Transcript:

00:00:00.280 hi
00:00:02.399 everyone I’m Dr Maggie nay I co-direct
00:00:05.960 the Women’s Clinic here at the aasha
00:00:08.080 center I’m a naturopathic doctor I have
00:00:11.360 been at aasha since 2006 it’s wild so
00:00:15.400 that means like I think 19 years this
00:00:18.000 summer so amazing and I love it and I’m
00:00:21.480 like so grateful to come here every day
00:00:23.720 I just love I love the work I get to do
00:00:25.880 and I love working with um I love
00:00:29.279 working with women
00:00:30.800 and I’ve always been interested in
00:00:32.759 women’s health but my passion towards
00:00:34.879 Perry menopause in particular and
00:00:37.320 supporting women in midlife has really
00:00:40.840 um I mean I got really focused on it
00:00:43.399 more because of the patients that were
00:00:44.960 coming into my office so I would see
00:00:48.360 women you know across their lifespan but
00:00:50.120 I had a lot of women in their 30s and
00:00:53.039 40s coming in and literally just crying
00:00:57.480 crying because they had no idea what was
00:00:59.199 going on with them themselves um Feeling
00:01:03.040 unvalidated by their other health care
00:01:06.320 practitioners um really not knowing what
00:01:08.840 was going on with their bodies and that
00:01:11.640 not knowing and not feeling like
00:01:13.400 yourself is really scary and it’s really
00:01:16.320 common during this per menopause window
00:01:19.200 but I think one of the reasons that make
00:01:21.360 it so hard part of it is really just not
00:01:25.040 knowing because when you don’t when you
00:01:26.520 feel like your body’s changing and you
00:01:30.040 don’t know why and you don’t know if
00:01:31.600 this is just the new normal it’s really
00:01:33.680 scary and that fear can like almost make
00:01:35.680 symptoms worse so I love having
00:01:38.360 opportunities to get to speak to people
00:01:40.399 and speak to women and men and really
00:01:42.600 educate about this time of your life
00:01:44.719 because it really can be like such an
00:01:47.040 incredible period I feel like this is
00:01:49.240 like such an opportunity where we can
00:01:51.360 make some changes and really set
00:01:53.920 ourselves up to live like the best life
00:01:56.560 like the life of our dreams like this is
00:01:58.840 our time but we do need to like take
00:02:01.280 care of our bodies and really have our
00:02:03.439 hormones working for us rather than um
00:02:05.960 the other way around like we we want to
00:02:07.600 use all our resources and we really can
00:02:09.800 set ourselves up to thrive so let’s talk
00:02:12.200 a little bit about per menopause I want
00:02:13.800 to let everyone to know that this this
00:02:15.879 talk is being recorded there’s a chat
00:02:18.920 box if you want to open it you can just
00:02:21.000 like say Hey or ask any questions um
00:02:24.120 I’ll be kind of keep an eye on that and
00:02:26.480 I’m going to talk for a bit and then
00:02:28.040 we’ll have lots of time for Q&A so get
00:02:30.160 everyone’s questions answered so let’s
00:02:33.160 talk a little bit about per menopause
00:02:35.000 and hormones so hormones are involved in
00:02:38.080 every single metabolic reaction in the
00:02:40.879 body we have hormone receptors from our
00:02:44.599 head to our toes every organ system so
00:02:47.760 when they start to behave differently
00:02:50.440 when they start to fluctuate more
00:02:52.159 erratically which happens in per
00:02:53.720 menopause and I’ll really go into the
00:02:55.000 par menopause definition in a moment but
00:02:57.599 when our hormones start to behave
00:02:58.760 differently we feel it of course we feel
00:03:00.920 it we have these receptors throughout
00:03:02.720 our entire body and what brings a lot
00:03:05.440 most women into my office is how they
00:03:08.400 feel um mentally so both women feel like
00:03:11.440 their brains aren’t working the same as
00:03:13.400 it used to so you know being able to
00:03:16.200 remember it’s so brain fog like being
00:03:17.799 able to remember things like I’m sure I
00:03:19.519 have notes here because I’m going to try
00:03:20.720 to stay on target but being able to
00:03:23.120 remember names or being more forgetful
00:03:25.480 when you not as efficient at work that
00:03:27.840 is really terrifying and a lot of women
00:03:29.840 come in because they feel like their
00:03:30.599 brains aren’t working the same and
00:03:32.640 another common reason that brings women
00:03:34.439 in is because their mood changes which
00:03:36.080 is another really common symptom of per
00:03:37.760 menopause and that’s because we have
00:03:39.519 hormone receptors throughout our brain
00:03:41.280 so when they are not being fed hormones
00:03:42.920 in the way they’re used to we feel it
00:03:45.480 both cogn cognitively and emotionally so
00:03:48.920 let’s go into some definitions so we can
00:03:51.840 really make sure that we’re like all on
00:03:53.560 the same page so let’s start with
00:03:55.480 menopause um so menopause technically is
00:03:58.400 the oneyear anniversary since your last
00:04:01.000 period so it’s truly based upon your
00:04:04.319 period so I see sometimes a lot of women
00:04:06.519 coming in and they said they their
00:04:08.000 doctor tells them they’re in menopause
00:04:09.680 because their FSH is is high and their
00:04:12.480 estrogen is low so they’re in menopause
00:04:14.760 but that is really not the definition of
00:04:16.720 menopause so you really need to go that
00:04:18.279 full year without your period and then
00:04:21.839 that oneyear anniversary since your last
00:04:23.759 menstrual period That’s menopause so
00:04:25.680 really technically menopause is one day
00:04:27.960 and then everything after is kind of
00:04:29.840 considered um postmenopause I prefer the
00:04:33.000 term menopausal years because you’re
00:04:35.400 really never done with menopause and
00:04:37.840 that’s another thing I hear a lot about
00:04:39.639 is women saying I’m done with menopause
00:04:41.520 well not really maybe your symptoms are
00:04:43.759 better but like you’re still if you know
00:04:45.520 not making hormones so you’re still in
00:04:47.120 that that state of the of menopause and
00:04:50.479 then here is a it’s not a new term but
00:04:53.560 it’s definitely getting more recognized
