Episode Transcript
And what I love about when we look at the facets of what evidence based medicine means is that it's like a three circle Venn diagram. And the first one makes sense. It's like best available research is the first circle. The second circle is clinical judgment, but the third one is the one that I feel like we forget and is the most important piece of all. And the third circle is patient value. And so together, we get to make these shared decisions, according to their values and the severity of their symptoms of what feels right for them.
Speaker 1
Welcome to this is perimenopause, the podcast where we delve into the transformative journey of perimenopause and beyond. I'm one of your hosts, Mikaela. And I'm your other host, Michelle.
Speaker 2
And we know firsthand how confusing, overwhelming, and downright lonely this phase of life can be.
Speaker 1
Join us as we share real life stories and expert advice to help you navigate this journey and advocate for your best health.
Speaker 2
We used to think menopause signaled an end, but really, it's just the beginning.
Speaker 1
Today, we wanna take a moment to thank our sponsor who's helping make this podcast possible, and we're genuinely excited to share this with you. Alright. Let's get real about GSM, those genital urinary symptoms that can hit you like a truck in perimenopause. We're talking vaginas that feel like the Sahara Desert, the kind of itching that makes you want to crawl out of your skin, and burning that turns basic activities into actual torture. When it hit me, I was literally questioning my sanity.
Speaker 2
Same. Same. I had to break up with my spin bike because my Volvo was basically staging revolt. But then Iris came into my life and, can I say, game changer? And, oh my god, they're lubricant? Wow.
Speaker 1
Right. Thank you, Dolores Fernandez. She's the amazing naturopath who created these products without the nasty additives that can turn your bits into a five alarm fire.
Speaker 2
So whether it's serious dryness, constant itching, or the bedroom blues, ladies, do not suffer in silence. Use code t I p twenty at love my iris dot com for twenty percent off. That's t I p twenty at l o v e m y I r I s dot com.
Speaker 1
Because life's too short for an angry vulva and vagina.
Speaker 2
A beautiful, hot mess. Wow. That's how today's guest, doctor Cara Dionisio, describes perimenopause, acknowledging both the chaos and the opportunity in this transition. And doctor Cara knows what she's talking about. She's a naturopathic doctor who fell down this perimenopause research rabbit hole in twenty nineteen. She brings impressive credentials to this conversation as one of the first naturopathic doctors in North America to earn the Menopause Society certified practitioner designation. She teaches clinical menopause education in academic and professional settings and leads the confident clinician menopause fellowship. With her comprehensive evidence based approach and refreshing perspective, she has helped thousands of women develop strategies to address what she so lovingly calls a beast. What makes doctor Cara truly special is her ability to merge medical knowledge with real world wisdom to help you reclaim your health and reimagine your future. Because as doctor Cara emphasizes, suffering is not an option. What are we waiting for? Let's jump in. Welcome to the show, Kara. We're so happy to have you here today. We would love to know and have our listeners know a little bit about your backstory and, who you are. And specifically, one of the things that we love is that it we've heard you say that menopause care found you. So we'd love to know how that happened.
Speaker 0
Absolutely. Well, first of all, thank you so much for having having me. I I'm super honored to be in in the rotation with all your fantastic you've had. And I was thinking of both your names. I'm like, there's the the documentary, The m Factor. You guys are the double m factor. I Oh, I'm so excited. And I I love what you're doing. I love the energy, like, that you bring and the facts and the guests. It's it's just really great to be here, so thank you for having me. Yeah. And I menopause definitely found me. I did not seek this out. I don't have a choice in it because I'm now fully in love with being a menopause clinician. But absolutely, I started out like most clinicians. No matter what field, whether you're a family physician, a nurse, a physio, we do not learn menopause. You know? From what I knew, it was hot flashes, hormone therapies. You don't know what you don't know. And, you know, to to many of us, we were going in blind and probably weren't acknowledging, you know, the stories of the patients in front of us because we really just weren't trained to see or recognize the depth of this transition. And patients also didn't have the vocabulary to come to us to really put things together. So it was like a double whammy of a problem until I started really, like, thinking interesting, like I would with any health problem. Like, I don't know if I'm really helping this patient. Like, let's look into this a little bit further. And that was the end of it all. And I did what, like, I love to do. It's like my favorite place is, like, a pack of highlighters and a stack of printed papers. Like, they have to be printed. They're no virtual.
