Episode Transcript
Mikelle Ethier (00:00.703)
Hello!
Michelle Stainton (00:01.774)
Hi, Michelle. How are you? Dr. Jacobson.
Michelle Jacobson (00:03.22)
Hi, Michelle's good. I was just trying to figure out how to get this light off my face, but maybe it doesn't matter.
Michelle Stainton (00:08.98)
no, light is good. No, I love it. Your hair darker since or lighter since, was it blonde in November?
Mikelle Ethier (00:12.8)
Yeah, yeah.
Michelle Jacobson (00:12.936)
All right. It's my halo.
Michelle Jacobson (00:18.356)
I mean, like I would say it's progressively just getting blonder and blonder because I'm so gray. I've got this like patch. Yeah, I've got this patch that doesn't pick up the diet also. My response has been I'm just going to make it blend in.
Michelle Stainton (00:23.054)
Getting grayer and grayer. Yeah.
Mikelle Ethier (00:23.627)
Same. I know.
Michelle Stainton (00:32.714)
No, it looks fabulous. Love it.
Mikelle Ethier (00:33.451)
Good for you. That's the route. We're all gonna be blonde soon. Yup.
Michelle Jacobson (00:36.928)
Right? But I think also the longer I go between like hair dyes and I use the toning shampoo, the lighter it looks because it's just getting stripped of all. Yeah.
Michelle Stainton (00:37.774)
Mikelle Ethier (00:46.283)
All right.
Michelle Stainton (00:46.326)
The purple, the purple stuff? Yeah, yeah, yeah. I use it too. Is that why it is? Because in the summer I went into my hair stylist and she was like, I didn't make your hair that blonde. And I was like, the sun? I didn't even think about the purple shampoo.
Mikelle Ethier (00:50.049)
Mm.
Michelle Jacobson (01:01.618)
the sun and the purple shampoo and depending which purple shampoo, like I have a couple and some of them, if you leave them on for like three minutes, like your hair will go almost platinum.
Mikelle Ethier (01:12.097)
Really?
Michelle Stainton (01:12.219)
I'm gonna try that. And then does it go back? I'm gonna try this.
Michelle Jacobson (01:13.352)
Yeah. No, like it takes all the brass out. So that's why it gets so light. But if you leave it on too long, it gets almost gray. Like it's so light that it's almost gray.
Michelle Stainton (01:19.458)
Okay.
Michelle Stainton (01:27.278)
I'm gonna try, I'm gonna play around. I don't wanna be too, light, but okay. Thank you.
Michelle Jacobson (01:29.33)
Yeah. So the ones that I find the most powerful are Phenola, no more yellow or something like that. F-A-N-O-L-A and the Schwarzkopf, whatever it's called.
Michelle Stainton (01:37.901)
Okay, I don't know this one.
Michelle Jacobson (01:45.756)
Like they're like this stain your floor. Right? Like don't you want to talk about this instead of men?
Mikelle Ethier (01:46.571)
Look at you delivering amazing information already and we're not even into. Yes, yes, we do actually.
Michelle Stainton (01:49.39)
I know we could just talk about this. Amazing. just used the, didn't you know the brand 11 out of Australia?
Michelle Jacobson (01:54.782)
Like.
Michelle Jacobson (02:00.979)
No, but like I don't know anything.
Michelle Stainton (02:02.571)
Okay, well, no, so I've been using my hairstylist used to use Kevin Murphy and then now it costs like a bazillion dollars and so I stopped buying it. So she's like, try this 11 stuff and it's really good. I like it. I like it. anyway, well, it's up in a pony. So bless you.
Michelle Jacobson (02:12.82)
Well yeah, looks good.
Thank you.
Mikelle Ethier (02:17.217)
Bless you. Bless you, bless you. Thank you for taking the time. You're super busy. So we'll stop with the hair tips, although we will talk to you anytime, anywhere about all things all day. We'll do a formal intro and rave about how awesome you are after the fact. And we'll just pull bio from and headshot from your Coven Women's Health website. Okay, or can send it or send us whatever.
Michelle Stainton (02:21.162)
Yeah.
Michelle Jacobson (02:22.654)
That was my pleasure!
Michelle Stainton (02:25.577)
I'm
Michelle Jacobson (02:27.57)
all day.
Michelle Jacobson (02:42.846)
Sure, yeah, I can send you if you need like a.
Mikelle Ethier (02:46.677)
you know, whatever your preference is. And then we won't have to bug you. After the fact. Okay. Amazing. Amazing, amazing. Go.
Michelle Jacobson (02:53.532)
Okay, whatever you need, just tell me. It's no problem.
Michelle Stainton (02:55.753)
We appreciate it so much. Thank you. Yay. We're so excited about this, especially after talking to Dominique. She's like, my God, we had the wackiest conversation in our podcast. And she's so funny. Yeah.
Michelle Jacobson (03:04.82)
She's so funny. I love her so much. I feel like, I mean, I'll say this in the podcast, but I really love the team at Coven. I mean, you can tell that this is a handpicked group of women who are like-minded in a very fun way.
Mikelle Ethier (03:13.301)
Hmm.
Michelle Stainton (03:21.389)
Dominique said your Christmas party was amazing. Yeah. Yeah, no.
Michelle Jacobson (03:24.68)
It was so much fun. And it was like at my house, like we just cooked and it was great. and it was great.
Mikelle Ethier (03:30.027)
amazing.
Michelle Stainton (03:31.853)
I love this, I love this. Okay, well, we can't wait to hear more about that. Okay, let's dive in. I'm at my in-laws, they're not doing well, so in case I have to skip, apologies in advance.
Michelle Jacobson (03:42.056)
I'm sorry. Okay.
Mikelle Ethier (03:44.106)
it's, it's a really, she's being a trooper. It's not a good situ. No.
Michelle Jacobson (03:48.326)
No, this is the sandwich generation. This is what happens.
Michelle Stainton (03:48.875)
No, it's all good. But look at my great background, Doors on each side.
Michelle Jacobson (03:54.996)
Okay, look at my lightsaber. Like what's going on?
Mikelle Ethier (03:59.906)
It's your superpower bursting out of you.
Michelle Stainton (04:01.07)
Superfair, my gosh. Okay, okay. Let's begin. Dr. Jacobson, welcome to the show. We're so excited to have you here today.
Michelle Jacobson (04:11.688)
Thank you, I think you have to call me Michelle so that we can really just confuse everybody. Michelle, Michelle, Michelle, yes. It's like being back in my kindergarten class where there were four Michelle's and I always think now, because I deliver babies, that if somebody was like, this is baby Michelle, I'd be like, that's a weird name. Like, I don't know, it's like just really dated.
Mikelle Ethier (04:15.402)
Ha ha ha ha ha!
Michelle Stainton (04:15.777)
Michelle and Michelle. Okay. Michelle Michelle McCowell. my god, Dunn and...
Mikelle Ethier (04:18.379)
Perfect, perfect, perfect.
Michelle Stainton (04:30.284)
Yeah.
Michelle Stainton (04:34.808)
Can I ask what your middle name is? Is it, Rebecca, okay, Lynn. I'm Michelle Lynn and I know like a million Michelle Lins as well. was like, interesting. Rebecca's like totally different.
Michelle Jacobson (04:37.075)
Rebecca.
Michelle Jacobson (04:42.43)
That's interesting.
Michelle Jacobson (04:46.832)
It's like, it's biblical, right? It's, was my great grandmother's name, which is why I'm named as I am. But, yeah, Michelle Rebecca. But now I just feel like I'm in trouble.
Michelle Stainton (04:54.67)
Okay well, welcome to the show Michelle Rebecca. So Michelle you are known as the doctor that other doctors turn to for complex women health issues and you've dedicated your career to menopause, menopause oncology, hereditary breast and ovarian cancer syndrome. What why the focus? What made you focus on this population?
