Preventive Health in Perimenopause with Dr. Amy Louis-Bayliss

Dr. Amy Louis-Bayliss is leading the charge in the world of preventive health, and in this episode, she’s sharing some game-changing insights with us. Learn how early interventions and lifestyle tweaks can keep diseases at bay, especially for women as we age. Get ready to learn some amazing tools and techniques to maintain your health proactively.

What You'll Discover:

• Why preventive health is key to long-term well-being and how to start incorporating it into your life right now.
• How genetics and environment play a role in disease prevention, and tips on navigating these factors.
• Busting the biggest myths about aging and disease.
• Dr. Bayliss's top tips on nutrition and exercise habits that help prevent diseases.
• The principles of preventive health could transform how we think about aging and disease prevention.
• Simple lifestyle changes make a big difference in preventing common diseases as we get older.

Get ready to take charge of your health and future!

Connect with Dr. Amy Louis-Bayliss
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Resources
Lume Women + Health
It's Our Time Canada - Advocacy
Signs and Symptoms of a Heart Attack in Women 

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Transcript

Amy: 0:00

I would love to see a future in which we had sort of like a menopause developmental milestone assessment, where you went in, you talked to your healthcare provider about symptoms you may or may not be having. Your doctor could give you some guidance on what to expect. You sort of talked about the key areas that are impacted, based on the menopause transition, and then worked with your doctor to kind of create a health plan, you know, for the next couple of years five years, 10 years, 20 years. We are probably not going to see that anytime soon, only because we don't even have a menopause billing code, but that would be like my dream situation. I think you could make it for yourself, though.

Mikelle: 0:36

Welcome to. This is Perimenopause, the podcast where we delve into the transformative journey of perimenopause and beyond. I'm one of your hosts, Michele.

Michelle: 0:45

And I'm your other host, Michelle, and we know firsthand how confusing, overwhelming and downright lonely this phase of life can be. Join us as we share real-life stories and expert advice to help you navigate this journey and advocate for your best health. We used to think menopause signaled an end, but really it's just the beginning.

Mikelle: 1:04

Welcome back to this is Perimenopause signaled an end, but really it's just the beginning. Welcome back to this is Perimenopause. Today, we're excited to have Dr Amy Lewis-Bayless with us. Amy is an emergency medicine specialist with over 20 years of experience. Her passion for aging well comes from her experience as an ER doctor. In today's conversation, we'll dive into why it's so important to look after your health now to enjoy your future, especially as you move towards menopause. Amy will share some straightforward tips that you can start using today to better your health tomorrow. We're all about making good health simpler and more accessible. So, Dr Bayless, welcome to the show.

Michelle: 1:37

Welcome to the show, Amy. We're so glad to have you here.

Amy: 1:40

Thank you for having me. I'm very excited to chat today.

Michelle: 1:48

Amy, you've got such a really great origin story, coming from an emergency medicine specialist to an advocate to You've come. Okay, amy, you've got a really amazing origin story, starting as an emergency medicine specialist to an advocate for women's healthy aging. I'll do that after. Can you please share your story with our listeners?

Amy: 2:06

Sure, I'd love to. So I, by background, am an emergency trained physician. I worked for over 10 years in the greater Toronto area and my other passion in life is education. I've had a faculty lead. I've been a faculty lead for the University of Toronto for postgraduate students.

Amy: 2:27

I spent a year of my residency focusing on medical education, and the reason why I say this is I've always had interest in education as a physician. So even when I was working in the emergency department, my favorite part of my job was getting to educate patients around why they came in in the first place. And what I found as I was continuing on in my career and going through COVID was the emergency department was becoming so busy that I sort of started losing the opportunity to teach and spend time with patients. And I also started learning about menopause, and to me this is crazy. I went to medical school 20 years ago and really it's only been in the last few years that I've learned about perimenopause and menopause, especially how it impacts women's health as they present to the emergency department in their 40s and 50s, and I started becoming really interested in learning more about it. I couldn't believe that I was teaching residents and teaching medical students and didn't know anything about it.

Amy: 3:32

And it was really Dr Natalie Gamache, who's a gynecologist in Canada. She did a lecture for us, like as a physician community, and really that changed my life. I listened to her lecture and I thought to myself I want to be a part of getting this information out. I think the other part of my journey in emergency medicine was I started feeling like I was spending a lot of my time seeing women once they were sick. I felt like I was providing a lot of sick care. I was diagnosing the heart attack, I was diagnosing the hip fracture, I was talking to family members about dementia and you know, taking the next steps. And as I entered my 40s, I wanted to start thinking about how do we prevent this, how do we take an active role in our health so that we do everything we can before the sick has been diagnosed? And really, to me, that's more the idea of healthcare.