00:04:55.000 and I’m super grateful but this idea of
00:04:56.639 per menopause and before I talk about
00:04:59.680 perod menopause there is one thing I
00:05:00.759 want to say about menopause because I
00:05:02.120 was mentioning how really it’s based on
00:05:05.000 your period that is not the best it is
00:05:08.039 how we Define menopause but it’s not
00:05:09.800 great and it can be really confusing for
00:05:11.400 a lot of women if you’ve had a
00:05:13.199 hysterectomy if you’ve had your uterus
00:05:14.880 removed you’re not getting your period
00:05:16.360 anymore but if you still have your
00:05:17.479 ovaries you’re still making hormones so
00:05:18.960 you don’t have that barometer of your
00:05:22.000 menstrual period and then if a a woman’s
00:05:24.759 having an IUD um like a progestin IUD
00:05:28.120 like a marina IUD a lot of women don’t
00:05:29.880 bleed anymore so it’s hard to know if
00:05:31.360 you’re in menopause or not so it’s not a
00:05:32.960 perfect definition and I just want to
00:05:34.360 like put that out there but per
00:05:36.280 menopause is this whole time frame that
00:05:39.199 leads up to menopause there it’s not
00:05:42.000 like it starts at age 40 or 38 but it
00:05:44.680 can start in our mid-30s the I think
00:05:47.360 like the CDC or professional
00:05:48.840 organizations say the average age is 47
00:05:51.520 but I definitely see it starting earlier
00:05:54.360 and women can report symptoms of per
00:05:56.479 menopause starting in their mid-30s
00:05:59.639 certainly through their 40s and you’re
00:06:01.319 basically per menopausal until you go
00:06:03.560 that one year without your period okay
00:06:06.120 so that and then premenopause is like
00:06:08.400 everything before per menopause per
00:06:11.680 menopause is a clinical diagnosis so
00:06:13.759 what does that mean that means your
00:06:15.240 symptoms alone can help diagnose you so
00:06:18.599 there are a lot of symptoms and we’re
00:06:19.840 going to go through that list together
00:06:21.440 because I do want you to hear all the
00:06:23.599 symptoms that have been associated with
00:06:24.680 per menopause but your symptoms alone so
00:06:27.759 there’s no blood test that can diagnose
00:06:29.400 it because during per menopause our
00:06:31.400 hormones fluctuate a lot so and it’s
00:06:35.039 that fluctuation that really categorizes
00:06:37.599 like really highlights what per
00:06:38.720 menopause is it’s it’s not so much
00:06:40.720 taking a blood test and and seeing you
00:06:42.880 know what your estrogen levels are your
00:06:44.599 FSH levels are it’s it’s because our
00:06:47.400 hormones during that time just fluctuate
00:06:48.960 so there could be a moment where you do
00:06:50.639 look per menopausal or menopausal um and
00:06:54.199 there could be times when your hormones
00:06:55.199 are totally normal so a lot of times
00:06:56.720 women come in saying their doctor tells
00:06:57.960 them they’re not in per menopause
00:06:59.120 because they’re are normal but that’s
00:07:00.639 absolutely not the case so labs are
00:07:03.560 important because it can rule out the
00:07:05.000 many other um possible causes for your
00:07:07.560 symptoms like thyroid or anemia or
00:07:10.400 vitamin D deficiency right like if you
00:07:12.400 can correct all those and and you’re
00:07:13.960 still having these symptoms and you can
00:07:15.360 be fairly certain that if you’re in your
00:07:17.240 30s or 40s and you’re experiencing these
00:07:19.919 symptoms that I will go through that you
00:07:22.199 are in per
00:07:23.759 menopause so let’s talk about um the
00:07:27.520 unique needs of per menopausal Wom so
00:07:30.080 per menopausal we said that they start
00:07:31.879 in like around mid-30s 40s so there this
00:07:34.440 is a time when our hormones do start to
00:07:36.240 fluctuate more ER radically so during
00:07:38.919 the premenopause year so when we’re in
00:07:40.919 our 20s you know maybe early 30s there’s
00:07:43.120 a regular rhythm in flow to our hormones
00:07:46.759 um we have estrogen that slowly like
00:07:48.680 increases in the first half of our cycle
00:07:50.680 that triggers um our brain to ovulate
00:07:54.520 tell our brain to send out the hormone
00:07:56.319 to cause our ovaries to ovulate then we
00:07:58.440 ovulate and then we make progesterone so
00:08:00.879 there is a normal Rhythm and flow of
00:08:03.159 hormones throughout our menstrual cycle
00:08:06.080 um but what happens during per menopause
00:08:08.240 is estrogen starts to be produced more
00:08:09.919 ER radically and it’s not so much how
00:08:12.560 much hormones we have at a particular
00:08:14.720 time like I was telling you it’s more
00:08:16.240 about how they fluctuate and estrogen
00:08:18.680 the ups and downs of estrogen can make
00:08:20.680 us feel like we’re PM PMSing like all
00:08:22.960 the time and then overall progesterone
00:08:25.319 which is a hormone that we normally
00:08:26.840 release after we ovulate so during like
00:08:29.199 a regular normal cycle we we produce
00:08:31.280 progesterone from ovulation to when we
00:08:32.919 get our period we tend to not produce it
00:08:36.080 as robustly so progesterone levels can
00:08:37.839 start to decline and sometimes during
00:08:39.640 per menopause we may bleed and not
00:08:41.559 ovulate so we don’t have any
00:08:42.880 progesterone being produced so we have
00:08:44.760 these erratic hormone level production
00:08:47.040 that can lead to a whole host of
00:08:48.760 symptoms and this is happening and I
00:08:51.360 just want to say these are unique needs
00:08:52.839 of of us of us per menopausal women this
00:08:55.240 these hormonal changes are also
00:08:57.240 happening at a time where we might might
00:08:59.600 have like um Peak craziness of our life
00:09:02.040 like we could be at the peak of our
00:09:03.320 career we can be um really a lot of us
00:09:06.279 are parents moms taking care of children
00:09:08.959 for many of us it’s like the sandwich
00:09:10.519 generation where we’re taking care of
00:09:12.000 our kids but also our relationships with
00:09:14.640 our parents are changing and we’re
00:09:16.079 taking more on the caretaker role which
00:09:17.839 can be very stressful we can have more
00:09:20.240 relationship challenges so this is all
00:09:23.399 of this life is happening at the same