Michelle Jacobson (05:00.756)
you
Michelle Jacobson (05:20.742)
It's a great question. There's a personal component to it and there's more of a, I'm a big nerd and this is really interesting and hard and so I want to do it component to it. The personal component was when I was diagnosed myself as a BRCA1 carrier, I was already in a gynecology residency but hadn't yet sub-specialized and I became very aware during my own
Mikelle Ethier (05:28.289)
You
Michelle Jacobson (05:44.67)
challenges kind of navigating this. And if anybody should be able to navigate this, it's a doctor in the specialty. How little of a clear pathway there was for women who wanted just good advice on when to take the ovaries out, what they could do for risk reduction, know, hormone therapy afterwards, the risks of premature menopause. So there was a real contrast between the breast pathway, which was so clearly defined, and the ovary pathway, which is so ill-defined at the time. So that drove me to say,
Mikelle Ethier (05:50.401)
Mm.
Michelle Jacobson (06:14.449)
What do I need? What are the components that I can bring where I can make this pathway fulsome and clear and evidence-based and help other women who are in circumstances like mine? But in that journey, learning so much about breast cancer and gynecologic cancer and spending time with specialists in these fields, again, became aware not of a personal connection to, but really of a recognition of another gap, which is their care stopped at the...
time that they were treated for cancer, but they had so much living left to do that wasn't being addressed from a quality of life and a health promotion and a longevity perspective, because everyone was just so afraid and didn't know how to advise them. And they're similar, right? They're sort of related, but they're a little bit different. But I was well versed in figuring out how to deliver this care.
Michelle Stainton (06:45.536)
Mm-hmm.
Michelle Jacobson (07:08.753)
because it was all sort of related. And then once you do one cancer, you become the cancer expert. And once you become the cancer expert, you become like the hard people expert. So now you're seeing kidney transplants and heart transplants and stroke survivors. And then all of a sudden people are like, I'll just go to Michelle Jacobson. She'll know what to do because she sees hard people. So that's how I ended up where I am.
Michelle Stainton (07:12.994)
Yeah.
Mikelle Ethier (07:17.769)
Mm-hmm.
Mikelle Ethier (07:21.716)
Wow.
Michelle Stainton (07:22.53)
Wow.
Mikelle Ethier (07:30.849)
Well.
Michelle Stainton (07:31.382)
You're like house. that, that was kind of like, what was his character? Yeah.
Mikelle Ethier (07:34.066)
my God, yeah, yeah, yeah.
Michelle Jacobson (07:35.379)
I mean, I'm like, how's it except that I only do the job of a gynecologist and not a radiologist, interventional radiologist, internist, surgeon?
Michelle Stainton (07:41.077)
it.
Mikelle Ethier (07:43.497)
You're also absolutely lovely, not a raging prick. So, you know, let's just be really clear about that too. Yeah. Yeah.
Michelle Stainton (07:44.115)
And your... Yeah.
Michelle Jacobson (07:49.817)
nor do I have a prescription drug addiction problem. So there are differences.
Michelle Stainton (07:52.942)
Okay, now, a few differences.
Mikelle Ethier (07:54.721)
Excellent. Excellent.
but you are really effing smart.
It is such a delight to have really, really smart people who are also just really fun. Like we've, we've had the privilege of meeting you in person a couple of times at the last two national menopause shows. And there are people who just give off a great vibe and you do. so that's amazing because it's not always very common to have super duper nerd smart.
Michelle Jacobson (08:26.493)
Thank you.
Mikelle Ethier (08:30.763)
people who are also really awesome to hang with and be around and bring good vibes.
Michelle Jacobson (08:34.813)
I mean, I really like my job. I really like the work I do. I like the people I work with. I like the patients I look after. So I'm pretty happy.
Mikelle Ethier (08:45.449)
Well, it shows. It shows. I also would, if I may, just let me go on this little 30 second rant and then we'll get back to the questions at hand. But truly very smart, self-confident people are really nice. So you rock. We love you. Let's talk a little bit about your work because there's a lot of it. Like, I can't imagine what your...
Michelle Stainton (08:46.698)
It shows. Yeah.
Michelle Jacobson (09:01.181)
Thanks.
I'm cry.
Michelle Stainton (09:05.558)
Hahaha!
Mikelle Ethier (09:14.015)
schedule looks like, what your day-timer looks like. And then you thought, hey, let's co-found a virtual clinic, launched this past October. Is that correct? Yes. he launched in June. Okay. Okay. My apologies. Okay.
Michelle Jacobson (09:24.861)
We launched in June, end of June, beginning of July. Yeah, but that's okay. But really the reason you may not know that is because so far it's been all word of mouth, no real formal marketing. And yet we have really helped a lot of women, I think. So it's cool if you think we launched in October.
Mikelle Ethier (09:43.065)
I have no doubt. I, well, but clearly, right? Like how amazing is that? So what you did launch Coven, women's health, and it's a multidisciplinary approach to hormonal health care. Um, that of course includes, um, menopause, perimenopause. And yeah, and you, you know, it's not just you, there's an entire team. And I thought maybe we'll start with.
Michelle Stainton (09:44.533)
Yeah.
Michelle Jacobson (10:02.12)
Very menopause.
Mikelle Ethier (10:11.327)
You know, why you need the team approach, why you, we all deserve more than a 10 to 15 minute appointment to cover perimenopause, menopause, peripose menopause, depending on where you're at. And, you know, get into a little bit of the nuance and skill required to, do so, do what you do so well.
Michelle Jacobson (10:35.323)
Yeah, mean, Coven came out of a desire to deliver the type of care that I thought everyone should have, but due to the confines of the system the way it is, we don't have. So I would see women and they would, you know, ask for advice on things that are really important, like their mental health and their moods and their diets and their exercise and strengthening regimens.
Michelle Stainton (10:37.823)
Thank
Mikelle Ethier (10:49.227)
Mm-hmm. Mm-hmm.
Michelle Jacobson (11:03.793)
And I would say, you should probably see a good social worker or dietician. And they'd say, do you have any recommendations? And I would say, no, like, I don't know, just go somewhere, right? And so I wasn't helping women or guiding them the way they needed. And I, as you kind of know, ran into this problem where my wait list was growing because everybody, thank goodness, wants to talk about menopause and...
Mikelle Ethier (11:09.857)
You
Michelle Stainton (11:11.713)
No.
Michelle Jacobson (11:32.475)
Unfortunately, we have 20 plus years of physicians who don't know enough, even if they want to know more, to advise women in a evidence-based and helpful way. So they would just refer them on. My wait list was growing and growing. And I became very frustrated that I couldn't help women faster and in a more fulsome way. So I thought, you know, what we really need is a way that I can scale my approach. And one way that I do that is I train fellows who have gone off
Michelle Stainton (11:54.018)
Mm-hmm.
Michelle Jacobson (12:01.669)
all around Canada, placed fellows in Halifax and New Brunswick and Ottawa and Hamilton who are doing what I do. So I'm so pleased about that. And that's within the covered health insurance. But also how do I scale my approach so that more women can get this care? And I spent a long time thinking about that and trying to figure out a way to do it. And then I met the right co-founder, which is so important in...
Michelle Stainton (12:20.408)
Mm-hmm.
Mikelle Ethier (12:29.025)
Mm-hmm.
Michelle Jacobson (12:29.778)
in building this kind of a platform because I couldn't have done it just because I wanted to. I needed someone to actually know what they were doing from the business perspective. And that's Jan, my co-founder. So we couldn't have a coven without her. And that's where we got to talking about what does this look like and what's our offer. And even now, the way we're offering the coven program is not even as much as I want to be able to offer, but it's a first step that women can access it from anywhere.
Mikelle Ethier (12:32.961)
Mm-hmm.
Michelle Jacobson (12:57.67)
that they are seeing a team of hand-picked, amazing, funny, smart women professionals in social work and dietitian. You've interviewed one of our social workers yourselves, our nurse practitioner, our registered nurse health coach. We're a team, like we're a loving family team, and we offer really, really good care because it's the type of care that I thought women should get. So yeah, the barrier is the financial barrier because none of these things are free in any healthcare system.
