314: 3 things every woman can do RIGHT NOW to manage Perimenopause - Dr. Stacy Sims [PART 2]
Perimenopause and hormone therapy: what you REALLY NEED to know.
This is PART TWO of my conversation with Dr. Stacy Sims.
🎧 Episode 310 was PART ONE - get it here.
In this episode:
- Three things every woman should be doing RIGHT NOW
- Revisiting Zone 2 cardio and why it's not optimal for perimenopausal women (but great for men) - we talked a lot about this in Part 1!
- The average age of perimenopause and what to expect in terms of symptoms
- Introduction to hormone replacement therapy ... now "menopause hormone therapy"
- What to do about loose skin and lack of muscle tone
- Treating vasomotor symptoms (eg hot flashes and night sweats) with SSRIs, antihistamines and metformin
- The possibility of using adaptogens to minimize symptoms
By understanding our options, finding the right support, and making lifestyle changes, we can navigate this phase with grace and vitality!
SHOW NOTES: https://www.onairella.com/post/314-managing-perimenopause
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Transcript
Unfortunately, our society puts such a negative slant on women getting older, but we have a wealth of information to share.
Speaker A:And so by making menopause a scary thing, it kind of shoves all the women back into their little box.
Speaker A:And we don't need to be shoved.
Speaker A:We need to take up space, and we need to talk about things and make it normalized.
Speaker B:Welcome, you're on air with Ella, where we share simple strategies and tips from people who are doing something better than we are.
Speaker B:Whether it's wellness or relationships to just living better and with more energy or changing your mindset to accomplish more in your own life and succeeding.
Speaker B:However you define it, this is where we share the best of what we're learning from the experts, and we're learning more every day.
Speaker B:Live better start now.
Speaker B:Let's go.
Speaker B:Hey, you're on air with Ella.
Speaker B:And I am absolutely thrilled to welcome back to the show Dr.
Speaker B:Stacy Sims.
Speaker B:Hey, Stacy, how are you?
Speaker A:I'm good.
Speaker A:I'm excited for part two.
Speaker B:I know.
Speaker B:Listen, we are gonna jump in pretty cold, so I hope you warmed up already with episode one, part one with Dr.
Speaker B:Stacy Sims.
Speaker B:I will tag it in the show notes.
Speaker B:But let me tell you something.
Speaker B:I often meet brilliant, brilliant people on this show, and I just want to download their entire brain, all of their work, all of their research, and have them on the show over and over again.
Speaker B:Very rarely do I need someone back almost instantly because we created such demand and we had so questions.
Speaker B:So, Dr.
Speaker B:Stacy Sims, thank you for coming back and thank you for everything that's about to happen.
Speaker A:Oh, you're welcome.
Speaker A:The more we talk about it, the more people know.
Speaker B:I hear you.
Speaker B:I hear you.
Speaker B:I'm here for it.
Speaker B:Okay, so you guys, I asked you for questions, and I told you in part one that I had questions.
Speaker B:We did not even get to.
Speaker B:Those questions largely center around hormone replacement therapy.
Speaker B:So you can expect a great many questions around hrt.
Speaker B:But first, we're going to start with questions that rolled in after part one.
Speaker B:Stacy.
Speaker B:And let's just start with exercise.
Speaker B:I got blown up.
Speaker B:This must happen to you every day.
Speaker B:People are like, what do you mean?
Speaker B:No, Zone two.
Speaker B:And just.
Speaker B:Just to refresh everyone, Stacy, can you refresh us on what is zone two exercise and what your recommendation is in the big picture?
Speaker A:So zone two is making the rounds conversation about how it's low enough of an intensity that it's more recovery.
Speaker A:And it's supposed to.
Speaker A:And I say it's supposed to increase mitochondrial health and density.
Speaker A:So the idea is that it'll make you more metabolically flexible, it'll increase your body's reliance on free fatty acids and it'll make your body more resilient to oxidative stress.
Speaker A:So that's what Zone 2 training is supposed to do.
Speaker A:So when someone asks me about Zone 2 training and they're not specifically an endurance athlete, I'm like, okay, if you're a guy, do it, because then you'll become more like a woman.
Speaker A:But if you're a woman, you don't need to do that because by the nature of being born xx, and this isn't even with estrogen coming on board, which helps.
Speaker A:But we already have more mitochondria.
Speaker A:We have more mitochondria density and, and this is across all tissues, not just skeletal muscle, because mitochondria is everything.
Speaker A:And mitochondria is very, very specific to sex.
Speaker A:So XX versus xy.
Speaker A:So when we look at what the XX chromosome has, it encourages mitochondria to be protective against oxidative stress.
Speaker A:It increases mitochondrial protein content for free.
Speaker A:At free fatty acid oxidation, we already are maximally capable of using free fatty acids.
Speaker A:And then when you add estrogen on top of that, it increases the health and well being, so to speak, of mitochondria across all tissues.
Speaker A:So when we're looking at zone two training, you don't have to spend hours and hours and hours of doing it because your body is already there.
Speaker A:And we talk about metabolic flexibility.
Speaker A:Women are already metabolically flexible just by the nature of being women.
Speaker A:It's men who need to do the zone two training, the fasted training to encourage their body to use free fatty acids.
Speaker A:But women are already there.
Speaker B:I mean, in my humble opinion, Mother nature has not given us too many advantages.
Speaker B:Like there are very few things where you're like, no, no, we got that.
Speaker B:So maybe we should take the win on this one.
Speaker A:I'm taking it.
Speaker A:If you are an endurance athlete, then it's not about zone two training, it's about making sure that you are actually polarizing your training so that when you were supposed to do easy aerobic work, you're actually in the zone one.
Speaker A:So people are like, oh, zone two training.
Speaker A:But they end up going too hard.
Speaker A:So they end up more in that upper like zone three where it's too hard to be easy, thinking that they're in quote, zone two.
