TNP220 Empower Your Perimenopause with Dr.Kristin Schnurr

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:05):
The Numinous podcast with Carbon Spano.
Hi there and welcome to the Numinous podcast where we have interesting conversations with everyday folks about the Mystery of Life.
I'm your host,
Carmen Spagnola,
joining you from the lands of the Lauan speaking peoples,

(00:27):
the Songs and the Esquimalt first nations recently known as Victoria BC Canada.
My friends,
I have been in the most amazing life changing class for the better part of this year.
I should say it's not a class.
Exactly.
It's actually a telehealth group.

(00:49):
In other words,
a group of patients under the care of Dr Kristen Schur.
She's a naturopathic doctor who specializes in complex endocrine concerns,
including perimenopause and menopause.
So every month we've been gathering for 90 minutes and for the first half,
Dr Kristen gives an educational presentation on a particular aspect of the midlife transition.

(01:14):
And then in the second half,
we ask questions and she can make recommendations and then later on through 1 to 1 telephone or in person appointments,
she can order lab tests or write prescriptions as needed.
And the topics have been quite varied.
Of course,
there's the things we expect hot flashes,
night sweats.
Um You know,

(01:35):
lack of sleep,
uh mood,
um the emotional changes,
the physical changes,
it's really a wonderful way to receive primary health care.
Like,
I mean,
it's genuinely as amazing as it sounds like.
Can you imagine having 90 minutes with your primary care giver who is explaining everything to you in detail and with lots of data and charts.

(02:06):
It's awesome.
And I of course,
being me,
I frequently show up to our monthly Zoom calls like in my pajamas with cowlicks in my hair,
yesterday's makeup.
So it's so awesome.
I don't even have to leave the house to get primary health care.
I take copious notes through the presentation and then afterwards again,

(02:27):
because I am fairly unburdened by like social norms around propriety.
I get like really excited about asking super specific sometimes very personal questions about stuff.
Like how can I find out if my preferred brand of lube is thinning my vaginal membranes,
Dr Kristen and she with her soft voice and gentle calming demeanor is always there with data and empathy experience knowledge,

(02:58):
know how so.
Of course,
I needed to invite Dr Kristen onto the show so I could shout from the rooftops.
Some of the most surprising things I've learned about perimenopause and postmenopause through this year of telehealth.
Folks have listened to this show before,
you know,

(03:18):
for a while.
They know that like,
you know,
I've been in peri menopause for a while.
Now,
I've talked about it with at least eight guests that I can remember in the past few years.
And I'll list those episodes in the show notes if you're like looking for a peri menopause playlist for the numinous podcast.
But this is the first episode where we make it the main topic of conversation.

(03:42):
And I want to preface this by saying,
you know,
we,
we do refer,
I think in this conversation to women's health at times,
but we are speaking to everyone who menstruates and it has been great to hear Dr Kristen share information in our telehealth group um for folks with lots of different kinds of hormonal histories and also lots of different social locations.

(04:05):
So,
you know,
maybe this topic does impact you even though you've never menstruated.
Um Some of the things I've learned about the intensity of black women's symptoms during perimenopause have been stunning,
yet not surprising.
Of course,
given what we know about the traumatic impacts of white supremacy culture on health outcomes,

(04:26):
et cetera.
Um All that to say we're trying to open the big tent here.
So you might not menstruate,
but perhaps you love someone who does or perhaps you have complex endocrine challenges.
I just,
I bet 99.99% of listeners are going to learn something today and then stay tuned to the end of the show when I share more about how you can be part of Dr Kristen's class,

(04:50):
either as a group telehealth patient or if you're outside of BC,
you could participate in her self paced online course coming soon.
Um Also,
I'll tell you about how you can ask Dr Kristen your own questions live in our monthly Perry meow A MA S ask me things which happen in the Numinous Network.

(05:12):
So stay tuned to the end for more details on that.
But for now without further ado meet Dr Kristen Schnur.
So Kristen,
what identities do you lead with?
I love this question.
I love thinking about um the evolution of our identities throughout our lifetime.

(05:33):
I am a cisgendered um white menopausal woman of mixed European ancestry.
So um English,
Irish French and German,
I'm a mother,
a partner.
Um deeply curious,
super sensitive person,

(05:54):
um very interested in humans,
the inner workings,
both the tangible and intangible aspects of those inner workings.
They try to be a compassionate truth teller.
Um insatiable learner.

(06:15):
In my work as a naturopathic physician,
my clinical focus would be on neuroendocrine health.
So the intersection of the endocrine system and the nervous system and I work on a small little farm as a side gig as a farmer.
Um And I'm really strongly connected to the natural world in lots of different ways.

(06:40):
Um I would love to hear more about your Nature girl side.
What are some of the or maybe one of the most formative experiences you've had in the outdoors?
Then I don't know if I can come up with a most formative I have been um outside for my whole life.

(07:03):
I,
when I think about my childhood,
I was out there building and exploring just gone,
you know,
child of the early eighties.
So left the house in the morning and came back after dinner or for dinner.
Um So it has been a part of me for as long as I can remember,
I think I was an m deeply feeling and very sensitive.

(07:25):
And I think at that time,
I unconsciously used being outside and moving outside as a way of regulating and I still do that.
Um More consciously now.
So I think,
you know,
time spent in the forest or on trails or in wild beautiful places.

(07:49):
It's how I integrate um process clear,
connect with myself more deeply,
I think.
Um Yeah,
so it's deeply regulating for me,
it's an anchor and it's really important for me to have that as actually part of almost every day.

(08:10):
It's very hard for me to go into big cities for extended periods of time where,
where I don't have access to uh like a,
a beautiful wild place.
Hm.
What kind of farmer are you like?
Are you farming in a subsistence way just for your family or do you sell your wares?
Are you like a little market farmer or bigger?

(08:32):
We are a very small market like market farmers,
I would say um we both have full time jobs and we farm on the side.
But I think we grow quite,
quite a bit of food.
Um,
even in that sort of part time capacity.
So we have lots of veggies and a small orchard,

(08:55):
um,
with apples and pears and blueberries.
And we have 13 chickens right now.
Um,
and we actually had meat birds this year for the first time.
We raised meat birds.
So that was new learning.
And we sell microgreens to a few local restaurants and markets.

(09:15):
And we also sell,
um,
butternut squash and carrots.
Hm.
The foodie in me loves it.
Oh,
that's so great.
Ok.
So we're here today to talk about the perimenopausal transition.
Uh,
this has been up for me for a few years but I didn't,

(09:37):
I just kept thinking,
I'm not really,
I'm probably not really in perimenopause yet.
I don't know why I'm 48 now.
So I don't know why I didn't think I was,
but I,
I think I had in my mind 50 that,
you know,
menopause happened and then the worst came,
the worst parts of it are the biggest changes,
the most obvious and the most obvious sign would be my cycle.

(09:59):
And so since my cycle has been so irregular for so long,
I sort of thought,
you know,
well,
I don't know,
I guess this is just how it goes but as I get closer,
you know,
maybe in the year before it'll start happening less and less.
But because it was happening sometimes more and more.
I just missed it.
So um please give us a brief definition or not a brief whatever,

(10:24):
however long a definition you want,
but define for us what is perimenopause and what is menopause?
Well,
first I just want to validate that your experience is super common.
Um I think many people have in their minds.
So many even health care practitioners,
clinicians have thought that things really get intensified at menopause.

(10:48):
But you know,
the truth is that perimenopause is for most people,
the most turbulent time and it seems to catch most people off guard when it starts.
So perimenopause,
it's a naturally occurring aging event and it marks the transition from your reproductive life stage to your menopause um to the last menstrual period and it can last 4 to 15 years and 4 to 15,

(11:19):
my friends,
we have to pause right there.
4 to 15 years.
It can last like that's,
that's a pretty stunning range and,
well,
I'm sure we'll get into it later about how it,
it seems to line up about a quarter,
quarter,
quarter.
Some people are gonna be on the lower end.
Some are,

(11:39):
you know,
half are kind of in the middle and about a quarter at the longer end for 15 years.
It's just,
that's just a little like the first mind blowing thing about it.
Ok,
sorry to interrupt,
carry on.
And that is just the perimenopausal component right?
Then we add on the post menopausal component,
which you know,
has its own trajectory as well.

