Episode Transcript
Speaker 0
Hi there. Volva speaking. We need to talk. For years now, you've been calling me the wrong name. I'm the vulva, not the vagina. I'm all the external bits you can see. My neighbor, the vagina, she's the internal tunnel connecting me to your uterus. You know, the baby highway. Different parts, different names. It's pretty hard to address dry uncomfortable situations when you don't even know which one of us needs the attention. Now that we're properly introduced, can you please hook me up with some Iris? Their water based moisturizer and lube are exactly what I need. No irritating fragrances, just clean ingredients to keep me happy and well hydrated, not dry and disgruntled. Eternally grateful for the hydration and finally getting my name right. Signing off, x o x o, your vulva.
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, Michelle. And I'm
Speaker 2
your other host, Michelle. 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. Trying to make sense of your changing body and mind? Feel like everyone's talking about hormone therapy but no one's giving you the full story? Or maybe you're struggling with mental health symptoms. Well, today's episode might just be the lifeline you've been searching for. We've got doctor Kiersten Smith back, and as always, she doesn't sugarcoat the realities of midlife health. Instead, she offers something better, genuine understanding and practical guidance. Doctor Kiersten Smith is a naturopathic doctor with over years experience delivering solutions for women struggling with hormone issues. Her areas of focus include perimenopause, menopause, hormone therapy, PCOS, endometriosis, PMS, PMDD, and thyroid conditions. What sets doctor Kirsten apart is her unique ability to integrate conventional medical diagnostics and treatments with natural medicine principles, offering your patients integrated care that harnesses the strength of both healing practices. If you're feeling shattered by perimenopause, confused about hormone therapy, or just searching for someone who truly gets it, this episode is your next step to reclaiming your power. Buckle up ladies. This is a good one.
Speaker 1
Kirsten, welcome back. For our listeners who have not had the privilege of meeting you yet, could you maybe start by telling us a little bit about your approach in your clinical practice?
Speaker 3
I just was thinking of it, and I was like, you know, the thing that I am often saying to patients is, like, there's a lot of because HRT was sort of relegated to some sort of danger because there's all this misunderstanding and because of the history of HRT, then there's obviously been this huge pendulum swing. And so now there's a lot of anxiety and and there's a lot of polarity and a lot of people, you know, saying, oh, you're fear mongering, and what about people who can't take it, and what about the breast cancer survivors, and what about all these populations? And the pendulum swing has made it feel like it's it's it's become a crucial baseline. And even within that statement, there's just a lot of anxiety because the guidelines really aren't good enough yet and all these pieces. But the thing is the the thing is that the what I'm always saying to patients is that the reality is that it's a much bigger story. And the story is that's just one piece of the story, which we'll talk about today as well. But it's, like, it's just one piece of the story because what it's really about is there's quite a lot of things that could be done, should be done to help women age healthier and age stronger. And and this is just one piece. Right? And it's a it's it's a valuable it's a very valuable tool. Like, we this is not disputable, but it's one piece of a much bigger story. And I think that I think soon I think it's starting that the conversation is starting to expand as it should, not just to be so frantic about the the menopause hormone therapy, the HRT. It's it's it's starting to expand into the bigger story. And and that is one of, like, what are all the things that we should be doing to prevent cardiovascular disease, which kills more people? Mhmm. More women are a long shot over fifties than anything else. You know, what what else can we do to improve our bone health, which is the second killer of women. You know? Like, the the it's it's just and and I think it's also just a big come to Jesus moment for people because the reality is if you're lucky, you've made it to your middle life. You know, if if you're lucky, I have a lot of people who are. I have a lot of people who haven't been. You know, they have other health issues. But for people who haven't really had to face themselves in terms of self care, it's a it's a big moment of inflection because they have to start to realize that it's not just about HRT or not and whatnot. It's it's about realizing that your your metrics have changed, your the landscape has changed, and the playbook has changed, full stop. Like, it's just not the same. You know? And so I was just writing about that. I sort of went on this weird because it's it's it's really important, and people get very fixated on, like, whether it's supplements or, like, whether it's the hormone therapy. And it's just no. It's like women the inattention and the lack of research and the lack of focus on a valuable tool, which is hormone therapy, is only one part of the problem. Like, women live longer, and they have much shittier quality of life than men, like, by a long shot in the second half of their life. And this this is a big story because it's like, well you know, and a lot of women are they come skidding in as I do.
Speaker 2
Oh my god. That is great visual. Oh
Speaker 3
my god. Yeah. You do you come flying in because most people have just are guns a blazing. They've got old parents that might be ill or dying.