Michelle: 4:33

Love that.

Mikelle: 4:35

Maybe we can talk a little bit about healthy aging, because I think that's really kind of where we're at and what's at the forefront and top of mind right now. So, Amy, what does healthy aging mean to you?

Amy: 4:49

So I mean the textbook definition of healthy aging is aging for as long as you can without disease. I kind of like the idea of taking a more active role in what health looks like. I think that health is an independent decision in terms of what that definition is, because what healthy means to me may be different from what health means to you. But when I think about healthy aging, when I think about what I want the next 20, 30, 40 years of my life to look like, I think about three areas, and those three areas are one being physically competent I want to be able to hike, I want to be able to lift my grandkids, I want to be able to play, I want to be able to be independent for as long as I can in my home.

Amy: 5:36

The second part is to be cognitively sharp. I want to be able to make autonomous decisions and be able to work and be a productive member of society for as long as possible. And I think the third part is to be really emotionally and mentally healthy. You know, be connected to my community, stay connected to my friends, have strong relationships with you know my partner and my kids. So when I like, I really think that that's my definition. But I think another part of health is really having, like I said, that agency or that active role in what health looks like to you.

Mikelle: 6:09

Why have we ignored this for so long?

Amy: 6:12

I don't know that everyone in health care period has ignored it in terms of I think there's been a lot of practitioners and like the alternative sort of medicine space that have really had a focus on preventive health. I mean, I think the backbone of medicine is treating disease. You know people present with symptoms, you make the diagnosis and you treat the illness. It really hasn't been a focus on. You know, we learn about pathology, we learn about disease process. There really hasn't been a focus in medicine and of itself of before the disease process starts and focusing on the interventions before disease is there. And I mean even right now, there aren't even billing codes, like doctors don't get paid to do preventive health.

Amy: 7:01

This is a novel idea, I think, in the Western medicine community and I think it's coming to the forefront for a couple of reasons. I think one you have thought leaders that have the ability to reach wider audiences with social media. You know Facebook, instagram, podcasts, and so they're getting information into the hands of the public and the public is saying I want to learn more about this and I think as a society, because we have so much access to information, our investment in our health, our interest in being active in our health, is increasing.

Mikelle: 7:39

Is that? Part of why menopause hasn't been taught in medical school is because it's not a disease. It's a natural part of a person's life, a person who has ovaries. Why has that not been taught?

Amy: 7:55

I don't think that's the case. I mean, if you look like historically at the history of menopause, I mean hormone like hormone therapy, was prescribed in large quantities in the 70s, the 80s and the 90s. I mean in the 90s it was one of the most prescribed medications for women, and so for doctors to have been prescribing hormone therapy there had to have been education around it. I think what happened was you know, we had this trial that I'm assuming that has been discussed on your podcast that came out in 2002.

Amy: 8:30

You know, this big news release happened with the Women's Health Initiative and the messaging to the medical community was hormone therapy causes cancer, increases your risk for heart disease and we can't prescribe it anymore. And I guess I was in medical school at the time and I think what happened was the medical community responded by saying like our hands are tied, there's no other options, and so this message started coming down the pipeline of this isn't something that we're going to address because there's no treatment option anymore that's safe, and so it kind of got, you know, pushed under the rug. I mean, historically there is a gender gap in women's health in general in the Western medicine system. There aren't enough studies on women and I think when that study came out, money going towards women's research studying perimenopause and menopause kind of stopped because there was a fear about causing more harm.

Mikelle: 9:34

So menopause is not a disease. We know that. But we also know that women are at increased risk for diseases when they reach, or in and about the time of menopause. They're at an increased risk for diseases such as cardiovascular disease, osteoporosis, diabetes, dementia. You mentioned all of these earlier in our chat. You mentioned all of these earlier in our chat. Can you tell us a little bit about why, and then maybe we can delve into what we need to do to have a preventative approach for all of us.

Amy: 10:06

Yeah for sure. So just to take a step back, I mean, as we age, our risk for disease is going to go up just by way of aging. When you are 85, 87, 89, you are not going to have the same health that you have in your 30s and your 40s. And a lot of that is due to the accumulation of risk factors, meaning that your lifestyle choices, your genetic risk, your environmental risk, as that goes on for years and years and years. These risk factors accumulate and that's what sort of sets the like primes the body for a disease to take place.

