137: Menopause Uncovered: Why It’s Not All About Hormones with Dr. Kali MacIsaac Francis & Dr. Ashley Damm from Acubalance Wellness Centre

If nothing changes, if we eat the same and move the same as we always have, but we just go through parry menopause. Women are on average going to lose about 1% of their muscle mass per year, their lean mass, and we on average replace that with like 1% to 3% at a post-tissue or fat tissue. What's really cool about that is like a couple of very minor tweaks to like how we eat and how we move can stabilize or even reverse that trajectory during this phase. I also just want to acknowledge like I'm sure a lot of women are listening to all the podcasts and reading and it's like just do this and just do this and just do this and it can feel really overwhelming and so I just love educating women and like letting them know these small consistent changes are the most impactful. By listening to the Conscious Fertility Podcast, you agree to not use this podcast as medical advice to treat any medical condition and either yourself or others. Console your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lauren Brown. I'm a doctor of traditional Chinese medicine and a clinical hypnotherapist. I'm on a mission to explore all the paths to peak fertility and joyful living. It's time to learn how to be and receive so that you can create life on purpose. I want to welcome you all to the Conscious Fertility and Beyond Podcast. Today is very very special for me because I have my two peers, my colleagues from acu-balance on the podcast today and we're going to be talking about Pyrenee Menopause and Menopause. So let me introduce my two friends and colleagues. We got Dr. Kayley McCoysik-Francés and Dr. Ashley Dam. First, Kayley. She's a women's health expert, clinical director of naturopathy at acu-balance wellness center and her focus expertise includes reproductive endocrinology, fertility optimization and menopause hormone therapy among other things. She is a licensed naturopathic doctor with the College of naturopathic Physicians of BC and she's also a member of the BC naturopathic Association, the Canadian Association of naturopathic doctors and the Energy Association of naturopathic Physicians as well as the Society of Obstetricians and Gynecologists of Canada. She is also a Menopause Society Certified Practitioner and she holds Prescriptive Authority in British Columbia. Dr. Kayley, welcome to the podcast and we also have with us Dr. Ashley Dam. She has her special interest in expertise in women's health. So we're looking at PCUS and Demetriosis fertility as well as her topic today, Pyrenee Menopause and Menopause and she also likes to focus on digestive concerns. So Dr. Ashley gained her bachelor of science degree in molecular biology and biochemistry at Simon Fredrick University with cooperative studies in research and development. Following this, she obtained her doctorate of naturopathic medicine from Bouche Institute of naturopathic medicine and Dr. Ashley's also accredited as a Menopause Society Certified Practitioner and she too holds Prescriptive Authority in British Columbia. So welcome, doctors to the Conscious Facility and Beyond Podcast. Thanks, we're super excited to be here. So I thought and then you guys said yes, we should get on and have a little episode on Pyrenee Menopause and Menopause and my reason was there's a lot of influencers giving tips and advice online which some we agree with and some we don't agree with and then there's a lot of celebrity doctors too. So they're medical doctors, celebrity doctors given advice and I thought what you guys are doing here at AccuBalance is pretty awesome and you've also done extra training in Pyrenee Menopause and Menopause. So I thought you'd be two people that I'd want to talk to and share with our audience what's happening in the forties and beyond to your hormone health and maybe some of these symptoms, you know, let's name a few that aren't typical like the hot flashes, night sweats, people kind of familiar with that when it comes to Pyrenee Menopause and Menopause. There's brain fog kind of can't remember that word can grab that word, the ability to regulate so you're kind of going off the handle a little bit, sleep changes to name a few, right? That isn't always discussed with joint pain and people may get prescribed an anti-depressant. I don't know if we always agree with that or maybe prescribed anti-pay medications but it's not really the solution not looking at the underlying cause. So this is why I wanted to have you on to talk about the holistic approach. Can you first define Pyrenee Menopause? Can we kind of get a definition? Because some people are hearing this for the first time. Menopause, no longer menstruating. What about Pyrenee Menopause? Can we just start with that? So yeah, okay. So Menopause is like this very like kind of arbitrary like day in the sand or day in time, one day in time when you've gone an entire year or 12 months without having a menstrual period. So you have your like final menstrual period. One year later you have this day in your life where we say like congratulations you're in Menopause and you will now be in Menopause for the remainder of your life. Harry Menopause though is like harder to define. It's kind of like loosely defined as when we start to see symptomatic changes that seem to be coming from the hormonal system. At some point usually in the sort of like seven to ten years before a woman actually hits Menopause. So for most women, these symptoms start to present in their 40s but they can start presenting in their mid 30s and especially for women who are going to hit Menopause at an earlier age. The Pyrenee Menopause will change as that proceed that could happen even earlier than that. And I think it's so difficult to define because there's no single like blood test or no like single set of symptoms that a woman will come into the office and present with where you can say, oh here, here's that number that we were looking for to say like to the oh, yep, today you're in Pyrenee Menopause and we're going to treat you as that. There are estrogen and progesterone and testosterone receptors in all of the body systems. So the chaos that we're seeing in the hormonal system that kind of defines this state of flux that is Pyrenee Menopause can influence literally everybody system and for every woman who we treat in the office, it presents slightly differently. So like one of Ashley's patients may come in and have like vaginal dryness and trouble with their cognitive function. And then one of my patients comes in and she's having trouble sleeping and it's more of like the anxiety or the or the irrational kind of ragee behavior. No two Pyrenee Menopause patients look the same. So it's kind of harder to clinically define. But that's sort of what we go based off of. It's kind of like an age factor and what we're seeing from a clinical symptom perspective. To add to that, like there are some guidelines that look at menstrual changes as well. So what we can define is like early versus late Pyrenee Menopause will look at changes to bleeding patterns. So you might experience more intense shorter cycles in the early years where you're bleeding every two to three weeks or it's starting to get a little bit heavier. And then in the later stages, we might be starting to skip periods. But as Kayleigh said, you might experience symptoms of Pyrenee Menopause before those menstrual changes even happen. And what can feel frustrating for women from what I hear is they'll go to their doctor who will run a blood marker and it looks normal. But there's so much volatility in those hormones that a blood test saying things are normal does not rule out that Pyrenee Menopause is happening. But some pack that a little bit because I know often you guys don't think the hormone the blood test is going to be super relevant because these hormones are fluctuating. And in this case, you're talking about the estridile. That's the one that's fluctuating a lot in Pyrenee Menopause. So you're going by a lot of physical symptoms. So when you don't feel right, some people go to their conventional, the medical doctor and they get dismissed. You guys don't do that. So when somebody says something doesn't feel right because they know their baseline, you guys pay attention to that because that's going to start to tell us something's going on in the background, even though the blood test may not show it. Why doesn't the blood test or why are you not as excited about the blood test? Yeah, we essentially believe women, right? When they come in, they say, I don't hear like myself anymore. Something's different. My brain doesn't work the same. Or you know, I feel like there's less, I often hear this or I'll describe it to women that it feels like there's less of a buffer there between me and my