Speaker 2
Yeah. Times times
Speaker 3
three. Yeah. And they and they may or may not have kids, and they're supposed to be at the peak of their career. And then they're just put on their back like a turtle with their like, kind of being like, I can't you know? And it's so shocking to people, rightfully so. And the thing is is Mhmm. It it it just you know, it's it's really different, and it's really worth people accepting the truth because that's where the power is. Right? When you if you just go in like a turtle and you don't know what's going on and you're flipped on your back, and then you also think, I'll just do HRT and it's all good, then you're just you're just not gonna have a strong few decades. You know? And I think that that's the thing I'm always telling my patients. Like, this is the beginning, and it, you know, it can feel depressing and overwhelming. It feels very negative, but but the other side of that is is power in terms of just having way more agency. And it is depressing to say this, but the truth is that a lot of not just this corner, but a lot of aspects of women's health have not been deemed important. Like that New York Times journalist said a couple years ago, like, we have a high cultural tolerance for women's suffering. And at the end of the day, women really need to realize, like, I they need to get educated, which is why your platform is of such value. And they just need to do it, and and and they need to just embrace because then if you have all the pieces of information, you can engage and you can kind of change your life. And because the playbook has changed, you can do the things that you maybe need to do if you wanna remain healthy or not, but you can do it.
Speaker 2
But and here's the thing too, though. Like, I feel like we live in this society right now where a these women are skidding in, and as you said, I love that. And they're hearing that HRT is the magic bullet, a lot of them, and they're also looking for like, we feel like shit, so we're looking for a quick fix. We want something to fix this, and we don't have to grin and bear. We don't have to suffer, but there's a bit of work involved. It's not just taking a pill or supplementing yourself into into good health. Like, you you do need to put in a little bit of work here. And whether it's the lifestyle changes or or this, you know, improving your sleep or whatever it happens to be, but there is some work here as well, and it's, unfortunately, we're already fucking tired and exhausted and overworked, and it's hard. It's hard.
Speaker 3
Yeah. It's it's I don't and I don't like to sugarcoat it with people in any capacity, but that's that's the art of practice, like, you just described, which is, like, you know, if I'm really gonna help I always think about this, and I always teach this. Like, if if I'm really gonna help someone, I have to sort of assess their situation and figure out whether they know it or not. I mean, figure out how to help them in a relatively easy way. Like, figure out the low hanging fruit so that they feel better enough to connect to bigger story, which is like like, we gotta we gotta regroup on how you roll because, you know, this is it's a sliding doors moment. I mean, like, listen, that sort of totally dates me. But the point is, it it it is
Speaker 2
It's us all. We're all we're all the same age, Kirsten.
Speaker 3
Is. Yeah. I mean, it just is. And, you know, you either and and I do have patients who they get, like, what I'm doing with them, and they understand the point, but it's really hard. And so it does. If you can help people grab onto something and feel better, in a meaningful way quickly, then you can get into habit stacking. Right? You know? Like, you can start to help people turn it around and find it to be empowering. But I I think it's really fair for people to feel just over it in terms and, you know, people are getting bombarded by people like us with I did a post with this a couple weeks ago. Like, just someone said to me in a post, like, it's always the work. And I was and I thought about that for a long time because I was like, god. It really just it just sucks. You know? Like, I don't like to pretend. Like, you know, the because the truth is it isn't just, getting on HRT. It really it can give you leverage. Again, like, that can be very empowering for people, and that's why it's a valuable tool. It's not the be all end all, but it's one of many tools that can really help people gain agent gain a bit more agency, and then they can find the wherewithal to do the other pieces. But, like, yeah, I'm just not gonna sit here and pretend it's, like, super fun sexy times. I mean, that's fucking ridiculous. Like, it's it's difficult. I don't wanna sit around fussing on more fiber. I'm like, I don't. Like, I'm very normal. I can't so I always tell patients, if you know what you are aiming for, you're just you're gonna end up over there and not over there, which is where everyone's going who has no idea what's going on and just keeps suffering mightily, gaining health problems, gaining prescriptions because they just keep on going the way they did. Even though the playbook is literally pulled out from under them, and it's not the same. And we can end up aging the way a lot of our parents did, which is totally terrifying, or we can try to work on the behavior change. That's it. And sort of end up vaguely over here. And, you know, the the thing about us is that we even have more of a burden to deal with in terms of reducing our inflammation and aging healthier because we have a much bigger chemical exposure than they were for our parents. So we even have that. It just takes time for people to realize that that's the story. It's a bigger story, and it's not a crisis. Like, you don't have to change overnight. It's a really messy space. So on the upside, you know, we've got all these people, hustling in the space of of women's midlife health, which I would lay money, you know, net for net is a profoundly positive thing just because Yeah. Even if you're selling some weird shit and, you know, god knows what, it's profoundly positive because people are really getting more educated about what the hell is happening with their own body. But but the con is that, you know, there's just it's creating a lot of confusion because there is a lot of polarization, around every single thing. HRT, this supplement, this test. Like, it's just it just I mean, I my patients are always like, just just tell me. You know? Please I don't they're just so sick of all the rhetoric and and people, you know, dying on a hill. It's just exhausting for people, and I don't blame them. I find it exhausting, and it's where I work. It's annoying.