Amy: 10:46

So a lot of women and men think to themselves like I don't have to worry about heart disease, I don't have to worry about dementia, I don't have to worry about osteoporosis until I'm in my 70s or my 80s, and what they don't understand is that these disease processes are starting 20, 30, 40 years earlier. So that's one part of it. The other part of it is that estrogen has a protective effect on quite a few of the diseases that impact women. So you know, cardiovascular disease is the number one killer of women, it's what you are most likely to die from. And estrogen has a protective effect on the heart, so it's anti-inflammatory. It impacts your lipid or cholesterol levels. It has an impact on, sort of the elasticity of the blood vessels. It affects your blood sugars and so when you go through the menopause transition, that loss in estrogen adds to that risk that's accumulating over time.

Amy: 11:46

The same thing with osteoporosis. Estrogen contributes to, it prevents bone loss and so as you age your bones are going to decrease in bone mass, no matter what. This process starts in your 30s, however, with that rapid drop in estrogen through that perimenopause and menopause phase, you have this period of rapid bone loss. You lose about 6% to 12% of your bone mass around the two to three years around menopause and that's because you no longer have estrogen protecting that breakdown of bone. That's happening. Same with muscle. Estrogen helps, you know, contribute to muscle mass. Muscle starts to decrease no matter what you do, but when your estrogen levels drop, that ability to maintain muscle mass is impaired.

Michelle: 12:36

Estrogen is really a great protector of so many things. It is a great protector Just for some of our listeners. Can you break down a little bit more like cardiovascular disease? Are you talking heart attack, Are you?

Amy: 12:48

talking strokes. So cardiovascular disease in trials is bundled, meaning that cardiovascular disease encompasses heart attack and stroke, and so it's referring to both. So when they're looking at you know what did you die from? They're looking, it gets bundled as cardiovascular disease. And the reason is is that the pathophysiology and when I say that I mean the process that happens, that causes stroke or to cause a heart attack is the same? Okay?

Michelle: 13:15

Okay, can actually, while we're talking about cardiovascular disease, amy, could you please share with our listeners some of the symptoms of heart attacks that women need to watch for?

Amy: 13:24

Of course. So there are so many disparities in women's heart health compared to men and I'm hoping, with recognition, that this gender gap gets better. And just to take a step back, women recognizing that they're even at risk for heart disease is already a problem in the first place. And you know, when you ask a woman, what are you more most likely to die from? Most women will actually say breast cancer, and in fact that's not the case. You're more likely, significantly more likely, to be impacted by heart attack or stroke.

Amy: 13:59

Also, when you ask women, and actually a lot of doctors what are the risk factors for even developing heart disease, a lot of women can identify the big ones. You can identify the smoking, the high blood pressure, the high cholesterol, the diabetes, you know sedentary lifestyle, obesity. But there's actually quite a few risk factors that women develop that are related to reproduction that are significant risk factors that women are not aware of. So, for example, if you have severe hot flashes, that is an independent risk factor for heart disease. If you had high blood pressure, diabetes during your pregnancy, these double your risk of developing heart disease. If you had recurrent miscarriages, if you had breast cancer or early menopause, these significantly increase your risk for heart disease. So a lot of women it's not even on their radar that they're at increased risk or have risk factors for heart disease. And the reason why I say that is one of the problems with women getting a diagnosis of heart disease is they don't even go to the hospital in the first place to be checked. So there's already a delay for women to seek care.

Amy: 15:08

Women dismiss symptoms and they often don't seek the attention when they need it. When they get to the hospital, most women will actually have the classic symptoms of a heart attack. You know sweaty, nauseous, short of breath. You know a pain or pressure in the chest radiating down the left arm. Most women will have those classic signs.

Amy: 15:33

Unfortunately, in medical school we're also taught about atypical chest pain, and it's bizarre to me because women tend to have atypical chest pain and we are half the population. So I do think this should be called the female experience of chest pain and not atypical chest pain. But for women they can present with a lot more subtle symptoms as well. It could just be nausea, it could be flu like symptoms. You may have pain on the right side. Jaw pain is another common symptom specific to women. They can have back pain instead of you know that anterior crushing chest pain, general malaise and weakness, and so I think why this is important to know is if you are at increased risk for heart disease and you're taking an active role in your health when you start having these symptoms. Maybe this helps you clue in to think, hey, I'm at increased risk, maybe I need to get checked out, maybe I need to see a doctor just to make sure that this is not, you know, something else going on.