emotional reactivity. So whether that's like my baseline anxiety or it's like my tendency to like go from zero to 100 and feel really irritable or ragy or it's me and like weepy emotionality. There's just less of a buffer there than what there used to be. I'm not sleeping the same. I have itchy skin or itchy ears. There's like a million things that are happening. This is different for me than what my baseline is. We like literally just believe women and then we kind of, we work up, of course, other systems as well and make sure that this isn't like a new onset thyroid problem or whatever's going on. So it's not to say that we don't do lab testing or blood testing. Of course, we do. Actually, I are both like scientists at heart and like we really want to see, we want to make sure that we're getting the holistic picture of what's happening with someone. But for me, the reason I'm not that excited about like your blood level of FSH or estradiol or progesterone is because like Ashley said, there's so much volatility in this hormonal system and that's essentially what creates the symptomology and defines this state. So I could draw someone's FSH and estradiol today and it's going to look like it's pretty normal for for someone in their like 30s to mid 40s. So maybe their estrogen per se. production is 200. Maybe their FSH is less than 10 still. It's still looking like everything's like relatively functioning normally. The brain's talking to the ovaries, the ovaries are responding. A week later, we could check and the FSH could be 30 and the estradiol could be 600. At different points in the cycle, we're gonna see low estradiol amounts as well. So there isn't a definable number that you can look for on paper that would tell you that this is gonna define the symptoms because the symptoms come from the changeability and the lack of resilience to sort of withstand those changes of the hormones in the system. - So this is important. I wanna unpack this a bit. And first of all, I suggest, I don't know if we're always doing this, I still think we should do a baseline anyhow, and what you guys do, just to see where their FSHs, their hormones are so we can compare it in the future plus people just like it. It just gives a little sense, but it doesn't really gonna, it's not gonna change how you treat, like you said, and just for audience, what I heard is the estradiol's fluctuating up and down. So you may get it on a low level, you may get it on a high level because it's fluctuating throughout the cycle in Pyramenapause and progestional starting to decline. So we're expecting this. In FSH, if we see that at 20, then we know you're kind of in that menopausal category based on FSH level, but you guys don't treat the estradiol level, the FSH level, the progestional level, you're looking for more underlying causes. So I still like a baseline testing, A, just 'cause patients wanna know, but I wanna clarify that it doesn't really give you a lot of information like if you could have hit it on a low estradiol, that doesn't necessarily mean they need estrogen therapy at this point in time. Did I understand this correctly or do you wanna? - I don't know that in my Pyramenopatians, and like I mean we can chat about this, but I would not say that as a rule, I am like even baseline testing their FSH. Because number one is not gonna guide, but I'm doing from a treatment perspective. Do patients like to see it on paper? Sure, and am I happy to like chat about those numbers with them and if they really wanna test an FSH like tomorrow and see what it looks like? I mean I'm happy to run a blood test for someone, but we'll be always wanna think about it as if we're gonna run a blood test. What is that gonna do to the way that we're gonna like currently see the case or treat the case? So I always kinda think like if I'm gonna do blood testing, I'm doing blood testing because if I find something, it's gonna change my clinical approach. It's gonna change how I treat that person who's sitting in front of me. If we come back and we have an FSH that looks like it's less than 10, are we giving this sense of, we probably have way more time than we think we do until this one's gonna hit menopause. Or if we check and we see an FSH that's 32 or we're giving her this false thought or narrative that you know you're probably in those last three years of paramedicause, you're probably gonna be losing your period sooner rather than later. I just don't know that it necessarily is that helpful to the conversation because I could check it again and it would be such of, like it could be such a change from what that first test showed. So not to say that we don't check those hormones as a rule and we check them all the time and we're looking at patient's fertility, for example, and to try and check something, try and catch something like a diminishing variant reserve. And I don't mind reviewing a lab result like that but always with that sort of grain of salt, they'll like this is going to be an unsteady marker that we're checking in you because of all the volatility that's happening in the background. - And the reason I'm asking you this is because as I say, the celebrity doctor's out there and actually like to hear your point on this, they just seem to be really stressing. When I listen to their podcast episodes, we had to test your hormones, we got to test your hormones and I notice we don't get so excited about that. If you're in your forties and beyond and you're telling us some of these symptoms, we got a sense of what's going on. And as I heard you say, Kaylee, the testing isn't gonna give us that much more information, definitely not more than what the symptoms are being reported. - There's definitely a demographic you may definitely be testing in, like a woman that doesn't have a uterus, for example, and we can't rely on their menstrual cycle to guide us and that might be helpful to see like what's going on. But like Kaylee said, like we can't know for certain and it can change the next day from what I've heard and listen to some doctors like the utility of testing hormones and we add in hormone therapy to see how it's changing serum levels. The menopause society guidelines at the present moment don't like advise that, but there's no harm, I would say, in having that knowledge. - Kaylee, thank you. I'd like to hear a little bit about why people are having these symptoms. People like to understand, so what is happening and why the symptoms? So we have, I'm just gonna list the common symptoms that we see in our practice, right? There's obviously the hot flashes night sweats. There's this idea of sleep disturbance, like people are having trouble fall asleep but even more so stainlessly can't get that deep sleep. There's the brain fog, I lose words. It's kind of like a my starting to experience dementia here. Like really starting to question their sanity, the anxiety, unwanted weight gain. Well, nobody wants weight gain usually. So I'll say unexpected weight gain. You're eating well, you're exercising, you're gaining weight. Moved swings. And then there's all the Euro genatory symptoms, right? Frequency, vaginal afterphy you mentioned, libido. Can we go through the hormonal system and just share kind of why this is happening from the first heart and then go into how you look for the underlying cause and how you can address these holistically and integratively? Well, there's homeore receptors everywhere in our body. We've got them in our brain, our heart, our reproductive tract. And so as we're transitioning through perimenopause, we've got these periods of high hormone, low hormone states. There's some months where we're ovulating, other months where we're not, other months where our ovaries aren't as responsive. So we're having high estrogen. And so that it's like kind of like the analogy I like is going through PMS or sorry, puberty all over again where it's just this like intense state of hormone fluctuation. And it's that change in hormone levels that can really bring on a lot of symptoms along with the high, high estrogen and the low estrogen state. So there's a lot of chaos that's happening in this stage. And the root cause, I guess that was your question, is like, why is this happening? It's, I think there's two theories at the moment. One is like ovarian depletion of follicles. So we're just running out of follicles as we transition through menopause. And then ovarian dysfunction. So the way that our brain is communicating with the ovaries and that hormone feedback loop isn't as functional until the point where they're not no longer responsive. And at that point were essentially quite low, no estrogen or progesterone production. We do get a little bit through the adrenal glands. And that low, low hormone stayed. As I said, like there's receptors for hormones everywhere our brain, our reproductive tract, our bones, our