And yet because we choose high quality registered professionals, they are covered if you have private insurance. So to me, the access and the high quality care is the plus, the cost is the downside, but overall the product I think is phenomenal.
Mikelle Ethier (13:44.226)
Absolutely. I'm wondering, know, and maybe not off the top, but off the top, can you think of or give an example of, you know, even if you do have a medical provider who agrees to prescribe menopausal hormone therapy, for example, could you give us an example of some of the nuance that gets, gets, gets missed in that typical, you know, public system scenario?
Michelle Jacobson (14:08.38)
Yeah, I I think for this podcast especially, it's perimenopause, right? Because our family doctors and nurse practitioners and primary care physicians out there who want to deliver care, they wanna do it safely. And so they're limited, right? They're limited by guidelines, they're limited by product monographs and what Health Canada says. And unfortunately, all those documents are based on the studies that are done. But who's a really hard group of women to study? Perimenopausal women, because there's no clear
Michelle Stainton (14:12.418)
Mm-hmm. Mm-hmm.
Mikelle Ethier (14:12.513)
Mm-hmm.
Mikelle Ethier (14:36.255)
Mm-hmm.
Michelle Jacobson (14:38.118)
definition about what makes you perimenopausal or when you enter perimenopause or what those criteria are. So all these perimenopausal women out there who are not feeling like themselves, who are suffering, who are not sleeping, who have low moods, who don't understand why they're getting hot flashes even though they're getting regular periods, those women suffer because their doctors don't know what to do with them. They're not written about, they're not guideline described. The product monograph says don't start this till after a year.
Mikelle Ethier (14:39.925)
you
Mikelle Ethier (14:56.929)
Mmm.
Michelle Stainton (15:07.79)
All
Michelle Jacobson (15:07.878)
So we've got women suffering at 11 months of no period because they haven't quite made it yet versus women who are 13 months. So they get a free pass and they get their treatment.
Mikelle Ethier (15:15.989)
We've had followers, listeners write in and say, my God, like my doctor who's amazing says that I can't start MHT until I'm in menopause, help. And they've told me that that's according to, I think this is one of most recent instances, it was the Canadian Menopause Society guidelines. And so I went in and looked around and I read through and I was like, I get why if you are not Dr. Michelle Jacobson.
OB-GYN extraordinaire or someone who's had a lot of clinical experience treating, helping women in perimenopause. I get why you would look at those guidelines and go, no, cannot, do not, right? It's tricky.
Michelle Jacobson (15:59.421)
Yeah, like guidelines are meant to be evidence-based, but they don't reflect the fact that the evidence sucks for perimenopause, right? So you're left with like a very small number of doctors who are experts in menopause who are willing to work outside the guidelines and live in the gray as my friend Kelsey Mills likes to call it, right? Where you say, well, like I know how to do this and you fall into a category that I'm comfortable with, but I don't wanna push that.
Michelle Stainton (15:59.854)
Yeah.
Michelle Stainton (16:06.863)
Hahaha!
Mikelle Ethier (16:10.56)
in.
Mikelle Ethier (16:21.024)
Mm-hmm.
Michelle Jacobson (16:28.38)
comfort on a doctor who's doing their best and just trying to be safe and work in an area they weren't really trained in and help their patients. Like we don't want to make those doctors do something that they think they're causing harm. It's not their fault. They don't know any better. The guidelines are not fulsome. The product monographs are not helpful, right? They're helpful for a small subset of women. And I always laugh because I actually think we've gotten to a point where the menopausal patients are almost the easy ones to treat.
Right? Like they don't bleed usually. Like they've read the textbook. Yeah.
Mikelle Ethier (16:59.497)
You're not the first on this podcast to say, know what, once you get to that, you're, there's almost a, there's almost a, okay, you're, you're leveled out. You know, it's perhaps not optimal and what have you. Like you, still need support, but you're not doing this roller coaster up and down all over the place. And yeah, yeah, yeah.
Michelle Jacobson (17:16.88)
Yeah, you're not fluctuating, you're not all over the place. Yeah, there's so many more nuances to treating perimenopause. And it starts with even recognizing that someone might be complaining of perimenopausal symptoms, which again is so varied across person to person in their presentation. So it's really hard. that's actually a group of women that I think really benefit from this kind of care because
They're getting that scaled approach, right? We can see as many perimenopausal women as we need to as present to us with the expertise of someone who's like, you know, F it, like I know how to do this. You know, let's recognize, let's validate, let's treat and let's treat all of the aspects, right? I'm not a hot flash doctor. That's another thing that bugs me is when I go to sometimes to even groups with key opinion leaders.
Mikelle Ethier (18:04.833)
Hmm.
Michelle Jacobson (18:09.731)
The gynecologists out there are like, well, I know what to do for half lashes and I'm comfortable, but I'm not comfortable prescribing sleeping, you know, advice because I don't know about sleep and I'm comfortable with hormones because I'm a gynecologist. But menopause is more than hormones. Menopause is all organ systems in the body. And we need to figure out a way to address a woman's needs as she enters this really confusing time that has very little research out there about it. And that takes a level of confidence and expertise.
Mikelle Ethier (18:16.161)
Hmm
Mikelle Ethier (18:24.417)
Mm-hmm.
Michelle Stainton (18:27.479)
Mm-hmm.
Michelle Jacobson (18:39.621)
that is unrealistic that everybody would have.
Michelle Stainton (18:43.8)
there.
Mikelle Ethier (18:43.851)
So, so well said. If we could just maybe touch on in the context of lack of evidence or shitty evidence. I noticed when I was going through your website, perimenopause is talked about as well in the same line as PMDD and PCOS. And I think that that is also something that is really hard for.
patients and probably regular providers. So maybe you could elaborate a little bit on those two things and tell us what they are and why they're so hard.
Michelle Jacobson (19:19.685)
Yeah, mean, PCOS and PMDD, which we can talk about, they're hard to treat and recognize and work with a patient together to achieve common goals at baseline. But when you have someone affected by PCOS or PMDD enter perimenopause, it gets extra confusing, right? Because you can't use those usual...
Michelle Stainton (19:43.758)
Mm-hmm.
Mikelle Ethier (19:43.998)
Mm-hmm.
Michelle Jacobson (19:47.58)
baseline characteristics to say, what's changed? Because that PCOS patient never got periods regularly in the first place. So the fact that she's not getting them regularly anymore is irrelevant, right? And she doesn't use that as a benchmark to recognize that this is a change. That PMDD patient who suffered so much every time she was in her luteal phase now feels that way all the time because she's having these luteal out of phase cycles.
Michelle Stainton (20:17.026)
Mm-hmm.
Michelle Jacobson (20:17.263)
So she is constantly having PMS symptoms, but for her, they're debilitating and she's suicidal and she can't function and her body hurts. So what used to be predictable and cyclic by definition in perimenopause no longer applies because the cycles are no longer regular. So being able to piece that out based on history, open your mind to what the presentation could look like and address the root causes rather than band-aid solutions.
Michelle Stainton (20:24.194)
Mm-hmm.
Michelle Jacobson (20:46.807)
is the really tricky part. And it's the part I love because my brain is going crazy trying to think of all the ways that we can recognize this and validate you and teach other people to recognize it. But at the end of the day, people just want to feel better. And that's what we do.
Michelle Stainton (21:04.184)
love that. It's amazing.
talking about other things I love. I love, love, love the name Coven and so good. And you also have a podcast which will link to in the show notes because it's amazing. It's super funny and also educational. Sorry, it's very educational, but it's also really enjoyable to listen to. So and it's called Hysterical Women. So both great names. Please tell us why you chose these names.
Michelle Jacobson (21:26.353)
I'll take funny. Like I want to be funny first.