Michelle: 16:36

It's. You know, this is really near and dear to my heart. My mother actually was kind of one of those typical women. She was on HRT, ripped off of it in 2002, 2003. And she passed about eight years ago from heart attack. And she was healthy as a horse. She was, you know, worked out all the time, always exercising. Never would have dawned on me, or her for that matter. I'm sure she was probably suffering for longer than she realized before she passed and it's terrifying to me that she had no idea that she was suffering from that when it happened. I'm sorry. Sorry, I didn't mean to bring it down, but it is very near and dear to my heart that that women become more aware that this is a possibility for them.

Amy: 17:24

Oh, I mean, and like we just talked about the disparities of getting to the emergency department or getting to your health care provider, once you're diagnosed with a heart attack, I mean, the care isn't even the same. You're more likely to have a poor outcome, you're more likely to die from a heart attack compared to a man. You're more likely to not be prescribed the medications that you know are required after having a heart attack. Why is that? It's the gender gap. I mean women do not get the same care as men. And I mean, like I said, the teaching about advocacy and advocating for your health is really important. I also think there's a lot of myths in the public that are not true. There's a lot of women that don't believe that statins, for example so the medication for treating high cholesterol are valuable for women, and that's that's not true. So I do think there is also misperceptions that result in women not taking medications that they would benefit from.

Mikelle: 18:25

Amy, do you have any tips? You know, I think about myself or people that I know, and despite being a fairly forthright, strong willed individual, I do have a tendency to downplay symptoms. I mean, I think that's just a socialized thing, unfortunately. So do you have some advice? You know, if someone, if one of our listeners is not feeling great and they're presenting in the emergency room and they know something's wrong and they are really not feeling well, do you have some tips, like what are things they that you might suggest they say or do in that scenario?

Amy: 18:59

so there's. So a big part of advocacy is becoming medically literate, which all of your listeners right now are doing. So, first of all, I think the biggest part is understanding where you sit in terms of risk for heart disease. If you're having chest pain at 20, it's very different than if you're having chest pain at 65. And if you are worried then you should be assessed, and I don't think we should be afraid as a community to ask for the help we want. And I think advocacy is a huge part of navigating our health care system right now.

Amy: 19:32

Doctors are burned out. They don't have a lot of time to spend with patients. You know the emergency department can be intimidating to go to. You may have to wait eight, nine, 10 hours, and so you may feel rushed in your experience. And so I think having the tools to advocate, to say I would like to have my heart checked, can I have an ECG, are great ways to start. Having worked in the emergency department for a really long time. You may have to wait a long time to see a doctor, but anyone who screens when they've come through the front door with any kind of symptom concerning for chest pain or cardiac issues usually gets an ECG significantly earlier than before they see the doctor. And so getting that ECG you know the nurse reads it, a doctor will read it fairly quickly, you know is reassuring to know that things are okay. It's a great suggestion, yeah.

Mikelle: 20:32

Good advice, thank you. Let's delve into what are the things that women need to be doing in addition to advocating, but what are the things we need to be doing to prevent osteoporosis, cardiovascular disease, dementia? We talked a little bit about diabetes as well, but we haven't really delved into dementia. What do we need to be doing, amy?

Amy: 20:54

So let's just take a. I'm going to give a lot of advice right now, and so I do like to prime it with just a couple of pearls, and those pearls are one we are right now planning your health for the next 10, 20, 30, 40 years. You do not have to get this right in the next five days, and so when I give you information you do not need to, you know, make jot notes and start implementing every little thing right now. And the reason why I say that is you won't stick to it. It's overwhelming, it's too much information. So start.

Amy: 21:25

If you're not doing, if you're not making a significant effort on your health right now, start by picking a couple of small things and start there. I really think that there, I really think that making small steps is the most likely way to have behavioral change and have positive results. I think the other key piece is to have a really clear understanding of what your why is Like. Why are you doing this now? Why are you putting in the time now for 10, 20, 30 years from now?

Michelle: 21:56

Well, because we don't have the time now. Right, we're taking care of our kids, we're working, we've got our parents. 100% who has the time? So how do I prioritize myself?

