A comprehensive health care team is essential for a woman in perimenopause. This team might include of a doctor, naturopath, dietitian, pelvic floor specialist, psychologist, pharmacist, or some combination of these specialists. Today, we have the opportunity to talk with Dr. Kirsten Smith, a Naturopathic Doctor (ND), to gain insights into the ways NDs can assist and support us during the perimenopause phase.
NDs typically integrate standard medical diagnostics with a broad range of natural therapies and treat the same conditions as a family doctor, including both acute concerns and chronic conditions for people of all ages.
Dr Kirsten Smith is a Naturopathic Doctor, regulated and board certified in Ontario Canada. But she’s much more than that. Kirsten is a women’s health warrior, advocate and hormone expert.
In our interview, Kirsten opens up about the struggles so many women in her practice are facing. She gets real about the state of women’s health care. And she offers some easy-to-implement solutions for women to consider to help ease their symptoms.
It’s an eye-opening, informative discussion. So let’s dive in…
Q: I understand that you’ve got a primary focus on women – why is that?
At the beginning of my practice, I kept seeing women over and over again who were confused by changes that were happening to them. I realized that the vast majority of women really don’t even know what the signs of the hormone fluctuations are. They don’t know that they’re about to go through, essentially a 10 year span in their lives, with all kinds of symptoms. And the reality is these symptoms mimic a lot of other diseases and conditions, so women are really confused.
They’re not literate about their bodies and hormones. But they know they have these strange symptoms and experiences. And their their health care providers are usually missing the mark. It’s a bit of a disaster. I spend a lot of my patient visits and a lot of my time in practice with women in this particular demographic. Perimenopause can start in your mid-30s and lasts until you hit menopause. It’s a good 10-15 year span and there’s a lot of confusion.
Q: How do women find you and your practice?
I end up with patients largely through word of mouth, but also my website and referrals from other colleagues and health care practitioners. But the reality is that even now that there’s more out there about perimenopause, most women that come to me don’t even know that that’s what’s bothering them.
It’s either entirely causative, meaning it’s the root cause for the things happening, or there maybe other health issues happening, but perimenopause is massively exacerbating them. Both of these scenarios happen everyday, and you have to be a medical practitioner to be able to differentiate between the things. Sometimes you need to do deeper investigations and do labs.
The truth is a lot of my patients don’t come to me because I have a lot of experience in perimenopause, because they don’t even know what perimenopause is. It’s wild!
They come to me because they know I do women’s health. A smaller percentage of women know that I specialize in hormones and they sense that something is up. And usually this smaller percentage are in the weeds. They are more advanced on their journey and have a lot more going on and they’re really struggling.
Q: Do these women tend to share a common symptom when they come to you or is it a wide range of perimenopause symptoms?
There’s a long, long list. The more common symptoms for women in the earlier stages of perimenopause are mood changes, stress and coping with changes. I call it the ‘no copes’.
Something is happening earlier and it’s usually really stealthy because it’s happening to women whose periods are still regular. That’s really concerning to me because it’s so very common and most women in their late 30s and early 40s don’t have a clue that perimenopause is a thing.
Of course there are mental health issues that can be driven by different conditions, diseases or states. And obviously there are people who have pre-existing mental health issues. So for those people, perimenopause can be worse. And for those who don’t have a history of mental health issues, they’re like “Whoa. What’s going on?”
And because nobody knows that there’s this overlay of increases in anxiety, irritability and not dealing with stress as well that comes with the hormone fluctuations that are normal and age related, they just think there’s something wrong with them. Or they think, “I’m just getting old.” Later on, the classic symptoms come up – we get night sweats and the heavy and erratic periods and hot flashes. Erratic mood changes and insomnia are also really common symptoms in the later phase of perimenopause.
The biggest problem is the lack of body literacy and then the secondary is that health care providers are not educated.
It’s not in their curriculum. It’s not being taught and so it’s not their fault. They just don’t know. So they offer a sleeping pill or anxiety medication because that’s what their scope is. And if they do know it’s hormonal, they offer the birth control pill. We could spend a whole hour on that because one of the major risks of the birth control pill is a whole bunch of mood disorders.