Speaker A:So I'm like, no, easy is easy.
Speaker A:Where it's like 80 watt ride and people are like what?
Speaker A:No, that's so low and easy.
Speaker A:But that's the idea.
Speaker A:It's about time on the feet, but not stressing the body.
Speaker B:Okay.
Speaker B:And I admit I struggle and because as a.
Speaker B:I don't know if I'd call myself an endurance athlete, but I do multi sport personally, I mean.
Speaker B:Cause you talk to people who do like 50 mile races and like, that's possible.
Speaker B:Yeah, she's.
Speaker B:She's not that.
Speaker B:Okay.
Speaker B:But I have to deprogram myself because.
Speaker B:And by the way, I hope you've already listened to part one, because we go into a great amount of detail about what to do instead.
Speaker B:And we'll just say for the sake of brevity here and not repeating part one, we're talking shorter, more intense, weighted workouts.
Speaker B:Is that a fair summary?
Speaker A:Yeah.
Speaker A:And I'm writing a piece right now on mitochondria health in women.
Speaker A:And we see that resistance training enhances mitochondrial density and mitochondrial function more so in women than in men.
Speaker A:So resistance training becomes really super important from that health aspect where everyone's talking about mitochondria for health and mitochondrial outcomes and mitochondrial resilience and all that stuff for health, it's resistance training and that polarized training, because both of those will actually encourage mitochondrial density.
Speaker A:And if you're looking at increasing the amount of mitochondria you have, that's what you want.
Speaker A:Not the Zone 2 stuff, because it's kind of pointless for the most part, because all the things that they say zone two does, women's bodies are already capable of doing it.
Speaker B:Okay.
Speaker B:And I didn't really finish my thought.
Speaker B:I distracted myself.
Speaker B:But basically, Zone one, that's challenging.
Speaker B:That.
Speaker B:That's almost like moving just for fun.
Speaker B:Stacy.
Speaker B:And that takes a lot of reprogramming in a lot of our brains.
Speaker A:It does, it does.
Speaker A:I've had a lot of people, like, use a watt bike or Zwift, you know, just to understand what it means to be in zone four versus Zone one.
Speaker A:Because if they're out on the road and themselves, they don't.
Speaker A:They can't put that together if they haven't actually seen the numbers and understand what zone one feels like.
Speaker A:It's like feeling like you're not doing anything.
Speaker A:And zone four is that threshold work, right?
Speaker A:Where it's really race specific.
Speaker A:And then you can get to the upper echelons when you're looking for health outcomes.
Speaker A:But it's really hard because people are like, oh, well, I'm going on rating of perceived exertion or using my heart rate, and those don't quite hit the mark.
Speaker B:Okay.
Speaker B:I had a listener ask what I think is a really good question.
Speaker B:She said, how do I know the workout schedule or, excuse me, the workout structure that I should follow?
Speaker B:Do I need to get a hormone test or some sort of test to know where I am?
Speaker B:I'm assuming I can't just go by my age since women experience perimenopause at different ages.
Speaker B:That's a good question.
Speaker B:What would you tell her?
Speaker A:Blood tests don't really tell you anything.
Speaker A:And what I really try to advise people is we see that the average age of menopause is around 51 and in your early 40s.
Speaker A:You can still kind of get away with the kind of training that, that you're doing in your 30s, but you'll start to see that it's not quite working for you where you're like, I'm not quite getting the training adaptations.
Speaker A:It's taking longer, I'm holding onto a little bit of extra fat or I'm not sleeping or recovering as well.
Speaker A:These are all signs that if you are not in low energy availability, these are all signs that, yeah, okay, your body's changing.
Speaker A:We need to change up some of the training.
Speaker A:And it's not a bad idea to really start implementing times of heavy lifting and looking more at that top end sprint interval training so that it doesn't come boom, all of a sudden and you have to change it up.
Speaker A:It's like, let's implement and phase it in and make that part of some of the blocks that you're doing as you're getting raced, race ready or race specific.
Speaker A:Because then it's just a natural transition into doing more of that and less of the volume.
Speaker B:Okay, this is slightly duplicative, but I want to share another.
Speaker B:I want to synopsize a few questions that I got, and that is one, how do you know if you are in perimenopause or not?
Speaker B:And then two, how do we ensure we're not ignoring something else, assuming that it is associated with perimenopause?
Speaker B:And then she names symptoms like itchy skin, itchy ears, bruising, easily stronger sense of smell, etc.
Speaker B:Etc.
Speaker B:Can you take both of those on?
Speaker A:Sure.
Speaker A:So it's.
Speaker A:There isn't a definitive point where we can say, yes, you are totally in perimenopause because it is very arbitrary in the fact, like we might have women who are younger than 40 who are having primary ovarian insufficiency.
Speaker A:So that's like really early menopause.
Speaker A:You might have surgical menopause where all of a sudden, boom, you wake up after surgery and you're in menopause, Right.
Speaker B:Any kind of surgery or, like, a hysterectomy.
Speaker A:So if you get both ovaries removed, okay.
Speaker A:You wake up, and boom, you're in menopause.
Speaker B:Okay.
Speaker A:And you also have some chemotherapy and radiotherapies that will damage the ovaries to the point where they're not working, and that might resume or it might not.
Speaker A:So there's lots of different things that will create menopause.
Speaker A:So when we're talking about natural age, onset of perimenopause to postmenopause, we have a guideline of ages.
Speaker A:But if we look at what our moms went through, what our grandparents went through, what our sister went through, we have sisters that can kind of give you an idea.
Speaker A:But we also know that lifestyle plays a huge factor.
Speaker A:The fitter you are, the less symptomology you have.
Speaker A:But the big telling thing is changes in your menstrual cycle, in your bleed pattern.
Speaker A:So we'll start to see, like, your actual cycle might stay the same length, but the bleed pattern actually changes.