Speaker 1
Kirsten, as a practitioner who works with women in the menopause transition, what's your perspective on HRT or h sorry. It's not HRT anymore. Hormone therapy or menopausal hormone therapy's role in managing symptoms. You know, a little bit about who, when, where, what, why, because it's not despite what we're seeing online, a one size fits all, and everybody should be doing this. So maybe you could tell us a little bit about your approach for this important tool.
Speaker 3
Yeah. So my my approach is very based in my scope. So that's the first point. So as an MD, that is, you know, regulated and licensed out of Ontario, Canada, my scope includes prescribing HRT if it's the right thing, but also all of the lifestyle pieces. So, you know, nutrition and botanical medicine and, you know, all the lifestyle stuff as well. And so all my patients, I'm coming at it with quite a big scope. Right? I have a lot of tools in the toolbox. And so that also informs my bias. Right? Because for me, a really successful outcome with patients is never gonna just be one of those tools. It's gonna probably be some combination. So, you know, it's a personalized care model when we see a non traumatic doctor big time. Right? The average intake is an hour, and it's because you're looking at everything. You're looking at their their own medical history, their family medical history, like like, maybe what vulnerabilities they might have. Genetically, you're looking at how they live, like, how they move, how they eat, how they stress, toxins they might be exposed to, and then obviously spending a lot of time on their experience, like their their lived experience and their their symptoms. And so that that's really the beginning. And for me, the first thing I'm doing is assessing if they're candidates for HRT. And, you know, contrary to what a lot of people believe, most people are candidates unless they have, you know, very severe liver disease may not liver gallbladder disease or or, you know, moderate to severe heart disease. So, you know, that means most of my patients are are candidates. There's a few cancers, obviously, that, they're you're not a candidate if you're active. And then there's the whole question around breast cancer cancer survivors, which is another like, it's really its own conversation. But I establish if they're candidates, quickly. And then I just assess whether it's the right time. Mhmm. You know? And, then if it is, I teach quite a bit. I mean, that's part of the reason the visits are long. And I also give them a lot of resources. And I quickly kind of I know, you know, we all know at this point, I mean, at least we do, what the kind of most common misconceptions are. So I immediately am like, this isn't a fact. This isn't a fact. This isn't a fact. You know? And then I I'm very transparent. I mean, I just treat people like adults in the sense that, like, I'm very clear that, you know, the guidelines are saying x y z at this particular moment. And, you know, in my orbit, I'm I'm I'm I pay attention to the British menopause society and the different endocrine societies, but mostly I'm working with the menopause society previously known as NAMS, the North American Menopause Society, and their guidelines, as you know, the most recent ones for twenty twenty two. And I just explained, you know, this is where what we're now saying. This is what what fits into that box. It's designed to be exceptionally conservative. It is really conservative. There are, you know I mean, one of the things about the guidelines is that menopause therapy or HRT is considered the most safe and effective, route of treatment if the person has vasomotor symptoms. Right? So hot flashes and and other things that fit under that umbrella. And, of course, a lot of people don't present with vasomotor vasomotor symptoms. It is unfortunate that each person who is like me, who specializes in this population, has to decide what they're willing to do. And, you know, for me, I've been aware for a very long time that menopause, you know, the fundamental mechanics of what's happening are the same for everyone. It's a natural process that's inevitable, but how people's bodies respond to it is there's a whole bunch of symptoms as we now know. Right? This is becoming more and more known. And now hot flashes aren't even the most popular, right, symptom of brain fog. The neurocognitive are actually more significant. Right? I explain the limits of the guidelines and then what a lot of people are doing, myself included, which is to offer, you know, low dose HRT to people who who stand outside of that parameter. Because if I hadn't chosen to do that, if I didn't choose to do that every single day, hundred at this point, I've been practicing hundreds and hundreds and hundreds of people would would just be in really, really significant trouble. You know? Some people, as you both know, have menopause lite, and their perimenopausal journey is kind of mild, and that's influenced by a million things. And some people, it's it's horrendous as you both know. And so, I'm obviously seeing most people who are in the middle space or in the severe space. But, you know, if I hadn't chosen to to do what I do, oh my lord. Like, it just it's it's it gives me it makes me sick to even think about it.
Speaker 1
Yeah. Well, and with a classic example of that, I don't know if classic is the right way, but a good example of that be, hormone therapy for mood in the context of depression or even anxiety symptoms. Right? Because that is not that is not a clear cut. Absolutely, this is indicated. It's not a Health Canada approved indication. However, there are level two and level three, resources or studies or information that support, okay, this does impact mood. And anecdotally, what I've seen in our circle is that, you know, that has been life saving in some instances for women where the SSRI or the other antidepressant type medications are not helping
Speaker 2
at all.
Speaker 1
And when they finally got convinced or finally found someone who said, let's let's try hormone therapy, it was miraculous.