heart, our blood vessels. And so we're losing the benefit of having those hormones present. And that's where we see kind of an acceleration of things in the menopausal climate frame where heart disease risk increases, bone loss, general to yourinary symptoms of menopause where we're having increased UTIs, pain with intercourse, low libido, dryness, bleeding, brain things like brain fog, et cetera, because we just don't have these hormones anymore. Our quick pause for a moment. If you're listening to this and recognizing yourself in the symptoms we're talking about, the sleep disruption, mood changes, anxiety, weight shifts, or brain fog, I want you to know there is a structured support available. At Accubalance of Encouver, our naturopathic doctors here, Dr. Katie McCoy, asic and Dr. Ashley Damne, have created a program called the menopause current. It's designed to help women understand what's actually happening hormonally during paramedic pause and menopause and how to work with those changes using evidence informed care. You can learn more at Accubalance.ca. That's acubalance.ca. Now back to the episode. I would add to that too. I don't know how often you see this as well, Ashley, but I often think about those two-- how we define those two phases of paramedic pause. So before we hit that final menstrual period, those seven to 10 years before, we in our brains, as clinicians, think about that in broadly kind of two phases, like early paramedic pause, and then later paramedic pause and Ashley totally hit it right, which is like early paramedic pause is like where we may or may not even see any cycle cyclic or bleeding changes, but we start to see these like global symptom picture changes. And essentially what's happening in the body at that point is the way, like Ashley said, the brain and the ovaries are communicating is not working as succinctly and as like functionally and as regularly, like the connection between those two systems is a little bit off. Essentially how I describe that to patients is like it's like your ovaries because they have fewer follicles left and they are of less good quality in our 40s than they were back when you and I were like 18 and had our best quality follicles ever. They are less responsive or more variably responsive to the call from the brain to get them to ovulate. So essentially you'll get these like pockets of more responsive and less responsive cells within the ovaries, such that when the brain starts kind of yelling at them to recruit them, some of them are going to take off really fast. So some cohorts, you'll actually ovulate really early, you'll have a really wicked estrogen, heat at certain points in that cycle. Other cells within that cohort are going to be less responsive and produce less estrogen. So there's just so much variability, especially in the estrogen side of the equation in that phase. And in less variably, I would say we kind of across the board see less capacity to produce progesterone from those follicles. 'Cause again, the quality of the corpus, which is the follicle that housed the egg cell, not as good our four years as it was back in our 20s. So kind of the trajectory of the estrogen or the up and down of the estrogen, there's a lot of chaos in that part of the system, but quite commonly we're seeing this like failure to produce a really robust for just room response. So some of those early early symptoms for lots of our patients will be like the sleep disturbances and then mood stuff. And maybe your cycle looks exactly the same, but you're the way your brain feels because we're lacking for that for just room, hitting the GABA receptor, which is like an inhibitory sort of neurotransmitter in our system, we're lacking for that inhibition and that calming in the nervous system. And then later on, when we get to the later part of that sort of paramedicostate is when I would say we are more likely to find symptoms of lowering estrogen production. So we're skipping cycles. These cohorts are even less responsive to the brain than they used to be of the follicles. We're starting to in addition to see more of the lower estrogen signs or symptoms, which maybe hot flushes nights, what's palpitations, maybe dryness could be vaginal, could be skin, could be eyes. I get the mood like itchy skin and itchy ears could be the joints lacking for that estrogenization. So we're seeing more stiffness or adhesive capsillitis frozen shoulder, those kinds of things. With we think about it and those kind of broad two phases, that's kind of how I like to describe what's happening. And then with again, that caveat that like it's different for everybody. So you could see those those changes in various phases. So here's my question for you because you talked about resilience and something I think about a lot from the Chinese medicine perspective. Every woman that lives into her late 50s or 60s is going to go through this phase just like puberty. So if everybody who lives to their say 60 is going to have these fluctuating hormones in decline, but not everybody has the same symptoms, not everybody has symptoms. So I would say the following that it's not this hormone fluctuation or decline that's causing the problem because if it was every single woman would suffer, but they don't. I suggest that what's happening is our ability, the resilience that we have and our ability to adapt is compromised. In Chinese medicine, it's kind of the kidney system, naturopath, you guys will probably talk more about the adrenals. It's also the liver system for shifting and change. That's also the adrenals for you guys. So because there is change happening unconsciously to you, hormonal changes, changes is the key. If you don't have the ability, the resilience or the adaptability, you will experience symptoms. If you have the resilience and adaptability, you won't, you won't notice the symptoms most likely. And this is what I think we're doing in our practice is we are not just trying to balance out these hormones, which we're going to talk about menopause hormone therapy, but really what we're doing is getting to the underlying cause in building up your resilience, your ability to adapt. So as your body makes these changes, your body can, your autonomic nervous system, your hormonal system can deal with it. And why we do use hormone therapy, but I don't think it's always our first intervention. My thinking is that if we just do the hormonal balance, some people will feel great on that, which is why we like to use it, but not everybody. So I want to ask you why not. But later on in life, when you get to your 70s, if you haven't dealt with the resilience and adaptability, new diseases are going to manifest in your body, doesn't have the ability to deal with them anyhow. So let's deal with it now because these symptoms are messages that the underlying ability of resilience and adaptability is lacking. That's my thinking. You're welcome to agree or disagree. I think that's a really important point. And I think I should agree with this too. I also think about it. I think about resiliency a lot when it comes to like women's health and our hormones. I think about it in young women who are struggling with PMS or pre-menstrual dysphoric disorder. I think there is this aspect to what I think is really interesting about this is we cannot, even in women's younger years, we cannot point to a specific, you know, excess or deficiency in hormones that would correlate with the symptoms of PMS or PMDD, for example. So even when things are like happening the way they're supposed to, and we're ovulating regularly, and we're making like young youthful amounts of hormones. Some women don't feel good in certain phases of their cycles, but we cannot in research define what hormone it is that's doing that. We can't point to it and say, "Oh, it's the progesterone," or like, "Oh, it's the estrogen," which makes us think that why is this woman in particular more susceptible to that set of symptoms in that part of her cycle, even though her hormones are doing the same thing as other women's hormones are doing. So we do think that there is this piece of like, if there is a lack of resiliency in the system, to withstand an even natural change in the hormonal rhythm that we all go through in a monthly basis, is that partly what's defining or what's creating the symptomology in those kinds of presentations? And what I also say that it within the parry menopause, transitional phase, if there's less resiliency, might we be seeing more significant symptoms? I think that that probably is the case, and that is also like you say, why we are not just using menopause hormone therapy as like the single tool in the toolkit. Menopause hormone therapy is wonderful and lovely and such a useful tool, which is why Ashley and I use it and why we have extra training in it and why we're so grateful to