Michelle Jacobson (21:39.356)
Thank you for asking. is my favorite question. So a coven for those who don't know is a community of witches. And when Jen, my co-founder and I were thinking about names for our company and we were floating names by our friends and doing some sort of market research, coven was not the most popular because a lot of people don't know what a coven is. And yet when you think about who we are, us Gen Xers, elderly millennials,
people who are entering perimenopause and to some degree menopause now, that we are people who grew up on the craft and all the witchy stuff that is so fun, right? And it's so interesting. Those women were our heroes. They were confident. They didn't care what other people had to say. They did what they had to do to survive and to feel better no matter what the patriarchy said. And they were supported by a community. And that to us really embodied
Michelle Stainton (22:14.984)
Mm-hmm charmed
Michelle Jacobson (22:36.791)
the notion of what we wanted to do. We wanted to be a supportive community of really interesting women who scared men so much they probably would have burned and drowned them in the 1600s because that's who we are. We're this like really funky, fun, quirky group of women. And so we identified with the witches and the people who were called witches. And we identified with the idea that a witch needs a coven because
Michelle Stainton (22:44.302)
Yeah
Nailed it.
Michelle Jacobson (23:04.473)
All of us need our village and our support system. So that's where Coven came from. And now it's kind of turned into a running joke that the people who call it, like who mispronounce it, it's like a self-identifying thing of like, you're not in the know. Like you're not, it's not Coven. No, you said it right. You're fine. You're good. And like apologies to anyone who hasn't, but it comes up a lot. You'd be surprised. A lot of people are like, Coven women's health. I'm like, you don't know what a Coven is. Let me explain this to you. Right.
Michelle Stainton (23:08.866)
love it.
Mikelle Ethier (23:16.385)
Ha ha ha!
Michelle Stainton (23:17.078)
wait, wait, wait, what did they say? Coven. No, no, I...
Mikelle Ethier (23:24.999)
Interesting.
Michelle Stainton (23:25.099)
interesting.
Michelle Stainton (23:29.11)
Uh-uh. Well, and I'm getting more witchy as I get older. I'm like getting more. Like, yeah.
Mikelle Ethier (23:29.793)
Wrong. Yeah.
Michelle Jacobson (23:34.481)
Right? I think we all are. It came up on Netflix that like the craft was going to be on Netflix and that scene where she goes, we're the weirdos, mister. And I'm like, yeah, we're the weirdos, mister. Like, that's why we have so much fun together. And so when we wanted to put our podcasts together, we were thinking along the same lines. Like, it's it's a very feminist approach, right? Like, it's it's wanting to be the woman you are without
Mikelle Ethier (23:39.361)
Mmm.
Yeah. Yeah.
Michelle Stainton (23:43.969)
Yeah, yeah.
Michelle Stainton (23:57.358)
Mm-hmm.
Michelle Jacobson (24:01.317)
conforming to what society or the patriarchy wants you to be. And so we wanted to reclaim this word hysterical, because hist in Greek means uterus, so hysterectomy, that's something a gynecologist would do to take out your uterus. But in the kind of early 1900s, to be hysterical meant to be crazy because you were a woman. And now we use it.
Mikelle Ethier (24:09.057)
Amazing.
Mikelle Ethier (24:24.693)
Mm-hmm.
Michelle Stainton (24:24.727)
Yes.
Michelle Jacobson (24:26.518)
more to mean like you're so crazy or you're funny. And so it was this sort of double entendre of reclaiming hysterical, but also we're so funny. And so we wanted to put this podcast together. So we are the hysterical women of COVID.
Michelle Stainton (24:40.16)
No, yeah, you nailed it. It's so good. Yeah, yeah.
Mikelle Ethier (24:41.599)
You so nailed it. Yeah. Really, really good. And also, of course, we're hysterical. Look what we've been shouldering, putting up with. Like, yeah, damn straight, we're hysterical. You would be too.
Michelle Jacobson (24:43.674)
Thank you.
Michelle Stainton (24:50.338)
Ha ha ha ha ha ha.
Michelle Jacobson (24:52.88)
Yeah. Right. And it was fine when we died at 40, but like that hasn't been the case for a really long time. So if we're going to live to 85 plus, we need people who can help us live our best quality, quantity and health life. And that this all comes together of what our mandate is at Coven.
Michelle Stainton (24:58.562)
Ha ha ha.
Michelle Stainton (25:03.022)
a re-
Mikelle Ethier (25:05.185)
you
Mikelle Ethier (25:10.763)
Yes.
Mikelle Ethier (25:19.327)
You mentioned earlier 20 years of physicians who don't know about menopausal care.
That stems from the WHO study in early 2000s that terrified a generation of women and medical providers about hormone therapy. And you and other experts have been working to set that straight because that was never the case. So for our listeners who grew up hearing hormones, especially estrogen, cause cancer, what do they need to know about, I guess, the reanalysis of the data?
How did it get so, how is it so wrong?
Michelle Jacobson (26:05.307)
Yeah, it's a great question. So the study itself, the WHI, it's a great study and we learned so much from it and the things that we learned can be presented in a really positive way. The problem is everyone likes a sensational story and a headline and that is what was done egregiously to women is capitalizing on how we can make this scary and interesting for a headline, which really overshadows the
Mikelle Ethier (26:10.612)
Mm-hmm.
Mm-hmm.
Mikelle Ethier (26:18.251)
Mm-hmm.
Mikelle Ethier (26:22.369)
Yep.
Michelle Jacobson (26:35.152)
quality of the information. Because it's not interesting to say everything's fine, hormones are good. It's interesting to say what you've been doing for the last 20 years is scary and you're going to die, right? So it's really the way it was. It was shared in the media that was so bad. So the WHI for those who don't know was a huge randomized controlled trial, which is the best type of research you can do. It tells you about cause and effect.
Michelle Stainton (26:41.463)
Yeah.
Mikelle Ethier (26:42.336)
in
Mikelle Ethier (26:53.717)
Mm-hmm. Mm-hmm.
Michelle Stainton (27:04.227)
Mm-hmm.
Michelle Jacobson (27:04.3)
and it looks at usually something, a variable, and a control group. So the control group in this setting was someone who was taking a placebo, so something that they didn't know if it was estrogen or nothing at all, but it was nothing. And the group of women who were studied were the women who were taking either conjugated estrogen plus a synthetic progestin, or if they'd had a hysterectomy and didn't require the progestin, they took conjugated estrogen alone.
So we have these three arms of women to compare against each other. And what's really interesting was the study was done in order to look at cardiovascular outcomes. It wasn't used to say, does this work for hot flashes? You weren't even supposed to have hot flashes if you entered the study, because you would know what you were on if you had hot flashes. So like, this isn't really even a group of women that you can extrapolate to that mid-40s, early-50s person with hot flashes.
Michelle Stainton (27:36.099)
Mm-hmm.
Mikelle Ethier (27:48.799)
Hmm. Right, right, right.
Michelle Stainton (27:51.288)
Right.
Mikelle Ethier (27:56.277)
Ahem.
Michelle Jacobson (28:01.329)
This was looking at older women who wanted to know if estrogen was good for their hearts. So the average age of women in this study was 63 years, which is pretty old for starting hormone therapy. You know from the people that follow you and that you interview that perimenopause typically affects people in their late thirties to like late fifties, depending on your timing. And they included women from the late forties and into the seventies. So...
When they did the analysis of these groups, immediately in the first few years, they found that there were more bad outcomes from a cardiovascular perspective and more breast cancer. So that's what went out there. Hormones cause heart attacks, hormones cause stroke, hormones cause breast cancer, everybody should get off their hormones. But when they took a step back and the sensationalism died down and they reanalyzed, so they broke the women into groups of age 40 and 50 versus 60 and 70,
They found very different things. The women in their 40s and 50s had better mortality, less cardiovascular events, less strokes, less heart attacks. And the women who were on estrogen alone, less breast cancer compared to placebo. And that was even true at 20 years of age. For the women who were in their 60s and 70s, yes, they had more cardiovascular events. And that is where these recommendations for a window of opportunity and starting hormone therapy before age 60 or less than 10 years from the final period came from.
