The menopause society recommends kind of the delayed release that acts more
like our own circadian rhythm.
So that's something that people can do. There's also things like adaptogens
that many women like to try under stressful situations that can kind of blunt that stress response.
(25:18):
I always say, you know, just make sure that it's safe for you,
check interactions, but also journaling, you know, doing a brain dump before
you go to bed, writing out your things you need to get done so it doesn't distract your sleep.
And then consider progesterone, consider that that micronized progesterone that really...
So progesterone is, I think of it as our calming hormone. It calms us down.
(25:43):
It interacts with the GABA receptors in our brain that, that kind of,
you know, modulates our stress response or anxiety.
So sometimes just adding a little progesterone and perimenopause can be so beneficial
for our mood and sleep and, and dealing with some of that anxiety.
That's really a game changer. Now there's an herb called Vitex that many women
(26:04):
try to do for progesterone support.
Support again not you know it's
not evidence like in medical guidelines but it doesn't
mean you can't try that if for some reason you don't
want to do progesterone but oral micronized progesterone is structurally like
our body produces so it's really beneficial so that's an option yeah so really
(26:28):
good places to start yeah nice yeah i think it's a big deal say again sleep sleep is a big deal Oh,
look, I've always been such a great sleeper.
And then when I was in perimenopause, I was waking, you know,
the usual three in the morning, couldn't get back to sleep till 5.30.
I was always running on not enough sleep.
(26:48):
It was a massive deal. And I did all the natural therapy things that I could possibly do.
And it wasn't until I started on HRT and melatonin at the same time and my sleep
came back pretty much straight away.
Yeah. Yeah. And another thing is don't, alcohol will keep you awake.
(27:12):
It will disrupt your sleep.
So alcohol, I always say, it's not really our friend right now,
maybe an occasional one, but when you're trying to get sleep,
it's just going to make everything worse, your symptoms worse, your sleep worse.
So to me, it's just not worth it. Really good to know, isn't it?
Because I think alcohol, a glass of wine, a glass of whatever lever is something that we go to.
(27:33):
We're tired at the end of the day. I just want something to help me relax.
But actually, I don't understand what it's doing in our body,
but I certainly saw it for myself that it was very irritating,
became very irritating for my system. That's right.
I wear something called an aura ring. I'm sure you've heard of that. It's interesting.
(27:54):
Occasionally, we go out for dinner. If I have wine, it's so interesting because
the next day, you know, I hadn't slept well, it will tell me my heart rate was
elevated above its resting. So it's definitely making an impact.
It's just something to think of it as a treat. If you're going to have it,
it doesn't, it doesn't, it doesn't make your symptoms better.
It doesn't help you cope with stress better.
(28:14):
It really just makes everything worse. So I would, I definitely say limit it
and it doesn't help with our sugar regulation.
It doesn't help with the weight gain issues. So, definitely something to kind of, you know, put aside.
Yeah. That's right. That's right.
Really good to think about. So, are there any recent advancements or research
(28:36):
related to prevention and treatment of these diseases that you've been talking about today?
Is there anything sort of on the horizon that you can speak to?
Well, I think really what's up that's been in the news lately is the recent
research on hormone therapy, actually, for benefits in women 65 and over.
(28:57):
So that was really good news. Because if you remember, at some point,
they said women need to stop it at some point, get off their hormone therapy.
But the research shows, no, women do better, live longer, have better health
outcomes when they don't stop hormone therapy.
So that was really great news. And the news was that they tend to do better
(29:20):
when the hormone therapy doses are kind of in the low to moderate doses.
You don't need high doses of hormone therapy to have those benefits.
So I found that really, really helpful.
Then they did some re-evaluations of the re-analysis of the Women's Health Initiative studies.
So you remember back in the day, the studies where it scared all of the women
(29:41):
off of their hormone therapy because it said it caused breast cancer.
Well, they did some re-analysis of that and found that, honestly,
no, women that just did estrogen only actually had a reduction in breast cancer.
But the overall risk of breast cancer in general was very insignificant.
There was not a significant increased risk of breast cancer.
(30:04):
So I found that really, really reassuring for us that, you know,
are on hormone therapy or want to do hormone therapy, just knowing that maybe
that those studies were overblown. So that's that.
I know they're coming out. They're trying to target some Alzheimer's drugs.
So those are in process and research.
And then talking to Dr. Nathan Bryan, they are working on some nitric oxide
(30:29):
type supplementation that can help women because that is a really big deal for
sexual function, cardiovascular, Alzheimer's prevention.
So that's really exciting as well. So that's really, I think,
what's up and coming as far as disease prevention and hormone therapy.
Yeah, really good to know. And I think because I went through menopause earlier
(30:50):
than my peers and because then I probably started hormone therapy earlier or
a lot of them haven't yet or don't want to,
I get a lot of questions around, well, how long are you going to be on it for? When do you have to stop?
And I just kind of make a joke and say, you know, they can bury me in the patch.
I'm not coming off it unless there's good evidence to do just that.
(31:17):
Yeah, so, yeah, really helpful to know.
And I think it's important for women to know that all of the benefits that they
were receiving while they were on hormone therapy can quickly decline once they came off of it.