(12:01):
So,
yeah,
it's not nothing,
not nothing.
Um menopause is kind of a retrospective diagnosis.
So it marks the end of our reproductive life stage,
but we don't know that we have reached menopause until we haven't had a period for 12 months.
And so once we haven't menstruated for 12 months,

(12:23):
we can look back to the day of our last menstrual period.
And we can recognize that at,
on that day we reached menopause.
Um And then everything after that is our post menopausal life stage,
right?
So menopause is the one day that is one year after your last period and then you're post menopausal.

(12:47):
So when we're like,
oh,
I'm in menopause,
that's actually kind of a nebulous languaging,
isn't it?
It's not actually,
um,
like medically correct.
You're perimenopausal menopause is one day,
then you're post menopausal.
Exactly.
I think we've just like,
already elevated the level of common knowledge for listeners.

(13:08):
For many,
I would say many people,
if not,
most don't realize that I,
I did not know this until a couple of years ago,
maybe.
And I don't even think I let that sink in until I became a member of your,
um year long telehealth group,
which we'll talk about at the end.

(13:29):
OK.
What about,
what do you say to your clients who say,
oh,
well,
this is what happened for my mom and my grandma or whatever,
this is what my mom's menopausal experience was like,
and so I'm kind of bracing myself for that for me or they kind of think whatever their mother's,
um,
perimenopause stage was like that they expect that's gonna be like that for them.

(13:53):
And maybe they have concerns or maybe it's,
you know,
they,
they have an idea of what it should be like.
Ho how do you,
um,
talk to them then about tracking their own experience?
Well,
this is also really common.
So,
so many people think that their mother's experience is going to really line up with theirs and they are either,

(14:21):
you know,
bracing or not bracing based on what their mother experienced.
And then of course,
some people don't even know what their mother experienced.
And I think many of our mothers don't even know what they experienced because at that time,
uh you know,
perimenopause wasn't even recognized.
Um,
they were being gas lit like crazy and told that,

(14:45):
you know,
what they were experiencing was a,
like a mental health issue because,
you know,
they,
but they were still menstruating and they hadn't reached menopause yet.
So,
yeah,
I've lots of thoughts.
Um But probably what I would share clinically is that,
um what your mother experienced could roughly predict when you might experience menopause.

(15:10):
So the timing kind of roughly correlates.
But it,
again,
that's,
I think it's about 40% of the time,
the timing correlates.
So not a super close correlation and then there's just so many other factors that I impact timing.
So um and symptom experience.
So we've got genetics,

(15:31):
lifestyle factors um your personal health history.
Um Yeah,
so the strongest predictive link is around timing and even that is only about 40% of the time.
There is a stronger link if your mother has experienced premature menopause.
So menopause before age 40 there's a stronger link there and it's even stronger if you've had multiple um women in your family.

(15:59):
So grandmother,
mother,
sisters,
aunts who have experienced early menopause,
then that would be um something that you might be more likely to expect would happen.
But the symptom experience really doesn't correlate according to the research very well at all because there's just so many factors that impact the symptom experience for people.

(16:22):
This is so good to know because I hear this all the time from women and people in the network.
Uh because we have our peri meo jams that where we were,
whether you're perimenopausal or post menopausal,
all are welcome.
And we just jam about this stuff.
And so many people are like,
yeah,
then my mom had this experience and,
and as soon as I sort of hear that,
I think,

(16:42):
oh,
I wish they were in Kristen's Glasses because that's a myth.
That's a myth.
It might,
it might line up.
But like you said,
it's not even the majority of the time.
So why did the perimenopausal transition become a focal point in your naturopathy.
Practice?
Great question.

(17:03):
Um So my background is in endocrinology and probably more specifically neuroendocrine health.
So,
the interrelationship between complex endocrine concerns and the nervous system and endocrine means hormones,
endocrine means hormones.
Yeah,
the connection between glands and hormones and that communication.

(17:26):
It's amazing and complex.
It's super interesting and that um area is also really strongly correlated with autoimmune conditions.
Um There's also quite a strong correlation with trauma,
history and onset of autoimmune or endocrine or nervous system issues.

(17:49):
So I was seeing many people with hormonal concerns,
many women with hormonal concerns and that was showing up in their reproductive years.
It was showing up postpartum,
it was showing up premenopausally and postmenopausally.
And I would say on the whole,
everyone was struggling and not feeling supported within the conventional system.

(18:15):
Um And I think that's probably a theme as an integrative practitioner.
Women's health is unders supported in general.
And then midlife women's health is even more so unders supported.
And then I think from a naturopathic perspective,
we're really focusing on prevention.
We're trying to be proactive,

(18:36):
there's a real education focus and I,
I don't really think there's time for that within the conventional system.
And so it's,
it becomes a bit more reactive in terms of supports and,
and so symptoms that are,
you know,
not a pathology aren't gonna get a lot of attention.

(18:57):
So I started to do additional training in BC.
Um we,
where I live,
we got prescribing rights in 2009.
Um And I started doing additional training in this area beginning in 2010 because I wanted to better understand and support my patients.
And then because with um complex endocrine issues and autoimmune stuff,

(19:23):
it strongly correlates with earlier onset of perimenopause and menopause.
And so I started to see more and more women who were meeting the diagnostic criteria for premature ovarian sufficiency.
And if you think women who experience premenopause are a gas lit within the system,
then you should talk to women who experience it early and are in their thirties because just many people don't even know what they're looking at.

(19:49):
And these people were really struggling and they were in need of support and they needed more lab tests and sometimes prescriptions or just more support from specialists.
So I was writing a ton of letters and advocating for support.
And in many cases,
it like,
you know,
the letters were just being ignored and these women weren't getting support and in some cases,

(20:12):
they were being given misinformation and you know,
just basically being told that there was no way they were too young.
So that was frustrating for them and it was really frustrating for me.
And I feel like I channeled that anger into trying to change,
make a change.
And um I decided to um achieved the designation which was at that time called the North American Menopause Society,

(20:44):
Nam's designation.
And now they're called the Menopause Society.
And I decided to receive certification with them because it's,
you know,
a globally recognized designation.
And I thought it would help my patients get better care if I signed off on a letter with ad like a designation that had sort,
sort of more um more recognition.

(21:09):
And it has,
it's made a big difference for our patients.
And yeah,
in terms of accessing into professional care,
it's made a big difference,
which has been great.
And then in getting that extra training,
it just,
you know,
I think my patients would tell their friends or colleagues.

(21:30):
And so it just more and more people started to seek support in that area.
And yeah,
I feel like there are lots of naturopaths who have the tools,
there's more now that have that designation.
But at the time,
I was one of very few that had the designation.
And so,
yeah,
that's,
I guess how I sort of shifted my practice in that direction.

(21:54):
How about your own personal experience of becoming menopausal?
Well,
my own personal experience kind of mirrored what happened for what was happening for my patients.
And that,
you know,
it caught me by surprise,
it was sort of earlier than I expected.
I was postpartum when I started to have symptoms and I have lots of great care providers and none of them and even me were thinking that that's what was going on.