Michelle Stainton (29:09.103)
Mmm.
Mikelle Ethier (29:09.153)
Mm-hmm. Mm-hmm.
Yep.
Michelle Jacobson (29:25.796)
which is a nice recommendation and it's actually a very flexible recommendation, but also the women who took estrogen alone had less breast cancer after 20 years than the women who had taken placebo. And the women who had taken estrogen with synthetic progestin who did have more breast cancer was on a magnitude of eight out of 10,000 women. So the way it was publicized was this is gonna give everyone cancer. And in reality, if you look at the way you can...
Michelle Stainton (29:27.172)
Mm-hmm.
Michelle Jacobson (29:54.448)
classify outcomes, this is like an ultra low risk event, right? But the outcomes and the impact was tremendous.
Mikelle Ethier (29:58.178)
Mm-hmm. Mm-hmm.
Michelle Stainton (30:03.361)
Mm-hmm.
Mikelle Ethier (30:04.253)
Yeah, yeah, we all know, right? Mothers, mother-in-laws, order, yeah, yeah.
Michelle Stainton (30:06.479)
My mother was ripped off. yeah, everyone. Get off.
Michelle Jacobson (30:08.752)
Yeah.
And if you look at like things like prescribing rates, that all dropped, right? It dropped tremendously. It dropped really quickly. Nobody was getting their hormone therapy prescribed anymore. Nobody was filling those prescriptions. It was recommended against across the board. But you know what didn't drop? Breast cancer rates, right? Like if anything, all we've seen is a rise in breast cancer rates over the last 20 years, right? When I started med school, in 11 women got breast cancer. Now one in eight women got breast cancer.
Michelle Stainton (30:15.31)
Mm-hmm.
Mikelle Ethier (30:25.569)
Breast cancer? Yep.
Michelle Stainton (30:27.582)
Hahaha
Mikelle Ethier (30:31.969)
Yeah.
Michelle Stainton (30:34.094)
Yeah.
Michelle Stainton (30:39.81)
I will.
Mikelle Ethier (30:39.829)
Yeah.
Michelle Jacobson (30:39.993)
So breast cancer rates or incidence is technically going up and yet hormone therapy prescriptions definitely went down. So that to me should be enough that you step back and say what I thought I knew is wrong.
Michelle Stainton (30:50.051)
Wait. Yeah, absolutely.
Mikelle Ethier (30:52.277)
Yeah, yeah. Maybe we can talk about breast cancer patients, people with a history, family history, et cetera. You were one of the experts who helped or who updated the 2021, I believe, guidelines for the Society of Obstetricians and Gynecologists of Canada. Is that correct? Yeah. So, and we've interviewed...
Michelle Jacobson (31:13.966)
Yeah, done.
Mikelle Ethier (31:18.241)
actually a few cancer survivors, not just breast but cervical as well. the quality of life horror stories, Michelle, we're not telling you anything you don't know, right? It's heartbreaking. Can you help us understand what the evidence says about hormone therapy in this population, in these populations? And are there ways to help them have a quality of life and not suffer unnecessarily?
Michelle Stainton (31:22.959)
Mm-hmm.
Michelle Jacobson (31:47.588)
Yeah, absolutely. So first of all, I think a really important caveat here is right now we talk so much about the benefit of hormones, that it's really scary for the women who are being told they can't take hormones because they think, there's been this resurgence of interest and safety, but I don't get to come to the party. So I'm going to live a bad life and a shorter life because I'm not getting all the benefits that are touted to go along with hormones. So that's not true.
Mikelle Ethier (32:00.482)
Mmm, yes.
Michelle Stainton (32:01.292)
Mm-hmm
Mikelle Ethier (32:04.521)
Yeah. Yeah.
Yeah.
Michelle Jacobson (32:17.453)
Right? There are definitely ways that we can optimize your health and your longevity that you don't have to suffer or worry that you are being denied something. That's from the behind the scenes stuff. That's what I call it. The bones, the heart, the brain, right? When it comes to the quality of life, this is where the breast cancer, not being able to take hormones, please, is the most obvious, right? It's affecting a woman's quality of life.
Michelle Stainton (32:43.801)
Mm-hmm.
Michelle Jacobson (32:46.921)
And hot flashes are one thing that impact women and they can impact a lot of women. They are the most common and specific symptom of perimenopause and menopause and they respond very well to hormone therapy. And I'm sure you guys have talked about this on your podcast before, but we are in a new era where there are highly effective prescription therapies that treat hot flashes as well as estrogen does.
Mikelle Ethier (33:07.315)
Mm-hmm.
Michelle Jacobson (33:11.353)
They are safe, they are efficacious, they are becoming more and more readily available. So this is a game changer just within the last 12 months. That is a bit of a ray of hope for women who are suffering from hallflashes. When it comes to why the Candida or the Neurokinin antagonists, the two that are approved in Canada are FezoLinotent, which is also available, and Elinxanotant, which actually has evidence for use in women with breast cancer and is approved.
Michelle Stainton (33:23.311)
Is this the candy?
Michelle Jacobson (33:39.481)
but is not yet available for prescription, hopefully very soon. But yeah.
Michelle Stainton (33:42.863)
Okay, and one more question on that story in the back. If I'm 70 and I'm still having hot flashes and I've never taken estrogen before, I can take this, one of these? Okay, amazing, thank you.
Mikelle Ethier (33:42.869)
fingers crossed.
Michelle Jacobson (33:52.216)
You could, yeah, yeah. So there are not the same restrictions when it comes to age or time for menopause or reasons that you would avoid hormone therapy. For the most part, anybody could take these therapies, barring somebody with very poor liver disease. That would be one of the, yeah, yeah. And other, search in other medications. But again, that's gonna be a very personal consultation, but yes, is the simple answer.
Michelle Stainton (34:09.323)
Okay, thank you asking for a friend. Thank you.
Michelle Jacobson (34:19.107)
The other thing that's important is to understand why can't women with breast cancer take hormone therapy? And it's not that they can't, right? It's that there was risk and everyone deserves an individualized assessment where they are able to make their own balance of risk and benefit and then make a decision once they've been armed with the information that they deserve, right? So as a gynecologist and a hormone therapy prescriber,
Mikelle Ethier (34:31.169)
Mm.
Michelle Stainton (34:40.047)
Mm-hmm.
Michelle Jacobson (34:44.503)
I don't withhold prescriptions to people who have contraindications. I give them information and I say, what do you wanna do based on this information? Because only you know how bothersome your symptoms are and how scared you are about the risk of recurrence and what you're willing to go through and what your quality of life is, right? We can't make that decision for you. You have to make it with the information. Now.
Mikelle Ethier (35:06.129)
my God, mic drop. We're gonna like blow that up and pump that out hard on social media. How wonderful and refreshing and thank you. And please anybody listening who is a medical provider, practice this way. Thank you. Yes. Yes.
Michelle Stainton (35:09.305)
hahahaha
Michelle Jacobson (35:27.533)
It's important and it's the definition of patient autonomy and informed consent. We hide behind do no harm, but what if we're doing more harm by withholding?
Michelle Stainton (35:30.819)
Yeah.
Mikelle Ethier (35:39.229)
Well, and why does do no harm seem to not include quality of life in so many instances?
Michelle Jacobson (35:44.067)
Right, we had a patient come through the Menopause Foundation of Canada. She went on their message board and said, my half lashes are so bad, I've had breast cancer and I can't take hormone therapy. So could you please help me find somebody to give me medically assisted death? Because I don't want to live like this anymore. And like, it's the perfect example of missing the forest for the trees, right? Like, we won't give you hormones because of your breast cancer, but we'll kill you.
Michelle Stainton (35:44.665)
Yeah.
Mikelle Ethier (36:05.895)
Yeah. Yeah.
Michelle Stainton (36:06.201)
my god, yeah.
