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This Is Perimenopause
Menopause isn’t the end, it’s just the beginning. Hosts Michelle and Mikelle are on a mission to help others be better informed than they were when they started their perimenopause journeys. The podcast is a blend of health, education, mindset, and personal growth. Michelle and Mikelle along with their guests are sharing real-life stories and expert advice to help you navigate perimenopause, menopause and beyond.
This Is Perimenopause
We All Deserve Better in Perimenopause: Blending Naturopathic Wisdom and Modern Medicine with Dr. Kirsten Smith, ND
Are you looking for a chance to understand your perimenopausal body better and find options to manage your symptoms? If so, this podcast is for you.
Dr. Kirsten Smith, ND, is an expert in women's health and hormones with 15 years of experience merging naturopathic and conventional medical approaches. In this episode, she offers insights on symptoms, evidence-based solutions, disease prevention, the metamorphosis that occurs with the right information and care, and more.
Key Highlights:
- The return of mental health challenges in perimenopause can be surprising, significant, and scary as they often don’t respond to medications that used to work.
- The chaos and the drama that causes sudden and seemingly unmanageable weight gain, and what you need to do differently to be healthy.
- How common it is for vaginal, vulvar, and urinary symptoms to be misdiagnosed.
- The Peri Collective: a new virtual program that teaches you what is happening in your perimenopausal body, the evidence-based solutions you can choose to manage your symptoms, including hormone replacement therapy, and how to advocate for the care you deserve.
Ready to stop struggling and start thriving? Don’t miss this informative and validating discussion with Dr. Kirsten Smith, ND.
Connect with Dr. Smith
Website
LinkedIn
Instagram
Peri Collective
Resources:
Meta-analysis: Severe mental illness and the perimenopause, Cambridge University Press
Dr. Lisa Mosconi, PhD
Dr. Stacy Sims, MSC, PhD
Genitourinary Syndrome of Menopause
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For women in your 30s, it starts a lot earlier than you think. For women in their 40s, you have to get educated. You also want to be discerning. Who are you listening to? That is the reality and it's not going to change in the next few years. It's going to take longer. For women in your 50s, it is not too late. You must do the same. You must get educated about it. You must find someone who has done extra training. You need to do it. And for people who are in their 60s, same thing. No, it's too late for me. No, it is not. You need to get into some good quality care.
Speaker 3:Welcome to. This is Perimenopause, the podcast where we delve into the transformative journey of perimenopause and beyond. I'm one of your hosts.
Speaker 2:Michele, and I'm your other host, Michelle and we know firsthand how confusing, overwhelming and downright lonely this phase of life can be.
Speaker 3: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. Today we're talking with Dr Kirsten Smith, a trailblazer in women's health and hormones With over a decade of experience. Kirsten's passion for empowering women shines through her innovative approach, blending the latest research with holistic practices. From debunking myths about hormone therapy to offering practical strategies for reclaiming your vitality, dr Smith is here to guide you on your journey to optimal health. Join us as we uncover the keys to thriving during midlife with Dr Kirsten Smith. Welcome, kirsten. Thank you for having me.
Speaker 3:We're so excited so excited to have you talk to us today and all of our listeners. Let's get started. Maybe you can tell us a little bit about who you are and your inspired mission to help women in perimenopause.
Speaker 1:Sure, I am a naturopathic doctor from Toronto, ontario, canada, and I've been working in the area of women's health for about 15 years. Where I'm from, in Canada, a naturopathic doctor is a primary care provider who's trained in regular medicine, but on top of that we do four years of botanical medicine, biochemical nutrition and all of the sort of you know, exercise, physiology, all of the components that are very well established, old modalities from the beginning of time, basically, but merging that with modern science, right. So in my scope of practice, dealing with women making the transition from perimenopause through to postmenopause, really it's ideal because I'm looking at the HRT piece, but I'm also looking at all of the lifestyle pieces, right. So whether that's using botanical medicine, whether that's dealing with their nutrition, altering exercise, looking at stress, physiology, all of that comes under the scope of practice of a naturopathic doctor from Canada.