It really is a serious situation what’s going on for women because it’s just a big rabbit hole. Women don’t know what’s going on. Medical practitioners don’t know what’s going on. And it really impacts people’s lives significantly.
Because in your late 30s to early 50s, life is very complicated. You’ve got parents that have health issues and are dying. There’s a lot of relationship breakdowns – divorce is more common. If people have kids, that’s another whole thing that’s going on. It’s just a lot of compression. And also, people are at the peak of their careers. So it’s normal to just deal and think I just have too much on my plate. And of course that’s true, but what if there’s this whole other thing that’s sitting on you?
Q: Why would a woman seek support from a naturopathic doctor versus their family doctor?
For the average person, there’s no way I’m the first stop on the train. Which I get. They should go to their nurse practitioner, family doctor, or OBGYN and ask “What is going on?”
Most women have no trouble advocating for themselves. They go early and they ask for help. But they’re mostly getting dismissed or blank stares or prescriptions that, after two minutes on Dr Google, they realize are dated recommendations. So I usually get people deeper into their journey.
The reason for people to see an ND is that NDs often have a lot more education and training on perimenopause and menopause. I do not know why. Perhaps because it’s a female-lead institution. And NDs have been embracing hormone research a lot longer.
NDs have training in areas like: nutrition, botanical medicine and lifestyle medicine. This includes things like how you cope with stress, how you’re exercising, how you’re eating and sleeping? NDs are the experts in these areas. We’re also trained in HRT, but we have the deepest amount of training in nutrition, botanical and lifestyle medicine.
Speaking of HRT, there’s been a lot of publicity about HRT the last couple of years. And the fact that it might be safer than we thought. It’s being reintroduced as a standard of care that should be considered for normal symptoms of age related hormone fluctuations. But because it hasn’t been a priority in education, the number of doctors and nurse practitioners that know and understand HRT is very low. And the ones that do know, often have short and shallow experience with it.
Q: If I come to you with a list of my perimenopause symptoms, what’s your first course of action going to be?
NDs work in an intensely personalized way. Of course we look at patterns and commonalities, but there really are’nt standards of practice. Everything is so highly individualized. I do an hour to hour and half in-take and we do a deep dive on symptoms, medical history and lifestyle factors. I also want to know what their number one stressor is and how they deal with it? Do they exercise? What are they eating? Do they have inflammation?
NDs spend a lot of time looking at all the different pieces of people’s lives. It’s like a big puzzle. Most people are flabbergasted because they haven’t spent that much time with a medical doctor before.
With hormonal conditions there are so many things that will bump in and run interference. A great example are endocrine disruptors or hormone mimetic chemicals that are all over our environments. I always examine how much exposure women have to these chemicals because this is an area that we can change pretty easily. The exogenous chemical exposure is very real. It’s found in our skin care, hair hair, refrigerators, laundry rooms – everywhere.
Then there’s the tension of getting people better quickly – because that’s what they’re paying money for. I balance this with my job of keeping women healthier, stronger and safer. Then there’s the added pressure of not working in a protocol-driven practice. You need to get people better, but you have to meet them where they’re at. What they’re capable of trying and adopting. If you put too much on them at once, they just can’t do it.
Q: Can you tell us a little bit about your mentorship and what makes your experience so unique in this space?
My training journey is unique. Pretty early on I decided to niche into women’s health. And early on in my career, at a time when NDs in my jurisdiction didn’t have prescriptive rights for medical drugs or hormones, I took a huge interest in HRT.
I went to a lot of conferences on HRT because so many of my patients were hitting an endpoint with botanical, Chinese medicine, acupuncture and lifestyle medicine. And they needed more support. There is a hard end point when many women, not everyone but many, just need hormones. I kept hitting that wall. So I went to conferences, even though I couldn’t prescribe HRT, because I wanted to be able to help my patients advocate for themselves.
At one of these conferences, I met a medical doctor who asked me to come work with them. And I began working about half my week with a medical doctor specializing in women’s health. At the time, she was one of the few doctors in the province that had tremendous knowledge about prescribing HRT.