(22:26):
So,
we were all sort of interpreting it as like a postpartum hormone insufficiency that would,
you know,
correct itself and the symptoms did you have like that?
That were like,
oh,
this is more than postpartum.
Mhm.
Um,
well,
I was having hot flashes at night,

(22:48):
you know,
breastfeeding and having hot flashes and I would say some mood stuff was there that was different than my,
you know,
previous postpartum experience.
Yeah,
I would say the primary symptom at that time was probably based on what are symptoms and then some,
um,
genital urinary symptoms as well,

(23:10):
which is super common in the postpartum um group of,
of women.
But it should correct in a few months and definitely should correct with treatment.
But yeah,
I would say that that diagnosis was missed and then,
you know,
my cycle wasn't coming back and again,

(23:32):
that was,
oh,
it will come back,
you know,
you're still breastfeeding,
it will come back and it did come back.
But it,
it never returned to a monthly regular cycle like I had before having my daughter.
Mm,
so even with all the knowledge and being able to like,
probably have a better knowledge of like what a,

(23:56):
a,
a right fit or good fit is just like sourcing care providers.
Like you had a high level of knowledge,
self knowledge and industry knowledge.
And even then it's like,
uh it'll probably,
it'll probably even out it'll probably be ok for folks who heard that term kind of slide in but aren't familiar with it.

(24:18):
Vaso motor symptoms is essentially hot flashes.
Right?
Yes.
Sorry,
please.
Correct me.
No,
that's great.
Was that?
Yeah.
Correct.
My terminology.
If I'm saying things that are more medical,
I'll try not to.
No,
I think it's great.
Well,
vaso motor symptoms,
you know,

(24:38):
that,
that is uh,
more what it is because not everybody experiences it like a flash as they say,
you know.
Exactly.
Yeah.
Mine actually,
I've only had,
I don't know,
maybe seven hot like vaso motor symptoms.
And they are almost exactly like when I was 14 and I started to develop allergies with the primary symptom was hives and they would,

(25:04):
I could feel the heat come up my body and then I would have these like large red itchy patches that were like a raised plateau of skin.
So imagine my surprise,
Kristen when I was like,
I am suddenly on fire,
it's rising from my groin,
front and back and I am itchy all over my body and I'm like taking antihistamines and all this stuff because the problem is that kind of vasomotor symptom creates kind of a domino effect where it's like now my histamine like I am inflamed.

(25:40):
So hot flash is not what I would have called it.
I would been like,
I am having an allergic reaction to my body.
So,
yeah,
vaso motor symptom is I think a,
a little bit,
it may sound technical but it is less.
Um,
I think diminishing of what the actual experience might be for some women.

(26:02):
Yes.
Agreed.
Very true.
It is that I would say there is,
you know,
huge variation,
right?
It can be seconds to 10 minutes and it can be like,
profuse sweating and drenching your clothes to like,
you know,
not sweating at all.
People can feel panicky before or around a hot flash or that vaso motor symptom.

(26:25):
So yeah,
it,
there is a huge range and I think if we don't understand that there is a huge range we can miss,
but what we're experiencing might be related to a hormonal fluctuation.
Totally.
Ok,
let's get into some statistics because there's like a few that have popped into my mind.
So,
first of all,
uh I remember you talking about,

(26:47):
ok,
like here's how we decide if a person is having a lot of vatos of moor symptoms or maybe just fewer.
So like what we can expect.
And you said like,
so if a person is at the high range of frequency of vaso motor symptoms,
so hot flashes in a day,
if a person were to guess right now,
like I asked my husband,

(27:08):
I was like,
guess just guess,
just guess what's the number at the upper range?
And are you like,
are you tracking the statistic?
I'm trying to,
do you want to share with the listeners this range of frequency.
Yeah.
Well,
it will be 1 to 2 a day all the way up to like 2425 to 50 a day.

(27:32):
50 a day can happen.
Friends listeners.
It's a static like that is absolute.
That's such a focusing event.
You can't work,
you can't function,
you can't be on time for things.
Uh OK.
Let's go to the basics here.

(27:53):
So 49% of Canadian women are over 40 95% of women have their last period between 45 and 55 years old and 20% of women are firmly in perimenopause by the age of 40 20%.

(28:13):
That is a huge portion of women already by 40 are firmly in their perimenopausal transition.
I don't think,
I don't think even 20% of women know that.
Uh,
yeah.
Well,
I didn't know that and I think that,
um,

(28:34):
you know,
for 20% of women to be firmly permenopausal at 40 they had to have been symptomatic in their thirties.
Well,
before probably they were expecting it or looking out for it or their practitioners were looking out for it.
Mhm.
And so they're getting prescriptions for other things,

(28:57):
like,
you know,
in the seventies,
maybe it was Valium because they're not feeling good and they're anxious or there's a,
well,
what was the one you said to me with the urgency of escape was what it was when my progesterone was dropping.
You're like,
so that urgency of escape.
I was like,
yes,
I wanna like,
I wanna leave my life,

(29:18):
my life that I love,
but I need space like thousands of miles of space,
you know,
so they would have had these things and maybe been prescribed Ssris or like other things.
And I'm not saying those things are bad.
I'm just saying that.
But what if you could prescribe the thing that is actually,
you know,
getting out of whack here and that that could be potentially hormones.

(29:42):
Anyway,
we'll talk about that in a moment.
The other statistic I wanted to mention is one you just shared in our last um class.
And that was about the amount of funding that goes to research for women's health issues.
Do you know the statistic?
Um Do you remember this is 8% you said 8% of research,

(30:02):
medical research in any given year is going to women's health issues,
which is including all of our health issues,
not just perimenopause.
OK.
OK.
So what you shared about um something called the straw classification of women's reproductive lives.
That was a shock to me,

(30:23):
real game changer.
I had never heard of this.
I was happy to have heard of it.
Um But the Straw classification is specifically um this these recommendations for,
it's like a classification system for people who menstruate and their caregivers,
their medical caregivers helps them understand what stage the patient is in their reproductive life.

(30:49):
So like in other words,
where are you in your,
in this bigger arc of your perimenopausal transition?
How can we figure that out those guidelines that was initially developed in 2001 and then kind of ratified again or like updated in 2011.

(31:09):
So like literally,
we could say the entire medical profession is going off information that's like 1020 years old around this universally experienced uh stage of life for people who menstruate.
I was absolutely stunned by this.

(31:30):
So can you tell people,
like,
give us an update on like the sort of what we say in Canada,
the Canadian classification um for how,
you know,
when you're in perimenopause and like,
are you early in that process or late?
Tell us about this?
OK.

(31:50):
So the straw criteria,
it stands for the stages of reproductive aging workshop and it was a huge deal because it was one of the largest studies at that time.
Um And it was um a meeting,
a workshop um involving experts from five different countries,

(32:12):
looking at the review of data and information from the largest cohort studies we had at that time on midlife women.
And they wanted to standardize the baseline staging system so that we it would make clinical decision making easier.
And it would also sort of create like a standardization for research as well.

(32:34):
So we could classify people as you know,
early in the permenopausal transition versus late in the premenopause transition.
And I would say,
you know,
it,
it began in 2001,
but it wasn't until they met again in 2011.
And then I think,
actually published the beginning of 2012 that it really became useful and as useful as it is now.

(33:00):
So we're like,
it's like 11 or 12 years old,
which is why I often say,
like our parents are mom,
like,
they didn't even know they were perimenopausal because that wasn't even a thing.
I mean,
I'm sure they knew but no one was listening to that.
And if your doctor just graduated in the last 10 or let's say even 20 years,

(33:20):
they like they don't.
And if they graduated from medical school school earlier than that,
they have no freaking idea what,
what,
how to classify you.
Exactly.
Yeah.
So the straw criteria broke um the reproductive and post reproductive life stage into seven stages.
So there's stop me if you want less detail.

(33:43):
So there's five,
we love it.
Give it to us pre premenopausal stages.
So there's the reproductive stage which is divided into early peak,
reproductive and late reproductive.
And then there's the perimenopausal phase which is divided into early and late,
then there's menopause and then there's early post menopause and late post menopause.