Speaker 1:So I very rapidly began to see there was a huge need like a huge, which remains to be the case now. I mean, it's just always been the case. There's a huge, huge need, as you know, and that my training really was amenable to sort of filling an important role. And so I began a long, long time ago you know, 15 years ago, pursuing a lot of extra training whenever anything came up on menopause care, perimenopause care, anything about HRT, because back then it was sacrilegious to just even practically say the word. That was in the years where women were pulled off, and so that began a very interesting journey, obviously. But yes, that's that, that is what I do, and I, of course, I see women for all kinds of other health issues, but a huge, a huge part of my patient base and my everyday is people in perimenopause and postmenopause and thankfully now there's a lot more of a high beam on that, which is great.
Speaker 3:For the, for the patients you see in perimenopause. What are the most common things you're seeing in terms of symptoms?
Speaker 1:are the most common things you're seeing in terms of symptoms? I'm so glad you asked because it's really interesting because nowadays because there's a bit of a menopause moment, right, there's a bit more media, there's more, certainly a lot more on social, which is all. That's another question, another conversation, but mostly it's a very good thing, of course. And so there's sort of two sets of patients. There are people who have a strong sense that they're having hormone, you know related, or perimenopausal related changes going on, and they have a strong sense, you know, and usually their period has already changed or they're having, you know, hot flashes, which these are very, I would, you know this is low hanging fruit, meaning this is very obvious, right, they're having, you know, flooding periods. Actually, a lot of women having flooding periods don't even realize that that's a part of perimenopause. But, generally speaking, people who are having erotic cycles and hot flashes, they know. So I get a lot of people like that. But what's what's hard to see is that they actually have no concept that they're in perimenopause. And that's because the earlier symptoms that I see all the time happening are insomnia, a rise in anxiety, some rage and I mean when I say rage it's really its own independent issue and some people that will just be extreme irritability, but for some people it is unbelievable, like very destructive and very scary because it feels very out of their control, so rage, and their cycles are like this right Clockwork and they just have not connected because some of those changes don't just happen in the PMS zone, right, like the few days before your period, they can happen all cycle long. So it's understandable that a lot of women don't connect it. They don't realize it. So for me, a lot of mental health like anxiety, depression.
Speaker 1:There was a meta-analysis that came out a couple months ago by the University of Cambridge Press that examined mental health in the context of the perimenopausal window, which you know give or take is about 10 years, and I got weepy when I read it. I mean, I still get weepy thinking about it because it just verified what I see, which is to answer your question, is an overwhelming amount of mental health issues crop up during this time and that's because when you look at the data, any woman who has a previous history of any diagnosis whether it's generalized anxiety disorder or whether it's psychosis or major depressive disorder or bipolar for all those people who are in remission the chances of it coming back during this time are very high, which is extremely frightening. And what's even more interesting about this paper, this meta-analysis, is that it's evident that the regular medications that you would give for those disorders, women, don't respond in the same way. So you have a set of women who they have a research in some mental health and they're obviously terrified about that because, you know, I think let's all just call a spade a spade.
Speaker 1:Life in your forties is aggressive, it's a great way to put it. Some days I'm just like my parents are this happening, and then you know my child, and then the dog, and then there's a flood, and then career. I don't even know what's happening and I'm trying to, like you know, walk the talk and do all my self care, and they're like I don't know what the hell, but it's a lot. It's a lot of things are happening that we are supposed to be. So if you suddenly, you know, have a little friend visit you, which that you thought you'd put to bed, which was your historic event with mental health, it is terrifying, but also it gets obfuscated by the fact that your life is a little bananas when you're in your forties.
Speaker 1:Right, so it. So my point is nobody connects this. Women go in seeking help because women generally want to take care of business with their health. Men, that's a whole other. Those people are crazy. That's a whole other thing. They have issues with admitting that there's a thing Women just want to get it done, so they go and then they're prescribed their medication and like they're not having a great response. So that is a fiasco. That's happening. And then for women who are the lucky people who don't have a history with any mental health, it can come and they can get really anxious and be like what is this you?