Speaker A:Where we start to see more spotting or heavier bleeding for two days.
Speaker A:So your regular pattern is changing within that five to seven days of bleeding.
Speaker A:So that's where we start to go.
Speaker A:Oh, okay.
Speaker A:Something is running a miss here.
Speaker A:Or if you start to have irregular cycles, shorter cycles, then that means that there's more anovulatory episodes happening.
Speaker A:So this is a good indication that you're getting into that perimenopause.
Speaker A:When you go to a physician and you're like, I don't know what's going on, and they start running a list of symptoms, they'll go on a symptom chart, and they'll say, vasomotor symptoms.
Speaker A:Yep.
Speaker A:Okay.
Speaker A:Definitely perimenopause problems, sleeping insomnia, brain fog, vaginal dryness, problems with cognitive focus.
Speaker A:You're having more issues of loss of lean mass, loss of bone density, more stress reactions, There's a whole bunch of symptoms that they'll go through on this checklist.
Speaker A:And depending on how many you say yes to, then they'll make that definitive diagnosis of.
Speaker A:Yeah, perimenopause.
Speaker A:But when we really look down to it, when women hit that age of 45, you're pretty much in it.
Speaker A:You are pretty much in it.
Speaker B:Okay.
Speaker B:All right.
Speaker B:What would you tell itchy skin, itchy ears, Like, I want her to get fully checked out.
Speaker A:Yeah.
Speaker B:Especially if she's bruising very easily.
Speaker A:Yeah, bruising easily.
Speaker A:And then having skin episodes.
Speaker A:Those aren't normal symptomology.
Speaker A:Of perimenopause.
Speaker A:So that's something to definitely get checked out.
Speaker B:Okay.
Speaker B:And isn't everything you just said applicable as well?
Speaker B:For those women who have had a hysterectomy, by the way, that's the same.
Speaker B:Are they in the same boat as the.
Speaker B:As the surgically induced menopause?
Speaker A:So if you've had a hysterectomy and you have not had your ovaries removed, then you follow the same natural progression as women who are naturally cycling and have not had any kind of surgery.
Speaker A:So I'll get questions of I had a complete hysterectomy.
Speaker A:Do you still have ovaries?
Speaker A:Yes.
Speaker A:So just your uterus is removed?
Speaker A:Yes.
Speaker A:Okay.
Speaker A:Well, you can track your cycle using basal body temperature because you are not in surgical menopause.
Speaker A:If you've had one ovary removed, you are not in surgical menopause because you still have one ovary that's functioning.
Speaker A:If you've had both ovaries removed, then, yes, you are in surgical menopause.
Speaker B:Okay.
Speaker B:Okay, let's switch gears, because I had some questions about that loose skin that women get, and I'm sure men get it too, but we're.
Speaker B:We're not talking about them right now.
Speaker B:And that is sort of crepey skin and loose skin so that even when you're working out and you're lifting and you're starting to develop muscle, some women complain that that's still not yielding the tightness that they want to see.
Speaker B:And I understand this in two ways, and I might be wrong, Stacy, but one is like a general flappiness, which is a lack of muscle tone, which can be a frustrating consequence Right.
Speaker B:Of this phase.
Speaker B:But the other one is actually like the skin texture itself.
Speaker B:Can you comment on both?
Speaker A:So we lose collagen.
Speaker A:We lose it rapidly when we hit magnet because our body's in such a stressed, sympathetic breakdown state that we go through a lot of collagen and we lose it.
Speaker A:Some collagen supplementation helps, but might not.
Speaker A:And it is just the fact that our body isn't creating as much collagen as it should.
Speaker A:So that crepey skin, that dehydrated look, it's there.
Speaker A:So we can counter it by making sure we stay hydrated.
Speaker A:You can have more animal products have collagen in it.
Speaker A:You can look at collagen supplementation, but really it's like, what kind of building blocks are we going to bring in to encourage our body to create more collagen?
Speaker A:And that's zinc.
Speaker A:It's vitamin C, it's copper.
Speaker A:Those are all some of the building blocks that help with collagen production.
Speaker A:So it's not necessarily taking the supplementation.
Speaker A:Yes, it does work for, like, joint health, but when we're looking for skin and, like, vaginal dryness and that kind of stuff, the collagen supplementation doesn't necessarily work.
Speaker A:So we want to make sure that we're providing our bodies with the building blocks.
Speaker B:Okay.
Speaker B:That's the first I've heard that zinc, vitamin C and copper are tied to collagen production.
Speaker B:That's new to me.
Speaker A:Absolutely.
Speaker A:Yep.
Speaker B:Okay.
Speaker A:So whenever you feel like a vegan collagen booster, because there's no such thing as a vegan collagen because it comes from animal products, a vegan collagen booster usually has spirulina, zinc, copper, vitamin C.
Speaker A:And the spirulina is because it has so many trace minerals and protein and other, like, compounds that can help with collagen.
Speaker A:And then the zinc, the vitamin C and the copper are all essential for helping collagen production.
Speaker B:Okay.
Speaker B:And I will remind you that in part one, we really go into collagen supplementation, folks.
Speaker B:So you're saying.
Speaker B:And.
Speaker B:And.
Speaker B:And I' won't.
Speaker B:We won't repeat it, but summarize it.
Speaker B:And what you said at the time was, collagen supplementation may, in fact, be beneficial for joint health and that element that collagen is known for.
Speaker B:But if you're looking for healthy, glowy skin, you might be barking up the wrong tree when it comes to collagen peptides and adding scoops of collagen into your diet.
Speaker A:Fair.
Speaker B:Okay.
Speaker B:By the way, somebody asked where you get blue spirulina from, and I said I had no idea.
Speaker B:Do you?
Speaker B:Because you mentioned it, but no one can find it.
Speaker B:Tell us where.
Speaker A:Oh, I order it off.
Speaker A:Unicorn superfoods.