(34:08):
So,
should I tell you about stage?
OK.
Curious.
Yes.
So one of the things that I find most interesting is that in the late reproductive life stage,
this is often quite a symptomatic period of time for women.
So as we were saying,
you know,
at forties,
20% of women are firmly premenopausal,

(34:31):
but they were likely symptomatic before that.
And in that late reproductive stage,
they're still menstruating very regularly.
There may be slight fluctuation in cycle length.
So if they consistently have a 28 day cycle,
they might have a 27 day cycle or a 26 or a 30 day cycle,
but just a little bit of variation and they're still consistently getting a period every month.

(34:55):
So if we were to try to measure hormonal changes,
we probably wouldn't see much change in terms of lab work.
But they are probably feeling pretty symptomatic in many cases.
And then early premenopause is when we see an increase in symptoms,
the cycle is still coming pretty consistently.

(35:19):
But at this time,
we start to see changes of seven or more days in terms of a cycle length.
So someone might get a period that is 21 day,
a 21 day cycle and they menstruate.
And if that happens twice in that year,
you know,
we are pretty confident they're in that early premenopause stage.
Oh my God.
So this was me for this was me certainly eight years ago.

(35:45):
No idea.
This would be,
this should have been on my mind.
This was me before I had my second child,
but I didn't realize like,
you know,
I thought,
oh yeah,
it's normal for cycles to shorten.
But I,
I wouldn't have said,
you know,
I'm in early premenopause right now.
Right?
It's normal for cycles to shorten.
And also I'm super fatigued and also I wanna burn down the patriarchy.

(36:07):
And also I'm having like relational troubles and also I'm feeling more anxiety than I used to.
And,
you know,
like,
because we have so many environmental causes that we're like,
it's probably just stress which of course,
life under capitalist and per white parents,
patriarchy,
all of that does make sense.
But when we start to see it in our cycle,

(36:29):
we could start to maybe also consider that there's um physiological changes we need to be tracking to anyway,
sorry to interrupt,
carry on.
No,
that's helpful and it's helpful to uh for sure have the changes in psycho length because it's just a more um objective marker and then late perimenopause,

(36:49):
you know,
symptoms are increasing even more at this stage.
And now there will be a missed cycle.
So someone will go 60 days or more without a period.
And if that happens twice over 10 months,
we say they're in late perimenopause.
If it happens a once in a year,

(37:11):
you know,
we know they're getting closer,
but they're not quite in late premenopause.
And this phase we think for most people lasts 1 to 3 years,
this late premenopause phase.
It's harder to quantify the late reproductive and early premenopause because the timing varies quite a bit.
And then we have menopause,

(37:32):
which we've already defined and then early post menopause is the first five years after your last menstrual period.
So you haven't had a period for up to five years.
And at this point,
we start to see consistently elevated FSH,

(37:53):
it was creeping up in perimenopause in late perimenopause.
It's,
it's up,
but it may not always be up.
If someone has a period,
it might normalize what's fshfsh stands for um follicle stimulating hormone.
And it's a pituitary hormone that is communicating with your ovary and asking for an increase in estrogen.

(38:22):
So when we help you FSH,
so when FSH goes up,
it's kind of like your brain is yelling at your ovary.
It's getting louder.
It's like come on,
I need more estrogen.
And so we,
it's harder for our ovary to produce estrogen at that stage in our lives.

(38:43):
And so our brain is trying really desperately to balance everything out and it's producing more and more FSH.
Mm mhm.
And eventually,
you know,
our ovary just can't make estrogen anymore and FSH just stays high and it's nice and stable.

(39:05):
But in that late perimenopause,
it's gonna come up,
it's,
it might successfully induce ovulation and we might have normal estrogen levels or low normal estrogen levels.
But once we stop menstruating,
that FSHD is really high.
And in late postmenopause,
our um estrogen levels stabilize as super low as well.

(39:30):
And late post menopause is from five years after our last menstrual period until the end of our life.
Right.
Hey,
so that's kind of like how people could kind of get a general sense of like,
where are they in this transition if they are anywhere from their thirties to their fifties,

(39:52):
let's say there's something up for them probably.
And,
um,
one of the things that has really come home for me that I just don't think I really took seriously or I didn't internalize for so much of my life was how crucial and central hormones are in the functioning of every system in the body,

(40:16):
everything,
everything,
everything,
you know,
uh I even think about um you know,
I came from a family of like chronic dieters,
lots of diet culture and now looking back,
it's like,
it's not about what you're eating,
it's about your hormones.
Like,
you know,
there's so that has been absolutely eye opening for me and very helpful and so to have a map of like,

(40:41):
ok,
how far along am I in this?
It has been helpful for me to go?
Ok.
Should I be looking at medication?
Should I be looking at things that could help boost my hormones?
Because here I am at this stage and we know that actually it's more effective for me to be getting hormone enhancement earlier than later in my transition,

(41:03):
right?
Do what would you feel comfortable saying this is not medical advice,
everyone,
but what would you feel comfortable saying then about,
um,
once a person identifies,
here's where I am in the process,
should I be looking potentially at,
um,
uh,
menopausal hormone therapy?
WW.
What would you say to them in terms of where they are in their process and decisions they might want to make about that or explore?

(41:29):
Mhm.
Well,
you know,
it,
what is true for most people is that the perimenopausal transition is a more turbulent time because we're having greater fluctuate fluctuations and more variability and hormone levels.
And so for most people,
the early and late premenopausal period of their life is more tumultuous symptoms are more intense,

(41:57):
more variable.
It's,
it can be a harder time.
Um There are many things that we can do to kind of smooth this out and help with our sort of bodies inflammatory response in a way to the hormonal fluctuations.
But I think that everybody should have a conversation with someone who understands menopausal hormone therapy.

(42:24):
I think it should be something that you are informed about and it,
it could be part of your decision making process.
You know,
it's something you could consider the pros and cons need to be weighed individually.
It's definitely not for everybody.
But I think for so long it was kind of off the table for women in general and even until really recently for perimenopausal women,

(42:51):
you know,
so many people have been hearing for even the last five years that,
oh,
no,
you know,
you don't do that until you stop menstruating.
But what we actually know based on the research is that there can be significant benefits for some people and starting it earlier because it is a really um turbulent time,
right?
And so when you're talking about early and late reproductive period,

(43:13):
just so people know that's like adolescence getting your period and then starting to have that taper off.
What I noticed for me at adolescence was the onset of mysterious and like incredible allergies and hives and inflation.
And of course,
it was like,
oh,
it's probably stress or it's probably whatever,
but there is a hormone link.

(43:34):
And of course,
what we,
what I know now is a huge histamine response like that is considered an autoimmune response.
And so when you were saying earlier about like,
there's a lot of correlation between autoimmune disorder and trauma histories,
um hormonal imbalance,
like all of these things interplaying together.

(43:56):
So I think that's really important for people to recognize.
One of the things that I also did in my adolescence was,
was on depo Provera was on the pill was on these other kinds of um contraceptives that had higher doses of hormones than what is even recommended for most women in perimenopause,
right?
So for people who are kind of scared of that,

(44:19):
like,
oh,
you know,
like we're scared of cancer,
we're scared of these other things.
I just want everyone to know.
So the research is updated and we know so much more now and we don't have to be afraid of it.
You in your course,
the year long telehealth course.
And then soon we'll talk about this at the end.
But your self paced course have it,

(44:40):
have two parts.
It's two whole sessions on understanding um why there's been so much fear around um hormone therapies and what the current research is.
I'm super happy about that.
How does this classification system,
this straw classification and like even our standards of treatment for perimenopausal and menopausal women compare in Canada to other places in the world because I,

(45:09):
I hear from people I know who are in the UK,
who are in Ireland who are like,
oh,
we think of it differently.
We do different things.
We,
you know,
our mammogram frequency is different.
What would you want to say about how our system is in Canada versus other places?
Well,
it's not standardized globally.
We don't even standardize health care province to province,

(45:30):
right?
So you know what we do in Alberta is different than what we do in Ontario,
et cetera.
Um So we definitely do things differently in the US.
They are standardized between states.
Um And I would say to generalize in the UK in Australia,

(45:51):
Europe,
in general,
more progressive,
even in the U SI would say more progressive,
probably because of the larger menopause societies.
So the um North American menopause society which is now called the menopause society is based in the US and the International Menopause Society,
the British Menopause Society,
they're larger and more robust.