Speaker 3
It makes me really emotional because, like, I I referenced a second ago, the the most debilitating part of this is the neurocognitive piece. It's just because it just is soul killing. Like, it erodes confidence. It affects every single relationship you have, mostly the relationship you have you have with yourself, but affects your work your partner, you know, your intimate relationships, your parent. It just it just totals people. And it's very easy for women at that phase phase of life to look at what they're coping with and what they're dealing with and be like, oh my gosh. I think I just developed mental illness. Like
Speaker 1
Yeah. Or I just suck. I'm not good enough to be able to handle all of this anymore.
Speaker 3
Yeah. Look. I've just not Yeah. Having the bandwidth. Like, I'm just not good enough, and I'm not I'm not enough. And and and or I'm ill. Like, I've developed an illness. Like, it's heartbreaking. And the thing is, it's very muddy. Right? Because a million things do cause mental health. Right? But the reality is is that if people are in a certain age range and time window, it's really criminal not to consider immediately that this is actually due to their progesterone syncing. Right? Which can. So the best best paper that exists on this particular topic is a meta analysis that the University of Cambridge press put out, I think, in twenty twenty four, very recent. We can put a link to it.
Speaker 2
Yeah. We definitely will be doing that.
Speaker 3
So this study looks at all the studies that have been done to date on mental health in this demographic, and it's chilling. Right? So just a few things that I can remember from it from off the top of my head, which is that suicide rates skyrocket in women aged forty five to fifty five. That's just one fact from it. Women who have a preexisting mental health disorder, which is, unfortunately, as we all know, a huge segment of the population. And it doesn't matter whether it whether it's a mild thing or it's a severe disease. Right? Whatever it is, it's gonna come, and it's gonna come in hot. And it is really scary for people because they're like, oh, it's bad. If they've had remission from the thing, what will happen is they'll they'll be like, okay. It's here. I think it's happening again. And they'll go to their psychiatrist, their psychologist, or their GP and say, it's it's on. Like, I think I need my medicine. Like, I need I need to go back because it's happening. And their doctor will be like, okay. Yep. I think you're right. And they go on, and it almost does nothing. Because if the root cause is that the fluctuations in your hormones and the decrease in the hormones is impacting your neurotransmitters, obviously, the drugs that are for neurotransmitters, like, struggle to work. Right? So that's that's chilling. Right? So all these people advocating for themselves and then being like, oh, my gosh, it's not working. It's it's it's very upsetting for them because often by the time they get to me, often I'm the last stop on the train.
Speaker 2
Well, and there and a lot of people probably are coming to a natural path thinking, supplement my way out of this. I I do have to tell you though, Kirsten, we almost this company, this podcast, this everything, almost didn't get off the ground because Mikaela and I kind of started it and then I hit a major depression and my hormones went. And I reached out to her and I was like, I've got nothing. I can't, I can barely get out of bed. I have no capacity. I can't do this. It was to
Speaker 1
the point and and if you've spent five minutes with Michelle, right, you you get who she is. We would get on a call in about thirty seconds, and she would just be crying. Like, she couldn't tell me why. She was a shell of a human being and not functioning in any aspect. Mhmm. In in
Speaker 2
the aspect. Like, I could it was I've and I've never been there before. That's like, that was, like, I had no idea. I couldn't figure it out.
Speaker 3
Yeah. And it's and that's the thing. And for some people, they have no history of mental health, and it comes in, and it's disorienting, and it's scary, and it erodes a confidence. And, yeah, it's a hill I will die on in terms of just educating people about the major girl cognitive changes and challenges with perimenopause. I think, you know, what we really need are way more studies than we have on, you know, the relationship between estrogen and progesterone and, you know, GABA and, serotonin and dopamine. You know, what people often are fixated are like, you know, it's it's it's the hormone level or it's the hormone, and it's not usually about that. It's often about the the changing and the flickering. And that's why you can see someone who's in perimenopause who gets completely totaled. Like, they just get, like, you know, they get comp like you experience. They just get completely but in postmenopause, not everybody is lying under their bed, you know, eating Cheetos. Like,
Speaker 2
But that sounds really good right now.