Speaker B:Unicorn superfoods.
Speaker B:Is that just.
Speaker B:You're in New Zealand.
Speaker B:Is that just for you, or shall I look into that for everyone?
Speaker A:Well, you can look into for everyone, but if you go to.
Speaker A:On Amazon, which I hate to promote, but they have a whole variety of different blue spirulina.
Speaker B:Okay.
Speaker B:And if you have to settle for green, you're okay.
Speaker B:Would you co sign that?
Speaker A:Absolutely.
Speaker A:It's the same stuff.
Speaker A:Blue.
Speaker A:Blue spirulina isn't as grassy because they've taken out some of the chlorophyll, which gives the grassiness and the color of green.
Speaker A:But the blue spirulina is pretty mild, and it doesn't have that Grassy flavor, but it still has.
Speaker A:It's a little bit higher in protein and iron because it's more concentrated because of less chlorophyll.
Speaker A:But green spirulina still absolutely beautiful to use.
Speaker B:Okay, you heard it here, folks, and thank you to my lovely listener who asked that question.
Speaker B:Okay.
Speaker B:You mentioned vaginal dryness.
Speaker B:Let's talk about it for a minute.
Speaker B:Somebody sent me a question that said, how do we keep elasticity and texture in the.
Speaker B:In the vaginal area.
Speaker A:Yeah.
Speaker A:So this is, again, one of those symptoms that may or may not hit every woman going through perimenopause.
Speaker A:Right.
Speaker B:Do you mind telling us what happens when it isn't ideal?
Speaker B:Like, what.
Speaker B:What is the threat here, so to speak?
Speaker A:So we see what they call urogenital issues.
Speaker A:Pelvic floor health tends to dissipate.
Speaker A:Among that is, they used to say vaginal atrophy, but that's a really patriarchal term.
Speaker A:So now it's just like, we get vaginal dryness, and we have more skin issues, more UTIs, and this all is because we're losing estrogen and we're losing a lot of muscle function.
Speaker A:So remembering that pelvic floor muscle.
Speaker A:Right.
Speaker A:Is still a muscle, and it's still stimulated by estrogen.
Speaker A:So if we're looking at that being a severe symptom, then we can look at using vaginal estradiol cream.
Speaker A:So it's something to talk to your physician about because it can be very.
Speaker B:Very bothersome and unnecessary.
Speaker B:Right.
Speaker B:You don't have to live that way.
Speaker A:Exactly.
Speaker A:Yeah.
Speaker B:Okay.
Speaker B:And am I crazy for thinking that this is also a use it, don't lose it situation?
Speaker B:Where.
Speaker B:And.
Speaker B:And maybe I'm overstepping here, Stacy, but my understanding and what I read is if this is a concern, it's more likely to happen the less frequently you are having sex.
Speaker B:So if you are in a relationship where sex is on the table, I would just like to encourage people to try it because.
Speaker B:Yeah, frequency is your friend.
Speaker B:Am I right?
Speaker A:You're absolutely right.
Speaker A:Yeah.
Speaker A:True.
Speaker B:Okay.
Speaker B:All right.
Speaker B:We're gonna switch gears now to hormone replacement therapy.
Speaker B:And this is pretty much where we're gonna land for the rest of our time together.
Speaker B:Because I got so many questions, but I'm gonna start with my own question.
Speaker B:I don't know anything about this.
Speaker B:I'm the type of person that, like, I won't take an Advil unless a limb just fell off.
Speaker B:Like, I just don't like the idea of taking pharmaceuticals if I don't have to.
Speaker B:And at the same Time.
Speaker B:I am absolutely here for HRT if the research is telling me that this is going to spare me some of the symptoms that we are talking about, because I don't want to shrivel up and go into the menapocalypse.
Speaker B:And I am very open to this and I don't think we need to.
Speaker B:It doesn't matter whether I am or not.
Speaker B:But I wanted to share that with my listeners because they know sort of what I'm like.
Speaker B:And so I wanted to get on the table that I personally am wide open to the science here and for anything we can do to help women with their longevity and their vitality and feeling good in their own bodies.
Speaker B:But Stacy, we've spent time on the show already debunking the interpretations of the earlier research that just killed HRT and took it off the table for, say, our mothers and our grandmother's generation.
Speaker A:Yeah.
Speaker B:So we've done that.
Speaker B:So what I would like to do is get your Overall take on HRT, just, just your 30,000 foot overview and then we'll go in and ask some specific questions.
Speaker B:But first of all, for the uninformed, including myself, what is hormone replacement therapy versus bioidentical horse hormone replacement therapy?
Speaker A:So when people say bioidentical, it's still in the same pocket, but what we like to do is reframe it and say it's not hormone replacement therapy.
Speaker A:We're not replacing our hormones.
Speaker A:We are looking at it as menopause hormone therapy, just the same as if someone is looking to use an oral contraceptive pill.
Speaker A:Right.
Speaker A:So they're different levels and they are different hormones.
Speaker A:If someone says it's bioidentical, it means that they're using micronized estradiol or micronized progesterone, which means that it's more receptive in the body than if you're using conjugated.
Speaker A:So conjugated estrogens and conjugated progestins were what were used in the Women's Health Initiative and in some of the earlier studies that caused a lot of the issues because they were not metabolized the same way as your natural hormones.
Speaker A:And although we say bioidentical and micronized is more similar to natural hormones, they are still not metabolized the same way.
Speaker A:And I say that because when we look at natural hormones that are being released by the ovaries, they are first brought to the liver and they are bound up or conjugated, which is why people are like, oh, we should use conjugated estrogen Progesterone, so they are bound up with sex hormone binding globulin.
Speaker A:So it's kind of like putting them to a different structure which then is excreted into the intestines by bile.
Speaker A:And then your little gut bugs unbind it and shoot it back out in circulation.