(46:13):
And I think um that has been driving more updates to standard of care.
So,
you know,
we all have access to this research,
but we,
ok,
I won't say necessarily as a naturopath because we don't have the same standard of care guidelines as a family physician would.

(46:35):
But,
you know,
if a standard of care guideline was last updated in 2010,
you know,
that's what clinicians are making decisions based on unless they've done independent research or unless they're a member of a society that is up showing them updated guidelines.
Um And so,
yeah,
I would say Canada has been,

(46:56):
I would say a little bit behind um other countries for sure.
Um So we really do have to take a very proactive stance.
I would say if,
if we feel like we have persistent symptoms or we're like,
oh,
you know,
my malaise isn't going away.
I don't think my ssris are working as much.

(47:17):
It turns out I'm turning 40 you know,
like it's like,
ok,
well,
you may need to be awfully proactive with your GP and like potentially find um a naturopath who has additional training because even your naturopath may not um know how to track those kinds of endocrine issues.
Yeah.
And the societies,

(47:37):
I would say like the International Menopause Society and um the menopause society,
they have great guidelines and they have patient um information.
So it's not all sort of medical lingo high level uh research based data.
Like it's,
there's some lots of things that are very accessible and those can be,

(48:01):
you know,
you can read them,
you can share them with your doctor.
I would say,
you know,
there has been many physicians used up to date,
which is a medical database and there's been updates and up to date recently,
which should help people get better access to care.
That's great.
I would like to add just one thing that we should follow up on from the straw criteria.

(48:22):
So it wouldn't apply to someone if they've had a hysterectomy.
If they're using um,
a birth control pill or have an IUD or if you have a diagnosis of PC OS Polycystic Ovarian syndrome.
Yes,
thank you.
Um Or if you experience premature ovarian insufficiency.
So,

(48:43):
um the cessation of your menstrual period before age 40 ok.
It doesn't apply to that.
And then the other piece to just follow up on diagnosis is it's really a clinical diagnosis.
So you have to take a good history.
You have to really listen to people spend time listening to what's happening with their cycle,
what their symptoms are,

(49:04):
you know,
the breadth of their symptom experience and how that may correlate with their cycle.
And then we do measure in serum.
So basic blood work,
we would measure FSH,
which we talked about um as,
as someone progresses and then we might do more testing if someone was very symptomatic under the age of 45.

(49:27):
But,
you know,
usually for people who are 45 or older,
we really are just making the diagnosis based on their clinical presentation and symptoms.
Like an interview.
It's not gonna be peeing on a stick or taking blood necessarily.
It's that you need to have that spaciousness with your medical provider.
Yeah.

(49:48):
Ok.
And it can be really helpful to,
you know,
bring a list of your symptoms in and just have that information ready to present it as well.
For sure.
Well,
I will definitely make sure we put links to the societies and those resources for um self advocacy in the show notes.

(50:09):
I was also struck by one little factoid you shared about um the Ace studies and vaso motor symptoms.
So for uh folks who are maybe not familiar with uh my work in terms of what I teach in the numinous network in my course,
secure magical art and subtle science of attachment.

(50:32):
There's a whole section where I talk about the Ace studies which stands for adverse childhood experiences.
And uh this was work that was um co led by Doctor Vincent uh Felitti and who I just like adore.
I've watched hours and hours of youtube with him.
And uh yes,

(50:52):
there are some problems with the,
the a studies they,
they like arose out of the insurance industry,
Kaiser Permanente.
But it was like this massive um data set that they were able to get because they were trying to help their um uh uh clients who were struggling with their weight.
And in spite of all that,

(51:14):
II I would still say yes,
there are problems with a studies.
However,
the additional research that has come out of that has been phenomenal and Vincent Felitti who was looking at the data was able to move beyond the insurance company's goals of like,
how do we get these people to stop,
you know,
like maybe they get surgery or you know,

(51:36):
the what is it laparoscopic surgery and then they gain the weight.
How do we reduce that?
Well,
Vincent Felitti was like,
basically was like,
oh Trump uh traumas the cause of all of these adverse health outcomes.
So I'll put a link to the Ace um uh questionnaire in the show notes as well.
It's just questions,
uh 10 questions and the,

(51:56):
and uh one of the interesting things about the ace studies is that just being asked,
the questions,
not having any treatment referred to them,
but just being asked,
the questions reduced the number of doctor visits in the next year by 30% people literally just felt better being asked what happened to you uh in your life before you were 18.

(52:24):
Um So it is worthwhile just kind of knowing what's your ace score and also no stigma here like I'm an eight and I turned out fine.
So um it'll be ok.
But one of the things that you shared in your course,
Kristen and I think it was Doctor Rebecca Thurston's research,
correct me if I'm wrong.
But it was that if you even just have an ace score of just two,

(52:47):
which is essentially there's like two kind of,
you know,
um negative,
let's say they have a negative val two rough things that happened to you before you were 18 could be like divorce or could be um you know AAA family member getting incarcerated.
You know,
there's like these but it's like out of 10,
these two things happened,

(53:09):
you were 70% more likely to report debilitating vasomotor symptoms,
hot flashes just with an ace score of 2 70% more likely to have debilitating hot flashes.
So can you tell us what is the connection between a scores and vasomotor symptoms?

(53:31):
This will be more interesting for people if they know what their a score is but two is very,
very low,
I would say go ahead.
Yeah,
many people I would say could could have an a score of two.
So Doctor Rebecca Thurston is a researcher in Pittsburgh and she has a focus on um midlife women's health and specifically looking at cardiovascular disease and dementia.

(53:54):
But she also has done a lot of work um looking at the link between trauma and increased risk of cardiovascular disease And so,
um yes,
this stat came from her work.
It also came from the work of doctor um Atka Kapoor who's an endocrinologist.
And she led a study that examined the link between menopausal symptoms and a score and saw that there was a strong association even after they controlled for other factors in terms of self reported intensity of symptoms,

(54:30):
longer duration of symptoms.
And then once the a score became four or more like intensified um a lot.
So we already there's already a well established link between um adverse childhood experiences and long term health outcomes.

(54:50):
So um substance abuse,
eating disorders,
autoimmune conditions,
diabetes,
cardiovascular disease.
And there's been some previous research that linked a higher likelihood of a bilateral lateral oophorectomy.
So,
removal of both ovaries early in women who had a higher ace score,

(55:14):
which I think is very interesting.
So presumably they had ovarian symptoms or potentially they had extreme intense symptoms and they were trying to regulate.
So we don't totally know why this is happening,
but we have some idea.

(55:36):
So intense vasomotor symptoms are definitely related to fluctuating hormones and an inflammatory response.
So that change in hormones,
fluctuating levels of estrogen activates the nervous system.
And that shift in estrogen in midlife impacts our ability to thermo regulate.

(56:02):
So,
balance our temperature.
And one of the ways we thermo regulate is we dilate and constrict our vessels and so our blood vessels against our skin and then we you know,
sweat to cool off.
And I think this is just very connected to the nervous system response and a historical trauma,

(56:23):
stress response.
So people are having an amplified response.
If they have that history,
there's I think we're gonna talk about this a little bit later on,
but there are also links with depression incidents around perimenopause and an a score higher a score or even an a score of two or higher as well.

(56:44):
So,
yeah,
I hope that was helpful totally.
And we also know um so a scores don't uh filter for marginalized identity.
So can you share for listeners who are uh people of color?