Speaker 1:know and really not coping with stress and really sad or just like really angry, but in ways that they absolutely know is not proportionate to what's happening. And that is early right. And that stuff is special because, yeah, it might be really ugly the week before your period or a couple of days before, but it can be at any time. And that's very confusing if you're 42 and your cycle's completely regular, like you don't know what the hell's going on, so that I see a lot. And if I say the P word, like if I say perimenopause, people are like, oh, like, they're just like offended no they're just like this lady like, or she's just like I've got a bias or something.
Speaker 1:I'm like no, I'm pretty good at what I do. It's shut down because women have been subjected. Certainly I won't speak for the whole planet, but in our culture it's just horrific ageism, right? So when people think perimenopause they think like the year before you hit menopause. They don't understand it's like a long. It's a good decade of your life. That can be rough if you're not getting help. I do, of course, see many of the other symptoms that you hear about that are really weird, like really really dry eyes or really itchy skin or heart palpitations.
Speaker 2:Weight gain. I'm going to throw that one out.
Speaker 1:Oh my Lord, we could talk a long time about that. The weight gain is really obviously very distressing for people, both because they feel horrible and their self-esteem is affected, but also because they know it's a major health risk and because you know, they apply logic, which is, you know, calorie restriction, some adjustments to their diet, maybe no more alcohol for a while, increased exercise and not a lot happens which we can speak to. That that's an interesting combination of forces and a whole bunch of different hormones that are interacting that cause that problem. What is more significantly interesting to me is that women who are post-menopausal it is not like that, no, you're not okay, you're not going to have like the body that you had when you're 30, obviously Right, but you're not.
Speaker 1:It's not because you don't have the bouncing around insulin and the bouncing around cortisol, right. So your blood sugar hormones and your stress hormones are doing a lot of weird things, which causes this belly fat. And also, in end stage, perimenopause, for a few years, estrogen, you know, can be high, which causes some of this belly fat too, and so I could go on. There's a lot of things happening which makes sense, which makes it very difficult right to lose, but it is easier to get leaner and stronger. There's a lot less drama and disorganization when you're just post-menopausal. Bring it on then please.
Speaker 2:It's a good news story. Well, I can't wait. Actually, you know what? I thought? I was getting really, really close. I was like eight months into the countdown and then it's now.
Speaker 1:it's back every month and you know, it's just the biggest burn it really is. I just thought, oh, I'm not counting this. And then my menopause doctor was like yeah, you know we are.
Speaker 2:I was like nope, you know better it didn't happen.
Speaker 1:It didn't happen. I'm writing it down. I was like delete it's not. You know, at the end of the day, that one year thing is, it's just because we have to put a stake in the sand somewhere, right? Because postmenopausal bleeding isn't normal.
Speaker 2:Kirsten, I actually listened to a clip this week from Dr Louise Newsom where she was saying that menopause is one of the few things that require a full year before you can get diagnosed with it that require a full year before you can get diagnosed with it.
Speaker 1:It's an interesting thing, though, right, because you know a diagnosis right. It's like menopause and perimenopause can cause a lot of destruction and a lot of collateral damage, but they are not a disease. What's more important than the semantics around all of it right Is just that until very recently, there's been just no effort to educate physicians and other healthcare providers and women about the scope of it. It's multi-system, it's your whole body. It's not just your ovaries and your uterus and your breasts Like it's. It's an epic whole systems transformation. That happens, you know, relatively speaking, kind of quickly. Obviously, as with everything in medicine, there's a continuum, and some people have perimenopause light and some people get eaten up by it.
Speaker 2:We've highlighted a lot of the issues that women go through in perimenopause and I understand you've got this really great new program out the Peri Collective and it's to support women through this transition. I'd love to know more about that.
Speaker 1:In full honesty, out of just me being, day after day after day, just feeling a lot of anger, to be honest, and a lot of despair over what I was seeing right, which is that women were going through what was clearly perimenopause and going and advocating for care and not getting it or getting misdiagnosed, or getting prescribed sleeping pills, antidepressants, weight loss medications I mean all kinds of different medications because they were seeing their health slowly slip away.