Speaker 2
Oh, me too. Me too.
Speaker 0
Yeah. And I I have a picture of me with a stack literally this big. It probably was a year long of, like, going down the rabbit holes of looking at menopause research. I like to say I was in the asshole of PubMed. That's the that's the saying of a colleague of mine. But, like, it's like it just unravels the more and more you read the research and you realize it expands out. Right? Like, oh my gosh. This branches out into bone health and cardiovascular disease and patient experiences and culture and all of the things that it brings in. How much it goes to all the ologies, which was just fascinating to me. Like, it's not in this little silo. Like, it's gynecology, but it's endocrinology. And, like, all the ologies that we can come up with, we get to, like like, bring all that we know about health and medicine into one transition. But then it also really has this interplay with, like, a more biopsychosocial lens, which really is, like, we get to meet our patients and women and individuals in the in the menopause transition at the messy middle. It really has this cool human intersection on top of the geeky science and, like, roll that altogether. And it's just, like, both fun and an honor and challenging to just really be a menopause clinician at the height of it really taking off. Now I always say I was here before it was cool. It was not cool when I was doing it. No one was talking about it.
Speaker 2
How long have you been doing this, specializing here?
Speaker 0
I think I started that rabbit hole was about twenty nineteen. They're not as early as some, but definitely ahead of the the big buzz. I'm not trendy. I don't I I don't do I'm the last person to follow trends, so that's not why I'm here. I just I really just fell in love, and I get to talk to the coolest women all day and really get messy with them and figure it out together.
Speaker 1
That's amazing. Already just so inspired by what you've said. Your website says, we help hormone change not suck. Maybe even be kind of fun. I know a lot of our listeners' eyebrows just went way up like fun. Are you kidding me? You're talking about it like it's fun. And so maybe you could, tell us how that hormonal change can be fun, not just for you, but for your patients or how you help them find the fun, see the fun.
Speaker 0
Yeah. Absolutely. I I'll start with a caveat that my I have three favorite words. So the first one is paradox, the second one is nuance, and the third is curiosity. So, like, I love I love seeing the nuance and, like, the, like, the give and take of any problem. Right? And so I feel like when we're sold a narrative of like, the the current narrative of menopause is like, this is scary. This is horrible. This is like the start of decline. This is the start of aging. You know, and absolutely, like, so many patients should feel like it sucks. Right? They should feel like it's challenging that they're not getting the support they need. Like, what do you guys hear? Like, what are the words that you hear from your I'm sure you hear all the words that are sucky and Yeah.
Speaker 1
Just Yeah. Brutal atrocious. Absolutely.
Speaker 0
And so for believing You know?
Speaker 1
And we we could go on and on. It's it's it's shock and and, really, it's shocking, and it's abhorrent that this is the state of play for someone who's perimenopausal.
Speaker 0
Absolutely. Absolutely. And so I don't like, you know, when we look at this paradox, it's like, it's not it can be this or this. It's like, yes, ma'am. Right? Yes. It sucks. Yes. It's hard. Yes. You don't have information. You your body's changing. You have no idea what's happening. And if you do, you're not finding the help that you need. You know, you you used to be able to do certain things for your health, and they're not working anymore. Your hormones were doing these things. Now they're doing this crazy thing in the middle of a roller coaster, and then they're about to leave the building. And it's really it can really suck. It can be really hard. And and I totally I get so angry that we don't have answers for women, that there's not enough of, you know, people like me or people in general who can help support, support women. And so that's me acknowledging this has stuck, but I'm here to help you. Right? So so that's the first part. And the second part is and there's also some opportunity here. There also can be time, any transition. Right? Whether it's a job transition, you know, a transition with your kids or a major life transition or a move. Right? It's hard and challenging and difficult. And some days, it's just like, how am I gonna get out of this? But it's also an opportunity. Right? It's like we have this chance for growth. We have this chance to think about myself again, to think about my health again. And for very good reasons, maybe that has been on the back burner. We have this ability to think of what we want the next half of our life to look like, to, like, set more boundaries, to get rid of things that just really aren't serving us anymore, and it's time because our body can't do it, our mental health can't do it, it's time to transition and really create a new path forward. And so, yes, it sucks, and there's opportunity. It it's all passive. That opportunity does not come to you passively, but it's there for the taking with the right support. And so I understand people might be like, it sucks, and I want to take that opportunity. I want to know what I need to do, but I can't find any support. So, again, it goes back to that that missing piece. And then it can be fun. Right? Like, I've I've watched I've listened to your podcast. You guys laugh with your guests when you're feeling supported and you have someone who's like, I get it. I understand. Let me tell you why that's happening and what we're gonna do about it. Then it can be funny. Right? It's like, my vagina is the Sahara Desert. My vagina is drier than a popcorn fart. Like, then we laugh and then we pee properly. And then we laugh. Right? And so there is opportunity for this to, like, bring women together as community and, like, really talk and say, here's what I'm going through. Here's what I'm struggling with, but here's the funny side. Here's the here's the sisterhood side. Like, here's the part that we also can have fun with it.