(57:04):
There is some data that like black women in particular have much more intense perimenopausal symptoms.
Is that right?
That is true.
Um Black women,
Hispanic women have greater symptoms,
higher intensity severity of symptoms.
And that's really important for us to acknowledge because they maybe missing out on care.

(57:29):
Um In terms of timing of their reporting,
I should say that that study that was done by Dr Ekka Kapoor was one of the criticisms was that it was mostly white females with post secondary education.
So again,
like we're missing a huge portion of the population.
Absolutely.

(57:49):
So yeah,
let's talk about the connection between hormones and depression and anxiety.
So one of the things,
this is again,
mind blowing every single class,
I take tons of notes and I write down all these statistics and then I go immediately to the Perryman hospital and go like,
oh my God,
you guys,
I tell my husband first and then I tell every other person.

(58:10):
Um So you shared that even if you've never had a major depressive episode before in your life,
you are four times more likely to experience one during your perimenopausal transition.
You've never had a history,
anxiety,
depression,
never had a major depressive episode,

(58:31):
but four times more chance you're gonna experience it now.
And if you have had a major depressive episode,
and I just want everybody who has just like right now,
feel your feet,
feel your seat,
it's gonna be OK.
We've got you,
we see you,
here's the number,

(58:52):
you're 13 times more likely to have another one now in your perimenopausal transition.
So why does this happen?
Kristen?
Um Well,
we 100% we don't,
100% know why,
but we,
we have some things that we think might be causing this based on what we currently know.

(59:15):
So we know that there is a higher risk of depression and premenopause whether there's been a history or not and that it's an even higher risk,
as you stated,
if there has been a history of depression.
Um and we also know that if you have a,
a score of two or higher,
then you do,

(59:36):
you are at an increased risk of perimenopausal depression,
even if you haven't had a historical um incident.
So we have estrogen receptors all over our body and throughout different areas of our brain.
And we know that estrogen influences neurotransmitters like serotonin or adrenaline dopamine.

(59:59):
We also know that estrogen influences something called BDNF,
which is brain derived neurotrophic factor.
And it is neuroprotective and it decreases inflammation in the brain and gives us sort of more flexibility and adaptability in terms of our nervous system response.

(01:00:23):
So,
in perimenopause hormones are changing,
we're losing our rhythm,
which is inherently destabilizing estrogen levels are going up and down.
We might not be ovulating every cycle.
So our progesterone levels are shifting as well.
And now our brain is more inflamed because we're making less BDNF.

(01:00:43):
We also have um more systemic inflammation because these estrogen receptors are all over our body and our stress response is impacted so that communication between our hypothalamus,
our pituitary and our adrenals is impacted.
Our communication between our hypothalamus pituitary and our ovaries is impacted.

(01:01:06):
We have lots of research that um classifies perimenopause as a neurological transition state and also a systemic inflammatory state.
So then we layer in like cumulative individual factors,
genetics,
a history of adverse childhood experiences,

(01:01:27):
possibly personal history of mood changes that may have correlated with hormonal transitions,
puberty,
postpartum,
maybe there's ongoing and current stress related to just life.
Uh the world,
um patriarchy,
our health,
we're not sleeping,

(01:01:48):
we might be experiencing vasal motor symptoms,
we might be caregiving,
not only Children but also parents or community members.
And we just don't have as much ability to regulate.
And so that's uh those are all things that contribute.
And then we also know that some women are increasingly sensitive to hormone fluctuations.

(01:02:10):
So this might be women who have severe emotional symptoms in the late part of their cycle.
So before they start to start to menstruate,
this might look like someone who has a history of postpartum depression or anxiety.
And we also know that some women are gonna be more sensitive to these hormonal fluctuations in perimenopause.

(01:02:32):
There is an amazing researcher actually who is Canadian based at the University of Regina,
Doctor Jennifer Gordon,
and she's on a mission to um really investigate the link between um estradiol levels and depression.
And what her work is showing is that a certain percentage of women are reactive to high estrogen.

(01:02:56):
Some women are more reactive to when estrogen levels are low.
Some women react to just fluctuations in general.
And then some fortunate women don't seem to react to the fluctuations at all.
And that is I think a huge part of why this permenopausal transition.
It it just varies in terms of what our individual experience will be totally.

(01:03:21):
And this is why we need good attuned hormone support with a good attuned practitioner and it's not a one and done.
It's not like,
oh I just got on some hormone therapy or whatever it's like.
No,
no.
And now we're gonna track it and we're gonna see how it goes.
We're gonna keep tweaking it.
And for listeners who listen to uh the mini series I did with my husband Ruben on portrait of a marriage.

(01:03:44):
And episode four,
Ruben was like,
I feel like I wanna bring up that in our arguments.
There were certain times when I could tell I just could not reach you.
And what we know now is the hormone fluctuation and perimenopause.
And these things were like,
not named.
And he's like the,
there's like the fights,
I mean,

(01:04:04):
we've always OK,
this is,
this podcast is rated um explicit.
So I'm just gonna say it,
we've always been an eat drink fight kind of couple.
OK?
I said it very quietly.
Um So sometimes the arguments could get very intense,
but he would say there would be sometimes where you just,

(01:04:25):
the rage was like,
I just knew I couldn't talk to you.
There was just,
you were just in this like whirling Dervish Tasmanian devil kind of rage.
And I was like,
oh yeah,
I know that one where it's just and so I don't know if it's just that.
So the estrogen which is like the hormone that makes you more pa like palatable to society,

(01:04:49):
it makes you nicer,
it gives you a better mood.
I don't know if I just,
that helps me to calm myself down or what it is or,
but there would be something at some point in my cycle and he would have to go.
I bet she's gonna get her period in a little bit.
And what do you know,
it would be the next day or two days later.

(01:05:11):
And so this was why tracking,
not just me,
but my householders,
my partner,
it was very helpful for us to all have this knowledge.
And the more I've learned about hormones,
the more I've also been like,
oh,
we need to learn more about menopause because it is so clear that there's hormonal issues that are showing up.

(01:05:31):
You can see it physiologically,
emotionally energetically burn out,
you know,
all of that stuff when we talk about like uh men's loneliness and depression spikes later on.
It's like it's the hormones,
right?
So uh yeah,
this is like such good critical information.

(01:05:53):
So for listeners who are like now realizing they're probably in the perimenopausal transition,
maybe they've been for a while,
but they and their medical,
you know,
providers have missed it.
What would you recommend people do as a first step to prioritizing their care?

(01:06:13):
Well,
first,
you should just offer yourself tons of compassion and validation because you have probably known for a while that something hasn't been quite right.
And um you are right,
something is changing and you're feeling different because um hormones are changing most likely.
So I think the most important thing you can do is track,

(01:06:34):
not only your cycle but track symptoms as well and that includes physical and emotional symptoms.
So there are some tracking sheets out there.
I have a worksheet that um maybe I can share with Carmen and we can share with you and it just has multiple symptoms,
not just,
you know,
symptoms related to your menstrual bleeding that can be really helpful just to orient when things are shifting.

(01:07:02):
What do you think of these things you can see on the internet,
like the 48 signs of perimenopause or 48 signs of menopause.
They usually say,
um,
are those helpful?
I think sometimes,
um,
but sometimes like I'm very,
very happy to see per menopause and menopause being spoken about in the media.

(01:07:24):
You know,
it was as two years ago,
we just saw nothing,
right?
Like it's a big change in the last couple of years.
But I also think like we're maybe going a little bit o over.
I don't know.
I think that,
um,
it's gonna be unique for everybody.
It's also going to vary in intensity.

(01:07:46):
Um I don't know if it's helpful for people to feel like they're going to experience 48 symptoms of men being menopause.
That's a little bit alarmist.
A quarter of people.
I mean,
this was another statistic we didn't talk about,
but essentially the way it breaks down,
it's like a quarter of people feel kind of pretty much nothing.