Speaker 3
It's so interesting because historically, it's all been like, oh, in menopause and menopause, which is important, but, like, the the the time where people get wrung out hardcore is in the metamorphosis. Right? It's in perimenopause, and there's just women are totally literate about what happens to their bodies. Nobody realizes to be looking out for all these things, the different sort of modalities that might be relevant. And I think what is the most terrifying thing of all is that as women are learning this in a kinda janky way Mhmm. Through social media and whatnot, and and podcasts and books and whatnot, The medical community is being really slow to respond even to the conservative guidelines we have, and that makes people feel insecure. You know? It's just it's not it doesn't feel good when you know from a podcast where a doctor is being interviewed or an expert like myself, and you you when you know more about what's happening to your body, and what the treatment options should be and are even per guidelines than your doctor. That's really unsettling. Like, it really is scary for people. I do not understand it because I'm not from their world, but I don't understand why given that we're half the population, every single specialization isn't mandated to train. You know? It's like because every part of your body, like, you know, doctor Vonda Wright, who's who's really been amazing in terms of the bone health piece. She's an orthopedic surgeon. Right? She once she did a post ages ago, and I thought, you know, she's bang on. She's like, what? Every single specialization should have to I mean, everyone should have to be training in what happens to women's bodies and what are the current, you know, treatment options. And, you know, the thing is they weren't taught. And I I will say neither was I. So it's not like naturopathic doctors are better in this department. No. There's there is no health care profession. Physios, chiros, naturopathic, medical doctors, nurse practitioners, RNs, like, nobody learned. Nobody learned. Nobody learned. It may be different now in my in my schools, but I don't think so. The only reason I learned is because I specialize in women's health very early out of my practice, and I saw things that you can't unsee, very quickly. There's gaps in care, and I pursued education before it was in my prescribing scope. I took courses, tons, and then I ended a partnership in a partnership working with a medical doctor who did nothing other than hormone therapy when she risked her license to do that. Like, she we were we were doing very pioneering things, and going to conferences all over the world on how to prescribe hormone therapy when it was probably, you know, considered completely sacrilegious, like, just completely high risk. And I did it. No dude again because I saved another people's lives, literally, and so did she. And I worked with her for eleven years, and that's all we did, was just throw people back in the ocean. It's it's offensive that it isn't mandated that people train. And and what I I mean, unfortunately, yes. You know, there's all this there's all this action. It's, like, the hottest thing ever right now. It's like femtech. And everyone wants to make a business that is, you know, focused on us, and, oh, like, it's a big moment. Capitalism. So there's all these products and there's all this effort, and there's all these, you know, people like us out here, you know, putting on the megaphone. But, really, like, a lot of the patients think that they don't tolerate it or it doesn't work, and that's because the person prescribing has no skill. They have no knowledge of how to view it.
Speaker 1
Can we talk about that? Because we wanna talk about, you know, you hear, oh, I can't tolerate it, and and we know people who can't tolerate it. It. So tell us let's let's talk about that.
Speaker 3
There's a few possibilities with that. One is what I just referenced, which is there are a lot of people who can. They just need help, you know. This is this is something that has been sort of shifting in our bodies our whole lives. And then we have perimenopause where progesterone is going down, but estrogen is going like this for a lot of it until the very end when it starts to drop. And that's the perimenopause. But even in menopause, right, you have an individual. And it's like, you know, how do we, help someone who comes in and is like, I just can't do it. I always just retry, and I always take very good notes about what their symptoms were with the dosing that they were on or are on. Like, what is it that they're and you often they're over they're overdosed. So often people come in with me, and they have raging signs of high estrogen, but they don't know. And so they, you know, very understandably are like, this is a hard pass. Like, I can't do this. And I'm like, oh, I think so. I think you're just fine. You just need you know what? People don't this is hard. I have, you know, colleagues who message me, and they're like and I'm I am saying this particular thing every day to somebody. I mean, honest to god, everybody. Dosing estrogen is is an uncomfortable thing for everybody, for for for patients and for providers because it's a little bit wobbly in the sense that there is it's not based off of your weight. It's not based off of the severity of your symptoms. It's not based off of your age. It's not based off of your blood level. Why? Well, you can have a person who's, like, eighty pounds who needs a megadose of estrogen, and you have somebody who's six feet tall who needs a tiny dose, and that is based on a bunch of different things. One is how people absorb it. But, also, it also more than that, I have come and understand people metabolize estrogen in very there's a huge sort of continuum of how people some people do it very quickly. So that's why, again, if somebody is small and they need a higher dose or they need to split the dose morning and night because it's just ripping. They're just detoxing it really quickly. And you have people who they clear it very poorly, very slowly. And these are the people who are like, you need very low doses or they get, you know, hot symptoms.
Speaker 2
How do I know? So if if I'm on my HT and things seem to be going well and then suddenly they're not, like, what are some of the symptoms of this is too high a dose for me, and what are some of the symptoms of this is too low?
Speaker 3
So exactly. And I think that's key. I always do in my treatment plans, I always obviously explain all these things to patients, but I also write it out Mhmm. Over and over and over and over and over again. Because because I want them, you know, I want them in four months or whenever it is to look at it and be like, wait a second. Like, what did she say? And it's so important. Yeah. Oh, lord. Because so even in postmenopause patients, I always have this this little note there, which is, like, just remember, like, you're watching. Because there are things even when you are sixty or seventy years old and you're on HRT that can happen, that will influence the way in which you detox it or the way in which you accumulate, which we can talk about in a second if you want to. The point is, in perimenopause, we know that by definition, it's a very unstable time. So if someone's on progesterone, usually, you can figure out that dose alone ahead of time. And then if you're adding a bit of low dose estrogen, this is a really important part of the work with patients is to teach about the fact that sometimes, even if they're having periods like every six months or, you know, even if there's no there's still these there'll be these hits of estrogen that pop out. It's possible that even if you're on a low dose estrogen that in two weeks or in seven months, that dose, which by and large, most of the time has made you feel quite a bit more normal, less rough, it just suddenly becomes too much. And I always teach my patients, I'm like, get it out, pull it out, but just stop, you know, stop the estrogen immediately so you can come down, wait a bit, and then put back in. So the signs of high estrogen always, you know, whether you're perimenopause or post, are your breasts get painful and big.