Amy: 22:06

I try and go for really high yields, make high yield interventions, and what I mean by high yield are interventions that are going to benefit your health today, in your 40s, in your 50s, and are also going to benefit you in 67, you know, when you're in your 60s or 70s and your 80s. So things that are going to you're going to feel better now and also feel better later in life. I mean I have, having been an emergency doctor for a long time, I've had the privilege of dealing with families where frailty is involved, where caregiver burnout is involved, and making the effort to try and live independently as long as possible is not just a gift to yourself, it's a gift to your family members, it's a gift to your partner, and so I do think that's part of having a strong why Lifestyle interventions do not have to be super complicated either. There's probably a hundred podcasts, journal articles, posts right now about what the right way to exercise is, and I feel like that detail, those detailed prescriptions, can become hard to navigate and can also contribute to this overwhelm of midlife and just cause you to just quit. So I'm going to try and make a couple of intervention strategies that I think are not on most women's radars that I have implemented in my own life. That has been a change for me and that I hope you know will cause you to consider thinking about what changes you want to make in your life, cause you to consider thinking about what changes you want to make in your life. So the first is related to exercise. Any form of movement is going to have a benefit for you.

Amy: 23:50

I think the shift for me that I advocate a lot for is including strength training or resistance training into the exercise that you're doing, and the reason why this is helpful is that your bones and your muscles are going to decrease in mass as you age full stop. You can't really prevent that from happening. However, by incorporating strength train, you can minimize the impact that it has. If you break your hip, it is a very, very big deal and if it's from osteoporosis especially, there is a 20 to 30% chance that you will die from breaking your hip and there's a 50% chance that you will never live independently again. So having bone health and muscle health on our radar is really important. As women, we are under-muscled and we continue to become more and more under-muscled as we age. The less muscle we have, the less metabolism we have, the more likely we are to not have as much. Metabolic fitness and muscle has multiple benefits. It doesn't just benefit your heart, your brain, your bones, it also improves your mood. It lengthens your life and improves your quality of life. So incorporating strength training is really important and this does not need to be put on a sports bra.

Amy: 25:01

Get a personal trainer and, you know, look cute in a gym. Any kind of intervention is helpful. I mean, twice a week, three times a week, for 15 minutes has an impact and really we want to be lifting weights to tiring. So if you only have 510 pounds at home, lift them until you tire. You don't want to be lifting weights to tiring. So if you only have 5, 10 pounds at home, lift them until you tire. You don't have to be doing back squats of 150 pounds to get this benefit. So I think that's like a. That's been hard for me to. I was like groomed to do cardio, cardio, cardio, and so making that change has been big for me. But I prioritize weightlifting now over any other form of exercise.

Mikelle: 25:40

Curious. Have you seen from a weight perspective? Have you seen a benefit from that by shifting from cardio to weights? Because I think a lot of women think, oh, I can't stop this cardio because then I'm going to gain weight.

Amy: 25:53

So you do, you will have a weight benefit. And the reason why you'll have a weight benefit is cardio will not preserve your muscle mass and as you get older and your muscle mass decreases, your body fat percentage goes up, even if you do not gain weight. And as that body fat percentage goes up you'll start to see the fat redistribution around the belly and that fat becomes medically metabolically active. And that metabolically active fat is where you start to get into trouble with your cholesterol and your blood sugars, your blood pressure and then your risk for disease. So cardio will keep you thin when you're younger but it will not have that muscle and bone benefit and it will also not counteract that body shift from more fat to less muscle.

Michelle: 26:40

And is it true that muscle burns or is more metabolically, keeps you more metabolically fit as well?

Amy: 26:46

Yeah, so I really think of muscle as medicine. I like that. It is probably the single best intervention. There is no medication that can outperform compared to muscle mass, and so if you are completely naive to lifting weights, my honest recommendation would be save the money on the supplements and spend a little bit of money on introducing some sort of weight routine into your life, whether that's finding a friend and doing YouTube videos together.

Michelle: 27:16

It's money better spent Like body weight can be beneficial as well. Right, like squats and planks and pushups, and all of those things can be beneficial if you can't afford the weights.

Amy: 27:26

For sure. All those things body weights, pushups If you're disabled I mean there's a lot of women with knee problems, with hip problems sit and lift weights from from that, like from a bench there are definitely ways to incorporate resistance and weight training into your life and, like I said, I do think it's a big mind shift for women and you can go down the rabbit hole in terms of what exactly this needs to look like. And if you're a fitness expert then you know you can go into the nuances. But I think just engaging in a resistance training which is a strength training Routine, routine, habit or routine, is the way to go.