(01:08:06):
A quarter of people are gonna have like a few symptoms for a little while.
A quarter of people are gonna have,
like,
yeah,
this is a big five year kind of situation and then,
like,
a quarter of people are gonna be on the longer,
more intense 15 year time,
48 plus symptoms.
So,
it's kind of a crapshoot 25% chance either way of how it's gonna go for you.

(01:08:26):
But that means that three quarters of the people are gonna have moderate to kind of not much going on.
So,
yeah,
I can see how the 48 signs can be like,
OK,
that could be a little bit too much,
but we're,
we'll share your worksheet.
So people at least do have a sense of it.
It could be stuff you haven't thought about like itchy ears and indigestion,

(01:08:47):
you know,
random things like that anyway,
sorry.
Carry on.
No,
that's great.
Um And then you referenced it earlier,
I think making some space somehow,
even if it's 10 minutes of space where you can,
you know,
just kind of orient with yourself and be present in the fullness of life because you,

(01:09:10):
you really need more space at this life stage to integrate to ground to just sort of figure out what's happening.
Um Prioritizing sleep is really key prioritizing nourishment.
So,
you know,
many people at this stage are fasting,

(01:09:30):
which I don't think is super helpful or they're,
you know,
focusing on feeding their family members and maybe not getting enough food themselves.
So it's amazing how just eating regularly and making sure you're getting enough protein can be so stabilizing,
not only to your blood sugar but to your other hormones as well.

(01:09:52):
Oh my God,
can I just say this is something I shared every,
every group of like people who menstruate.
I'm sharing it that in the five sessions this year where at the end of the telehealth session,
you're like,
ok,
here are the recommendations of things you can do of the five times.
You gave a dietary recommendation four out of five times.

(01:10:15):
You said protein out of the five times that you made a supplements,
you know,
some kind of like supplementary kind of like vitamin mineral,
whatever.
You made a recommendation four times.
You said vitamin D.
So this is my like kind of hack but I just like I have it on post.
It's prioritized protein,
prioritize protein.

(01:10:36):
That's,
that's like the kind of number one.
It's even,
I think just like a good collapse skill to just like kind of,
if you could only focus on one thing,
it would be protein.
If I can only focus on one supplement.
I'm like,
ok,
it seems like vitamin D because I'm so bad at taking supplements.
I just,
that's like one of the reasons I was scared to go to a naturopath.
So I was like,

(01:10:56):
they're gonna make me buy all these supplements.
I'm not gonna take them.
So,
yeah,
I really appreciated how simple you made it to be like,
ok,
here's some things you can do dietarily but like prioritize protein people.
Yeah.
Yes.
And most people are deficient.
Most people are,

(01:11:17):
you know,
entering perimenopause,
not even getting close to what they need.
And then we actually need a little bit more at this life stage.
So,
yeah,
I,
I think probably almost everybody could benefit from increasing their protein and I,
I wasn't gonna mention vitamin D here,
but I think it's a good one.
So that would be something to for sure,
look into in terms of some blood work.

(01:11:37):
This is a really good time of life to get a baseline health assessment.
And you know,
if you do have a practitioner who has the menopause Society certification,
you're probably gonna get a,
a good comprehensive baseline assessment at this stage of life.
But you can certainly advocate for that with um whoever you're working with and having your vitamin D levels assessed can be really helpful because many people are,

(01:12:04):
are really low.
And as Carmen said,
it,
it impacts multiple aspects of this,
of this stage of life.
Um I would also say probably if it's not part of your life already introducing practices that support your nervous system and help you to regulate.
And I think just thinking about that neuro inflammatory response,

(01:12:28):
all of the tools that you share within your community that you know,
are already supporting people on that level,
I think would be very,
very helpful and I am a really strong believer in information,
sort of directly empowering people and also leading to more resilience.

(01:12:50):
So if we don't know what is happening,
it's really destabilizing when we kind of have a sense of what's gonna happen or what we could expect.
It gives us more of a ground and we can be more resilient through this transition.
And I think if we can talk about it with our,
like,
one of the reasons I started these groups is because I was sitting here day after day listening to people who all felt like they were alone and going through this because,

(01:13:19):
you know,
we don't all meet this stage of life at the same age.
And so their peers may not be experiencing symptoms and they didn't feel like they had anyone to talk to or maybe they were shy about sharing some of the symptoms.
And so I do think it helps if,
if you can even talk about it with one person.
Um,
and,
and share the experience of this stage.

(01:13:42):
Yes,
it's been so helpful.
Of course,
in our,
our telehealth group,
I'm sort of the one who's like,
I talk about this with everyone.
People can't get away from it with me.
But it's so true.
It's good for me to sit in a group and be like,
wow,
this is a very isolating experience or I,
you know,
people feel isolated.
But I think also we have so much taboo and secrecy and um,

(01:14:07):
yeah,
just like patriarchy around.
Anything to do with women's physical bodies.
There's so much shame and concealment and um just lack of knowledge and it's,
it's very painful to be like I'm a grown ass woman.
Why don't I know more about what's going on for me and why don't my care providers either?

(01:14:29):
So,
and also what you shared,
sorry.
But just,
you know,
letting your partner be involved,
right?
So you share what's happening because you know,
that's another piece I want to do is I want to hold a group for partners of people navigating this life stage or family members because it's so destabilizing to the whole family system in a way to uh to not know what's going on.

(01:14:52):
And I think we can,
we can help people navigate this better.
We can,
we can help people support people going through this transition better if we um get them involved and informed too.
Oh my gosh,
1000%.
Actually,
I was,
was,
were you sharing this?
Ok.
I was reading this somewhere maybe or was in one of the classes where it was like back in the day,

(01:15:13):
you know,
men wanted to know about this transition because they wanted to be able to go back to their old submissive wife like she's,
she's no fun anymore.
So these days,
hopefully we can have like a more enlightened approach where it's like.
So there aren't environmental factors that exacerbate this and that kind of patriarchal attitude of like,

(01:15:38):
you're no fun anymore is part of it.
And so let's get educated about how this is like a whole um systemic kind of approach.
And also I imagine they'll do the same thing that the male partners.
I'm sitting here thinking about my husband the whole time and being like,
oh OK.
So that's what testosterone controls.

(01:15:59):
I don't remember this from like grade 10 bio or whatever.
Whenever I learned it,
it's like I'm thinking about how I'm tracking my partner and I,
I know he would want to know what's going on for me.
I bet he'd be curious about what's going on for himself too,
you know.
So,
ok,
it's very evident anyone who listens to this podcast or knows me at all knows that like,

(01:16:21):
you know,
I walk hand in hand with my rage all the time.
And so being able to talk about this and like rage about um all the things we carry,
all the knowledge we carry the uh emotional labor we do around health for our whole family.
Plus we're doing it for ourselves and it turns out our caregivers don't even freaking know.

(01:16:44):
I mean,
that gets nothing,
gets me so mad.
How do you Kristen personally cope with your own rage and potentially the grief too that you may have felt,
you know,
realizing kind of after the fact like,
oh,
this is it for me.
I'm actually going into,
I'm into menopause soon here and,
and I only just had my second child.

(01:17:06):
You know,
how have you coped with the rage and the grief?
Hey,
well,
I'll start with the grief because I think that,
um,
that is super valid,
you know,
it is a natural transition but it's still worthy of our care and attainment.
And,

(01:17:28):
you know,
some people,
I,
you know,
I had really easy cycles.
I was very fortunate.
So I really felt the loss of,
of that sort of my youth,
I think.
Um yeah,
so I think I,
how I cope was I,
you know,
I tried to figure out what was happening and once I figured out what was happening,
I was,
I think,

(01:17:48):
better able to let myself really feel it and experience the emotion.
I certainly also feel like it surfaces in my appointments with people in the clinic,
like,
you know,
I cry with people all the time as they're going through it.
And I think that's,
you know,
a way for us both to be present to the grief of this transition.