Speaker A:So this is why we start to see a change in our gut microbiome in about the three or four years before the onset of menopause, because we have less and less of our sex hormones coming in to drive diversity in the gut microbiome.
Speaker A:So we start looking at menopause hormone therapy.
Speaker A:If we look at the table of things to get us through the menopause transition, there's lots of tools out there and menopause hormone therapy is one of the tools.
Speaker A:What it is not, it's not the pansia that everyone thinks it is.
Speaker A:It is not going to put your hormones back to the same level of your natural cycle.
Speaker A:It is not going to stop body composition change.
Speaker A:It will slow the rate body composition change, it will slow the rate of bone loss, but it does not stop it.
Speaker A:So if you are having really awful symptoms and you're like, can't sleep, massive amount of vasomotor symptoms, vaginal dryness, just awful things that's interfering with your day to day life.
Speaker A:And there are some women who have such mood changes that they just can't cope where there's severe rage or severe depression, like off the scale where they've never had it before.
Speaker A:Menopause hormone therapy is absolutely appropriate, but you want to do it in conjunction to lifestyle changes.
Speaker A:But if you are someone who's like, okay, I'm already on an ssri so I'm not having hot flashes and I can change my diet and exercise program and I can get body composition change.
Speaker A:I'm going to use some adaptogens or maybe I'm going to use some L theanine to help with sleep.
Speaker A:So they're doing all the other things, they're going to get through it as well.
Speaker A:It's when we're looking at really bottoming out of testosterone, this is an option where we might want to look at using menopause hormone therapy, especially the estradiol patch, which will help with natural conversion instead of adding testosterone in.
Speaker A:If we're looking at lots of bone stress issues and bone density issues, then yes, menopause hormone therapy can definitely help with bone density.
Speaker A:But there's a big push in the UK that they want to reframe menopause as being female hormone deficiency.
Speaker A:Syndrome, and that's not right.
Speaker A:It's an.
Speaker A:It's just a part of aging.
Speaker A:So when someone's talking about that and saying everyone needs to use hormone therapy, that's a complete misstep and it's a swing in the pendulum in the opposite direction.
Speaker B:How shocking that we're going to overcompensate now and the pendulum is going to swing in the extreme.
Speaker A:Yeah, there was.
Speaker B:That never happens.
Speaker A:No, there was an OB in the UK who wrote a piece for the British Menopause Society saying that she is seeing more and more women coming in with an overabundance of estradiol by sticking like 2 or 350 microgram patches on thinking that more estrogen is better.
Speaker A:But it's not.
Speaker A:It's not about replacing your levels to what they were when you were naturally cycling.
Speaker A:It's about keeping a very low, consistent level to moderate the changes that's happening.
Speaker A:So you have to work specifically with a physician that understands and gets tested and works with you to see is it working or is it not?
Speaker A:What are we doing?
Speaker A:Are we doing two weeks on, one week off?
Speaker A:Where are you in your hormone levels?
Speaker A:Where are you in your cycle?
Speaker A:How is it making you feel?
Speaker A:So it's not just a one and done.
Speaker A:It's a continuous process.
Speaker A:And I think that's also lost in the conversation where people like, oh, yeah, I got my mht, I stick my patches on, I'm good to go.
Speaker A:That's not the case.
Speaker A:You have to work with someone to make sure that is actually working for your body and it is the right formulation and it's helping alleviate the symptoms that brought you in for the first place.
Speaker B:You know, the people I know that are on this journey right now, I know that what I, what I see anyway is that it's.
Speaker B:It's dials, and they're very sensitive dials.
Speaker B:So there's an estrogen dial and actually two types of estrogen.
Speaker B:Am I right?
Speaker B:Did I learn that from Next level.
Speaker B:Okay.
Speaker B:Yes.
Speaker B:Progesterone and then testosterone and these dials.
Speaker B:I think, honestly, Stacy, I truly believe the hardest part about this phase of life is finding a practitioner with whom you can partner.
Speaker B:Because this is not a one and done.
Speaker B:And what I am hearing you say is minimum effective dose.
Speaker B:This is a marathon, not a sprint.
Speaker B:These are dials that need to be tuned in.
Speaker B:And your dial isn't going to look necessarily like somebody else's dial.
Speaker B:And somebody needs to have their fingers on those dial and to.
Speaker B:And keep fine tune and fine tune and fine Tune.
Speaker B:And I'm going to go ahead and hazard a guess that once you get it dialed in, it could very easily change in a matter of months.
Speaker A:It could change on lifestyle.
Speaker A:Right.
Speaker A:If all of a sudden you have this uptick because you feel fantastic and you start training more, then that's going to change your hormone needs.
Speaker A:Right.
Speaker A:Because all of a sudden you're metabolizing more estrogen, you're going through more things.
Speaker A:So it does change.
Speaker A:So it's like slow implementation of changes across the board.
Speaker B:Okay, so let me pull out some threads to answer some very specific questions.
Speaker B:First of all, you are saying that hrt, we are throwing that in the bin.
Speaker B:This is menopause hormone therapy.
Speaker B:So from now on, this is menopause hormone therapy.
Speaker B:I am unclear because I'm a neophyte in this area.
Speaker B:I am unclear as to whether I need to specifically ask for bio identical slash micro.
Speaker B:Micro.
Speaker B:Micronite.
Speaker A:Micronized.
Speaker B:Okay, micronized.
Speaker B:Is that something people should be asking for versus conjugated?
Speaker A:Yes.
Speaker A:So the newer versions of menopause hormone therapy are the micronized estradiols and progestins.
Speaker A:Yes.
Speaker A:Ask for those because a lot of times physicians aren't that aware and they go by what a pharmaceutical sales rep tells them.
Speaker A:So you need to ask for micronized progestin.
Speaker A:Micronized estradiol.
Speaker A:Most often the micronized estradiol are the patches.
Speaker A:And then you are looking at micronized progestin as an oral pill.