00:09:25.800 time our hormones are fluctuating so it
00:09:28.399 truly can be this Perfect Storm between
00:09:30.959 hormones and life that can be making our
00:09:32.920 symptoms even more profound and
00:09:35.399 sometimes what a lot of women say to me
00:09:36.959 when they come see me it’s like I I
00:09:38.399 don’t know what’s going like I don’t
00:09:39.959 know what it is is it like my husband or
00:09:42.480 is it my hormones like I don’t know
00:09:43.880 what’s causing me to be so pissed off so
00:09:46.399 and sometimes it’s all of it because it
00:09:47.680 can truly be a perfect storm but let’s
00:09:49.560 go through some of the symptoms and I
00:09:51.079 have them listed and I just I’m going to
00:09:53.519 read most of them because they’re really
00:09:56.279 important um and they can be really
00:09:57.839 surprising but here are the most common
00:10:00.240 symptom so when the some of the earliest
00:10:03.040 symptoms of per menopause are your
00:10:05.200 period starting to change so sometimes
00:10:07.760 it’s very subtle so unless you’re
00:10:08.880 tracking your cycle you might miss it
00:10:11.160 but normally if you’re like a 28 day
00:10:12.959 girl getting your period you might
00:10:14.200 notice your period coming every 27 or 26
00:10:17.120 days so sometimes subtle you could have
00:10:19.160 a change in bleeding pattern so it could
00:10:20.959 be a lot heavier or more clatier and
00:10:23.640 then mood changes are another big one so
00:10:26.160 more irritability depression anxiety
00:10:28.959 sleep sleep issue so all of a sudden you
00:10:31.720 used to be a great sleeper and now
00:10:33.519 you’re waking up at night or you’re
00:10:35.360 having difficulty falling asleep that’s
00:10:38.279 really common and then later on in the
00:10:41.079 per menopausal Journey you can start to
00:10:42.920 have more of the hot flashes and night
00:10:44.320 sweats but some women get them early on
00:10:46.440 too and one thing that’s common that’s
00:10:48.279 not often talked about is getting these
00:10:49.680 hot flashes and night sweats right
00:10:51.440 before your period or right around
00:10:53.600 ovulation that can start to happen
00:10:55.279 during per menopause too and be new so
00:10:57.360 you could still bleed for another like
00:10:58.760 10 years
00:11:00.200 um after those symptoms start but you
00:11:02.079 can be more susceptible to them but
00:11:03.639 let’s talk about some of the other
00:11:04.880 symptoms so period changes mood changes
00:11:08.079 um are the big ones but feeling less
00:11:10.120 resilient kind of goes with the mood but
00:11:11.920 things that you used to be able to
00:11:13.000 handle with ease all of a sudden can
00:11:14.519 just feel a little too much too
00:11:16.560 overwhelming um heavier menstrual cycle
00:11:18.880 we talked about irregular menstrual
00:11:20.240 cycle more tender breasts headaches
00:11:23.160 fatigue brain fog is a big one um so
00:11:26.440 lack of focus a lot of women feel like
00:11:28.040 they have ADD or having early dementia I
00:11:30.320 hear that all the time um reduce libido
00:11:33.480 more anxiety we talked about um weight
00:11:35.480 changes worsening PMS H flashes dry skin
00:11:38.959 changes in body odor bloating insomnia
00:11:41.800 we spoke about night sweats vaginal
00:11:43.519 dryness also very common more burping
00:11:46.920 more GI issues like constipation
00:11:49.360 worsening allergies ringing in the ears
00:11:52.600 um painful intercourse hair thinning
00:11:54.519 hair loss more facial hair heart
00:11:56.480 palpitations that’s a big one that Oprah
00:11:58.760 Rin kind of brought that to the to
00:12:00.560 Center Stage because she was having a
00:12:02.240 lot of palpitations during her per
00:12:04.240 menopause and she was seen like a
00:12:05.720 million cardiologists and you can
00:12:07.000 imagine like she has like access to the
00:12:09.480 best Healthcare and it was missed for
00:12:11.279 Oprah the heart palpitations because all
00:12:13.360 of her tests were normal and no one put
00:12:15.120 the link towards um per menopause um
00:12:18.040 more achy joints joint pain Frozen
00:12:20.240 shoulders is really uh something that
00:12:22.279 happens more commonly during the
00:12:23.959 menopause transition during per
00:12:25.360 menopause more frequent urinary tract
00:12:27.320 infections not recovering well after
00:12:30.079 exercise um having like itchy crawly
00:12:33.120 things like feeling like things are
00:12:34.279 itching um crawling on your skin some
00:12:36.720 women have more electric shock
00:12:38.440 Sensations In Their Skin and then
00:12:40.120 feeling more dizziness so there are a
00:12:42.399 lot of symptoms some of them can be very
00:12:44.680 alarming like you you want to see a
00:12:46.760 specialist and many women do and and it
00:12:49.199 can be important to get like the full
00:12:50.920 evaluation but at the end of the day a
00:12:53.079 lot of women are told there’s nothing
00:12:54.720 wrong your labs are fine many women are
00:12:57.480 told welcome to aging which is like my
00:12:59.399 peeve um get used to it and it’s
00:13:02.360 absolutely not correct we can truly
00:13:05.040 Thrive during this time so I feel like
00:13:07.279 at this point we kind of get an
00:13:08.519 understanding that per menopause is this
00:13:09.800 time where our hormones start to
00:13:10.839 fluctuate more irregularly and I want
00:13:13.920 everyone to know that once we kind of
00:13:15.760 understand that there I want you
00:13:17.160 everyone to know that there are tools we
00:13:18.839 have to help ourselves feel better so
00:13:21.519 we’re going to go through that I will
00:13:23.160 say that when I talk about hormones
00:13:26.000 fluctuating that can cause a lot of
00:13:28.519 symptoms that that I spoke about but
00:13:30.160 also lifestyle stress where our hormones
00:13:32.399 are even more susceptible to stressors
00:13:35.040 so our hormones can fluctuate and that
00:13:36.560 could lead to you know irritability
00:13:38.079 anxiety and and sleep issues the
00:13:39.720 hormones alone but also during this time
00:13:42.600 our hormones are like exquisitely
00:13:44.480 sensitive to our lifestyle meaning if we
00:13:47.560 don’t sleep as well or we don’t eat as
00:13:49.399 well or we’re under a lot of stress it