have that in our scope of practice. But without doing the rest of the foundational work on stress resilience and sleep patterns and making sure we're eating right and moving right, hormone therapy in a vacuum is going to probably not do very much for our patients. So we, I really do think that we do have to kind of think of it as it's a holistic plan that we're building for someone. We're trying to create and build that resiliency now to help with some demand to help them respond better to their hormone therapy, but then also like you say, for the longevity. I agree so much with that. Like, I feel, and this is why I love being an etymethic doctor is because we have been time to sit and map out all of these pieces more than just a adrenal plan, but like how are we fueling our body for longevity? How are we creating support for our nervous system? How are we supporting sleep patterns? And when those pieces are in place, we age better, we hit prevention markers, we probably can tolerate the menopause hormone therapy even better. So I think it's a really important piece and I always talk about this with patients is like, we need to build that strong foundation and then utilize these other tools as we continue to work together. As kind of Lauren, you mentioned, there's other things that come up at the same time menopause often hits like our lipids are usually elevated. We start to see blood sugar and metabolic changes, changes to muscle. And so screening for those things and building out a holistic plan where we're supporting these foundational pieces and building resiliency. I also feel will help that transition period. I will say though, I'm sure you do have those patients that are doing all of the things and are still struggling through it. And yeah, hormone therapy can be really life changing for people. Yeah, well, that's what I like about how you guys are practicing what we're doing at acupuncture. There isn't a one-size-fits-all. And we do use menopause hormone therapy because we don't believe women should suffer. We would never say just wait it out for 10 years. But we don't always, like for example, estrogen is made to come back. Like the celebrity doctors, everybody's pushing estrogen. I don't see us prescribing a lot of estrogen in the paramanopause phase because estrogen is usually spiking. But we sometimes do. I know our local endocrinologist, your geroline priors, a big fan of progesterone because that's the big decline. So we do test. Like I love the fact you talked about the lipids change. We know there's sometimes shift in thyroid insulin cortisol. So you're looking at all these things so we can address that will also help with the resilience adaptability in hormones. And that's why just looking at the hormones is probably not enough because that's not the underlying cause anyhow. What's causing your body to have a spike in insulin, etc. So in the hormone therapy, there are some women that come in and they go on the progesterone therapy, for example, now they get spotting and more breast tenderness. So not everybody responds to the hormone therapy. Well, either. And it's nice that you have this big toolkit. And like Ashley said, the beauty of the naturopathic position, the way you practice, you have time, time to take a history, time to choose what testing you want to do. Then come up with a plan that you guys do. Can you discuss in a little bit about menopause hormone therapy then like when are you using it? And what are some of the other things? Cause I'm not going to hint to things. I'm thinking about like a lot of things that we've seen are practiced. There's cortisol changes. There's blood sugar changes. And it's a vicious cycle. You know, if you don't have the sleep, then your cortisol is going up and your blood sugar is changing and then fix your sleep. You know, so and you know, again, we know how progesterone affects the GABA receptors. Can you guys geek out a bit and just talk about what's happening in the brain, for example, why people will get hot flashes, night sweats, what's happening with this unwanted weight gain, all those things. And then some of the other things like, you know, simple things like more vitamin senior diet or magnesium or IV therapy, why are you doing diet? Why are you suggesting resistance, weight training in your practice? How is this benefit? So I want you to go into the diet and lifestyle and how this is going to benefit women preventively. And if they're actually experiencing symptoms that they want to help resolve. I think if there was like one clear reason, this would be an easy demographic to treat. And I don't believe I think there's like seven theories on why hot flashes happen at the level of the brain at the moment. And so I don't think we fully understand what is happening, but we have really great tools to treat those things and support resilient and kind of on that model, I think what's really missing for many women is a thorough assessment. So like sitting down, hearing their story, believing their story, and then running blood work, asking how they're fueling their body, how are they moving their body, what are those foundations? And once we have that data can kind of really go in on the areas that maybe need more support or are obstacles to cure, as I like to call it, like I know I think we practice pretty similarly where we're we're we're looking at things like preserving lean muscle mass. For example, we know that that declines as women age. I think it's like 8% per decade or something. So those are things that impact our metabolism, our cardiovascular risk, how we're fueling our body when it comes to protein, fiber intake, what's our sleep hygiene, like what's our nervous system doing? Those are all pieces that come in with our assessment. And I think our key starting points before jumping to something like hormone therapy. Would you agree with that? Yeah, 100% agree with that. I think we, you know, we've kind of danced around this idea that these hormonal changes within the ovary and the brain are affecting the rest of the systems of the body. How we can also think about that is that the endocrine system in the body or the hormonal system in the body is like this very intricately connected, delicate web. I used to say to women all the time, there's like three major hormone systems in your body and they're like three legs on a stool, your thyroid, your adrenals, and your ovaries. So as soon as one of those three systems is like not performing at its best, it's like we take one leg off the stool and then the whole thing can fall over. What I basically mean by that is like as soon as the ovaries start to like do some funny things and there's a bit more chaos in the estrogen and progesterone system, there's a lot more pressure on the thyroid hormone system and on the adrenal system and on the insulin, I mean, it probably should be like a 500 leg stool and not a three legs stool for simplicity, but as soon as the ovaries start to like change their pattern, all these other hormonal systems are also they feel the pressure, they are more likely to crack under that pressure too. So Asha is exactly right too that yeah, all these pieces are foundational and the frustrating thing to hear on a podcast is that it's always an individualized treatment, but it definitely has to be because the person sitting in this, you know, the first person that we see of the day who's sitting in front of us is dealing with weight gain and more insulin resistance and more lipob changes. And then the third person that we see that day is dealing with a whole different set of symptoms. And for patient number one, we have to work more on getting that lean muscle mass up and working with diet and then for person number two, we have to work more on the sleep hygiene. So we really are trying to like take this blown out view of what we think is happening in the system, test those endocrine pieces or nutritional pieces a little bit more closely for what we think make the most sense for the person sitting in front of us and then really hone in on those lifestyle factors that are going to make the biggest foundational difference for that person. And that being said across the board, like lean muscle mass in our 40s, it gets longevity. The more muscle mass we have on our frames in our 40s and our 50s literally dictates how long we're going to live as women. We are definitely needing to focus on the fiber pieces, Ashley mentioned. I think there's like this, there's kind of hyper focus on protein at this page, which is definitely important. But we also need to remember that like 80% of women are going to see an uptick in their LDL cholesterol during this time too. And what are we doing from a dietary perspective to help to mitigate that potential negative impact on the cardiovascular system? So we're really thinking about like these dietary pieces