Speaker A:And if you have an uterus, you have to take progesterone with estrogen.
Speaker A:It's a non negotiable.
Speaker B:You have to take progesterone, otherwise you are creating massive problems for yourself.
Speaker A:No, you are, because estradiol by itself enhances cell tissue growth.
Speaker A:So if you aren't using progesterone that counters estrogen, then you run the risk of having lots of endometrial hyperplasia, which means that you get an overgrowth of your endometrial tissue, which then can feed forward to cancer risks and things that we hear all the scary questions about.
Speaker B:Well, and really bad bleeds.
Speaker B:Right?
Speaker A:Yeah.
Speaker B:Okay, let me ask you this.
Speaker B:I had someone say, what if taking estrogen makes us feel great, but taking progesterone makes us moody and fat?
Speaker B:We know we need both.
Speaker B:But what if progesterone is having a really bad impact on mood and weight?
Speaker B:Is there anything we can take or do to counter that?
Speaker A:Change the formulation.
Speaker A:So you can look at using a Mirena iud, which is progestin only with an estradiol patch.
Speaker A:This is where you need to go back and talk to your physician and say, hey, the type of progesterone I'm on is just not working for me.
Speaker A:It is making me moody.
Speaker A:It's altering my body composition.
Speaker A:You wouldn't want to go in there and be like, it's making me fat.
Speaker A:Because they'll be like, yeah, whatever.
Speaker A:That's just a side effect.
Speaker B:Yeah.
Speaker B:They'll say, suck it up.
Speaker A:Yeah.
Speaker A:You need to say, this is not working for me.
Speaker A:Emphasize the mood changes, emphasize poor sleep, all the things that are not working for you, and say, yeah, this kind of progestin is not working for me.
Speaker A:We have to look at a different kind.
Speaker A:It could be that she's on conjugated progestin instead of a micronized.
Speaker A:So really?
Speaker A:Yeah.
Speaker A:Have that conversation.
Speaker B:And can you repeat the recommendation?
Speaker B:And listeners know I am summarizing every word of this in the show notes.
Speaker B:They will be very detailed.
Speaker B:What did you say is an alternate form that she could ask about specifically?
Speaker B:You named one.
Speaker A:So you can look at the marina iud.
Speaker A:So, you know, your typical progestin only iud, because a lot of women in perimenopause will have an IUD and then add an estradiol patch.
Speaker B:Patch.
Speaker B:Okay.
Speaker B:Okay, thank you very much.
Speaker B:Okay, next question.
Speaker B:How long can you safely use HRT patches?
Speaker B:We're going to call them MHT patches now, but how long can you safely use those patches?
Speaker A:Yeah, so the estradiol patch is what they're talking about.
Speaker A:The guidelines say, you know, you.
Speaker A:You start it as soon as the onset of symptomology is awful for you and use it.
Speaker A:You can use it for up to 10 years, close to the age of 60.
Speaker A:After the age of 60, you really have to have conversations and see, do you need to come off it or not, depending on when natural menopause actually hit.
Speaker A:Because we know that the longer you are away from the onset of menopause and we get into late menopause, the higher your risk factor is for all the nasty things that came out in the literature.
Speaker A:So it's, you want to use the least or the lowest effective dose for the shortest amount of time.
Speaker A:But that depends on you and what your symptomology is.
Speaker A:So if we look specifically at the guidelines, they say the smallest effective dose up to 10 years and try not to start it after the age of 60.
Speaker B:Okay.
Speaker B:Yes.
Speaker B:And thank you for highlighting that, because a big problem with that study that we've referred to now, a Couple of times was that they were administering these doses to women in their 60s, weren't they?
Speaker B:And they were post menopausal.
Speaker A:Yep.
Speaker A:So I.
Speaker A:The work I was doing at Stanford when I was doing my postdoc is I was working with Marcia Stefanik, who is the PI for the Women's Health Initiative.
Speaker A:The whole goal of the study was to see if late postmenopausal women would benefit from hormone therapy.
Speaker A:And they shut it down because.
Speaker A:No, they didn't go figure.
Speaker A:Because they've been 10 years without estrogen, progesterone receptors being sensitized and their body had completely gone through the withdrawal and then all of a sudden, boom, you're getting this dose of conjugated estrogen and conjugated progestin.
Speaker A:So, of course, risk factors increased because the body was now exposed to all of these hormones.
Speaker A:But instead of translating that out to the media and saying the whole goal was a look and see if we could reduce risk factors of atrial fibrillation and cardiovascular disease and bone mineral density changes in late postmenopausal women, they just said, oh, my gosh.
Speaker A:In postmenopausal women, all these things happen.
Speaker A:And they.
Speaker A:Then when you compare to the UK million women's study who looked at early postmenopausal women going on hormone therapy, there were no risk factors because their body hadn't undergone all the receptor site changes that naturally occur when your ovarian hormones start to decrease.
Speaker B:So what I would do to bottom line that, Stacy, quite honestly, is if someone is talking to their practitioner and their practitioner waves away the entire conversation and cites data from the 80s.
Speaker B:That is a great.
Speaker B:That is a yellow flag, if not a red one, that indicates that you should be asking more questions or asking someone else entirely.
Speaker A:Yes.
Speaker A:Finding someone who understands the journey.
Speaker A:There are more and more physicians that are becoming attuned to perimenopause, menopause, the issues that women are having.
Speaker A:Instead of just throwing you off the deep end and saying, oh, it's all in your head because you're stressed, they're actually digging in and trying to figure out what's going on.
Speaker A:How can we help you?
Speaker A:Some of the first steps are like venaflaxine, which is a ssri, or actually a serotonin or epinephrine reuptake inhibitor that's often used for anxiety.
Speaker A:But we see that it really works with the hypothalamus to stop vasomotor symptoms.
Speaker A:And you combine that with an antihistamine in, most all the symptoms go away.