00:13:50.959 can more easily throw off our hormones
00:13:53.920 um so it’s like this cycle so really
00:13:56.279 this is why how we take care of our
00:13:59.160 elves and our lifestyle becomes even
00:14:00.800 more important right like I’m sure we
00:14:02.480 can all remember that there was a time
00:14:03.959 in our life where we could stay up all
00:14:05.639 night drink a ton of alcohol eat a whole
00:14:09.800 pan of pizza and like wake up and be
00:14:11.600 like all right let’s go to our 8 AM
00:14:13.199 class like that just simply is not
00:14:15.360 realistic anymore like we really do need
00:14:17.560 to pay more attention to our lifestyle
00:14:19.759 so my Approach and what I want to teach
00:14:21.920 you guys today is to really Thrive
00:14:24.680 through per menopause it’s looking at
00:14:26.399 the lifestyle and we’ll go into that
00:14:28.759 it’s protect targeted supplements and
00:14:31.680 even hormone therapy when we combine
00:14:33.720 those and it can be um it can evolve
00:14:35.759 throughout your per menopause Journey
00:14:37.600 but when we can understand all these
00:14:39.360 resources and tools and know when to use
00:14:41.800 what we can absolutely Thrive during
00:14:44.199 this time so um let’s start with some of
00:14:47.440 the lifestyle um principles so let’s
00:14:50.839 start with nutrition so we a lot of us
00:14:53.639 are wondering like what to eat what to
00:14:55.480 eat what to eat I highlight that what to
00:14:58.240 eat is important and we’ll touch upon
00:14:59.920 that but also when we eat and how we eat
00:15:03.199 is also really important um nutrition
00:15:06.839 and nervous system regulation is really
00:15:09.560 important to highlight you know to focus
00:15:11.279 on during per menopause so as far as how
00:15:14.680 we eat I do like to mention this I
00:15:16.519 mentioned this to like most of my
00:15:17.800 patients and it does resonate um we need
00:15:21.160 to be eating slowly and mindfully we
00:15:25.040 really should not be multitasking when
00:15:27.279 we eat and this recommendation can be
00:15:29.920 harder than like popping a supplement or
00:15:32.040 taking a medication but a lot of us do
00:15:34.759 have more GI issues um during the
00:15:37.360 menopausal transition and instead of
00:15:39.440 like jumping to like a lot of test you
00:15:41.319 know invasive testing and restrictive
00:15:43.279 diet sometimes just being mindful of
00:15:45.079 just eating slowly eating mindfully chew
00:15:48.199 your food well and don’t multitask like
00:15:50.639 turn off the TV put away your phone even
00:15:52.959 put away your buck and just you and your
00:15:55.279 food and look at the presentation
00:15:57.319 appreciate the smell are digestion
00:15:59.600 begins before food hits our mouth when
00:16:02.199 we get in this state it’s it activates
00:16:04.160 that parasympathetic nervous system
00:16:05.600 which already activates our digestive
00:16:07.160 juices so eating slowly eating mindfully
00:16:10.160 is really important um what we eat we
00:16:13.160 really want to focus on nutrient dense
00:16:15.079 Whole Foods and and the goal during this
00:16:17.839 time is um we want to get adequate
00:16:20.600 protein I know that’s a Hot Topic right
00:16:22.279 now and the reason why it is for women
00:16:25.279 is that when we go through the menopause
00:16:27.160 transition we lose mus muscle mass more
00:16:30.199 quickly it called it’s a process called
00:16:32.959 sarcopenia and the reason why many of us
00:16:36.079 end up in like nursing homes when we’re
00:16:38.240 older it’s not because we’re sick but
00:16:40.800 it’s because we lost so much muscle that
00:16:43.399 we are we lack mobility and to safely
00:16:45.759 like get out of bed be able to get
00:16:47.000 dressed to get off the toilet so if we
00:16:49.319 want to prevent that from happening
00:16:50.920 focusing on our muscles during this
00:16:54.000 period our per menopausal period is
00:16:56.319 super important so lifting weights which
00:16:58.319 we’ll talk about is very important and
00:16:59.639 then getting adequate protein so how
00:17:01.199 much protein should we get well there’s
00:17:03.199 a lot of different theories and I think
00:17:04.599 we’re having a definitely a protein
00:17:05.959 moment in this in our time but generally
00:17:08.959 like if you can aim to get like 25 to 35
00:17:10.919 grams with a meal that’s great some
00:17:12.720 people say you should get a pound of a
00:17:14.599 gram of protein per ideal pound of body
00:17:17.240 weight that definitely pushes it up a
00:17:18.880 little bit more I think just being
00:17:21.039 cognizant being mindful that you’re
00:17:22.599 getting protein with every meal and
00:17:24.000 aiming for like 25 to 35 grams in a meal
00:17:26.559 is ideal um you want to make sure we’re
00:17:29.240 getting enough fiber because a lot of us
00:17:30.640 are not getting fiber and that fiber
00:17:32.200 helps with blood sugar stability it
00:17:33.679 helps us feel full it helps feel the um
00:17:36.760 feed the microbes of our gut which are
00:17:38.640 all very important for hormone and
00:17:40.080 hormone metabolization so we want to aim
00:17:41.960 to get like 25 to 35 grams of fiber
00:17:45.039 daily
00:17:46.720 um and um yeah so the blood sugar
00:17:50.559 stability the protein and then the fiber
00:17:52.960 and metabolic flexibility metabolic
00:17:55.120 flexibility is an ideal State we want to
00:17:56.880 be when we’re going through men per
00:17:58.360 menopause and that’s the state where we
00:18:00.240 can easily switch from burning sugar for
00:18:02.600 fuel which is glucose to burning fat for
00:18:04.520 fuel so if every if anyone ever feels
00:18:06.840 like dizzy or laded if they haven’t
00:18:09.320 eaten times that can be that we’re not
00:18:11.360 metabolically flexible so again eating
00:18:13.360 real Whole Foods lots of dark leafy
00:18:15.400 greens healthy sources of protein fat
00:18:17.159 and fiber can help us be become
00:18:19.960 metabolically flexible and then the when
00:18:22.159 we eat is the idea of like um
00:18:24.039 intermittent fasting and I think for
00:18:25.559 most people like having like a 12-hour
00:18:27.360 window can be like a um a very healthy
00:18:30.640 way where we can activate a lot of
00:18:32.320 metabolic processes when we go through