Michelle Jacobson (36:12.771)
because your quality of life is so bad, right? Like it's nonsense and it's such a good example of individualized decision-making, right? There is very strong evidence that the best outcomes from a breast cancer perspective in estrogen positive breast cancer have to do with lowering the total body estrogen exposure. So the best breast cancer recurrence information comes from people who...
Mikelle Ethier (36:14.173)
so bad Jesus yeah wow wow
Michelle Stainton (36:17.42)
Wow. Wow.
Mikelle Ethier (36:34.207)
Mm-hmm.
Michelle Jacobson (36:38.851)
go into menopause chemically, surgically or naturally, and then are given medicine that stops them from making estrogen in any part of their bodies, aromatase inhibitors. So the proof of concept is there for why estrogen is bad if you are an ER positive breast cancer survivor, because your benefit actually comes from estrogen suppression. But then to sort of further that, people who'd had breast cancer were studied in randomized control trials again, which can tell us about cause and effect.
Mikelle Ethier (36:57.537)
Mm-hmm.
Michelle Jacobson (37:06.413)
And they found that for the regimens that those women were given, which was estradiol and synthetic progestins in various forms, that there was a higher rate of breast cancer recurrence. The breast cancers came back in the same breast or in the other breast. The studies didn't go on for long enough to see if there were distant metastases, but they didn't see any in the short term that they were following these women for. But the question of does it increase risk of recurrence is yes.
Michelle Stainton (37:18.272)
Okay.
Mikelle Ethier (37:32.512)
Mm-hmm.
Michelle Jacobson (37:33.643)
on the realm of about 10%. So 7 % recurrence risk in people who didn't take hormones, 17 % in women who did take hormones. But again, that's your choice, right? This is the number, this is the information. I can't always give you the exact risk for your type of cancer, the treatment that you've had. Like if you've had a double mastectomy, how do we apply this information to you? Because you're not gonna get a local recurrence. If you're gonna get a recurrence, it's gonna be a distant recurrence, right?
Mikelle Ethier (37:43.253)
Mm-hmm.
Michelle Stainton (37:43.288)
Mm-hmm. Mm-hmm.
Mikelle Ethier (37:58.37)
Mm-hmm. Mm-hmm. Mm-hmm.
Michelle Stainton (37:59.895)
I missed it. Yeah.
Michelle Jacobson (38:01.763)
Triple negative or ER negative disease hasn't been studied to the same degree as fulsomely, but there are nuances in the studies like higher rates of recurrence than expected even in the triple negative group. So it's not as simple as, ER negative, you're good, but it's also not as simple as, ER negative, you're bad, right? It's an individualized decision based on age, quality of life, constellation of symptoms, goals, and those goals change, right?
Mikelle Ethier (38:21.962)
Right.
Michelle Jacobson (38:30.264)
When you first get diagnosed with cancer, your goal is usually not to get diagnosed with cancer again. But if you've been suffering for five or 10 years, and you start to sort of have that glimmer of hope that maybe that cancer is not gonna kill me, but then what does the rest of my life look like? That's when people really wanna start having these conversations.
Michelle Stainton (38:34.838)
Yep. Yep.
Michelle Stainton (38:45.314)
Right.
Michelle Stainton (38:50.314)
Interesting. And are there many people in your field that are specialized in this conversation? Like is in Canada, is this?
Mikelle Ethier (39:00.297)
Are you it?
Michelle Jacobson (39:00.59)
I mean, there's not many people in the field of menopause in general. And then even within people who are experts in treating menopause, I would say there's still a lot of discomfort around the scary cancer transplant sick people. So that's where this I don't know, this, this nickname or whatever of like the doctor other doctors turn to, like I'm usually someone people can come to and say like, what would you do in this scenario? I think Mikelle's cough is contagious.
Michelle Stainton (39:01.902)
Yeah, I'm like...
Michelle Stainton (39:14.997)
Yeah.
Mikelle Ethier (39:15.125)
Yeah, yeah.
Mikelle Ethier (39:25.853)
Mm-hmm. Mm-hmm. Contagious, yes, sorry.
Michelle Stainton (39:29.806)
So I'm just thinking like so if I know coven is open to every woman and all women every person that has was born with the uterus That said are you getting are you finding that more do you have a reputation out there that you're the breast cancer guru and that are more and more people coming to you with? those types of
Michelle Jacobson (39:54.063)
Some, yeah, I mean, more and more, would say Coven's client base is still primarily people who are just looking to get a faster access to good menopause care. And we love that. But people with cancer or complex medical needs should know that every consultation at Coven means a consultation with me, even if they're not seeing me directly, because the nurse practitioner reviews every single patient with me.
Michelle Stainton (40:05.73)
Mm-hmm. Mm-hmm.
Michelle Stainton (40:16.002)
Mm-hmm.
Mikelle Ethier (40:16.065)
you
Michelle Stainton (40:21.111)
Wow.
Michelle Jacobson (40:22.464)
So we can say that, that every patient is reviewed by me, the plan is sort of approved by me, the recommendations come from a combination of me and the team. And so it, like I said, it's a way to scale my approach and knowledge, which isn't, not everybody has.
Michelle Stainton (40:36.576)
Yeah.
Michelle Stainton (40:40.608)
obviously, clearly. Yeah, wow. Okay, that's amazing. Love it.
Michelle Jacobson (40:45.228)
Yeah, it's the offer, right? Like it's why we did this. Like people will say, sell out, right? Private, she went into this to make money. Like I don't take a penny from Coven, maybe one day, right? But like the purpose here was really to cut down on that two-year wait list and get this knowledge and treatment approach out to everybody who needs it, whether they're from Kenora or, you know, Timmons and they don't want to come down to Toronto.
Mikelle Ethier (40:51.605)
Mm-mm.
Michelle Stainton (40:56.737)
Me.
Michelle Jacobson (41:15.168)
or whether they're waiting on a wait list for two years and pondering medically assisted death because their quality of life is so poor.
Mikelle Ethier (41:21.665)
Wow, wow. Are you planning beyond the Ontario border? Ontario borders? Amazing, amazing.
Michelle Stainton (41:22.914)
Yeah, no.
Michelle Jacobson (41:28.92)
Yeah. Yeah. Yeah. So that's come to like be the next step for us. We see very clearly that this need exists outside of Ontario. Of course, if Canada made sense and there were less barriers, we would be there already. But when you have such a high quality team that you've trained so well, it's hard to expand. So either they need to get licensed elsewhere, which has barriers, or we need to find people who are just as good elsewhere.
Michelle Stainton (41:44.995)
Yeah.
Michelle Jacobson (41:58.784)
and train them. So there are barriers to expanding, but it is the number one goal because because that's what we want. We want to help people everywhere.
Michelle Stainton (42:06.198)
everywhere and and so much help is needed everywhere yeah that's amazing so for listeners who can't get access to coven but they they know that they need and deserve better menopause care how do they do you have any advice for them to get that support their medical providers
Michelle Jacobson (42:22.732)
Yeah, so first of all, like keep checking because we will get there in the near future. But second of all, I think the Menopause Foundation of Canada is a really great resource for people across Canada to check in and say, you know, who and where should I go based on where I'm at right now? They have lots of tools and charts and recommendations to direct you no matter where you are. And the other thing that we have done at Covin,
Michelle Stainton (42:43.661)
Yeah.
Michelle Jacobson (42:52.438)
and can do at Coven is see people from other provinces to give advice. We just can't order lab work and prescribe. So sometimes if all you need is to talk, be validated, help with your goal defining, and then see someone to give advice and take a note back to your doctor saying, this is what I need, we can do that. Yeah. Yeah.
Michelle Stainton (43:00.014)
Mikelle Ethier (43:00.865)
Michelle Stainton (43:11.024)
An action plan? my god. that's magic.
Mikelle Ethier (43:14.081)
Oh, I'm going to be calling you on behalf of a relative right after we're done with this. Amazing. Oh, that's so exciting. Yeah. I have someone who's in need of some PCOS expertise. Okay.