Speaker A:So, you know, if you're looking at all these alternatives to hormone therapy, you want to find someone who's well versed in it, because there are alternatives that are pharmaceuticals, but they're not hormones.
Speaker B:When you talk about vasomotor symptoms, what are you referring to?
Speaker A:Hot flashes and night sweats.
Speaker B:And those.
Speaker B:I had someone ask me.
Speaker B:I'm not sure if I'm having hot flashes because they don't sound like the ones other people are describing.
Speaker B:And she's young.
Speaker B:She's younger than the baseline here.
Speaker B:But my assumption for you to entirely debunk is if your body is heating from the inside out randomly, whether it's at night, while you're sleeping, or during the day, that's a hot flash.
Speaker B:Is that fair?
Speaker A:Yep, it is.
Speaker B:Okay, so vasomotor symptoms are the hot flashes and what, night sweats, what you just said, and I want to make sure I understood this, is that sometimes the anxiety and some of the physical symptoms, physiological symptoms, can be dealt with through SSRIs and antihistamines.
Speaker A:Yep.
Speaker A:Yep.
Speaker A:I have a physician friend here who specializes in.
Speaker A:In menopause, in the first course of action, she has a lot of women who are not active is.
Speaker A:She does antihistamines, SSRI and metformin.
Speaker A:So this helps with insulin sensitivity, it helps stop vasomotor symptoms, help with mood and brain fog, and it gets their life back on track without putting them initially on menopause hormone therapy.
Speaker B:Say those three again.
Speaker A:So that is your ssri, preferably venaflaxine, because this is a very strong, I guess, works with neurotransmitters and stops those hot flashes and night sweats.
Speaker B:Okay.
Speaker A:And antihistamine, because we have a huge histamine response, our body is very much in a catabolic and hyper state.
Speaker A:So the antihistamine helps with a lot of the other symptomology.
Speaker A:And metformin, because metformin helps with blood glucose control.
Speaker A:So we look at non active women really using that.
Speaker A:And then we look at recreationally active women who are struggling with blood glucose control, body composition, then metformin can be an option for them as well.
Speaker B:Okay.
Speaker B:Okay.
Speaker B:Wow, that sounds like a deep dive that I would like to make.
Speaker B:I will flag that for follow up.
Speaker B:Last question.
Speaker B:In this arena, is hormone therapy actually preventing the impact to my body or minimizing the symptoms?
Speaker B:A listener asked.
Speaker A:So it's slowing the rate of change.
Speaker A:At the same time it is slowing or reducing symptomology.
Speaker A:Because what's happening is with your natural kind of ovarian function downturn, right?
Speaker A:Your body's like, whoa, what's going on?
Speaker A:For 20, 30 years I've been used to the cyclical bunch of estrogen progesterone.
Speaker A:So my body responds to that and then all of a sudden you don't have that.
Speaker A:And so what the hormone therapy does is it helps modulate it to slowly let your body get used to lower and lower hormone levels.
Speaker B:Can the same thing be said of adaptogens, in other words, not the same and therefore not the same impact.
Speaker B:But can we try relying on adaptogens for the same net result?
Speaker A:Yes, absolutely.
Speaker B:One of the things in next level that I thought was a pot of gold was you actually detail many different options for adaptogens, which of course are plant based, 100% natural.
Speaker B:And you describe what symptoms they help with and why they work.
Speaker B:So my take, and again, I say this, everything I'm saying I'm positing to you as a question so you can tell me whether I'm mad or not.
Speaker B:But as someone who's not yet, I'm not symptomatic of anything.
Speaker B:But I'm trying to get ahead of the curve.
Speaker B:Like I want to go into this inevitable season with, you know, I want to be a plus on the chart so, so that I don't get quite so brutalized.
Speaker B:That's my, that's my current attitude.
Speaker B:And I'm thinking if I start incorporating some of these adaptogens and I already do some of them, folks who are listening, they include ashwagandha, which you've heard me talk about before.
Speaker B:Holy basil.
Speaker B:Rhodiola.
Speaker B:You know, the list goes on and on.
Speaker B:But just to give you a frame of reference there, Stacy, do you think it is wishful thinking to think that I could start introducing these into my diet and keep lifting heavy, not well, heavy for me.
Speaker B:I'm trying.
Speaker B:I'm building back into the gym and focus on higher intensity, shorter workouts and try to eat well and try to sleep well and rely on adaptogens as long as possible for help.
Speaker B:Is that a dream or is that a possibility?
Speaker A:It's absolutely possible.
Speaker A:My co author Celine, like she's gone through it all using adaptogens and changing her diet and exercise.
Speaker A:I had that lovely birthday of 50 this year and going the same things and I was like, why have I not had hot flashes?
Speaker A:Because my sister and my mom had them.
Speaker A:And it's like, oh, because I've been on vinflexing for depression and anxiety for many years.
Speaker A:So it was kind of like precursor.
Speaker A:Didn't have them, don't have them.
Speaker A:Right.
Speaker A:So there are things that you can do and like, I've changed my training, I've trained, changed my nutrition.
Speaker A:You know, long term ironman, bike racer.
Speaker A:Now I'm like, short, sharp, let's lift heavy.
Speaker A:A couple of soul food rides like I talked about in the other episode.
Speaker A:But yeah, I'm not on hormone therapy.
Speaker A:And there are a lot of women who try to and actually successfully navigate through without going on hormone therapy, understanding that there are alternatives.
Speaker A:What I am saying is that you don't have to suffer if those things aren't working for you.
Speaker A:Yeah.
Speaker A:Like hormone therapy is there to help you, but it's not the band aid fix to make you like you were in your 30s.
Speaker B:Yeah.
Speaker B:And at the end of the day, do what works for you.
Speaker B:But if you hear nothing else, invest in figuring out what works for you.
Speaker B:And that leads me essentially to my.
Speaker B:I have two more questions for you.