Speaker 1:And what happens when you have gone through that? And it's very destabilizing because you don't feel like yourself. You haven't for a long time. One of the very classic symptoms is insomnia. So obviously, if we're not sleeping, everything crumbles. And then you go and you have the courage to go and push for solutions and answers and you're getting exactly nowhere.
Speaker 1:Dismissed or prescribed medications, you know, have a bad risk benefit ratio and also they're not even helping. Yeah, and then you come and you and there are others of course there are many people like me but you you get with somebody who's trained and you recover. It's's very emotional for people. There's a lot of upset, right, because they sometimes have lost years of their life to being a complete mess and have developed other health issues as a result. So it really starts to wear on you, you know, after years and years, and I've been asked to make the program by people and recommended. So finally, like it was hard to do, right, because I had to create it on top of my day job, which is seeing patients, which is hard and I have a little kid. But I slowly, slowly wrote it and then I slowly found the right people to help me produce it and you know, the feedback has been really good and what I wanted, my vision, my hope for what it is is that people can transform and get a hold of their health and take charge of it.
Speaker 1:You know, and I wanted that, because I get requests from all around the world pretty frequently, and so I wanted whether you're in Dubai or you're in Denmark or you're in England, I wanted for women to be able to get it sorted out, get appropriate care, understand what labs they need and what labs they don't understand, what, what, what is the research on exercise, you know, for for us during this time, what? What is the research on nutrition? What, what does matter? Because there's so much, you know, the space is also heavily polluted by people who who are, you know, not really experts, but they're really good at marketing. I'd say, net for net. There's mostly positive out there, but still it's just very overwhelming for people.
Speaker 1:So, for me, what is required, even for my patients right, is not just me chucking recommendations at them is people don't do well with that. I learned that there has to be some education. They have to understand the ways in which their metabolism has changed, the ways in which their stress physiology has changed, so that they understand that when I'm advising them to do X, y, z, I really mean it. You know it's not just about going and taking HRT, it's just not. There's a few other things that you need to understand and learn about. But every module that I have, you know, there's like there's a summary, then that's like you got to do this, this, this, and so. So far, so good. I mean, the feedback has been excellent.
Speaker 2:What are some of the?
Speaker 1:modules. There's one on metabolism, the metabolic changes. There's one on exercise physiology, stress physiology which supplements and vitamins actually matter. There's a module on labs. What do you actually need? What is a lot of hype in marketing? What is the research looking at? What are you going to get the best traction with? If you're advocating for yourself, what do you need to ask for? So there's one on labs. Then there's, of course, there's a big beast on HRT. At the end there's a module on advocacy and learning how to really just get it done.
Speaker 1:You understand now what's going on. You understand that there's solutions and they're attainable, but there are pieces of it where you are probably relying on a healthcare provider. So how do you speak to them? And then there's also a module just on the psycho-spiritual component, which for me is like I actually get butterflies when I think about it and when I wrote it and reread it, and when I wrote it and rewrite it and when I deliver it because it's there's just there's all the details about the problem.
Speaker 1:You know the challenge. It's hard. That was not a vibe that I wanted to be. You know, rolling out Like I want it to be solutions oriented and I wanted to give a module, a chunk of time, to what is the bigger story, you know, in terms of our development as a person and in terms of, you know, radical acceptance over time around aging and learning to like really put a lens on gratitude. I really do see quite a metamorphosis happening with most people. That is ultimately super empowering.
Speaker 1:There's a whole thing that happens to people where they have a reconnaissance with themselves and are like wow, like if I'm going to be okay and if I'm going to be happy, I really it's on. I need to put into me and you know I say that from experience because I take care of people for a living. I do a lot for my family members. I solo parent and chose to, so I'm like the poster child for really having to learn to take care of myself during this crazy intense experience. I really the perimenopause part is the is the messy, dramatic part. The post-menopause part yeah, there's things like in I'm writing that course now. You got to do a unit on cardio. You got it. Bone health, vaginal pelvic floor health, you got to all that. It's not like you're it's your ticket to like the free ride no, but it's not. It's not as complicated and it's not as up and down, it's just not, and women tend to have arrived emotionally in a really a much, you know, a much stronger place, which is really fun to see.