Michelle: 28:13

Just something you said, so I will agree. Like I sit here, I eat, breathe, sleep, perimenopause I've talked to all kinds of experts. I know I'm supposed to be strength training and I also know that in my forties I was strength training early forties and I look like a rock star. Like I was cut, I felt great and for some reason I stopped and now it's so hard to get back into it, even though I know I'm supposed to. I know how important it is. So hearing you say this again medicine, muscles are medicine, muscle is medicine. I'm going to put that somewhere on my mirror so that I see it every morning and I go and work out.

Amy: 28:48

Thank you, yeah, I mean, as a society we are under muscled and so really thinking of muscle as medicine, I think, is empowering, just like you said, and that behavioral change is the biggest hurdle for all of this. You can receive the information, you can listen to the podcast, you can do the online research, but making that behavioral change, if you do not grant yourself the grace of small steps, this is a long haul. There's going to be times in your life when you're going to get off the wagon and back on and not have that all or nothing mentality. I think it's the best way to age in a really healthy way.

Michelle: 29:27

I really like that all or nothing mentality because I think so many of us have grown up in that. You know, either we're type A personalities or Not suffering doesn't count. Yeah, yeah, if it doesn't hurt, it doesn't count, and if I screw up then I've got to start all over again on Monday, but I take the rest of the week off, you know yeah.

Amy: 29:47

I also hear a lot like I'm now in my forties and fifties, no one cares what I look like. You know this like sort of passivity of just kind of giving up and I'm, you know, it doesn't matter, the same way as maybe it did when I was younger. And I think that's once again a part of that mindset shift of you are doing this for the benefit now, but you are also doing this because, if you do, it in 20, 30, 40 years.

Michelle: 30:13

You're going to be in much better health, we need to shift our why.

Amy: 30:15

Anything else? What about sleep? There's a couple of other interventions that I think should be on people's radars. One is, when we look at diet, I do think women should be prioritizing their protein intake, and the reason why I say that is if you're going to be lifting weights, you need to have the nutritional support to help support maintenance of that bone and muscle mass. And I think there's so much attention to whether or not you eat sugar, whether or not you eat carbs, whether, like what kind of diet you're on. And I'm really about what can you add to your life? Starting today to make your life better and maybe not promote as much as like what you need to your life. Starting today to make your life better and maybe not promote as much as like what you need to restrict or take away, and so protein forward eating will have a huge benefit for for you. Um, so when I think, when I sit down and eat, I'm not I personally am not adding up my proteins every day, um, but if you are someone who does like to do that, you really want to be aiming for like 100 to 120 grams of protein a day. But when I sit down and eat a meal now, I think to myself where have I had protein and did I prioritize it on my plate? So that has been a big shift for me as well.

Amy: 31:21

Another big shift for me from a nutrition perspective is cutting back alcohol. I think drinking alcohol is something that, as a female society, we need to shift away from. I think this idea of mommy drinks and drinking after a hard day and like normalizing excessive alcohol consumption is something we really need to reconsider. Alcohol is a massive risk factor for disease and cancer. It's a bigger risk factor for breast cancer than hormone therapy is and it's um, it's something we really need to be cutting out. There's no healthy amount of alcohol, and so, if you are going to drink, think about what drinking looks like for you, and I would really be urging you to reconsider if you're having more than one or two alcoholic beverages a week.

Amy: 32:12

Sleep is very important. If you are not rested, you are not going to be able to lift weights and you're not going to have, you know, the mental capacity to take on all the things you're wanting to think about in midlife and also when you don't sleep. The stress of not sleeping, you know, also has a health risk in independent of itself. The recommended sleep that you're trying to look for is somewhere between six and eight to nine hours a night. You don't want to be sleeping too much and you don't want to be sleeping too little.

Amy: 32:45

And once again, women in their 40s, 50s, 60s, I mean for myself I've got, you know, tween kids and they don't go to bed till 930. And so I, you know, get them to bed at 930. And then I want my alone time, and really my alone time ends up me being like half asleep on the couch and I'm not productive and at the end of the day I'm still tired in the morning. So one thing I've started to do is really try and force myself to go to bed and actually get up early. I'm more productive when I wake up, you know, at six in the morning and the house is quiet and I have my cup of coffee and I actually enjoy reading more than or catching up on a show than than I do, you know, when I'm exhausted at 930 or 10 at night.