Speaker 2
So I'm not having that right now. They're getting smaller and smaller.
Speaker 3
Yeah. Yeah. So getting that you know, spotting that, you know, this is more helpful as a sign in someone who's not getting bleeds. But spotting or bleeding, that's usually a very key sign, especially in the postmenopause. Obviously, that would be clearly not good. Weight gain, that seems really weird. I know that's a nebulous one because well, that's a little bit yeah. Everyone's. But things that are very quick headaches that are very strange, like like, frequently. Like, I read having headaches a lot is a sign. Getting really, really irritated in weird ways is a sign and getting nausea. So I know that I've just said all those things and a million things can cause all those things. But the reality is that is what people feel. Like, they just feel like inflamed and, like, raw.
Speaker 1
And can I say jump in, Kirsten, and just say, yes? Everybody feels all of those things for different reasons, but I have felt all of those things in hindsight because of really high estrogen and the nausea was unlike any nausea I'd ever experienced. It's all the headaches are weird. I actually and maybe we can also add in here user error is a bit of a problem in the dosing piece too. Oh, yes. I, a couple of months ago, was traveling, and I thought my patch had fallen off, jet lag, whatever. So I slapped one on, and the other one was still there. It was just in the wrong because I put it in a spot where I don't normally it cut well, sometime and they do. Sometimes they come loose and they kinda whatever. So I spend I'm like, babe, like, my there is something wrong with my boot. Like, I can't even explain the feeling. And then I was like, and do these look bigger? He's like, uh-huh.
Speaker 2
Interesting.
Speaker 1
Yeah. Yeah. So don't don't but PSA or or absolutely do not take extra estrogen to have bigger boobs. Bad hard no. Don't. It's tempting, and I have small boobs. Tempting. Don't do it. But and then, here soon, when I realized my error and took one of them off and went back to one, wow. Did that ever replicate the serious mood that that that estrogen crash? I was like, oh, I remember this. This is what was going on when I didn't know what was going on.
Speaker 3
Yeah. But that's a really good example of a lot of the mood pieces are the the fluctuation versus the Yes. The number. Right? Because you had you had one pass on, and so there's no way you were anywhere near rock bottom. You were just some in middle zone somewhere. So but when you had more and it just was snatched off, oh, it can mess with your brain. And it's this
Speaker 1
It was I was like, oh, yep.
Speaker 2
So not the greatest holiday of your life. No. Well, the big boobs for a
Speaker 1
couple of days were really good, but, yeah, then no.
Speaker 3
There's two extremes. Right? So there's people who who metabolize estrogen very slowly. They get you know, they they need very low doses, And these are patients who may have thought that they couldn't tolerate, but they can't. They just need some finesse. They just need some help. There are people on the other end of the spectrum. Right? There's a bit of a u curve with estrogen, and I always try to teach this too when I'm teaching about how to prescribe. In a sense that if you overshoot so there's a real art to onboarding estrogen so that you can clamp down on the sweet spot and stay there. Because if you overshoot with your dose, which is easy to do because estrogen bioaccumulates for a little while, unlike progesterone. So you have to wait. It requires different kind of patients to figure out your dose. But if you overshoot, what will happen is the receptors will the the little receptors are like catarismids on the cells, and they will go like this, and there will be less, and they will close shop. And then you can actually show deficiency symptoms. So you can start sometimes when people are overdosed, they will start to hot flash.
Speaker 2
Oh, so that's if if it's too low, I'm getting hot flashes and things like that?
Speaker 3
Right. But if people overdose themselves, like, if they overshoot the sweet spot, which is their happy place where they're symptom neutral, and they keep increasing their dose of estrogen, the receptors can come down, and then it your body kind of experiences what looks like or what is an estrogen deficiency with hot flashes and other signs coming out, but it's actually because they've overdosed. I know that's confusing.
Speaker 2
No. No. No. That makes perfect sense.
Speaker 1
It's that I it's I'm over the receptors are overwhelmed, and they're like, no more. No more. No more. No more. And then you're not getting any you're not getting near enough.