00:18:34.440 like that 12-hour fasting period so
00:18:36.480 that’s kind of the summary of the
00:18:37.880 nutrition piece um hydration so many
00:18:42.039 people don’t drink enough water so like
00:18:43.280 during period menopause we can have more
00:18:45.080 like rain fog um difficulty focusing and
00:18:49.679 if we’re not drinking we’re not helping
00:18:52.000 that situation and I want to give like
00:18:54.000 really easy to use like simple
00:18:55.960 strategies that can actually have
00:18:57.240 profound differences and
00:18:59.280 waking up in the morning having 16
00:19:01.360 ounces of water before your coffee
00:19:03.600 before your tea can have a profound
00:19:05.720 difference so that’s what I recommend
00:19:06.840 wake up have 16 ounces of water then if
00:19:08.799 you want your coffee or tea that’s fine
00:19:10.640 or another 16 ounces and drink that
00:19:12.480 throughout the day a lot of people come
00:19:14.320 back reporting more energy and more um
00:19:16.799 ability to focus and so um I definitely
00:19:19.799 recommend that as far as far as one of
00:19:21.679 our lifestyle sleep is key and sleep can
00:19:24.360 be compromised during perod menopause
00:19:26.080 it’s one of the most common symptoms
00:19:27.400 during perod menopause um you know
00:19:29.559 whether it’s night sweats waking us up
00:19:32.000 or our active mind which can happen more
00:19:34.960 during this time like we can ruminate
00:19:36.559 more and part of that is again like
00:19:38.799 everything we’re dealing with but also
00:19:40.240 the hormonal changes progesterone in
00:19:42.080 particular is a very calming hormone and
00:19:44.000 can help us sleep and as that is lowered
00:19:46.120 or non-existent for a cycle that can
00:19:48.520 absolutely contribute to poor sleep and
00:19:51.799 sleep disruption we want to make sure
00:19:53.600 we’re getting our movement in and
00:19:55.280 there’s four things we want to be
00:19:56.440 careful and really cognizant of during
00:19:58.919 per menopause there four different types
00:20:00.360 of exercise we need the cardio we need
00:20:03.000 the weights we need stretching and we
00:20:05.880 need balance exercises so think about
00:20:08.960 that when you’re making your exercise
00:20:10.240 oring we don’t need to just do cardio we
00:20:12.520 talked about the importance of lifting
00:20:13.960 weights and really making sure we’re
00:20:15.559 using all major muscle groups like at
00:20:17.320 least twice a week and lifting lifting
00:20:19.200 heavy so we’re preventing muscle loss um
00:20:22.159 stretching is key to prevent injuries
00:20:24.600 super important and then balance is also
00:20:26.799 really important because our balance is
00:20:28.280 effective as we get older can be more
00:20:30.720 susceptible to Falls and even just
00:20:32.880 practicing the propri reception exercise
00:20:34.960 balance poses can be really important as
00:20:37.480 we’re like setting up a pro to program
00:20:39.760 to really age optimally the other things
00:20:41.799 that are just really important during
00:20:42.880 this time that come up a lot with my
00:20:44.480 patience is like our community our
00:20:47.280 friendships mindfulness so being aware
00:20:50.520 are you aware when you feel stressed or
00:20:52.720 overwhelmed like are are you aware of
00:20:54.640 that and then do we have tools to help
00:20:56.679 lower that so mindfulness is really
00:20:58.760 important checking in with our bodies
00:21:00.200 what do we need in this moment to feel
00:21:01.600 whole and complete and doing that
00:21:03.159 without judgment because as we go
00:21:05.159 through per per menopause our nervous
00:21:07.360 system can become more disregulated what
00:21:09.360 does that mean that means we can feel
00:21:10.360 more easily stressed more easily
00:21:11.679 overwhelmed and a lot of us are just so
00:21:13.720 used to go go go goo and we just forget
00:21:16.720 that we need to slow down check in and
00:21:18.880 see what our body needs but having so
00:21:20.799 the Stress Awareness and then tools that
00:21:22.480 you use so journaling is really
00:21:25.840 incredible tool breath work emotional
00:21:28.960 Freedom technique which is tapping these
00:21:30.960 are all things you maybe just jot down
00:21:32.520 and you can like dig into or we can talk
00:21:34.320 more about it during the Q&A but having
00:21:36.960 these tools to help lower stress and
00:21:38.559 regulate our nervous system is a really
00:21:41.600 powerful um tool for getting through the
00:21:44.600 per menopause journey and then always
00:21:46.760 joy joy joy joy like we have to
00:21:48.720 prioritize Joy can’t tell you how many
00:21:50.480 times I’ve talked to women what brings
00:21:52.559 you Joy and that is a trigger for Tears
00:21:54.720 because we’ve lost that so that’s just
00:21:57.080 another thing that I always want to PR
00:21:58.559 prioritize during this time okay let’s
00:22:00.720 talk about certain supplements um that I
00:22:04.240 think are very foundational for women
00:22:05.840 who are going through per and Pa so the
00:22:07.720 lifestyle piece that is like we never
00:22:09.520 reach the end like we’re always going to
00:22:11.600 be on a journey to modify tweak um and
00:22:15.120 bring in more of the lifestyle pieces so
00:22:17.080 I want everyone to kind of just be
00:22:18.360 cognizant of all the things I talked
00:22:19.840 about and work them in and then for
00:22:21.400 supplements I think magnesium
00:22:23.480 particularly magnesium glycinate is a
00:22:25.919 really great supplement for many women
00:22:28.679 who are going through per menopause
00:22:30.679 magnesium is a co-actor in like 400 plus
00:22:32.840 reactions in the body um it’s important
00:22:35.120 it can help us calm our mind for and our
00:22:37.640 bodies to get ready for bed it’s good
00:22:39.679 for our muscles it’s good for hormone
00:22:41.480 metabolization detoxification so I
00:22:43.679 really like magnesium glycinate for most
00:22:46.159 women you know before bed I think a nice
00:22:48.559 B complex again these B vitamins list
00:22:50.840 like magnesium are co-actors in a lot of
00:22:54.919 reactions so just to have that to have
00:22:57.600 that extra support neurotransmitter
00:22:59.520 production we need the bees and