Amy: 33:25

But that's my approach and everyone's different. But I would just think about, you know, when are you going to capture sleep and when are you like how much is no, being half comatose on the couch serving you when you're you know, binging that Netflix show. And the other thing that happens for women in midlife is their risk of developing sleep disorders do go up as you go through the perimenopause and the menopause transition. So the lack of estrogen actually does change some of the structures around, like your throat, when you're sleeping, and so your risk of sleep apnea does go up as you as you go through menopause. And so if you are noted to be snoring, if you've been told that you're holding your breath, if you are feeling exhausted despite going to bed and sleeping eight, nine hours, or your sleep is disruptive, I think you should talk to your doctor about having a sleep study done just to make sure there isn't another reason behind why you're sleeping poorly.

Michelle: 34:21

We actually have one of your colleagues coming on to our podcast in a few weeks and specifically to talk about sleep apnea, amy. So for some of our older listeners, who might be in their late 50s or 60s and they haven't been doing all of these great preventative measures, are they just shit out of luck?

Amy: 34:36

No, not at all. So I think that's a really important message to take from this is that there is no too late, so you can start implementing. Maybe what weight training looks like is a little bit different if you have mobility issues that have already developed at that time. But there's, first of all, most of multiple guidelines for resistance training, even once you've had a diagnosis of osteoporosis. It's in all the osteoporosis guidelines, and resistance training is actually been now advocated by the American Heart Association as a intervention, even once you've had a heart attack. So the benefits are not only in prevention, but the benefits are there even once disease is present.

Amy: 35:18

I think, as you age, awareness of where you sit in terms of risk is really important, and we didn't touch on that. It's probably unreasonable to think you can sit down with your doctor and go over all of your heart risk, cardiac risk, all of your bone risk, all of your dementia risk all in one appointment. So pick one area and book an appointment to discuss that with your doctor. But there are certain risk factors that put you at higher risk for osteoporosis. For example, if you smoke, if you drink, if you have a family history of hip fracture, if you took steroids for, maybe, asthma or an autoimmune condition, and so, if you are in that category, maybe you need a bone scan.

Amy: 36:02

Maybe it's important for you to understand where you sit in terms of your bone health. Same with cardiovascular disease. Maybe, if you have higher risk factors, you should be looking closer at what your blood pressure is, what your cholesterol panel is. Maybe you need a stress test or a further cardiac risk stratification. So I think, as you get older, having that health literacy is really important so that you can gather the information to know like am I good? Do I need to be doing any more? Is there a medication or treatment that my doctor should be including to what I'm doing on a day-to-day basis to keep my risk low?

Mikelle: 36:36

Amy, what about dementia? Is there anything? I mean all of these things that you've talked about with us so far would obviously be preventative from that perspective as well. Is there anything in particular that someone might put that at the top of their list to get a risk assessment for?

Amy: 36:58

So a lot of the risk factors for cardiovascular disease are the same for dementia, and so healthy blood flow through the heart is the same as healthy blood flow to the brain, and so managing your blood pressure, looking at your cholesterol, exercise is very important for brain health. There's a couple of risk factors or contributors to dementia to have on your radar. One is hearing loss, and hearing loss is a significant contributor to development of dementia and it's a treatable, it's something that you can, you know, have hearing aids or have an intervention done that actually will mitigate that risk. So hearing loss is a big one. The second is traumatic brain injury. So if you have a history of, you know, concussion, you know from car accidents, maybe you played competitive sports, maybe you are at increased falls risk, you know as you age, because maybe you have, you know, osteoporosis trying to mitigate falls risk so that you're not having repetitive head injury, we know that that's a risk factor for dementia as well. And the other big one is alcohol.

Michelle: 38:01

Amy, sorry, hearing loss. So how does that impact it and how could getting preventative care for my hearing loss help me prevent dementia?

Amy: 38:09

Just in terms of when I discussed, you know, emotionally, being emotionally connected as you age, is important. Social interaction is important, same with mental health, and it is a risk factor for heart disease as well as for dementia, and so, really, with the hearing loss, it's the impact of that, it's believed to be, the impact from that social isolation and that sort of lack of, you know, connectedness that can happen. That's considered the thought to be the contributor.

Michelle: 38:39

That's really interesting.

Amy: 38:40

Wow.

Michelle: 38:42

Very cool, I didn't know that.

Mikelle: 38:44

Amy, you've started an initiative called it's Our Time Canada. What inspired this and what's your mission?