Speaker 3
Yeah. So that's one that's another scenario. There's another scenario where there seem to be people who just need more, and that's where there's been a lot of press in UK, because there have been some incidents and some highlighting of some providers over there who were prescribing more. The problem with that is that there really are people who sometimes need a bit more. I think that, yeah, and I think the problem with that is is that, the whether someone's on sort of a high dose of estrogen or on a normal dose of estrogen, all patients have to be monitored full stop out of discussion in a sense that, like, what's the big risk? The big risk is, I mean, there's a few, but the, really, the main risk is that your uterine lining can grow in a risky way. You know, oral estrogen sorry. Oral oral, progesterone or vaginal progesterone, obviously, will protect the endometrial lining from overgrowing. That's why everyone with the uterus must be on micronized progesterone to or they have to have an IUD. And there has to be a progesterone, in the mix to keep the lining thin. But it's possible even if you're on the right type of progesterone that if your estrogen levels are high that it just overwhelms and that the balance is such that the So it is a risk for endometrial cancer, which is uterine cancer. And so that's that's the problem. Right? Is is is and but the thing is, like I've just explained a few minutes ago, you can have patients who are on a low dose, but for them, they clear it very slowly. So for them, it's kind of a you know what I mean? So this is this is this is a lot of information, but it's just that it's important to understand that whether you're on a guidelines dose, a small dose, a high dose, that you just have to be monitored. So the problem is just when when when people are in touch with their providers, like patients who are in my orbit, you know, no matter where they are, I make them see me twice a year. And that's not because I need that. It's I don't. It's because it just a lot happens that can influence your dose needs. And then there is so we're talking about the categories of of tolerance. Right? There's people who really struggle. They need very little. There's people who metabolize it quickly. They might need slightly higher doses. For those people who detox it very quickly, it helps to give it to the morning and night instead of right? So that they have more balance and coverage. And then there are people who there are people. I mean and this is a medical mystery. Why is it that there actually are people who don't tolerate it at all, even with someone like myself who knows all the wizard blue ways of trying to get it into people to help them? I really must because I work very hard at it. I I have theories about it, but I don't know. I mean, again, it hasn't been studied. I don't I don't have many of these unicorns. I don't have many of these people. If I do, they're at least I'm one of the best people to be with because I have everything else on my side. Like, I know how to use herbs. I know how to, like, help them the best that we can with the other things. You know, I don't have any problem, with certain medications if again, every single thing is what's the bang for buck? What's the risk to you? I don't care. Like, if the best with all our what's left if this is out of the picture, what are we gonna do? Okay. We're gonna look for me, I'm gonna look at what are the drugs that exist, pros and cons for all the drugs. What are okay. What are the herbs that exist, pros and cons for the herbs? What are we gonna do? You know? And it's very it's very it's very person dependent. How people you'd have the the exact same patient on paper and how said person is gonna respond to a drug intervention to help them with medical symptoms or a herb intervention is is is kind of interesting. It's it's a bit individual. So, you know, I just get very practical and just just I just Yeah. I just I just fix it. You know? You always find a way. Like, I don't ever let people I don't leave people behind, and it's really important to, to find somebody that will not give up, you know, in terms of finding the the tools. Because there are people there are people who have very strange reactions to it even though it is body identical, which is totally interesting. But it is exogenous, and they're think meaning coming from the outside. And clearly, there is the potential because these people exist. And I think I have a lot of feelings for all those patients and all those people because there is FOMO. You know? There is a lot of worry in that cohort about being left behind or about yeah. And I I think that's really fair because all we're doing, all of us, is being bombard bombarded twenty four seven with all of the that this is sort of an urgent crisis, you know, with HRT, and it's necessary. And like I said earlier, that's really just the result of a pendulum swing because it was in obscurity and deemed morally dangerous. And now it's like the pendulum has swung, and so there's a lot of noise coming from you know, even from me about really busting up these myths. So it's terrifying for people who are not candidates or don't tolerate it, and that's fair. You know? And I I feel for them terribly, you know, in that I think it it's it's it's very real to feel FOMO. But the truth is is that there are other tools, and you just have to figure out what fits for you and what leverages you the best and the safest. And, like, you just gotta work with somebody and not give up on just not, you know, just throw a heads up and be like, well, I'm screwed because that's just not because like we said earlier, this is this is the acuteness of the symptoms. Sort of the the urgency in the early years is really harsh, but it's very temporary. Right? So this is it's also a bigger plan. Like, what's the bigger plan for me over time? Needs can change over time. But, really, like, HRT is one piece of the foundations of a house. Right? It's just one. It really is just one. Because you also have all these people get on HRT, feel quite a bit better, and then they don't do anything to help themselves age well. They just they're just just chilling.
Speaker 2
And as you you just said it, HRT is one piece of healthy lifestyle to help longevity.
Speaker 3
Yeah. It's like a house. Right? If there's four corners to the house, HRT is just one. Right? The others are nutrition, exercise, and supplements, toxins, stress management.
Speaker 2
Sleep?