00:23:00.880 magnesium so just to have that as a
00:23:02.520 foundational support during this time
00:23:04.520 can be really powerful um many women and
00:23:08.080 men do need a vitamin D3 product because
00:23:10.919 we’re tend to be low and that helps with
00:23:12.640 like energy and mood and um we know it
00:23:15.720 it’s protective against heart disease
00:23:17.360 and cancer so vitamin D is good
00:23:19.279 definitely recommend having that level
00:23:20.720 check and make sure it’s um you know in
00:23:22.840 the optimal range an omega-3 fatty acid
00:23:25.840 another really great foundational
00:23:27.240 product that’s good for heart health
00:23:29.240 um it’s
00:23:30.279 anti-inflammatory and then um two
00:23:32.559 specific ones for per menopause that is
00:23:35.559 getting a little bit more talk that I
00:23:36.960 like one is collagen again it’s like
00:23:39.480 good for Hair Skin and Nails which can
00:23:41.880 be affected as estrogen levels decline
00:23:44.039 or elastin and collagen production
00:23:46.720 decline so we’re more prone to those
00:23:47.960 fine lines and wrinkles so collagen is
00:23:49.600 an easy addition um creatine is another
00:23:53.120 one that helps build muscle so I I like
00:23:55.640 that as well and then these are kind of
00:23:58.080 the found foundational ones I also like
00:23:59.559 anything to support mitochondria which
00:24:01.480 are the energy powerhouses of cells that
00:24:03.760 make you know ATP cellular energy those
00:24:06.640 are like
00:24:07.600 foundational supplements that I think a
00:24:10.559 lot of women do well on when they pair
00:24:12.440 it with you know all the lifestyle
00:24:14.279 pieces they’re specific herbs and and
00:24:17.679 others that can be helpful specifically
00:24:19.480 for hormones which if you’re curious
00:24:21.120 about maybe just we can talk about it in
00:24:22.720 the Q&A but those are really
00:24:24.600 foundational easy to find products that
00:24:27.480 again combining with the lifestyle can
00:24:29.000 be really profound and then um for the
00:24:32.080 last few minutes of this talk I do want
00:24:33.720 to talk about hormone therapy because
00:24:37.200 this is something that there’s a lot of
00:24:39.399 misinformation about it I know I
00:24:41.840 practice in LA and I can’t and a lot of
00:24:43.559 my patients say like I’ve seen so many
00:24:45.279 doctors and are given just absolutely
00:24:47.159 like the wrong information about
00:24:48.799 hormones so many women are told they
00:24:50.320 can’t start hormone therapy until
00:24:53.279 they’re done until they you know are in
00:24:54.880 their men postmenopause and that’s
00:24:57.080 absolutely not correct so hormone
00:24:59.640 therapy um is actually giving your body
00:25:02.919 back the hormones that are are
00:25:04.960 fluctuating more erratically or that
00:25:06.559 we’re losing during the per menopause
00:25:08.240 process so we can actually give you back
00:25:10.240 a little bit of estrad bioidentical so
00:25:12.640 the same molecular structure as our own
00:25:14.559 estrogen we can give you back a little
00:25:16.480 estradi we can give you the progesterone
00:25:19.640 and sometimes even testosterone and
00:25:22.799 basically like because as I was
00:25:24.600 mentioning our estrogen levels fluctuate
00:25:27.120 so erratically during this time and it’s
00:25:29.720 that fluctuation that can lead to a lot
00:25:31.559 of symptoms so giving your body back
00:25:34.320 like a very low dose estrogen it like
00:25:37.799 fills that tank that if you think of it
00:25:39.559 like a gas tank so that if your estrogen
00:25:41.799 drops low like you have a little in
00:25:43.720 there to help stabilize you and if you
00:25:45.960 during per menopause you can have
00:25:47.960 periods where your estrogen naturally is
00:25:50.200 very high like itjust as that
00:25:51.559 fluctuation but giving your body back
00:25:53.720 just these low levels of hormones it
00:25:56.240 fills the tank so if it goes High it
00:25:57.840 doesn’t push too high and if it goes low
00:26:00.080 you have some hormones in there and so
00:26:02.039 this can be a really powerful tool
00:26:04.200 during per menopause so like if you’re
00:26:08.000 having night sweats H lashes we think
00:26:11.000 estrogen I mean there’s studies to show
00:26:13.279 that when a mood disorder happens during
00:26:16.000 per menopause this is studies just done
00:26:18.640 for women in per menopause it hasn’t
00:26:20.240 been replicated for postmenopause but
00:26:22.399 actually hormone therapy can be as
00:26:24.679 effective as an anti-depressant so that
00:26:26.559 the menopause Society has even
00:26:28.679 documented in their literature but
00:26:31.200 what’s happened so often is a lot of
00:26:32.880 women experience depression anxiety
00:26:34.799 sometimes for the first time during per
00:26:36.200 menopause and what are they given
00:26:38.279 they’re they’re given often like an SSRI
00:26:41.240 and if that’s the appropriate Choice
00:26:42.799 amazing but like you should still have
00:26:44.640 this conversation right like the link
00:26:46.440 should be made that perhaps the hormones
00:26:48.480 are playing a role and that this is also
00:26:50.480 an option so the FDA approved
00:26:53.120 indications for using hormone therapies
00:26:55.440 are hot flashes and night sweats vaginal
00:26:57.919 dry Rus osteopenia which is a little
00:27:00.399 loss of bone mineral density which you
00:27:02.000 only get from getting a bone density
00:27:03.840 scan and then premature early menopause
00:27:06.760 which I didn’t talk about in the
00:27:07.840 definition but that’s if you go through
00:27:09.799 menopause like before age 45 that’s
00:27:12.000 early and premature is before age 40 so
00:27:14.679 if that ever happens like you really do
00:27:16.440 need to be on hormone therapy so mood is
00:27:20.720 not one of like the FDA approved
00:27:22.279 indications for hormone therapy but we
00:27:24.279 use off label use of medications all the
00:27:26.880 time in fact when a lot of women present
00:27:29.279 with Hof flashes and night sweats the
00:27:30.679 most common recommendation is an SSRI so
00:27:33.000 that’s like an anti-depressant even
00:27:34.919 though that’s an off Lael use but the
00:27:37.279 idea of using hormones to address some