Speaker 2:That's amazing. That sounds incredible and I feel like all of us on this call right now are like oh yeah, I need some of that. The tips and tricks that you're sharing at the end of each chapter you need to, or at the end of each module you need to, is it things like immediately in my head, I think God jumps to like learn to sleep better or prioritize sleep, or is it things like that? Or is it different for every woman? Is it different for every module? Are there any common threads that you could advise our listeners? Like, if you're suffering right now and can't get into the program tomorrow, here's what you could start doing today.
Speaker 1:Sure, these biochemical changes happen to all of us, right? So, because there's a lot of hormonal pivots and adjustments that are happening, even beyond your sex hormones, right? One of them is cortisol, which is a stress hormone it has also it's a critical circadian rhythm hormone. You know it comes up in the morning. And hormone you know it's comes up in the morning and then slowly throughout the day it goes down and at night it has to go low so you can go to sleep.
Speaker 1:So some examples that are simple would be with cortisol, you want to have, like you said, all the sleep hygiene. So a completely black room, a cold room, no digital, no screens, no screens for a good hour and a half two hours before bed. This, all of this has research right. For a good hour and a half two hours before bed. This, all of this has research right. And you know, getting up in the morning and sitting in the window, even if you're in the winter time and the sky is gray, just if your retina sees the sky, it tells your brain okay, let's go, we've got to make cortisol. But the other thing is exercising. And going back to the belly fat, a really useful thing to understand is that during this time in perimenopause, useful thing to understand is that during this time in perimenopause, it does not help you to do intense cardio, which a lot of people, I might add, are frantically doing because they have belly fat and they're like what the hell?
Speaker 2:Well, and that's what we learned in our 20s, right, that's our era.
Speaker 1:Right, we actually do. Yeah, you're right, we do come from kind of a cardio focus. I'm going to fly away on the spinning bike, I'm going to go. I mean, that is what we come from. But here's the little nugget that is helpful to know, which is that cardio, if you're going much above your sort of moderate intensity, will stimulate cortisol to come high.
Speaker 1:Why do we care? Because that causes sugar cravings, it harasses insulin, your blood sugar hormone. It causes weight gain and that is already a problem because of other things that are happening. So the last thing you want to be doing is exercising in a way that's contributing to the problem. So what you need to be doing, per the research and there's an excellent scientist who has dedicated her career to researching exercise physiology in paramenopausal and menopausal women Her name is Dr Stacey Sims and she's phenomenal because she's given a lot of time to this area and we deserve that, because we got unique things happening but what helps you is to not do, you know, super intensive cardio and to lift weights.
Speaker 1:It doesn't mean you can't go on a walk. It doesn't mean that you can't do Pilates or yoga, of course. Of course you can, but you don't want to be, you know, running an hour four times a week, because you're just going to have problems that don't make sense with your weight and with your sleep and with your energy, because cortisol is doing weird things. Why the weights? Weights? Because estrogen is declining in a very erratic way, but net for net on each month. You're making less and less as you approach menopause and estrogen has three or four things, three or four mechanisms for stimulating growth factors and growth hormones and therefore muscle, and so one of the things that affects your ability to manage your metabolism is muscle loss, which starts to happen at about 40. So lifting weights to make sure you're not losing muscle but even maybe to build a little bit, means that you're burning more. Your basal metabolic rate is spinning a little higher. Well, that helps you when you're in this fat storm from hell in your forties, right?
Speaker 1:So just these are the types of things that I teach what's happening, and then there's sort of an executive summary of, like what are the things you therefore want to do? Now that you understand what does the science say? Like, I'm interested in the intersection between what I see, because I've been doing this a long time before. It was cool, you know, and so sometimes I report on science to people but I'm like I don't really see this. I don't see this clinically. Yet I think we'd all like to think that really high quality trials, you just see it and it translates into real people. But clinically things sometimes are not perfect.
Speaker 3:Well, and to be fair, we don't have enough trials, we don't have enough research we have, we're barely scratching the surface, right.