Speaker B:I mentioned already that one of the biggest hurdles in this whole process is finding a practitioner.
Speaker B:What do you advise women who are beating their head against the wall because they can't get anyone to partner with them in this season?
Speaker B:What do you recommend for them?
Speaker A:So I wouldn't, I wouldn't go to your normal GP because they are bombarded by so many different things.
Speaker A:And like I said, they get information from pharmaceutical sales reps.
Speaker A:And that's just how the whole Westernized, especially in the states, that system works.
Speaker A:You want to find endocrinologists, primarily a sports endocrinologist, if you can, if you're an active woman.
Speaker A:So I mean, like Katherine Ackerman at Boston Children's Hospital, she's a sports endocrinologist.
Speaker A:You look at Carla Diaglimo up in Boston, she's also a sports endocrinologist and she specializes in menopause and women going through menopause.
Speaker A:So there are pockets of women who really understand.
Speaker A:So Chimpson Alika is also in D.C.
Speaker A:she is a sports endocrinologist.
Speaker A:She works with puberty all the way through menopause.
Speaker A:So there are pockets of women who are specializing in it.
Speaker A:So it's more about digging in and finding someone who is a menopause specialist in the Western physical medicine and physician world.
Speaker A:And if you are lucky enough to be able to find a sports endocrinologist as an active woman, then you want to work with them.
Speaker B:Okay, that had never occurred to me.
Speaker B:Thank you for sharing that.
Speaker A:Yeah.
Speaker B:And then in general, where would you direct the general public?
Speaker A:Yeah, that one's hard because when we're looking at who's listed.
Speaker A:Yeah.
Speaker B:I would say talk.
Speaker B:Let's talk to your friends.
Speaker B:Talk to everybody.
Speaker B:Talk to somebody who looks good.
Speaker B:Talk to somebody who's enjoying their life.
Speaker B:Talk to us.
Speaker B:I mean, just like anything else.
Speaker A:Yeah, yeah, exactly.
Speaker B:But, my God, have these conversations.
Speaker B:That's.
Speaker B:I mean, that is what.
Speaker B:That's what lights both of us up.
Speaker B:That's why we're doing this right now.
Speaker B:Like, let's please start having these conversations and dragging this into the light and sharing people who are good and sharing people who care.
Speaker B:Like a rising tide will lift all boats in this arena, in my opinion.
Speaker A:Exactly.
Speaker A:Yeah.
Speaker B:My last question for you.
Speaker B:If somebody is looking down the barrel of this joyful, joyful experience and they're not quite in it yet.
Speaker B:Right.
Speaker A:Yeah.
Speaker B:What are just a few tactical things that either you wish you had known, although I have to say, you literally wrote the book on this, so you kind of did know.
Speaker B:But, like, what would you tell someone?
Speaker B:Let's say she's 40 years old.
Speaker B:She wants to get ahead of this.
Speaker B:She wants to be doing things right so that she has a better experience in the perimenopausal season.
Speaker B:What are three things she needs to be doing now?
Speaker A:Taking care of her gut, microbiome, lifting, putting resistance training in as a forefront, and sleep.
Speaker A:Because those are the things that are really going to make you resilient.
Speaker A:So then whatever symptomology comes your way, you're going to be able to navigate and understand.
Speaker A:But the biggest thing is I don't want women to be afraid.
Speaker A:It's a natural aging process.
Speaker A:Right.
Speaker A:So Western society has put it into such a negative slant where, you know, women after the age of 40 somehow fall off the cliff.
Speaker A:And we don't talk about them, but we look at other societies, a lot of the Asian societies, and there isn't a word for hot flesh.
Speaker A:There isn't a word for menopause.
Speaker A:It's just part of the aging process.
Speaker A:And they're like, yeah, great, now I'm in this new biological point in my life, and now I'm really revered by society because I am an elder that has all this knowledge.
Speaker A:And that's the thing.
Speaker A:Like, unfortunately, our society puts such a negative slant on women getting older, but we have a wealth of information to share.
Speaker A:And so by making menopause a scary thing, it kind of shoves all the women back into their little box.
Speaker A:And we don't need to be shoved.
Speaker A:We need to take up space and we need to talk about things and make it normalized.
Speaker A:So don't be afraid of it.
Speaker A:Just understand that these are natural things that happen.
Speaker A:And some people get through it in a breeze.
Speaker A:Other people don't.
Speaker A:But there are things to do to help to get you through it and get you through the other side.
Speaker B:Yeah, there's a lot of power in this season, and I'm so, so glad that we can end on that note because I believe in it.
Speaker B:Like, I.
Speaker B:I actually love this season.
Speaker B:I'm really stronger than I was when I was 20.
Speaker B:I'm happier than I was when I was 20.
Speaker B:I'm a hell of a lot smarter than I was when I was 20.
Speaker B:And I'm having more fun, quite frankly.
Speaker B:And I think that you are.
Speaker B:I think it's such a service and such a kindness that you offer when you remind us that this is just.
Speaker B:This is something that we now have information to manage better so that we can stay powerful and stay vibrant.
Speaker B:And I'm here for it.
Speaker B:So thank you for having this conversation with me.
Speaker B:Thank you for part two.
Speaker B:Dr.
Speaker B:Stacey Sims.
Speaker B:I am eternally grateful for you.
Speaker A:You are welcome.
Speaker A:Like I said, the more we talk, the better it is for everyone.
Speaker B:Okay, that's a wrap.
Speaker B:I hope you enjoyed today's show and got something out of it that you can use.
Speaker B:If you did and you want to learn more, find me on Instagram at on airwithella or get the show notes and all the links shared today@onairella.com.
Speaker B:there's no whiff.
Speaker B:It's just on airella.com.
Speaker B:thanks for listening.
Speaker B:Thank you for sharing the show and thanks for inspiring me.
Speaker B:You are, quite simply awesome.