00:27:39.000 of the mood disorders of Perry menopause
00:27:41.000 is sometimes looked upon frowny but I’m
00:27:43.440 telling you off label use of medication
00:27:45.440 is done all the time so I can go and
00:27:47.760 talk about hormones for a really long
00:27:49.480 time I guess I just want to say there’s
00:27:50.720 a lot of misinformation when you’re
00:27:52.480 working with someone who’s trained in
00:27:53.640 the hormones it can be a real
00:27:55.559 GameChanger for women when it’s also
00:27:58.399 combined with all the lifestyle and the
00:28:01.039 supplements and really kind of set you
00:28:03.440 up to thrive because I do feel like this
00:28:05.399 is our time to be really clear on like
00:28:08.360 our the vision of the life we want to
00:28:10.600 lead what is it how do we want to live
00:28:13.039 our life what do we want out of this
00:28:14.679 life like I I encourage people to have
00:28:16.880 fun and visualize the future they want
00:28:18.840 to live and when you can start to feel
00:28:21.559 so good you know through all these
00:28:23.559 different ways that I talked about you
00:28:25.080 can truly like feel epic and really get
00:28:27.840 after all the things in life that light
00:28:29.440 you up so I hope that was helpful now we
00:28:31.960 have time for Q&A and I see one in the
00:28:35.000 chat I’m going to just read it I
00:28:36.600 recently had a large stress in my life
00:28:39.399 that will be present for a while since
00:28:42.480 that has happened I have been getting
00:28:44.159 night sweats can stress bring on some
00:28:46.039 symptoms of per menopause yes so our
00:28:49.440 hormones become more sensitive to
00:28:52.200 stressors right so if you’re under a lot
00:28:54.120 of stress then it can throw off our
00:28:56.039 hormones more so yes absolutely I mean
00:28:59.240 I’ve had people who’ve had such extreme
00:29:00.799 stressors it kind of put them into
00:29:02.240 menopause I mean it put it stopped their
00:29:04.399 period um so yeah I mean that’s why
00:29:07.240 looking at this through like an
00:29:08.679 integrative holistic lens is really
00:29:11.240 important now we can give the you things
00:29:13.799 to help like reduce those night sweats
00:29:15.880 but yes the stress could be the trigger
00:29:18.200 and that’s another thing I talk about
00:29:19.399 like per menopause is not necessarily
00:29:21.000 this like it can last 10 years but it’s
00:29:22.960 not like you’re going to be symptomatic
00:29:24.399 for 10 years necessarily like a lot of
00:29:26.640 times symptoms come and go
00:29:29.080 and the trigger for the for the coming
00:29:31.480 part is like a
00:29:32.919 stressor so it’s a time to like step
00:29:36.000 back re-evaluate think about what’s
00:29:37.880 going on in your life I know it’s like a
00:29:39.399 crazy time for many of us like that
00:29:41.200 sandwich generation the taking care of
00:29:43.679 so many people or the work stress um Can
00:29:47.039 can make this experience more difficult
00:29:50.360 but being aware of that and
00:29:51.640 knowledgeable is is helpful and I think
00:29:53.600 very
00:29:54.640 empowering um what is your approach in
00:29:57.279 determining the best delivery of of of
00:30:00.279 hormone therapy so um well yes there’s a
00:30:04.240 lot of approaches and um options so
00:30:08.559 estrogen um you have a lot of choices so
00:30:11.120 the FDA approved estrad options which is
00:30:13.559 a bioidentical FDA commercially
00:30:15.600 available estra dial can come in many
00:30:18.080 forms it can become come in a patch a
00:30:20.360 gel a spray and a ring and a pill so you
00:30:25.679 have choices I and many many other
00:30:28.840 practitioners generally we’ll say let’s
00:30:31.039 start with the Trans dermal it’s it is a
00:30:33.240 little safer not that oral is like super
00:30:35.480 high risk but oral estrogen does
00:30:37.919 increase your risk of getting blood
00:30:39.200 flots a little bit like less than birth
00:30:41.440 control pills which we know is handed
00:30:42.840 out so easily um less than being
00:30:45.720 pregnant um but it does slightly
00:30:48.120 increase your risk of getting a blood
00:30:49.440 clot whereas a transdermal does not and
00:30:52.399 because you can be on hormones literally
00:30:55.039 you could start in your 40s or 50s and
00:30:57.000 be on them to the day you die even the
00:30:58.720 most conservative medical organization
00:31:00.760 say there is no more a time limit to how
00:31:03.440 long you can be on hormones our risk of
00:31:06.200 getting a stroke does increase you know
00:31:08.679 as we get older anyway so like if we can
00:31:10.320 start with transdermal that is usually
00:31:12.480 what I recommend um the patch is the one
00:31:14.880 that’s like often covered by Insurance a
00:31:17.480 lot of women love the patch um because
00:31:19.559 you can just put it on and like leave it
00:31:21.720 on and change it twice a week so so
00:31:23.960 those are the commercially available
00:31:25.559 estr options and then you know some
00:31:27.480 people want to go through a compounding
00:31:28.799 pharmacy if you’re curious about that
00:31:30.200 but that can come in all different sorts
00:31:32.240 of ways from creams to trokes and um a
00:31:34.600 lot of different options I do think if
00:31:36.320 you are working with someone like they
00:31:39.279 should present all options for you they
00:31:41.279 shouldn’t skip the FDA approved
00:31:43.200 commercially available like the stuff
00:31:44.919 you can get at CVS AR right a they they
00:31:46.720 should present all options they
00:31:48.519 shouldn’t just go straight to
00:31:49.600 compounding you should know that you
00:31:50.639 have um because the often these hormones
00:31:53.279 can be covered by insurance and they’re
00:31:54.720 bioidentical they’re they’re they’re
00:31:56.600 good um so that’s estrogen
00:31:59.480 progesterone um oral micronized
00:32:02.399 progesterone or also known as perriam is
00:32:04.519 a bioidentical progesterone that is
00:32:06.120 given orally so if you have a
00:32:08.480 uterus um and you’re on estrogen you do
00:32:10.919 need to take progesterone a progestogen
00:32:14.000 is like an umbrella term that includes
00:32:15.840 progestin and progesterone so the
00:32:18.440 bioidentical which you were asking about
00:32:20.440 is the oral micronized progesterone and