Speaker 2
I seem to be using the saying a lot lately, you can laugh or you can cry. And, like, I feel like that's where my life is at right now. Like, I could laugh or I could cry, and you just have to choose laughter. And also, as you said, like, reach out for support. And the more we talk and the more we share our stories, the more you realize that you're not alone in this.
Speaker 1
Yeah. That was your answer was really it really resonated with me because, when I think about my own journey, perimenopause sucked. I was not good, and that contributed to a lot of changes, but career change, having to put myself first sometimes and to prioritize my health. And because of it, I also get to spend a lot more time with Michelle. I got to meet Amy. Like, there are so many wonderful things that have happened because of, the fact that my body changed in a dramatic way. But it also has given me an opportunity to live my life differently and to live my life better.
Speaker 0
Yeah. It sucked. And look at look what's on the other side because I finally Yeah. Yeah. Took too long, but I did finally find that support. And then, like, the more we talk about this, the more you're having these conversations on your podcast, the more there's a chance the more that there's menopause informed practitioner practitioners like me, the more there's a chance for future women who are coming into this phase, it can suck less and be more of an opportunity. And so that's my hope.
Speaker 2
Can we talk a little bit about that? We've you've sort of a few times, danced around this. Menopause certified practitioners. Who are these magical people? How do they how do they become certified? What does this all mean?
Speaker 0
Yeah. Absolutely. So it's, the designation is called MSDP or menopause society certified practitioner. But, essentially, anyone with this menopause society certified practitioner designation has written a exam through the menopause society, and that exam is one that we have a textbook called menopause practice. And the exam is also based on all of the current guideline. And so that's the hormone therapy guideline, the nonhormone therapy guideline, all of the consensus papers that were developed by the Menopause Society, really by the world expert. So what it helps to attempt to do is is this certification at least gives a basis for I have this knowledge. What I love about the exam is that it's not just, like, actually only one or two chapters of the textbook are hormone therapy. It really is a nice comprehensive overview of here is what we medically, physiologically, mentally, emotionally see are the changes in the menopause transition, and here's how we can support this phase of life. So it is really diverse and comprehensive, and I also love that it crosses designation boundaries. So there are a lot of medical doctors who have this, nurse practitioners, myself as a naturopathic doctor, pharmacist, I think some physiotherapists. So it's really cool that, you know, having written that exam, we have this common based understanding of here is the current standard of care, here is here is what we need to understand to really serve this population, which I think is is really nice and gives patients at least a little bit of something to hang their hat on when they're hopefully able to find a menopause.
Speaker 2
So if my family doctor isn't designated, do I have to find someone different? Can I still speak with them about my mid pause care?
Speaker 0
Yeah. Absolutely. And, honestly, like, that is the relationship. And if you have that base and that trust set up already, then ask them. You know? Have the conversation and, you know, book a dedicated visit to say, listen. I'm coming into this phase of life where I am here. Where is your knowledge base? How can you help support me? And that's really the questions to start with and then go from
Speaker 2
And then if you're not getting the answers you want or you need, that's when you Yes. Can look.
Speaker 0
Absolutely. And how do Yeah.
Speaker 2
How do we find a menopause practitioner, certified practitioner?