Amy: 38:50

So it's Our Time. Canada is a advocacy group with myself and two other doctors and we have a social media page on Instagram and really was inspired by trying to share evidence-based health information. That was empowering and inspiring to women in Canada. There's a lot of thought leadership happening in the United States, but it doesn't necessarily translate to the Canadian landscape.

Amy: 39:19

I also, I mean, I see I do menopause management now and I see a lot of women who spent a lot of time waiting for a diagnosis. So, whether that's spending a lot of time suffering from palpitations and not getting the diagnosis that it was related to menopause, whether it's, you know, vaginal symptoms and not getting the diagnosis of the genitourinary syndrome of menopause, and I think the opportunity to provide information to women who don't have access to care became really important to us. I have women reaching out to me all the way from PEI, all the way to BC, and a lot of women cannot find care for themselves, and so I became really passionate about trying to help those women and that's what we do. We share information related to all things healthy aging. It's all evidence-based and it's been a really great journey.

Michelle: 40:13

It's really great. I love it. It's got a lot of great information. It looks great too.

Mikelle: 40:17

Thank you.

Michelle: 40:18

What is the one thing you want every woman to know about navigating this time of life?

Amy: 40:23

My take-home message is twofold. It's one is it's never too late to start, and I really like the idea of having agency over your health, really taking health into your own hands and being empowered to age. You know, age in a healthy way.

Michelle: 40:41

I love that. What I've heard from you today is getting old doesn't necessarily mean that we need to get sick, that there's a lot of things we can do, as you said, if we take agency over our health and we take take an active role in our health. So thank you for that. Oh, you're very welcome. I'd love to know what is your vision for the future of women's healthcare.

Amy: 41:01

Yeah, so I mean a couple of things. I love the idea of just in the way that, when you were, you had a two-year-old year old or a six month old, you took your baby to the doctor and you had like a mile developmental milestone assessment. I would love, you know, to see a future in which we had sort of like a menopause developmental milestone assessment, where you went in, you talked to your healthcare provider about symptoms you may or may not be having. Your doctor could give you some guidance on what to expect. You sort of talked about the key areas that are impacted, based on the menopause transition, and then worked with your doctor to kind of create a health plan, you know, for the next couple of years five years, 10 years, 20 years. We are probably not going to see that anytime soon only because you don't even have a menopause billing code, but that would be like my dream situation. I think you could make it for yourself, though, and the way I think you could make it for yourself is I think you could break down the appointments. I think you.

Amy: 41:59

I think what tends to happen with menopause symptoms is they're not getting the time they deserve, because they tend to be added on by the patient. I'm going to pop in with my son to get his throat checked and I'm going to quickly ask about my hot flashes. So I think booking an appointment saying it's for perimenopausal symptoms or concern about the menopause transition, it cues the doctor that that's what you're coming in for and maybe if they're uncomfortable they'll read a little bit around it before you come in and already have kind of a plan in place. And I think understanding that you may not be able to deal with this in multiple like in one appointment and it may require multiple appointments, is probably good for your doctor and good for yourself. In terms of this is not going to all be sorted out today, but I'm happy to come back and even when you go to leave, making that comment of can I book a follow up appointment in case I have any more questions I think is another advocacy piece that you can do really well for yourself.

Michelle: 42:57

Well, especially Amy, my doctor has a sign that says like one, come with one concern only, and it's like so, yeah, that's great, one at a time, yeah.

Amy: 43:09

Well, I hope that was helpful for your listeners.

Michelle: 43:12

Oh, amy, it was incredibly incredible, thank you, and I love the advocacy piece and just I think it's so important for women and we've been really trying to promote this as well but just learning to speak up and learning to how to ask for that care that they need. So, thank you, this was extremely helpful.

Amy: 43:30

Yeah, and to how to ask for that care that they need. So thank you, this was extremely helpful. Yeah, and I think like we're like in the overwhelm is so easy right now, like I've got small kids and I've got demented parents and you know I'm also trying to be, have a career and like lift my weights and everything else, and there's so much going on. And I feel like for some women, if I come on this podcast and I'm like, if you're not doing this and this and this and this, they're going to leave feeling disheartened and also with a feeling of too late. And so I really try and use my platform to like empower that, like anything is better than nothing, and like to give yourself the grace that you don't have to do all of this overnight.

Michelle: 44:04

Thanks so much for listening to the show. If you like what you hear, please take a moment to rate and subscribe to our podcast. When you do this, it helps to raise our podcast profile so more women can find us and get a little better understanding of what to expect in perimenopause.

Mikelle: 44:20

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. Thank you.