It was an invaluable experience and this mentorship lasted for almost 10 years. And vice versa. I came into the practice with a lot of experience in lifestyle and botanical medicine that she didn’t have.
What this means is that I’ve been working in this space, prescribing HRT for a really long time. A lot longer than the others who just arrived at the party. Although, it’s not really a party, it’s a bloody mess. It’s really a disaster.
Sure there’s a small percentage of people who are not HRT candidates. I always have those women in my practice. And I do everything I can for those women with all the other tools I have. There’s also a tiny percentage of people who don’t tolerate HRT. So of course, we use all the other tools to help them. But for most people, HRT is a big deal and it can really help them feel better.
Q: I’ve worked with NDs and I didn’t realize that HRT was something they could prescribe.
Let me clarify… NDs in Canada and the United States, who have gone to an accredited Naturopathic school, have to write their boards and are regulated by different states and provinces. Not every state and province is regulated for naturopathic medicine, even though they all have NDs. Within each regulated state or province, there are different scopes of practice on the drug front, so not every ND will be able to prescribe HRT. In Ontario where I am regulated as an ND, HRT is within my scope.
Q: Is there anything you recommend women do to prepare for a visit with their ND, MD or any health care practitioner?
That’s a great question. Because you don’t have a lot of time, it helps to write down your list of things that are bothering you and bring them with your list of questions.
There’s a natural power differential when we see doctors and nurses that makes people a little edgy and nervous. Even when they’re comfortable with their practitioner. And so it’s great to have the symptoms and questions prepared in advance. We can stick them right in their chart. You can even visit NAMS (North American Menopause Society) at menopause.org to do some research first and get educated before your appointment. You should know that a lot of practitioners are just getting educated themselves and they might not know a lot about perimenopause yet.
I understand that you’re creating a course to help educate women about perimenopause. Please tell us about that.
I’m creating The Peri Collective because I just don’t have enough time to teach and do all the things I want to do with my patients. It’s costly for them. And when they’re interested in really acute symptom management, the truth is that there’s so much to know. There’s more than I could ever begin to cover in a one-to-one call. And it’s a disaster; the lack of literacy about what women go through during this time.
This course is designed to help women in perimenopause, but the truth it will help women to avoid a whole bunch of other health concerns as well. The course covers topics like:
what’s happening during perimenopause,
why is it happening,
what are the different body systems involved in this transition,
what are the symptoms one might experience due to these fluctuations,
what are the things that might help me to stay as healthy as possible during this time.
There are modules on things like lifestyle, exercise, botanicals, vitamins, adrenals and stress, HRT, environmental medicine, and of course, advocacy (how to speak to your health care provider, what questions you should ask, what language to use).
My goal is that anyone can buy this program and come out saying, ‘I’ve got this. I understand all the common symptoms and the weird ones. I know why. And I know what the current evidence says.” I want women to walk away from this course feeling so solid about their knowledge and to have some tools to help them to start feeling better.
I’ve got a whole lot of experience teaching this stuff and I know how to simplify things for people. I want women to walk away knowing almost as much as I do.
What is the one thing you’d love women in their mid-30s to mid-50s to know about perimenopause?
I would love them to know that they need to get educated. They need to find reputable people to follow on social media. People who are actually experts with a lot of experience.
Educating yourself is so important because I work with a lot of people who are smart as a whip, and they are lost. It’s no one’s fault.
A lot of the hormone related components of being a female are infused with secrecy, shame and dismissiveness. We’re supposed to just transit through this really big change that affects every organ system in our entire body. Just tuck our head down and get through it, because it’s embarrassing. And because we’re aging in a society that doesn’t allow women to age.
The truth is that there are a lot of things that you can do. But first and foremost, you need to get educated. You shouldn’t just cruise through perimenopause. Because a lot of things will happen to you that you’ll blame on other things, and you will be wrong.
Thank you Kirsten! This is all incredible information.
Or visit the North American Menopause Society (NAMS) to find a ND near you.