Speaker 3
Oh, sleep sleep. No. I mean, I have to make someone sleep in order to help them do what they need to do to get well. But, yes, the point is there are tools when you are like someone like me and you're trying to get somebody rated and then permanently sort of on a path to sort of more robust health. And HRT is just one corner of the house. Right? We've got nutrition. We've got this. It's I think where people go like, oh, gross. Like, just shut up, lady. It's when I'm like, oh, you know, it's all pillars. All the pill like, you gotta do this with your thing and your fiber, and you've gotta lift weights seven hundred times, and you've gotta eat pounds of protein.
Speaker 2
They're like, Fuck off, Kirsten.
Speaker 3
Yeah. They're like, No. Just shut it. Like, just shut it. You know? It's like, Yeah. This and that. And it's like but the truth is somewhere in the middle, right, as is the case with all things, which is to say, like, again, if you just understand that these pillars have merit and that, where you're gonna end up in the sky is gonna be you know, you just make slight pivot sometimes in your life. And because of it's the consistency. You know? It's like the river going through the canyon over millennia is what carves the canyon. Like, it's the consistency.
Speaker 1
That's the superpower. That's
Speaker 2
a and it's a brilliant analogy.
Speaker 3
Yeah. And also, like, I, yes, I'm sitting here saying all these things, but I'm also saying, like, I fail. I I you know? And then I don't I don't, you know, do perfectly with all the things. But I think if we just understand the general target, it's hard depending on your personality to cope with what how I manage it with myself, which is I I know that it's important that I value these things and that I work at them, but I'm also okay that I'm not perfect at it.
Speaker 2
Progress over perfection. Right?
Speaker 3
Yes. There's a listen. You could spend your life listening to podcasts where people are telling you to breathe one nostril like that, do something weird with your downfall, like, do this weird like, it's it's just insane. Like, we live during a time it used to be, like, it was just me that was insane. Meaning, like, I just it used to be not so trendy. Right? But now it's it's it's like Yeah. Yeah. It's a lot. And I think that it's really important to just find, people who really, have the expertise to sort of be talking about what they're talking about. And then try to, like, you know, I always tell Yeah. I was trying to teach this to Gabe the other day. You know? He's not even on social media, but I was deleting all kinds of things, and he was lurking. And he said, well, why are you doing it? And I said, it's kind of like the way that I think about who I follow is I I just I think you have to be a bit discerning just in the same way you are with nutrition. Like, you just gotta clean the fat. Like, you just wanna you just narrow it down, you know, and and you just need to, really realize that you wanna understand the key things to think about that are important and then just move on. I mean, it's just so boring, and it's so endless, and it's too much. And there's always some new gimmick. Now I get it. I get a message daily about creatine. Everyone's in a complete frantic froth about and then and then the that or testosterone. Oh my god. Like, that's the key. That and I'm like, oh, no. Like, it's just enough meat. It's Like, it's, like, unreal. You know? I just can't it's just a lot for people, but, you know, the truth is somewhere in the middle, which is that all of these things are pillars, and it's worth just understanding the fundamental nonnegotiable truth, which is that the way that you're you know, the needs that we have from middle the middle zone, from the perimenopause on are different. And so to to to maintain your health, like, to to to keep it robust, it does require more work. And, you know, that's just the shitty fact of it. It just is. It's better to face it than to be an ostrich and put your head in the sand. And then, I mean
Speaker 2
Yeah. Do you know what I love? I love that this I I love every time we talk, Kirsten, because our conversation I feel like our listeners are like, woah. Woah. Where are they going? But we started at it takes a little bit of work, and we just finished there too. Like, we're we're pretty we come back around. Right? It's a it was fascinating. Always fascinating. Kirsten, thank you.
Speaker 1
Kirsten, thank you. As always, your insight, your perspective, your, skill level are so appreciated and so needed. Right? And this is these are insights then that people can take away and think about and digest and have more robust conversations with their providers or figure out, I'm trying to have a robust conversation and I can't, so I need to find somebody else. Right? And then, you know, we've got some tools and resources that we put out there to help people find people like you who are there to support and help figure it out, not just tick a box. Because this is not a tick a box exercise. Yeah. Thank you.
Speaker 3
You're so welcome. I really enjoy it. I just wanted to say as well, I just think that it's it's important exactly to your point to realize that there are a lot of really good free resources. You guys have many. There are a lot of really, really important resources that help people with advocacy, help them just have the right language and to just sort of, you know, have just feel very comfortable just saying, you know, I have this going on, and I'm the sage. Could I please try? You know, I think this is just people are I mean, the good news is that people are getting more success slowly with the app. CP. Mhmm. It's changing, and I think, yeah, there's a lot of resources, and you guys provide a lot of resources. And it's just it's just important not to give up because this isn't a short term problem. Right? Even perimenopause, it's, you know, it's a ten year haul. So you you need to keep you just don't give up. Like, you you you've got to find somebody who can walk with you and knows what they're doing. It's just it's it's it really is critical.
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
Speaker 1
expect in perimenopause. We also read all the reviews, the good, the bad, and the ugly to help us continuously improve our show. We would love to hear from you. 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. This podcast is for general information only. 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.