Speaker 0
So the Menopause Society has a directory. Okay. So you can go right to their website. You can put in your province, state, location, and it will come up with anyone certified, in your province or or jurisdiction.
Speaker 2
So that's amazing. So some peep because not everyone has the same journey or the same, philosophies about medicine. So if they wanted to go to a naturopath versus an MD, they're all in one database. They can find everyone there.
Speaker 0
I think we think, okay. This is medical. I go see a doctor, and I get the results and the information I need. And it is medical, and you should be able to go to your doctor. But it also is a life transition. Right? So think about what we do for pregnancy. Right? So we have clear standards of care. We go to our family physician. They order very defined first trimester blood work. We get an ultrasound at twelve weeks, you know, and again at twenty weeks, we get our gestational diabetes screen. We're maybe passed on, you know, throughout to a midwife or we are passed on to an obstetrician. So we have, like, a very clear medical pathway for supporting women in a time when they're growing a human, which is super important. But the other thing of of pregnancy is not just medical. Right? It's like we have baby showers. We have support groups. We have prenatal classes. You know, we listen to podcasts and figure out what the best stroller is. Right? It is a medical topic, but it's also, like, cultural. We have cultural tradition. We talk to our friends. We, like, build the support network around the doctor patient relationship, and I really think that menopause lends it really needs that support. Right? Like, it's not a disease. Really think outside the box of how you can create the people around you that you need. Absolutely understand that not everybody has the accessibility to pay for all of these people. But when you can, there are lots of people that can fill some various, and specific roles in getting you the the care and really the more comprehensive or or holistic, you know, support that you need around you to, like, really get through this position, but also thrive through it.
Speaker 2
I'm gonna add one more that you didn't mention that Mikel has talked about in the past, and that's a really great pharmacist. Absolutely. It doesn't cost any money, but if you've got a great relationship with your pharmacist, they're they've got a wealth of information. Some of them can prescribe. Like, it's it's, yeah, another good one. But Kel wrote a blog about that. Check it out. Well, I mean,
Speaker 0
a good pharmacist is, they're, like, I think, a forgotten part of the team, but you can go and say, hey. I just got this prescription. This is great with my other medications. Is there anything I need to know? So they can be a really great team member as well.
Speaker 1
Let's talk about, your team, your clinic. Is it just you? And how busy are you? I know for a fact that
Speaker 2
a bunch of people listening
Speaker 1
right now are like, okay. How do I find this woman?
Speaker 0
Well, I'm a little busy. But I love love what I do. So, yeah, my team is doctor Karen Associates. I used to have a big team of ten people. So I used to actually have an had an integrative health team, with physios and mental health professionals and whatnot, which they were amazing, but I was more business clinic administrator than clinician, and I am a clinician of art. So so my team is, like, small and nicely curated. So it's myself, my most amazing office manager, patient coordinator coordinator Lisa, and then I have an associate, doctor Bronwyn Hill, who is another naturopathic doctor and menopause society certified practitioner. She, just is coming back from mat leave. So, which super happy for her, but it has certainly made, I've been taking care of her patients while she's on maternity leave. And it has meant that our wait list has gotten a little bit long, but we are she is back, and we are hopefully sorting that out. And I'm here in Owen Sound, Ontario, and doctor Bronwyn's physical location is in Creemore, and we both are able to virtually Ontario as well.
Speaker 1
Fantastic. Fantastic. When we when we first met, we talked a little bit or you shared with us, something you called the art of clinical practice, and I'd love to delve into that now if we could. And through that, tackle some of the myths and misconceptions, how you go about actually achieving individualized treatment. Right? Because there are guidelines and then there are humans. And connecting those two is not as straightforward as putting a cast on a broken leg because I think that is really the critical piece here when we talk about great menopause practitioners.
Speaker 0
Absolutely. And I am going to use that, Maykelle. There are guidelines with your hand over here, and there is, like, human. Or it's, like, logically, you medically know it's here, but then getting said human, myself included, right, to do what I know I should be doing is
Speaker 2
Yeah.