Speaker 1:We have so little in terms of science and it's a hard thing to hear. You know how deprioritized it has been is difficult for all of us. I mean, I honestly think about this in terms of my heart and the ethics of how to sell the program, because I really want to. I really would like it to get all over the place to help people, because I think it really will, but it's like I don't want to be making people feel sad. But the truth is we got to be honest and the honesty is important because it's a huge change that requires, like it's, a different playbook. If you're honest about it and you help people and they cross the other side, then there is a lot of power in that.
Speaker 3:I was going to say the same thing, kirsten. There's a huge amount of power in that and the understanding that there are things that you can do about this and there are things within your control. And I think, probably most importantly, something that we've never really understood is that we have a choice, and we should have a choice about our healthcare and how we want to take care of our bodies, and we just haven't been given that opportunity. And so what you're doing is, instead of saying, well, you need to exercise more, you need to do this, you're explaining what's going on, what the science says, and here are your choices, and I don't think there's a human alive that would walk away from that feeling sad.
Speaker 1:Well, I mean, they came away from it feeling actual massive relief, to your point, because they understand what's happening to themselves and they understand the options for actual, real solutions Like this will work. This, this medium, this, this absolutely it's more. Just that when we're talking about it it can be sort of sad, right, Because a lot of the as you guys know, a lot of what's out there on social is it's kind of sad or it's kind of scary. It's like we have been forsaken. There's no research, there's misogyny in medicine, which there is, of course. I just don't want people to give up or feel like it's too much, or feel like they can't because they can.
Speaker 3:They can. I think they'll get riled up and, frankly, that's what we need, because the only way we're going to affect change and make it so that the system is doing what it should be doing for us is if each of us demands better, and you can't demand better until you know. So I say riled up, not sad.
Speaker 1:Yeah, well, I appreciate that. I think it makes me feel better because I think you either have to kind of take on getting educated or you're going to pay quite dearly. That's the reality. What's hard for people, especially in the Canadian space, is that we come from this beautiful public healthcare space where we're used to just taking direction and having an incredible amount of faith in that, and it's been really hard for people to kind of come face to face with the fact that they actually know about perimenopause a lot more than their doctor. Like that's very alarming for people and that's the reality. And and you know, I think that will change but it's going to take for a whole generation of people. They're going to be swallowed up and spat out by the time that change happens, because it really has to happen in medical school.
Speaker 2:Right? Well, it's already happened. There's already been two decades where women weren't receiving potentially the care that they needed.
Speaker 1:Yeah, and that's another huge demographic for me is every week I have a few people who are in their sixties who are getting hit with all this information.
Speaker 2:How angry would you be right If you've been suffering for 20 years and suddenly now people are talking about it? I think I'd be fierce, fucking mad.
Speaker 3:Fucking mad.
Speaker 1:I also think I know this sounds dramatic, but it's kind of horrifying, Like I think we understand about feminism or about misogyny in so many industries, but it's really gross to think about it in medicine. So yeah, there's a lot of upset about that, to say the least, to think that they could have had much better bone protection. Listen, you know, at the end of the day, heart disease, by quite a margin, is the number one thing in Canada that kills women, way more than cancer. And we are not on the books yet as saying for sure, 100%, because we don't have freaking studies. But it reduces cardiovascular risk. But it sure looks like it on my end. Who's doing it all day with patients and looking at labs and looking at how their bodies change and looking at what happens to their bodies if they pull themselves off HRT because somebody scared them. Like it sure looks. I'd put my money there. But the truth is, at this point we don't have enough science to just fully say that Bone health, as you guys know, we're allowed to go on the books and say with great certainty it reduces risk a lot.
Speaker 1:You know a fracture, which is the second thing, that kills women. Women don't? They're like what do you mean? And that's because you could just be standing chopping a fricking cucumber and just your hip snaps. That's osteoporosis. It's not necessarily that you fricking rolled down the stairs.