Michelle Jacobson (43:18.327)
No problem.
Michelle Stainton (43:21.346)
Wow, that's really cool. Yeah.
Michelle Jacobson (43:29.856)
And I mean, there are so many people who are in need of PCOS expertise and we're not quite talking about PCOS so much yet, right? It's not that this is PCOS podcast and you know, there's not influencers talking about PCOS, but we probably should be because this affects a lot of people and it affects their quality of life. It affects their long-term health. So that's why we took the Coven model, which started with menopause, perimenopause and said, actually this applies to everybody.
Mikelle Ethier (43:39.35)
Mm-hmm. Mm-hmm. Mm-hmm. Mm-hmm. sh-
Michelle Stainton (43:39.702)
Yeah.
Yeah.
Michelle Jacobson (43:58.464)
You're an adolescent with painful periods, you're missing school, you're nauseous, right? We can help you. You're wondering about your fertility potential because you're not sure if you should keep taking birth control pills. Like, we know that too. You're postpartum and trying to figure out contraception in between your kids, but you've had a heart transplant. We can help you, right? And so on and so forth. PCOS, PMDD, like it doesn't matter if it's hormonal, if it's women's health. We either know what we're doing and can help you or...
Michelle Stainton (44:18.904)
Wow.
Michelle Jacobson (44:27.873)
We know everybody, so we'll direct you to the right people.
Mikelle Ethier (44:31.137)
Amazing. given your level of expertise and the expertise that you are associated with in your line of work, what aspect of women's health would you say needs the most attention right now? Let's, Michelle and I win the lottery and we're like, okay, we're gonna make a dent in this problem. Where do we donate?
Michelle Stainton (44:32.194)
Love it.
Michelle Jacobson (44:57.813)
It's a great question because I actually, know, five years ago would have said menopause. But I don't think menopause actually needs more attention right now. I think it needs better studies, better evidence, more oversight. So maybe there, maybe it's you take that money and you do studies in people that we actually want to apply this information to, like perimenopause, right? Because having high quality studies would be really, really helpful.
Mikelle Ethier (45:02.145)
Hmm.
Mikelle Ethier (45:05.921)
Mmm.
Yeah.
Michelle Stainton (45:09.674)
the research, yeah.
Mikelle Ethier (45:14.303)
maybe more research.
Mm.
Yeah. Yeah.
Michelle Stainton (45:26.104)
Yeah.
Michelle Jacobson (45:26.189)
And then also researching that for the women who can't or don't want to take hormone therapy or have contraindications to it, beyond the hot flash, how are the ways that we can improve your long-term midlife and beyond health? And then there's that dissemination of information, like exactly what you're doing and what I spend many nights a week doing, giving talks, right, educating. How do we come up with tools that actually get the message across?
I want every doctor to know how to recognize perimenopause and to treat it, even if it's not what the guideline says. So how do we teach and make that education stick? That's where I would want to see those resources go.
Mikelle Ethier (46:08.385)
Amazing. Okay, now we just need to start buying. Oh, good, good. I was going to say we had a flawed strategy because I don't buy lottery tickets. So I'm glad you are. Excellent. Excellent. It's a good thing there are two of us. Yeah.
Michelle Stainton (46:08.738)
Perfect. I bought a lottery ticket. Yo, I already did. So I'm winning this week.
I'm on it, I'm on it. Michelle, what is the one thing you would love every woman to know about perimenopause?
Michelle Jacobson (46:15.886)
It's a good thing there are two of you.
Michelle Stainton (46:28.556)
That's a tough question for you. Yeah.
Michelle Jacobson (46:29.781)
It's a tough question because there's so much, like the truth is, and I hope this doesn't come across the wrong way. Like I see women who thrive through hard things and I see women who let it get the best of them. And it's not their faults, but their quality of life is so poor when the same thing has happened to them, right? This is a resilience problem. This is a...
strength and exhaustion and a lack of support problem. So what I would want everyone to know is that there is no one-sized-fits-all approach to fixing your symptoms, but one of the most important parts of the approach is that deep, uncomfortable mental health, trauma, resilience piece that we all have
a little bit of a problem with and that having the right team to support you through it can make all the difference. So if it's uncomfortable and you just want that silver bullet, that's not going to work. But if you're willing to do the work with the right people to support you, everybody can thrive through perimenopause and beyond.
Mikelle Ethier (47:30.305)
Mmm.
Michelle Stainton (47:42.563)
Yeah.
Mikelle Ethier (47:44.31)
Mm-hmm.
Mikelle Ethier (47:50.849)
So well said. And so right up my alley. Love it. Love it.
Michelle Stainton (47:54.988)
Yeah.
Michelle Jacobson (47:57.505)
Like challenge accepted, right? Like I got this, yeah. And it's hard. And I'm not saying everyone should be able to do it, but they should know that there's a component to it that they can do even the hardest things with the right support behind them.
Mikelle Ethier (47:59.562)
Yeah, yeah, yep, yep, I got this.
Michelle Stainton (48:00.278)
Yeah. Yeah.
Mikelle Ethier (48:15.073)
Absolutely. And that I think also for anyone listening who's just dipping their toe into this water, which can seem really scary. So, so worth it.
Michelle Jacobson (48:28.865)
Yeah. And then there's the benefit on the other side of it. Like I said, everyone can thrive. Like there's a lot of good that comes to being like 40 plus not giving a, you know what anymore, not worried about, we allowed to swear? Like not giving a fuck, like, right? Like, like being independent, not like, there's the sad part about like my fertility potential is gone and I can't have babies anymore, whether you could or couldn't. But there's also this like very liberating.
Mikelle Ethier (48:36.826)
Mm. Mm-hmm. yes, swear away. fuck yeah.
Michelle Stainton (48:38.742)
We can say fuck, not give a fuck. Yeah, yeah, yeah.
Michelle Jacobson (48:57.933)
part to it, right? Like if I needed a new partner tomorrow, I wouldn't care if he was someone that I could raise kids with. Like I would just be looking for someone for me. Not that I'm saying I do. Like I really love my husband. He's great. But like I just think about this all the time, like how liberating it is to be past all that, the periods and the fertility and the breastfeeding and all that stuff. And like just able to focus on the best you for the rest of your life.
Mikelle Ethier (49:06.645)
Mm-hmm.
Michelle Stainton (49:06.647)
Yeah.
Mikelle Ethier (49:18.401)
Mm-hmm.
Mikelle Ethier (49:27.329)
And getting to know who you really are, right?
Michelle Stainton (49:28.664)
goodness.
Michelle Jacobson (49:30.507)
Yeah, without defining you by your kids and your marriage or lack thereof or career. Like a lot of that big stuff becomes behind you to some degree and then it's uncomfortable. But then you get to really like embrace your inner witch.
Mikelle Ethier (49:34.778)
huh. huh. huh.
Michelle Stainton (49:38.359)
Yeah.
Michelle Stainton (49:43.597)
Yeah.
Mikelle Ethier (49:43.808)
Yep.
Michelle Stainton (49:48.915)
Ugh. Yes, please.
Mikelle Ethier (49:50.494)
Love it. Love it. Can we just be de facto coven members? know, just side. Okay, awesome. Thank you. Thank you. Yay! Thank you, thank you, thank you. Amazing. Michelle, Dr. Jacobson, I think we'll just start calling you the goat, you know, whenever we see you or we should, like, so good. So good.
Michelle Jacobson (49:56.417)
Yes, yes you can. I grant you into the coven.
Michelle Stainton (49:57.005)
Yeah. Thank you. Amazing. Thank you. No, this was so wonderful.
Michelle Jacobson (50:15.873)
That would mean so much to me. I wanna be your goat.
Michelle Stainton (50:17.984)
my god. You are a thousand. Done and done. Thank you.
Mikelle Ethier (50:19.091)
Okay, well, you are done. Done.