Speaker 0
A whole different story. And I love so I'm an evidence based, clinician, and that means that I use the best available evidence from research, not one study, but, like, what do we know in totality from the best research we have in order to guide clinical decisions. And what I love about when we look at the facets of what evidence based medicine means is that it's like a three circle Venn diagram. And the first one makes sense. It's like best available research is the first circle. The second circle is clinical judgment. Right? So a clinician that uses that evidence and uses their best clinical judgment to make decision. But the third one is the one that I feel like we forget and is the most important piece of all, and the third circle is patient value. And then let's make shared decisions with our patients that is aligned with their value. So I love that that circle is part of evidence based medicine, and I think of it as a as a as a ladder, so or a menu. Right? And so together, we get to make these shared decisions, according to their values and the severity of their symptoms of what feels right for them. And those are just the tools. And for me, I will tell my patients, I'm gonna give you options from down here, and we're gonna have options all the way up to here. So that could be let's let's think of something heavy menstrual bleeding. Right? So it's like, I could give you some ginger that can reduce flow by my maybe twenty five percent. We can use ibuprofen in this way that might reduce flow by thirty percent. Or the next level up on this ladder is how about you talk to your doctor? There's a medication called tranexamic acid, might reduce flow by fifty percent. After that, we have birth control pill and IUD. Maybe that's something you we can chat to your gynecologist about. And up here is hysterectomy. Right? And people are surprised. It's like, I come to a naturopath for natural things. I'm like, no. No. No. You come to me for strategy. And so whether it's ginger or hysterectomy, there's no judgment on that. Neither are good or bad. It's like what will solve the problem to the degree that it's impacting your life, and what is the best medical choice in consultation with your gynecologist, your doctor, and what feels right for you. And judgment free choices. Absolutely. Absolutely. And sometimes you'll hear this in the menopause space. Like, I went to my doctor and they gave me this, and that doesn't feel right. And I'll be like, I can see why that was offered. That is a valid choice. What you weren't offered was an understanding of why that was the choice on that day and what other options there were.
Speaker 1
When it comes to mood, do you also include, menopausal hormone therapy in that latter?
Speaker 0
Absolutely. I do wish that our current guidelines said that is and that is it doesn't currently say this is an indication for hormone therapy, but it's a really amazing bonus and the research really supports that. We're less clear about starting hormone therapy for the benefit of mood when we started after the last period, it's ridiculous that we don't have more. But the current research absolutely suggests, and I'd say my clinical experience absolutely suggests that starting hormone therapy in perimenopause especially and and for some women have a really beneficial impact on you.
Speaker 1
And that's, I think, too where that nuance and that clinical judgment becomes so important because to your point, so the menopause society guidelines don't say that menopausal hormone therapy is gold standard for mood. It does say that there are level two and level three supporting evidence that shows that it can be beneficial particularly for depression, but also, I think there is some information there that suggests that it's also good for anxiety. And then you can see it in your patients, right, when they come back. And maybe they started taking it for hot flashes, but suddenly they just aren't as anxious or they don't have those scary days of depression. Right? So that's where the nuance comes in. And it's also it's not approved. Health Canada does not say that that is a valid indication. So if you have a practitioner who's not menopause certified, right, they don't have that nuance to be able to offer a patient something that might be the absolute right thing or the best thing for their particular need.
Speaker 0
Yeah. Like, we have we have the research. We have the clinical judgment because, yeah, here. I started this. I didn't actually think my mood needed any improvement even, and I just feel more like myself. And that's someone who didn't even come in with a mood problem. And we have patient values to say, I understand after I say to them, this is not on the actual list, but we have the research. And they say, my value here and how this is affecting me is that that's okay with me. That's informed consent and that's shared decision making. And I think the other nuance to this art of practice is that it's not always menopause.
Speaker 1
It's not always perimenopause. Exactly.
Speaker 0
And so I'll say to a patient like, hey. Here's the rationale for hormone therapy. Here's where I think it really could help you.
Speaker 2
Mhmm.
Speaker 0
And I'll say, like, hot flashes, that's estrogen. We give we we give hormone therapy. Your hot flashes really should go away ninety five percent. You might have that one remaining. First thing in the morning is the always the tenacious one that sticks around.
Speaker 1
Oh, interesting. I didn't know that.