Speaker 1:Heart disease is silent, bone loss is silent and the education that we get is just piss poor. It's not even, it's not a priority. The big thing that is three times more common in women is dementia, and that is also we know. There's Dr Lisa Moscone who's doing a lot of important research looking at estrogen's relationship to dementia. We are again not on the books as saying that HRT or estrogen officially reduces the risk of dementia, but it's looking awfully like it might one day. My point is, an entire generation or two of women, as you just said, were yanked off because of the Women Health Study Initiative and a lot of women received almost nothing for surgical menopause. They had to get a radical hysterectomy uterus and ovaries out at 40. And they're given like oh, you can only have this for two years. That's insane To leave somebody with no hormones at 45, like so so the reality is.
Speaker 1:there's a huge wave of people like me seeing women who are older, seeking answers, seeking clarity. Can they start it now and again the conversation is difficult because we just don't have enough research. But the research looks like it is a risk if you restart or you, you you never on it and you start if you're over 60 or more than 10 years post-menopausal. Because there's not awesome research, it's put. It puts people like me in an awkward position Cause I'm like well, this is what the studies really are showing. And here's the position statement from the menopause society. This is what they say when we're talking about a stroke. We would like a concrete yes or no, and what's interesting is if we perceive that they are having a list of symptoms. That really could be, because, pete, you can very much still have symptoms in your 70s from not having estrogen. That is a reality that shocks people. It's not just this five-year heinous party that you're having.
Speaker 3:No, it is more acute in the years following menopause. Can we also just add in the vaginal symptoms? Those for sure don't get better and that's also totally ignored.
Speaker 1:Oh, my God, we could do a whole thing on the genital urinary syndrome and menopause, because that also sends me into outer space. I really rage about that because I've had so many patients, so many patients who get misdiagnosed and I don't even understand how, oh, I have the best gynecologist in Toronto. I'm like, do you in Toronto? I'm like, do gynecologists are heavily focused on disease, tumors and problems and cancers and fibroids and they got a lot going on. But like, have they had any training in menopause care? No, I don't think so, cause like I'm the one diagnosing stuff and I'm not even in their junk. I can, I'm trained to do all that, but I don't.
Speaker 1:I work remotely these days, so I mean I'm constantly like no, no, no, that's it's you know. I mean when you have females who aren't even sexually active and they're getting chronic urinary tract infections, it's a huge red flag that gets misdiagnosed all the time and that repercussions are serious because they are on cycles of antibiotics and then they have a massive yeast problem. Also, the other thing that gets misdiagnosed is a little bit of special times with a continent, right, so you sneeze and you pee your pants. I mean I don't know if anyone has been on a trampoline lately, but that's not Not for years.
Speaker 1:I am making weird faces because I'm clenching so badly so I don't pee my pants on the trampoline with my son. There's a huge role for pelvic physio, but there there's no amount of kegels, sister, like they're. The whole pelvic floor is littered with estrogen receptors. If your tissue is changing and you're not in front of it, it's not just painful sex, it's a disease you know that's coming at you, that you have to manage. So I get very mad about that. This isn't just about pelvic floor physio and it's not just about hammering someone with a repeat for antibiotics. Yeah, the genital urinary syndrome, menopause, is a collection of really, really shitty symptoms and it can start young and that is very poorly understood in women and in doctors, whether they're nurse practitioners, nurses, gps, gynees. So people need to know about that.
Speaker 2:If someone's listening to this thinking, oh my God, that's me. What should they do so?
Speaker 1:what you would do is go to your GP. You don't. You could go to a gynecologist, if you have a gynecologist, but you can go to your nurse practitioner or your doctor and you can advocate to do a trial to just get a few months of vaginal estrogen, which is a prescription in Canada and vaginal estrogen is safe for everybody. In fact, in many parts of the world it's over the counter because it's so safe. So you would advocate for that because there is no risk right and you will know pretty quickly if you're getting frequent infections or pain or stress, incontinence or you will notice that you start to feel better very, very quickly. Everyone should be offered it. I would like to iterate that this doesn't mean that you're two years away from hitting menopause because you need vaginal estrogen supporting your 40. No, it just means for you in your body. You're at that threshold where some weeks, the output that you're making is just dipping for you in your body. You're at that threshold where some weeks, the output that you're making is just dipping for you.