getting the lean muscle mass up from an exercise perspective, the stress reduction, the sleep, like the almost pieces need to be in place. And if you're eating to like just for example, fiber, if you're doing the fiber, that's going to impact your gut microbiome, which is important for your hormones, especially the mood ones, serotonin as well. Then you talked about with that fiber, just the liver and the the the gut's digestion ability to metabolize estrogen in the body, like the hormones. So they're like we realize these are things that seem so simple, which is unfortunate, they're simple because we dismiss them. However, they're so important. The muscle, you talk muscle skeletal stuff, just hearing the longevity, a research that you share, you know, if you're having that unwanted weight game, well, that's what's going to help with the blood sugar and metabolism. And so if we're losing it as we get older, then we have to work a little bit more at building up the muscle mass versus the cardio, then I would assume. I often tell them in that data that you shared, actually, which is like if nothing changes, if we eat the same and move the same as we always have, but we just go through paramedics, women are on average, going to lose about 1% of their muscle mass per year, their lean mass, 1% decline per year. And we on average replace that with like 1 to 3% adipose tissue or fat tissue. So it's this like for most for many women, this kind of like gentle decline and strength and and gradual increase in adiposity or in fat tissue deposition, eating the same and moving the same as we always have. So there was that study, I think what was it like 2023 where they looked at this like muscle mass decline and I think they just shifted the protein content of the diet by like, I think it was 2% of your caloric intake. I don't know if you remember the numbers. Exactly right, but if you just like slightly increased women's protein intake during this phase, you could prevent that 1% per year lean mass reduction and you could stabilize their lean muscle mass through this phase. I also just want to acknowledge like I'm sure a lot of women are listening to all the podcasts and reading and it's like just do this and just do this and just do this and it can feel really overwhelming. Like how do I do this? How do I eat more protein? What does fiber even look like? And so the magic is really in the follow up of like let us like figure out how to make this easy for you because it's an overwhelming time especially if your brain isn't firing on all the cylinders it used to be calculating your unique protein needs can feel really impossible and then integrating that in your life can also feel impossible. Oh and also you need to exercise. Oh and also you need you know it's a lot. So I want to just acknowledge that point but I just love educating women and like letting them know these small consistent changes are the most impactful. You don't have to overall your life. It's like we can make baby steps that make sense for you in the context of exactly what's going on and that's what's so useful about working with a naturopath is that we can focus in honing on those like little pieces that are going to make the biggest difference for you today and we can build on those over time. And to highlight what you said because in this time often the the ability to focus concentrate the brain fog already makes it overwhelming and so this could feel overwhelming and shadowed to naturopathic physicians because they do this really well and if you're in BC where where you have this at acrobounds with Dr. Ashley and Dr. Kaylee and they've done additional accreditation with the menopause society certified practitioners for NDS. I want to talk a bit about progesterone because everybody's getting all the information they need about estrogen. It's all over the web. It's all over everywhere all the celebrity docs. I still think the the sibling of progesterone doesn't get enough attention and it is the one that's declining in the pyramid opause more so than the estrogen. So I kind of got a little uh made a few notes here and I kind of looking for a little rapid fire true or false can you clarify this but I was thinking about progesterone and how it can potentially support weight loss in women who are in pyramid opause and menopause and the notes I was digging through Jherland prior's website just looking at some data as well. So the idea I get here is when you when you're going into this pyramid pyramid opause menopause progesterone levels are declining usually much faster than estrogen in that pyramid opause and then you kind of have an out of balance um of estrogen compared to progesterone. This can mainly to increase fat storage particularly around the abdomen um true or false insulin resistance making weight loss more difficult more water retention and bloating and when the progesterone is dropping you get more your sleep becomes can be poor which is stressful in the body which increases cortisol dysregulation so you get more of the blood sugars. So if you supplement with biodinical progesterone it may help balance some of that estrogen reduce belly fat may help improve sleep below cortisol levels help with the insulin sensitivity and cravings help with water retention bloating may even support thyroid function metabolism. From what I've now going to your brain there is now make this accessible to people why is it that biodinical progesterone something that you're often using and why you guys often don't use estrogen on opposed with progesterone in our menopause patients. The big question for sure. So I think there is definitely a hyper focus in like what you're hearing online and what you're hearing in podcasts and and within the expert community about estrogen because it is such an important molecule to us as women and we we use it therapeutically when it makes sense in the for the patient and we hear a lot less about progesterone for sure. We what we often hear about progesterone or the progesterions as a category of hormones is like if we're going to give someone estrogen and they have a uterus we have to make sure to give them progesterone. I think that that's kind of like the blanket and that's usually as far as a goes statement for for the utility of progesterone in these systems but we can think that you know as one of the major hormones that our reproductive system produces that progesterone has other influences in the body and it can be a really useful again piece of the puzzle. When I give progesterone am I expecting to see immediate weight loss? No. I wouldn't say that as a rule, my patients who are taking progesterone versus those who are not are losing weight at a more rapid pace. But is it a useful tool or a piece of the puzzle to create more stability in the hormonal system that helps to be get the ball rolling down the hill in the right direction when it comes to noticing effects from weight loss? Yeah, I think it can be a useful tool, but I don't think it's ever doing it on its own. It is one of those very intricately connected hormones within that system. So if the thing that the body needs is a little more progesterone for more stability, we may see some better metabolic balance and effects there. But I think we can't think of it as like the hormone that's doing this one particular thing. Where I see the biggest benefit of my patients for progesterone is within that sort of like nervous system and sleep piece. Now does everyone feel really good on progesterone? No. And that's why this medicine has to be individualized. But I would say, and actually you might disagree, but like 97 to 99% of the women who I put on progesterone, I get a better set of symptoms when it comes to sleep and nervous system regulation. So progesterone, as I mentioned earlier, hits that GABA receptor in the brain. GABA is an angiolitic neurotransmitter system. So it lowers anxiety threshold. For me, it helps my patients get a little bit of that buffering back in the nervous system. A lot of women get a sleep promoting effect from progesterone being metabolized down through alopagnetolone. That often helps with the falling to sleep and the staying asleep aspect. So I think if it is like a mood nervous system and sleep supportive hormone, and it's kind of like biggest role that it plays, with then that thought that it also is going to help to stabilize the rest of the system. Not to say that we don't use estrogen and perimenopause because we do sometimes use estrogen and perimenopause. We are thinking about this as like during perimenopause, the use of hormones, we're doing it on a case-by-case basis to create more stability and help with symptom management and overall stabilization and balance. The different conversation happens is when we're using estrogen and progesterone in a postmenopausal women. We are using it to help