Speaker 0
Yeah. I hear that's that's a really sticky one. So it's like the nuance is it could be part part partially, hormone therapy will help, and then, partially, it won't. And we only know by doing like, if you do a trial, you know, a, b, and c, a and b are way better, like, amazing. And c and d don't change. And then we say, okay. That's not related to this. What other things do we need to look at? Again, that nuance they don't hear on Instagram. And I love being that conduit between here's what I'm hearing on Instagram. What does that mean for me? And how could this therapy help me in particular?
Speaker 1
Yeah. And I think, like, the hot the hot buttons right now in Instagram are, menopausal hormone therapy in the context of cardiovascular, health is one of the big ones. Right? And you've got some practitioners saying, yes. It does. And other practitioners saying, no. The guidelines say it doesn't. I am I correct in saying that neither extreme are correct in that instance?
Speaker 0
Yeah. Absolutely. I can do you want me to shed some light on that topic?
Speaker 1
Yeah. Please. Because I know it it's very, it's very confusing, and it's hard to to make heads or tails of it.
Speaker 0
You're right. Because the current guidelines say hormone therapy should not be used for prevention of cardiovascular disease.
Speaker 1
Unless you're under the age of forty five and you've gone through menopause.
Speaker 0
Yes. That early menopause is it's that it's like a not different, but we really have to think a little bit differently about supporting, early menopause. And so this hormone therapy, it's not currently in the guidelines for many reason. We may we don't necessarily have the long term outcome data to say this prevents this. We do have the data to show when we're starting hormone therapy in that window of opportunity, so under the age of sixty and within ten years of menopause, adding that estrogen to a really healthy blood vessel can do some great thing. But should it be our strategy for everybody to prevent heart disease? No. Do we have the research? Probably. We have some research that in the right women who haven't, like, you know, that have healthy blood vessels and we give hormone therapy, can it keep protecting them? Absolutely. And as a naturopath, I say, I can for sure say, you know, a healthy diet and whatever variables we bring into that can be part of preventing our disease. I know that an active healthy movement lifestyle can be part of like, those things we know for sure. Does hormone therapy help? Fair. Probably. But I just don't I think where the guidelines are coming from is we just don't have enough to say for sure that universally, for all women, this is what we should be again, the nuance is and it's difficult on Instagram because you'll say, if you wanna protect your heart and not have heart disease, you need to start hormone therapy. And I think we get in a lot of trouble when we say all people, all women should do this.
Speaker 2
I I think one of the challenges too is that and not that these influencers are preying on women, but women want an answer. They want an easy fix. They don't necessarily wanna do the work. Like, you just said nutrition, movement. I know sleep is one of those. Like, that now I'm like, oh my god. I I'm already exhausted. I don't have time. Like, this is this sounds like more work for me, and they just want a quick fix.
Speaker 0
Yeah. And I think it's very challenging to get Nuance in on a social media square if they're in a Reel or, like, even a ten carousel. Like, it it it just is very difficult.
Speaker 1
I think it's it's difficult to get that nuance. It's also very easy without intending to do so, to impart a negativity on, for example, hormone therapy. You know, when someone when a practitioner does come on to say, you know, it's not appropriate to prescribe menopausal hormone therapy as preventative for cardiovascular disease. Right? There is going to be nuance applied to that by the listener. Right? So it's very you you can quickly see how things become so polarized and heated and right? So, yeah, social media is is dangerous because it's the nuance. You can't provide the nuance, but it gets applied regardless.
Speaker 0
Absolutely. Absolutely. And I'll have that is a very big thing that, you know, the patients that sit in this chair beside me, you know, I'll have patients say, I have no symptoms. I'm feeling great. I'm, you know, exercising. I'm eating well. Like but I want hormone therapy to prevent my protect my heart. And I can I can say, I'm like, I understand why you've heard this message, and I'm open to talking to you about it? Right? This is what we know. Here is what I know about your risk. Here is how much fiber you're eating. Here are all the things that you're doing. Like, you are doing such great things for your heart. It may not be necessary. It's probably not necessary to add in hormone therapy.