(01:18:09):
And,
you know,
certainly the forest holds a lot for me um as well.
And then in terms of rage,
you know,
this is complicated because I think a lot of the rage is really important to attune to and,
you know,
when we feel it surfacing,

(01:18:30):
like,
you know,
what is it that what boundary are we,
you know,
compromising here?
What,
what do we need to say that we haven't said,
where have we not taken a stand for what we know to be a need or,
you know,
all of those things are so important and,
and,
you know,
to get the rage kind of moving to a point where I'm able to express a need,

(01:18:54):
like my shovel in the garden is really helpful.
So just that sort of motion in the ground and movement really helps me and finding a way I guess to take action,
sort of channel the energy into,
you know,
maybe it's my own communication or maybe it's sharing with my colleagues or helping um you know,

(01:19:19):
just further support for,
for women that that is a way that I can,
can move that energy because it's very potent and powerful.
Right?
Absolutely.
And it's been very powerful to learn from you over the course of this year.
And I'm so excited we'll put in the show notes how,

(01:19:41):
you know,
people can get on your newsletter.
I will,
I'll be your hype gal.
I'm gonna tell them all about your upcoming programs.
But for now I just wanna say um thank you,
thank you.
Thank you,
Kristen.
You've changed my life.
It's been,
yeah,
it's been so empowering and as I shared in our last session,

(01:20:03):
I'm so excited for elder hood because finally my exterior will match the cranky old lady inside me.
That's been there for so long.
But I feel,
I feel fired up about this and about um helping women harness the potency of this.

(01:20:25):
I think it's a protective mechanism in society.
We protect our youth,
we protect the culture,
we,
you know,
protect um our boundaries.
I think we can be very powerful role models.
But how would I ever know if I was still caught in the quagmire of all my physical symptoms?

(01:20:46):
If I didn't have a framework of understanding,
if you hadn't done all this research,
how would I have known?
So,
thank you.
Thank you.
Thank you so much for sharing your knowledge with the world.
I'm super excited about the monthly,
ask me things that you will be part of in the numinous network.
Um Yeah,
more detail on that in the,
the Outro in the show notes,

(01:21:07):
but so grateful for your wisdom.
Thank you Carmen.
I am so grateful to be here and I'm so grateful for your wisdom and your work in the world as well.
I said it before.
I'll say it again.
I am quite sure that most people listening to this episode have learned something today.

(01:21:28):
And I think one of the major issues we have in terms of education around the treatment of perimenopausal symptoms has been around outdated information and poorly communicated science with regard to cancer and hormone treatment.
So I loved that class in our telehealth group and the other class I really loved.

(01:21:52):
And that really stood out to me was about how much work is missed,
how much of the labor force is like disappeared.
And the financial hit we take when we're going through perimenopause.
So the political movement to campaign for paid time off for perimenopausal people has caught my attention for sure.

(01:22:17):
I'm looking to politicians to start taking that seriously and it's going to require a broad reaching revolutionary spirit and action,
probably a general strike.
And I actually do believe that people who like,
don't give a fuck anymore about being nice could really push the needle there.
And so we should so just planting that seed for all of us before we talk about programming around this.

(01:22:43):
Can I just share one little personal anecdote?
Like just about what it's been like to be on progesterone and it's not going to be right for everyone.
I get it.
But for me,
I had honestly forgotten what it felt like to wake up so well rested and restored and rejuvenated and revitalized and ready to waste the day,

(01:23:05):
you know,
and then when I got on the estradiol,
like it actually is nice to feel amiable again sometimes,
you know,
I have so much more patience and capacity again and energy.
Like I feel like I felt like six years ago.
I love my new hormones.
Thanks,
science.

(01:23:26):
OK.
So go to the show notes at Numinous podcast.com for the link to Doctor Kristen's website and sign up for her newsletter.
That's how you can get access to all of her offerings and things sign up for her newsletter.
You can get on her waitlist there for her next telehealth group happening in 2024.

(01:23:50):
I think she has like a couple of groups happening.
That's where you'll also find out about um,
details about like who's eligible for that is on her website or get on her mailing list.
So you get it in the newsletter.
Um You'll also be the first to know when her self paced course begins.
So go to her website,

(01:24:11):
which you'll find in the show notes,
get on her newsletter.
The self paced course is gonna have the exact same information as the telehealth group,
but just without the medical advice and prescriptions,
then also not medical advice but supports that we have over in the numerous network.

(01:24:32):
Um We have two offerings specifically for folks interested in exploring the midlife transition.
So once a month,
we host a what we call the Peri Meow jam.
So it's a jam for people in perimenopause or menopause.
It's led by Brita mckibben who is trained in functional medicine and a variety of embodiment practices and who has years of experience as a psycho educator.

(01:25:00):
And then the second monthly event is the one with Dr Kristen.
It's an A ma an ask me anything.
Each ask me anything,
has a topic of focus.
Like the one in November is about genital syndrome of menopause GSM,
which is a condition that affects like 90% of people in perimenopause and beyond.

(01:25:21):
So that's what we're talking about in November and then we'll vote on what we're going to talk about in January because we're going to take a break from this programming in December because each year at that time,
we focus on the ritual season of tide in the network.
But programming,
regular programming will resume in January 2024.
So just join the Numinous Network for those two that support people who are going through this midlife transition.

(01:25:45):
And when you sign up for the network,
you get many other monthly offerings that support your health and well being as well.
You can find out more about that at Carmen spaniolo.com.
OK.
Listener.
Shout out today.
Thank you so much to someone who goes by Ghost who left a five star review on amazon.com for my book,

(01:26:06):
The Spirited Kitchen.
They write,
I wanted to find a way to connect with friends around holidays in a way that feels meaningful.
This book offers a guide for old and new traditions around the Wheel of the year.
Carmen has deep experience in both ritual and recipes.
She trained at Le Cordon Bleu.
I bought copies for all my friends so that we can begin our journey to transform our year into a magical celebration of seasonal ritual and delicious food.

(01:26:35):
Yay.
I,
I feel so warm in my heart that you're doing this with friends and What a great gift.
Thank you.
Thank you so much for leaving your review and thank you for doing that work in your community of spreading rituals and recipes.
I,
I love it.
Thank you.
All right.
Last thing,
friends,
the spirit of Yuletide returns to the Numinous Network starting on December 1st with our class on spiritual hygiene for the holidays.

(01:27:02):
We always start by getting right.
We get centered,
we get grounded,
we connect with our spirit.
Then on December 2nd,
we have our annual session called Grounding the season.
So in that one,
we go a little deeper.
We connect with ourselves and our values and we practice saying no to what we say,

(01:27:22):
we don't want to do.
We say no to what we want to say no to.
We practice saying yes,
only to what we want to say yes to this holiday season.
And then we take a look at like some of the rituals and recipes and things we might want to do this year and we just accept we can't do it all.
So we prioritize,
of course,

(01:27:43):
I'm gonna do my annual classes on Fancy Garland and wreath making.
I love having that like cra afternoon with folks.
I'm also gonna do forage sweet Vermouth for those of us who like cocktails and seasonal tipples and foraging.
Plus this year,
I'm adding a sugar cookie decorating class.
I'm so excited and I'm also sharing all the cookie recipes that couldn't fit into the yt chapter of my book.

(01:28:07):
Then also,
I'm adding a daily 15 minute live stream of altar tending as ritual devotion for the 12 days of Yule Tide.
It's going to be quiet and gentle and warm and cozy and magical.
And the spirit of yuletide in the numinous network is going to help keep your values and spiritual connection at the center of the season.

(01:28:31):
Simply become a member of the numerous network to join us during the holidays.
You sign up at Carmen spagnola.com Carmenspagnol A until next time,
take care.

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