So bone loss, think of that, you know, the effects on your blood vessels.
So those things can significantly decline when you come off of your hormone therapy.
(31:41):
So research shows you don't need to come off it. The menopause society says
there's no time that you have to stop it.
So I think that's good news. I don't think you have to come off of it as long as it's benefiting you.
As long as it's still benefiting you, you're not having any issues, then you're good to go.
That's really good to know. And something I've heard from a friend,
(32:05):
and she said she was talking to a practitioner that was helping her with menopause symptoms.
And the practitioner said well if
you take HRT and then you
stop you're just delaying menopause you're going
to have to go through it at some time and my
internal flags came out I was like that doesn't make sense to
(32:27):
me at all but I don't have a science brain so can you sort of speak to that
absolutely so before we're even born the amount of eggs that we're ever going
to have or is already predetermined and we lose them along the way, right?
So as we ovulate, some of them are just lost.
(32:47):
You know, they don't all ovulate. Some of them are lost to atresia,
it's called, or apoptosis.
So they don't make it. They don't survive the ovulatory cycle, right?
Our menopause is kind of predetermined. I mean, no, nothing is really going,
you know, birth control pills is not going to delay it. that nothing's really
going to delay menopause because like I said, you have so many eggs that are gonna be ovulated.
(33:10):
So no, nothing's going to change it.
Now, things can make it happen earlier because we can have things happen to our eggs, right?
So take for example, smoking.
It said, the research shows that a smoker may experience a menopause one to two years earlier.
Surgical menopause, obviously. Those are some things that can cause it,
(33:33):
but no, you're not going to delay menopause.
And yes, every woman will go through it. There's been some posts and different
things saying that women don't have to go through menopause.
And, and I say, that's not true.
If you're a woman at some point, you're going to experience menopause typically
between the ages of 45 and 55.
The average age in the U S I don't know about where you're at is 51.
(33:56):
So, but yeah, I don't, I don't necessarily agree with that.
Yeah, good to hear from you around that. Yeah, the research I've looked at,
I think it's 51 to 52 is the average age here.
So very similar. Yeah. In the same ballpark.
And so I really want to thank you for sharing your wisdom and your knowledge today.
(34:18):
That's been like this incredibly inspiring information gathering exercise for me.
So I know it's really going to help women that are listening to the podcast.
So what would you like as
we start to wrap things up what's the sort of final nugget
you would be really thrilled if women walked away
with what what sort of advice would you leave them i
(34:40):
think first of all i would say kind of ignore the social media noise you're
going to have people that are for hormone therapy yeah against hormone therapy
i think this is a personal decision you have you You have personal medical history
and things that affect you personally. So it's a personal decision.
(35:00):
I would say advocate for your own health. Make appointment with somebody that
understands the risks associated with menopause. And they want to be proactive.
They don't want to wait till you have all these things going on to initiate hormone therapy.
Or they may not, if they say they don't prescribe hormone therapy,
then I would find somebody different because there's definitely medical guidelines
(35:24):
for hormone therapy that every physician should know about.
And it's an indication for hormone therapy, but also know your own risk.
Like we talked about earlier, what are your risks?
You know, if you're at risk for early cardiovascular events,
then your prevention strategy needs to be greater than if you have no risks, right?
(35:45):
Know your preferences for menopause. Do you want to try to do it natural with
lifestyle changes and supplements?
Do you want non-hormonal therapies, hormonal therapies?
Those are things that you can kind of think before you ever meet your practitioner.
How do you wanna manage your menopause? This is your time, right?
I would say perimenopausal women, definitely track your cycles,
(36:07):
track your symptoms that can help guide your treatment.
You know, like we talked about earlier, early menopause, perimenopause versus late.
Know where you're at so that that will help guide your hormone therapy if you
decide to, or your supplementation or whatever you're working on.
Lastly, I think I would just want to say, I want women to embrace the opportunity to age.
(36:30):
Don't get caught up in societal standards of women. Just enjoy your life.
Age stronger, not harder.
Take care of those muscles and your bones and your body so that you can live
happy, healthy, and long.
So I think that's what I would say. What a beautiful way to wrap up our conversation.
Thank you so much, Kim. How can people connect with you if they want to learn more from you?
(36:56):
Absolutely. So my website is kimhefnerwellness.com. On social media,
I'm just Kim Hefner or Kim Hefner Wellness.
My podcast is the Midlife Wellness NP podcast. So it's on YouTube and podcast
platforms everywhere. I would love for you to subscribe.
I interview all kinds of authors and experts on the podcast.
And we talk about all different kinds of things.
(37:17):
So yeah, I would love it if you would follow me, subscribe, connect with me.
Happy to have you. Thank you so much, Kim.
No problem. I'm happy to be here. Thank you so much for having me.
Hey, thanks for joining me on the podcast.
Really appreciate you. Check out my course where we just go so much deeper than
I can ever do on a podcast over an eight-week period.
(37:38):
The Midlife Upgrade course is a blend of video and learning modules and weekly
live calls where you will discover a roadmap for psychological freedom freedom in midlife.
Check out all the details on my website. I really, really would love to have you join the course.
MeganKier.co.nz forward slash course.
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