Speaker 1
And there are risks with any medication, whether it's taking ginger as a supplement or taking and something natural, a herb or a pharmaceutical product, there are risks. And I'm gonna go off on a tangent here, but you know, I took birth control for years and it worked well for me. And then, I went off and had kids and all the things, and then I started feeling really lousy. And, I had some pretty scary, premenstrual things going on. And, so a doctor I finally landed on who listened to me and said, I think you're in perimenopause. And I was so relieved. So let's try this low dose pill. Great. I was a shell of a human being on this pill, And that doesn't mean it's bad. Why I'm going off on this tangent bringing this up is if you have someone who is doing so well and then they add in something as a preventative, it could wreak havoc.
Speaker 0
Yeah. And I can see why that type of that patient is so proactive. They wanna be more proactive. And it's just assuring them, like, you're doing great stuff here. And then I'll have another patient. I'll say, there is risk here. One of the things we need to do in perimenopause is, like, where do we have buffers and where are we a little bit our book is about to pull over. Right? Because as soon as you lose estrogen, your cholesterol is going up, your blood sugar is going up, your your your blood pressure is going up. I will have another patient that'll say, you're not sleeping. You're soaking the bed. You're getting four hours of sleep. You're making poor food choices because you're exhausted, and you're, you know, you're doing okay, but you have heart disease risk factors. Hormone therapy is not here for preventing heart disease, but if we don't get this under control, if you're not feeling better, then all those things are gonna get worse. So this is gonna improve your heart disease risk because we can get you sleeping and and doing the other things and also not suffering as, like, a minor side thing.
Speaker 1
Oh, yeah. That. Right? We're not supposed to suffer and feel like shit and be miserable all the time. Right. Right. Thank you. Oh, yeah. That. I I'm being flippant and facetious, but oh my god. What what we still so wear that as a badge of honor. It's gotta stop.
Speaker 0
As Michelle says, if you don't laugh, you cry. It's like Yes. Like, that that is not an option. It's not an option out of my office. Offering is not part of this protocol.
Speaker 1
Absolutely. Well and listen. We wanna have you back, like, again and again and again when you're available, and I know you're we know you're really busy. You know, so if we could maybe even have you on for little short spurts to address a particular question that a a listener or a follower has, we would love to have you on because I am so excited to get this out into the world because how we've been talking about this is not how menopause, perimenopause, hormone therapy, all of the things. It's not how it gets talked about, especially on the Internet. And this is gonna be so helpful for so many people. Hope so. Oh, I I know so.
Speaker 0
I think the last thing I'd like to try to convey is, like, you know, as I have a patient in my chair, my brain is clicking all the things. Right? It's like, where's the risk? What assessment do we need? What does that tell us? How are they feeling, you know, what is the first three things that really need to get solved, and what's the long term game plan. I really feel like we need to give women more agency over, you know what you need. I know you're having trouble accessing it, but what are the what are some things you know you can do? What do you have control over right now while you're searching for a good menopause clinician or whatnot? We all know some things we can do. Right? And I always say perimenopause is like it's a chance to to lay these foundations. Right? We can't change that we have this roller coaster on top of it. We can't change the hormones are changing. We can support you and treat you, and you don't have to suffer suffer through that. But the more that we can lay a great foundation for our current health and future health, it doesn't solve everything, but it's really good to base everything off of these foundations. This is not sexy on Instagram. Eat your vegetables, Mediterranean type of diet, eat your fiber, you know, eat good nourishing food, not too much, definitely not too little. Like, don't be trying to survive on coffee till two two. Like, nourish your body, eat your vegetables, move your body, and, yes, like, don't get worried about the fancy stuff. Like, again, like, Instagram will be like, aerobic exercise is not good for your cortisol and menopause. I'm like, no. Like, I love running. I'm gonna go run, and that is what I'm gonna consistently do. And you can't tell, like, that is ridiculous.
Speaker 1
Yeah. And if you're if you're barely able to squeeze in lunch and breakfast, don't start flipping out about what kind of creatine you should be taking.
Speaker 0
Absolutely. Yes. Yeah. Like, get the foundations in place. Don't get fancy. Be boring. It is a time to be boring and, like, as consistent as possible.
Speaker 1
You just said my new favorite word, consistent, and that's my new mantra. Consistency is a superpower. Maybe I didn't get to the gym today, but I'm about to have a bath and I'm waiting for the tub to fill. Maybe I'm gonna do six push ups or not even fill push ups because I can't even do a full push up these days. Right? But, like, that's something.