Speaker 3:And I think too, maybe we could just add this gets back to the problem with healthcare and how we're served that the FDA is insistent on vaginal estrogen having the same black box warning as systemic estrogen, even though it doesn't have the same risk profile.
Speaker 1:I just can't wait. There's so many things I just can't wait because I don't. I have to have these conversations over and over again and it's insane. So it's not just with vaginal estrogen. They have dated pamphlets. Okay, it's every single human, identical bioidentical estradiol product. So systemic estrogen, all of the. You know there's a bunch of Health Canada approved or in the US, fda approved estrogen products that have warnings on them that are like 25 years old, you know from the Women's Health Study Initiative, that terrorize people. Right, and vaginal estrogen, to your point, gets the same pamphlet, basically, and it's very upsetting that they have these stupid dated pamphlets that terrorize people.
Speaker 2:Kirsten, before we go. I think that your Perry Collective is an invaluable resource and I would love every woman to be able to connect with you on this. So can you let us know, like how do they find out about the program? Can anyone join? When is the next session starting? Tell us everything.
Speaker 1:Yes, thank you so much. It would bring me a lot of joy to get it out there. So the next round where I will be live on Wednesday evenings, and it starts April 24th of 2024. It's five Wednesdays at 7 pm Eastern Standard Time. It's available to anyone around the world, but it is at 7 pm Eastern Standard Time on Wednesdays starting April 24th. Each night. It's about two hours because I am presenting for an hour, an hour and 20, and then I leave a lot of time for Q and a, because I have learned that that has been of great value and really fun as well.
Speaker 1:So, and then at the end, everyone gets to choose to to jump into a private Facebook group, which is where all the alumni who have taken the course and I'm soon I'm going to start to pop in there live every couple of weeks to give people access to me, but the way that you can find it is through my Instagram or through my website, of course, or through Facebook Pericollective. Also, after this next round this spring, we're going to be recording it so that people can buy it and do it self-paced. Oh, I love that. So I'm going to have the option of being with me, which will cost a bit more because obviously I'm there and there's the Q&A. And then for people who want to do it at their own pace, they can buy the course with all the recordings, minus the Q and A, obviously for privacy reasons for the people who are asking questions. So they can buy the whole course and do it. You know, like any of those courses, do it at your own pace.
Speaker 2:Oh, that's great. I love that option. Kirsten, what is the one thing you would want every woman in their thirties, forties, fifties, their 30s, 40s, 50s to know about perimenopause?
Speaker 1:For women in your 30s. It starts a lot earlier than you think For women in their 40s. You have to get educated. You cannot rely on the care that you're getting. You have to read a book, take a little program, listen to some doctors. You also want to be discerning. Who are you listening to? Is it a fitness trainer? Is it a dietician? Is it a doctor? Is it a naturopathic doctor? Please be discerning.
Speaker 2:And are they selling?
Speaker 1:products. Yeah, I mean selling. I'm also going to be selling my program, right, but so selling is a part of life. But to your point, like if you're buying a program from someone who's just selling tons of herbs and is not a trained herbalist, like I just think the internet is full of sort of pseudo experts in any discipline, in anything right, and so you just have to be like like, who are you getting your information from and what are you spending your money on? And you know, understanding that we can rage about it, all we want and I do rage about it, but you have to take it on to get educated about how this works and what your options are and what the research says. And then you have to be prepared to, you know, kick a bit of ass. You got to be prepared to advocate for yourself and you have to be prepared to, you know, kick a bit of ass. You got to be prepared to advocate for yourself and you have to be comfortable with it. That is the reality and it's not going to change in the next few years. It's going to take longer.
Speaker 1:For women in your fifties, it is not too late. You must do the same, you must get educated about it. You must find a menopause perimenopause literate, naturopathic doctor or medical doctor or gynecologist or nurse practitioner. You must find someone who has done extra training. It is not too late. There's all kinds of things that are very, very important that you can do to reduce risk and you need to do it. You need to do it. And for people who are in their 60s, same thing. No, it's too late for me. No, it is not. You need to get into some good quality care.
Speaker 2:I love it. Thank you, kirsten. Thank you, 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.
Speaker 3: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 healthcare 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 healthcare practitioner.