Michelle Jacobson (50:24.032)
This is great. I'll come back anytime. You must invite me back again. We can talk about anything. Okay.
Mikelle Ethier (50:27.201)
we'll have you back. We'll have you back.
Michelle Stainton (50:27.598)
We would love, we would, and also Dominique was saying like, like, doors open. I don't know if you told her, she could say that, but she's like, if there's anyone else we want to talk to at Coven. Yeah, yeah.
Michelle Jacobson (50:41.706)
Yeah, no, like the coven team is amazing. The people are like really funny and really high quality experts in their realm. And I'm sure they would love to talk to you guys and vice versa. Like we would love to have you on the podcast because what you have done is so amazing for women like to talk about this and bring this into the spotlight. Like you should also be very proud of yourselves. And I would love to know more about how you got here. So it's it's all mutual.
Mikelle Ethier (51:01.537)
Well, thank you.
Michelle Stainton (51:06.135)
thank you.
Mikelle Ethier (51:06.625)
Thank you.
Mikelle Ethier (51:11.541)
Okay. Well done and done. We would love that. And just very quickly, I'm very cognizant of time. We'd love to get a couple of hot tips. We're going to do a couple of hot tips if you have time. I put them in that. But we're also so that we can continue to do that. mean, much like you're not taking a penny from Kavan. know, Michelle and I have been at this for well in earnest since 2022. you know, don't, we're not taking, we're not making any money.
Michelle Stainton (51:12.142)
Yeah.
Michelle Stainton (51:19.862)
Yeah, Mick hit stop, Mick. nevermind.
Michelle Jacobson (51:24.246)
Okay. Sure.
Michelle Stainton (51:40.29)
We're on the cusp though, it's about to happen.
Mikelle Ethier (51:40.512)
right where we've put in our own money, we're on the cusp of, part of what we wanna do is launch a paid subscription, very nominal, but to allow us to continue this, but also to give women a space to truly feel safe and connect. People aren't really comfortable on a public like Facebook forum or Instagram, and what we'd like to do is maybe have, if we can get some of your time and say to some of the paid members, hey, Michelle's coming on.
Michelle Jacobson (51:40.928)
Yeah. Yeah.
Michelle Jacobson (51:59.158)
Yeah.
Michelle Stainton (52:00.514)
Yeah.
Mikelle Ethier (52:08.447)
It's not medical advice. It's not, but she's going to answer questions about, you know, topic X. And I suspect then you'll see a complete uptick in, you know, calls to Kevin saying, book me in. it just, I just, just quickly, girlfriend, telling me about her mom visiting who's in her early eighties took her to the emergency department, thought she was having a heart attack. Lo and behold, it was yet another UTI.
Michelle Jacobson (52:19.701)
Yeah, absolutely.
Mikelle Ethier (52:37.725)
this woman has been suffering since as long as she can remember with chronic UTIs. And I said, I'm not a doctor and I'm not, but you know, we talked to lot of specialists. Have you ever thought about, you ever talked to anybody about vaginal estrogen? No. And so my girlfriend had to push hard with her mom's male doctor, but I gave her some talking points and this is the first time in this woman's
Michelle Stainton (52:42.178)
Wait till you hear the rest of this, it's crazy.
Mikelle Ethier (53:05.533)
life in her eighties that she can remember going this long without a UTI. She's sleeping better. She's not getting up to pee every hour on the end. and, my God.
Michelle Jacobson (53:11.488)
Unbelievable.
Michelle Jacobson (53:20.756)
I always call this like the low hanging fruit. Like how nice to have something that is inexpensive, without risk, easily accessible, that fixes serious problems. Like when do you ever get that? And we have it and still she couldn't get access to it. Like it's bananas.
Mikelle Ethier (53:22.761)
Yes, I was just gonna say.
Michelle Stainton (53:23.512)
Yes.
Mikelle Ethier (53:34.028)
That's, it's like the, yeah. She still couldn't get access and had, but anyway, all of that to say, you know, we're trying to come up with ways to continue doing what we're doing, but also to get more people in front of the right people and to hear the things they need to hear so that they can go, even if they can't work directly with you or your team to say, hey, here's what I have.
Michelle Stainton (53:38.484)
she still couldn't get access.
Michelle Jacobson (53:51.99)
Mm-hmm.
Mikelle Ethier (54:01.406)
understood or read. I'd really like to try this. Could we? Right? Anyway, okay, I digress. Thank you, thank you, thank you. Michelle, do you want to take one of these and I'll take one of these? I can do, I'll do, why I do the first one? So we just, we've.
Michelle Jacobson (54:06.016)
Yeah, of course.
Michelle Stainton (54:06.392)
Yeah. Yeah.
Michelle Stainton (54:14.232)
Sure, wish me luck.
Michelle Stainton (54:18.496)
Okay, I'm a little, my brain power is too long with question. Perfect.
Mikelle Ethier (54:22.249)
Okay, so I think you're good with this, right, Michelle? We just ask a question, you give us your short answer and...
Michelle Stainton (54:29.506)
It's like three to five minutes, you know, two minutes. Yeah, perfect, perfect.
Michelle Jacobson (54:32.128)
That's what we have left. So yeah, like...
Mikelle Ethier (54:33.321)
Yeah, perfect. Okay. Today's question for OBGYN, Dr. Michelle Jacobson is, I've started having migraine headaches and was told by a friend they could be related to my menstrual cycle and perimenopause. Is this true? And if yes, what are the solutions?
Michelle Jacobson (54:52.214)
Great question. Yes, it is true. You start ideally by tracking. So get yourself a menstrual tracker, a menstrual calendar tracker that helps you track your PMS symptoms, your body temperature potentially, your cervical mucus or vaginal discharge consistency, because that will give you the information about where you're at in your menstrual cycle and then track the headaches, track the triggers, track the weather, track the foods that you're eating, because you need that data, right? AI is so cool. It knows everything. No.
It only knows what it knows based on the data that you give it to learn from. So this is how we're gonna learn about you, your triggers and what's going on with you. Once we have that information, then we can look for those patterns and we can hijack your cycle to not have those triggers happen. Some people get ovulatory migraines. Some people get the migraines right before their period comes, because their hormone levels have dropped. I can't give information out without knowing what's happening for you.
but we can almost always improve things. And if we can't do it with our hormonal fluctuations and fixes, we can connect you to a really good neurologist.
Michelle Stainton (56:02.318)
Great answer. you. Today's question for OBGYN, Dr. Michelle Jacobson is, my partner's chewing now makes me want to stab him. Could hormone therapy make me a little less stabby?
Michelle Jacobson (56:06.975)
and about to be something.
Michelle Jacobson (56:16.106)
What a great question, yes. He could also just be kind and not eat ever again. mean, I don't know if you've ever considered that as an option, but if that's not an option, then yeah. What you're experiencing is irritability, as are we all. And there are sort of three approaches to irritability and mood changes in perimenopause.
One is therapy, and again, therapy is helpful for everybody because it helps you reflect and be a little more thoughtful about your responses and your triggers. So acknowledging that the chewing is annoying, but that it doesn't deserve homicide, right? Then there's mood medications, which always help people who have mood problems. And if you have a mood problem, it may respond to mood medicine.
Michelle Stainton (56:59.052)
Yeah
Michelle Jacobson (57:11.488)
That's gonna be things like SSRIs or SNRIs. But the cool thing about perimenopause is that this is one time in life where mood symptoms like irritability respond well to hormones. And so hormone therapy can help with depression, anxiety, irritability, anger, rage, right? All of these symptoms. It can also help with the things that may be going on in the background that might be making you more ragey. Like not sleeping at night because of.
night sweats or sleep disruption, the hormones will help with that even if they don't necessarily help with the actual mood. So the simple answer is yes, it could help. The hard answer is without more information, it's hard to know what to use or if you're a good candidate.
Michelle Stainton (57:56.121)
Thank you.
Michelle Jacobson (57:57.292)
You're welcome.