with our symptoms. We're also using it to prevent osteoporosis, to protect her brain, to protect her heart as a preventative medicine strategy as well. So kind of like, yeah, we grab for these when we think that they're needed. I'd also add to that, like, I agree that like giving the hormone or progesterone like X doesn't equal why or we take it and we're going to lose weight. I don't see that in practice. But if we're sleeping better, we know poor sleep increases weight gain by I think the set's like two and a half pounds a year or something. So we're sleeping better. If we're feeling better, we're going to feel more motivated to do the things that may help move the needle a little bit more. If our joints are hurting less because we're on progesterone which is anti-inflammatory, we're going to increase our mobility to be able to do the things that so hormones communicate their messengers. They talk to all the cells in the body. So holistically, I believe homotherapy is holistic medicine because we're preventing and we're treating the deficiency that's there and giving you back the things that are going to help with some of those goals you listed like weight loss. But I don't think it's as simple as progesterone can cause weight loss necessarily. There's a cascade event. So as you said, if your joints are hurting less, if you're sleeping better, sleeping better is going to help with your cortisol blood sugar. So because those can impact your weight, you won't be grabbing for the sugary process foods because you're less stressed and you want to move more. Can I have clarification? You said progesterone is anti-inflammatory. I've offered her to estrogen being the anti-inflammatory, progesterone being the dampening down the immune system. Progesterone also has an anti-inflammatory impact on the body as well. So let's talk about, because you're using estrogen therapy and you're not doing birth control pill here for our paramedic pauses and menopause women because that's a whole different form and dosage. You're talking about usually biodentical hormone support here. Estrogen therapy has made a comeback. They rebranded it. So it's gone from hormone replacement therapy to menopause hormone therapy, MHT. And a lot of people discussed that study that got everybody quite scared and they stopped using it was misinterpreted. So can you share the, what is the confusion and why are we now comfortable using estrogen therapy again in women in their 40s and beyond? Yeah, happy to. So estrogen therapy has this really very long convoluted history and I'll try and condense it if I can. The Women's Health Initiative is the study that you're referring to, which was the largest scale. What was it like billion dollar study? Finally, we're going to look at women's health and hormones and try and get some answers. And the primary goal of that study was to look at the impact of estrogen on cardiovascular disease. It was like the initial implication for like, you know, we were seeing at this observational level that women who were using hormone therapy might have had a reduction in their cardiovascular disease. Let's test it. And cardiovascular disease for women isn't usually present in their 30s or 40s or even their 50s. We usually cardiovascular disease develops later in life. So the cohort of women that were selected to participate in the Women's Health Initiative were much older than women who were like just initially going through paramedics or just initially going into menopause. The average age in that study, what did you just say was seven? It was seven. I think it was seven to even they started. I'd have to double the age. I think if you look over the entirety of the study, it was like somewhere around age 63, it ended up being around age 63. But it was women who had been in menopause for more than 10 years, for sure, on average, when they initiated this study, when they initially gave them hormones. They did two arms to the study. Women who did not have uteruses got estrogen only, women who had uteruses got both these are about oral estrogen products, oral estrogen and then a progestigen, which is midjurxi progesterone acetatus, synthetic version of progesterone. It was also not estradiol. It was conjugated. Yeah. Yeah. Can you just highlight that? I want you to highlight that. So in the research, they weren't using the bio-dannocal progesterone or estrogen. They were in a different version. Okay. They were using oral, oral synthetic estrogen and progestigen, which is not the same as a bio-identical estradiol or progesterone. Very different. Another brief announcement before we close. I want to leave you with one clear takeaway. Pairing menopause and menopause aren't something you just have to endure. When you understand the hormonal shifts and support the nervous system, metabolism and inflammation, things can change, often dramatically. That's the intention behind the menopause current. A program created through acu balance and Vancouver by our naturopathic doctors, Dr. Keely McCoyzik and Dr. Ashley Dam. It's a thoughtful, structured approach that helps women make sense of their symptoms and move forward with confidence. Whether that includes nutrition, supplements, lifestyle changes, nervous system regulation, or guidance around bio-denocal hormones when appropriate. If this episode resonates with you and you're looking for next steps, you can learn more at acubalance.ca. You don't have to navigate this transition alone. Now back to our episode. They had these two big arms of the study and basically what happened was in the arm of the study that was getting the oral, CEE and the oral progesterone, not progesterone progestin, NPA, QAWIS, progesterone progesterone. That group they started to see a slightly increased risk of breast cancer. The couple of head researchers in that study through a big press conference spread to the world that estrogen causes cancer, although when we've looked back and done re-evaluations of that study, the estrogen-only arm of that study actually had a decreased risk of breast cancer. It was the estrogen plus progestin arm of the study that had a slightly increased risk in breast cancer. They shut down that arm of the study. Everyone in the world heard. It was the biggest news story of 2002. Everyone in the world heard that estrogen causes cancer and you saw an immediate 80% reduction in hormone therapy, prescriptions and use by women in North America after that study came out. Now, when we look as to what was the actual change in risk that they were seeing in that study, the headline said that there's a 25% increased risk of breast cancer in the women who were using those two products that we talked about, the oral CEE and the oral NPA. 25% risk increase sounds terrifying. That's because you're talking about the relative risk increase. But relative risk is not the same thing as absolute risk. And that's what makes the difference when you think about the actual risk to the patient who's sitting in front of you. So in that arm of the study, literally what happened was the baseline risk, the women on placebo, about four in a thousand women per year were diagnosed with breast cancer. Four in a thousand was the baseline risk. The women who got the CEE plus NPA had five in a thousand women per year get diagnosed. And they increased your risk by one in one thousand one in one thousand, which relative risk four to five is a 25% increase. absolute risk, it actually increases your risk by 0.08%. So that's the level of risk increase that you're talking about. It's not 25% up from your baseline. It's one more woman per thousand per year, get diagnosed with breast cancer. Now, was it the hormones, even that was like fueling that change? Was it the type of hormones that we were using? Was it the age of the women in the study? Was that a baseline risk that wasn't accounted for? Like there's so many questions around why we saw that. But even if that is the case, that hormone therapy increases your breast cancer risk, that's what we have to like really tell people, is that it's not a 25% increase risk. It's one more woman per year out of a thousand. To put that into context, that's a less significant risk increase than drinking two alcoholic beverages per day is. If that increases the amount, but I think it's two out of a thousand women per year, more will get breast cancer. They drink two alcoholic units per day. If you're sedentary, it's an additional like seven women per thousand in a year that will get diagnosed with breast cancer. So like these risks, we have to like take into account all of the lifestyle risks that go into this conversation around safety of hormone therapy. And yeah, and it's not the headline that we all read. Correct. I think for the average woman, most women are good candidates for hormone therapy. That's what the guidelines suggest in what we see. And