Speaker 0
Yeah. Absolutely. And it's a time when we can relearn. You know, patients will be like, give me the diet. Give me the calorie like, give give me give me the fan the creatine and all of I'm like, a, I barely do supplement. I'm a supplement minimalist. There's maybe a couple that are evidence based that your health needs. Don't get fancy. Just do something. Right? And part of the frustration of this time of life is you feel stuck. You're immobilized. There is more information than ever, and women are more confused than ever. They don't know what to do. And that is immobilizing you almost freeze. And that is the opposite. You just need to take action with the simple things that you know are right in front of you, like lift weights while watching Netflix. Right? Like, it
Speaker 2
I brought my weights upstairs
Speaker 1
because I was
Speaker 2
like, otherwise, I'm not doing them.
Speaker 0
Exactly. And and also progress over perfection. If you fall off and you don't do weights and you eat gummy bears, fine. The next day, do weight. Like, don't worry about, like, if if it's not
Speaker 2
be perfect. Life is not perfect.
Speaker 0
No. No. Just keep going. And so a lot of that art of practice is, like, really helping with that habit change. So part of this, which everybody listening can do, is, like, what is one thing I can do? How can I prove to myself I can set a goal and show up for myself? Because I don't have a great track record. I have a track record of saying, I'm gonna go to a boot camp five days a week and then that last three weeks. And then I've proven myself I can't set a goal, and I can't follow through.
Speaker 2
And I failed again.
Speaker 0
Yeah. I'm like and we know that the best goals are self motivated. So I'll ask the patient, what's your movement goal? And they'll say something. I'm like, go smaller. Like,
Speaker 2
I'm definitely coming to your point.
Speaker 0
So you are doing nothing right now, and you're all of a sudden gonna go to the Y five days a week?
Speaker 1
It's not gonna happen.
Speaker 0
No. Like, how about do you think you could like, what about two? Oh, I can do two. I'm like, you you can do two, and you're telling your partner you're doing two, and you're putting a checklist on the fridge. And I need you to show up consistently and set a goal and follow through on that goal. And then we can, like, get fancy after that. We might go to four times a week.
Speaker 2
Maybe.
Speaker 0
Yeah. So I I don't want to I don't want to give the message that you need this unicorn menopause practitioner. I would love that and wish that for everybody. And we all do need a menopause specialist, or at least build a team to get the support we need. And in Canada, that you have to be creative. But there's so much around this that is accessible, and you have agency over and you can change right now. I'm not saying that's everything, but it's something.
Speaker 2
Thank you. Cara, what is the one thing you want every woman to know about perimenopause? How do you sum all that up?
Speaker 0
Oh, I funny. I think you might have said this at the at the start, but perimenopause is a beautiful hot mess. It's a time where you can listen to your body again, where you can make changes, where you have to listen to things that need to change, and you can kind of embrace and it's hard to embrace something that sucks, but there are parts of it that are hard and stuck, but there's also opportunity and parts that can be life changing and wonderful. And I just wish for everybody to actually have elements of both. I think we can reframe it. And I do think in ourselves, if we just take a minute to say, what do I want this to look like? What's important to me? What do I need to what do I need to change? Right? And that is not usually a drug or a hormone. It's it's a little bit bigger than that. And so I just hope that everyone maybe listening today can get a slightly wider angle lens of what this could mean for them.
Speaker 2
Thanks so much for listening to the show. If you like what you hear, please take a moment to rate and subscribe to our podcast. When you do this, it helps to raise our podcast profile so more women can find us and get a little better understanding of what to expect in perimenopause. We also read all the reviews, the good, the bad, and the ugly to help us continuously improve our show.
Speaker 1
We would love to hear from you.
Speaker 2
You can connect with us through the podcast, on social media, or through our website. Our information as well as links and details from our conversation today can be found in the show notes.
Speaker 1
This podcast is for general information only. It's It's designed to educate, inspire, and support you on your personal journey through perimenopause. The information and opinions on this podcast are not intended to be a substitution for primary care, diagnosis, or treatment. The information on this podcast does not replace professional health care advice. The use of the information discussed is at the sole discretion of the listener. If you are suffering from symptoms or have questions, please consult a qualified health care practitioner.