I think that's important to note because this Women's Health Initiative did a lot of damage and a whole generation of women have missed out on the benefits of hormone therapy. And I think now a lot of it is educating how, and I think Kaylee and I both like have really good conversations with patients about their personal risk, how that risk changes, what are other risk factors in their life outside of hormone therapy. And I think that's really important to highlight is. - Women suffer that didn't need to suffer because of misinformation. And we still have women coming in afraid to do any hormone therapy because of that and you're doing your education. Sometimes we've tested their genetics, their and certain other pathways to help give them ease. Why we used to do that. I don't know if we're still doing that to see how they detox, how do they metabolize their estrogens? Are any mirroring in that now? I know at one point when people were quite nervous about it, we would see if they had a genetic risk whether they're on hormone therapy or not of how they metabolize certain estrogens. Does that ring a bell to you guys? - Yeah, it's a good question. And is there clinical utility to that maybe in some cases, yes, to kind of know about what a woman's going to do with those hormones when we put them into our system so far as her ability to toxify and get them out and are we making sure that we're not seeing DNA level damage from some of those metabolites? We will sometimes look at that. But I think the overall overwhelming data that we have for the use of these low doses of menopause hormone therapy make us feel quite safe that we are not significantly increasing that baseline risk of cancer in a drug show. We actually reduce the woman's risk of colorectal cancer when she chooses to use hormone therapy. The other thing that I did wanna just briefly mention is that as much as the Women's Health Initiative, unfortunately, it's done as a big disservice within our population of women who are so scared to use hormones and to this day I get women coming and scared to use hormones. And we're having those important conversations. One really great thing that came out of the WHO is this understanding that there's like this sensitive window, the sensitive timing window of initiating hormone therapy in a women's system where we are going to most greatly benefit the rest of the systems of her body if we choose to initiate hormone therapy earlier. So this is why we're having these conversations in women's 40s and in their 50s is we wanna try and catch as many women as we can when they're still in that sensitive window, which is generally considered the first 10 years of postmenopause. If you choose to initiate hormone therapy within those first 10 years, you are going to unnet benefit the cardiovascular system, for example. Ashley and I would argue that the closer to actual menopause that you start hormones, the better because, for example, the bone density starts to decline immediately. And probably even in later period menopause, but once you're in menopause, first five to seven years is a rapid. Yeah, I think the first two to three years, you get the most loss of like if that is a goal then we need to talk about that. And prevention of osteoporosis is a first, using hormone therapies, a first line option for that. So yeah, I agree. And for the brain benefits too, there's like that little bit of data that suggests that if we start hormone therapy within the first five years, we may help to decrease the dimension Alzheimer's risk in the long run. So there's like this timing hypothesis piece that came out of the Women's Health Initiative that we didn't know about, right? Like we didn't know that before we did that study. So the average age being 63 or 70 in that cohort when they started like, you know, kind of seemed reasonable. These are women who are in postmenopause. We now know the cardiovascular system, the bones, the brain, they like having these hormones around. And we don't want to let a woman system go without those hormones for too long of a period of time before we add them back in because we at that point are no longer protecting those systems. And there may be some risks associated with adding hormones back in later when someone hasn't had hormones for 10 or more years. So addressing the hormone chaos and decline through menopause hormone therapy can slow down with the osteoporosis, the risk of that, cardiovascular diseases. You said there's some research on dementia. So there's a lot of pros and benefits to that. Can you also, both of you, touch on the itchy ears, the weird skin, the autoimmune-like diseases. So I'm thinking of like increasing histamine, increasing inflammation. How come this is happening to women in the parent and menopause and menopause? What's the relation to the change in hormones that affects our histamine or inflammation? I think the itchy ears and dry skin piece and dry, that very much relates to me to like the lack of estrogenization in those two things. Yeah, I agree. Like estrogen is so lubricating. So lubricates our joints, lubricates our vagina, lubricates our eyes. So that dryness piece. And then for a histamine piece, my kind of take on that is that volatility and that chaos and impairment. And a pause we know estrogen is linked with histamine. So when there's high estrogen, we can get higher histamine states. So that change in the hormone levels is really disruptive and can come out and really random and, and strange symptoms. Pierre, I want to kind of tie things together of some of the things that we're doing and why. So supplementation, herbs, acupuncture, nothing is going to, as they say in supplements, nothing can out-supplement poor diet, poor lifestyle. So just want to say that the pillars we're asking for is going to bed like sleep hygiene. So finally, you know, we're not talking about whether you can sleep or not, we can help with that. But at least give yourself the opportunity by good sleep hygiene, movement, rest, and diet, right? These and stress reduction. These are things that is expected. And then there's supplements. So I'm curious, do you guys have certain supplements that you think, you know, because I think of the dreamers are picking up a lot in menopause, right? So the dreamers like vitamin C, magnesium, how it affects the body. These are things that I'm thinking about. You guys may have, you know, some people are being put on bi-text. Can you share, and again, it's individualized, but there's probably some core supplements and why, you know, nutritional IVs, why naturopaths like to use that, why that would be something you would use, why certain supplements or herbs. For those that are looking for those little pearls, right? Like, okay, I'm going to do all these things. I need the home-moment therapy. We got Dr. Kayley and Ashley if you're in BC or find your local naturopathic doctor. What else you have found that's quite common that you're using in your practice? - Good question. Yep. And the like, the scope is very wide and so we have a really big bucket to pull from. But if I were to say like there's a handful of things that I'm using most often in this population, the parry and then the menopause transition. I really like magnesium B6 in touring. I use quite a lot of that in like an evening time stack for my patients. What I think those things are doing are helping with the relaxation of the muscular system, the relaxation of the nervous system, and then the priming of that GABA receptor. I actually do find clinically that when we have those things going and then I layer in some progesterone in those early phases, I'm getting kind of like the best response from the nervous system to that progesterone. So I use quite a bit of that and I will often maintain that through that sort of transitional phase. Those nutrients on their own can even just give that sort of relaxed nervous systems and sleep support and some adrenal support because we're getting better sleep. Adaptogenic herbs, I'm using pretty often during this phase and then to know I think one important thing that patients should know is that adaptogens kind of like exist on this scale of like how stimulating or how depressive they may be to cortisol production in particular. So as of clinician, I'm selecting like particular herbs or particular formula to try and do something very specific to the cortisol at that time of the day. So the thing to do would not be to just like run out and buy ashwaganda and just like take it all day long because in my opinion, ashwaganda sits a little bit more on the like neutral, decidedly depressive end of the cortisol spectrum versus licorice root would be more stimulating. So I would be targeting, I want to get a higher cortisol peak in the morning and I want it to lower down before bedtime. So things like ashwaganda, magnolia, falladendron, phosphatose serine, those things I'll use in like an evening time stack for the adrenals, something with like licorice. route I might be using more so in the morning time. But I think in a Dappagetic formula, mag B6 and Toring can go a long way to create some good stability in the nervous system during this phase. I think for me, I agree, like often sleep, like if we sleep better, I really believe everything else kind of that's a big important foundation. But I think the assessment piece is so important. So if we know, like, because there's such a plethora of symptoms for parimenopause, if we're really thinking like brain and cognition, like I love creatine and the research of that showing for the women's brain, for example, if we're thinking osteoporosis prevention, because we're on the cusp where there's a family history, then I'm thinking vitamin D calcium protein, that kind of thing. So that one's a hard one for me to answer because it really depends on my patient's goals. And yeah, you know, one thing I want to ask is you're both accredited as menopause society certified practitioners. I know you guys were quite nervous when you were preparing and writing these exams and quite excited when you knew you had passed these exams. Is this a big deal? Is this just something like I write in the little $50 lotto and I get lucky and I win? Or is this, you know, is this a big deal basically? Should I be at the party basically at the clinic? Because you guys passed this exam. And we wouldn't be against a party. I mean, I don't know. I was pretty nervous. Actually, we studied for these exams. You did it first. So you kind of like were the one to like get me motivated to do the certification too. I you know, it was always something like that would be really nice to have. But I don't know that I want to like study that. Why did you guys do it? Because you guys are both been in practice for a while. And you guys are like you're good. The Dr. Past tend to be smart. But you guys are smart smart. I'm really see this in our clinic. So why did you go and do this? I think like I don't I think for both of us, we practice very similarly. And it didn't change too much of how we practice. But I do think it's important when we're integrating care within a health team to know and have like a standard of care and understand like this is what the research says. So patients have confidence that we are up to date on the research. It requires like a million CE hours of research. So we're up to date. And I think that's really important because not all physicians or naturopathic doctors know how to prescribe hormone therapies to be honest. And so having some confidence in your clinician that they've undergone this process and are continuing to be up to date on the research coming out. I think that's important for for patients and gives security. Yeah. I think that was a big reason for me. So if you're not in BC and you're looking for a provider that's like confident in menopause hormone therapy, you can go to their website and look up within your region and and someone who's done the training and is kind of up to date will pop up there. Well, I respect that because our acupuncture is majority of them have done the fellowship in acupuncture TCM for reproductive health. So we like that. So they've done the extra training. You guys have done that as well for menopause now. Sounds like you have to do a lot of prep work, CE courses, so training. And then there's an exam to pass. So congratulations on that. Thanks. And I guess I put myself on the spot here. We're going to throw you guys a party at the acupuncture because why not? All right, we got to celebrate it. Let the whole team know about this. I would love some closing remarks from each of you. So Dr. Ashley Damn, I'll start with you and the Dr. Taylor MacKinds, Francis, just anything you want to share with those that have been listening, they've listened this far that you'd like to share with our listeners. I think for me, it's really important. Just to highlight that this a lot can happen in this time. And there are there's menopause is having a movement, which is fantastic, but they can come with a lot of fear as well. And just finding a practitioner that you can develop trust with that can walk you through it step by step and talk about all the options, non-hormonal and hormonal and talk about the risk of inaction and action. So like, what are the risks of taking home on therapy? What are the risks of not taking home on therapy on your health? And how can you map out a plan so you succeed to meet your goals? Because there's a plethora of information out there, but having a strategy really, really in my experience moves a needle. I would totally agree. The other, I would say my closing statement would be that this is like a really, I think, opportune moment in our lives as women in our forties and in our fifties as we go through that perimeno to menopause transition. I often say to women that I think, yeah, we want to like do this deep dive and we want to get you in on a program and we want to develop a strategy because we want you to feel better now. But also the things that we're putting into place with our strategy today are going to define the next third of your life, the last third of your life that you're going to spend in this postmenopausal state. And I think that that's not trivial to can start considering those factors in our forties because literally the things we're doing today, the way we move our bodies, how we're fueling ourselves, how we're stabilizing our hormonal system, whether or not we're choosing to introduce menopause hormone therapy in our forties and fifties, that is literally setting the course of our life into what we're going to be able to do in our eighties. And I think what's unfortunate is that we see so much decline in women's health in our eighties, in our seventies, honestly, and beyond. The common narrative is that we stop, you know, we stop moving our bodies, we stop engaging socially. We don't, we haven't taken care of ourselves because we've always taken care of everyone else. And then we spend that last decade of our life in a nursing home, you know, with cognitive decline or, you know, with real physical and capabilities, and then we break a hip and, you know, 30% of us will die within that first year of breaking a hip. And it doesn't have to look like that. So the stuff we're doing in our forties and our fifties, yeah, we want to make you feel better now. We want to make this transition as easy as possible, but we are also setting the foundation for you to be functional and active and vibrant in the last several decades of your life. I want to give a shout out that to naturopathic doctors. So if you are in your forties and beyond, and you're looking for that support, then look for a naturopathic physician. And if you're in British Columbia, Dr. Ashley and Dr. Kayleigh, again, their naturopathic doctors here at acupuncture, but they also have done extra certification in naturopathic doctors and working with menopause. And then in our clinic, our acupuncturists also because we work with reproductive health, all of our, most of our women are in Pyramenopause trying to conceive. And so we're very familiar and work with Pyramenopause and women in menopause. So I think we, I'm proud to say that I assembled a team that I, that will take great care of you. So if you're in BC, check us out. And if not, ask us, we'll, we may know people around the world that we that can help you as well. Dr. Kayleigh, Dr. Ashley, thank you very much for taking time on the weekend to record this. I know it's your rest day. And I appreciate you making the time today. Thanks for having us. I, Dr. Lorne Brown, I'm the host of the Conscious Patelian Podcast. And if you like this episode, we invite you to post comments, like, subscribe, because it's our understanding. It helps other people find this episode as well. If you're looking for support to grow your family, contact Accubalance Wellness Center. At Accubalance, they help you reach your peak fertility potential through their integrative approach using low level laser therapy, fertility acupuncture and naturopathic medicine. Download the Accubalance fertility diet and Dr. Brown's video for mastering manifestation and clearing subconscious blocks. Go to Accubalance.ca. That's a CU balance dot CA. Thank you so much for tuning into another episode of Conscious Fertility. The show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose. I would love to continue this conversation with you. So please direct message me on Instagram at Lorne Brown official. That's Instagram Lorne Brown official. Or you can visit my websites Lorne Brown dot com and Accubalance dot CA until the next episode. Stay curious and for a few moments, bring your awareness to your heart center and breathe.