00:32:22.240 you want to take that
00:32:23.799 Orly um most people love their
00:32:26.200 progesterone it’s like they describe is
00:32:28.039 like having a warm cozy blanket that
00:32:29.840 they can just like go to bed and like
00:32:32.200 feel warm and cozy and sleep really well
00:32:34.120 it’s like kind of works can be as like
00:32:35.639 works as a sleeping pill for some people
00:32:37.480 they love it so much and it can reduce
00:32:39.159 anxiety some people don’t notice any
00:32:41.159 changes when they take progesterone but
00:32:42.600 they actually like have to be on it um
00:32:44.960 because you have a uterus right so if
00:32:46.279 you take an estrogen you have to be on a
00:32:48.159 progesterone to protect that uterus and
00:32:49.919 there’s a smaller percentage of women
00:32:51.639 that actually are sensitive to
00:32:53.000 Progesterone they don’t feel good on it
00:32:55.360 um that’s that’s not common but if if
00:32:57.440 that’s the case then we talk about um
00:32:59.279 other ways so you can still get the
00:33:00.720 uterine protection and then testosterone
00:33:03.880 is another hormone that I give through
00:33:06.880 um
00:33:07.639 transdermally um it’s the safest way to
00:33:09.880 do it it’s there’s no FDA approved
00:33:12.320 testosterone option for women currently
00:33:14.720 which is unfortunate I don’t know if
00:33:16.320 it’s ever going to be in our lifetime
00:33:17.760 just because of everything that needs to
00:33:19.080 go into getting um FDA approval but um
00:33:22.760 so the options for that is either I will
00:33:24.799 prescribe a man’s testosterone and women
00:33:27.360 just use one tenen of the dose or I will
00:33:31.159 use a compounding pharmacy and get it
00:33:33.799 compounded into um a cream with the
00:33:36.320 right dose for that woman so that’s
00:33:38.399 those are the delivery options I hope
00:33:39.960 that helped you um oh I have another
00:33:43.000 question um from Susie okay for the
00:33:45.360 supplements do you have a recommendation
00:33:47.120 for those foundational ones what to look
00:33:49.000 for well I know aasha Naturals we have
00:33:52.320 them and I think we can send a link for
00:33:54.240 like we have the Magnesium glycinate we
00:33:56.000 have a methylated be we have a really
00:33:58.120 good omega-3 that I love um but for
00:34:02.600 those B’s B12 um omegas you can really
00:34:06.000 find them most places like Air1 Whole
00:34:08.800 Foods I mean they’re pretty and the D D3
00:34:11.599 we like D3 paired with K because um and
00:34:15.079 so more and more D’s you’ll see are
00:34:16.480 paired with K2 which is it helps because
00:34:18.839 D cause helps facilitate calcium to be
00:34:22.000 absorbed and then the K helps guide that
00:34:24.359 calcium to the bones which is where we
00:34:26.040 wanted and not like the arteries of the
00:34:27.839 heart where we don’t want it so we’ve
00:34:29.480 like to pair the D3 with K2 which we
00:34:31.599 have at a caution again you can find it
00:34:33.520 over the counter and then collagen
00:34:35.918 there’s like a we don’t I think at this
00:34:37.639 time have it at aasha but but there’s a
00:34:40.119 lot of like over-the-counter options and
00:34:41.719 same with creatine I mean Thorn makes
00:34:43.800 one but there’s a lot of Brands so I
00:34:44.960 don’t even know I mean I can I can talk
00:34:47.119 separately about getting you guided to a
00:34:49.320 particular one but I do think it’s good
00:34:51.399 to look at the ingredients and look at
00:34:53.639 the inactive list like if you look at
00:34:55.679 Centum multivitamin not to put it down
00:34:58.560 down down but like the inactive
00:35:00.760 ingredients is so long like we don’t
00:35:02.880 need that so it is nice to get in the
00:35:05.079 habit when you’re looking at a
00:35:06.040 supplement to look and look at the
00:35:08.599 what’s in it and then to look at the
00:35:10.720 inactive ingredients there should be no
00:35:12.280 red dye or Blue Lake or any of that it’s
00:35:15.079 unnecessary and that usually says
00:35:17.040 something so just look it you have
00:35:18.320 minimal inactive ingredients so another
00:35:21.280 question is um how long would per
00:35:24.640 menopause last and postmenopause on
00:35:27.839 average how long to keep experiencing
00:35:29.359 symptoms okay great question it’s
00:35:32.079 interesting um the swan study is like
00:35:35.560 one of the one of the amazing studies
00:35:37.839 that it’s currently being done it’s it’s
00:35:39.119 it’s measuring it’s like one of the
00:35:40.240 studies that looked at different
00:35:41.240 ethnicities of women going through
00:35:43.320 menopause because so often it’s just
00:35:44.960 done on like white women um so we know
00:35:47.920 for like it’s different and and it’s
00:35:50.280 different for everyone like I mean some
00:35:51.680 women literally have like no symptoms
00:35:54.359 many women will have it I think for like
00:35:56.520 white women it’s like s years on average
00:35:59.520 we know Asian women on average have it
00:36:01.920 for like 4 years and then black women
00:36:04.119 tend to have it for like 10 years now
00:36:06.440 it’s different it’s different um but so
00:36:09.200 you know it can last up to 10 years and
00:36:11.599 if the average age of menopause I should
00:36:13.800 let everyone to know is around like 52
00:36:16.880 but anything like above 45 is still
00:36:19.520 considered normal so you can literally
00:36:21.520 subtract 10 from like the you know so at
00:36:24.079 42 you know is is a is a totally
00:36:26.920 appropriate time when a lot of women
00:36:28.680 might start to have some symptoms or you
00:36:31.079 know in the late 30s so and then um yeah
00:36:34.400 so that’s a great question about like
00:36:36.720 how long are these symptoms going to
00:36:37.920 last for well like I said I have very I
00:36:40.000 have very little tolerance to like
00:36:41.319 dealing with symptoms so please know
00:36:42.520 there was a lot of treatment options
00:36:44.680 like I had like two hot flashes and I’m
00:36:46.680 like put that patch right on like I
00:36:48.520 didn’t I’m like I didn’t want to deal
00:36:49.760 with it um but okay so but the mood
00:36:53.480 changes that are so common during
00:36:56.280 menopause like the depression the
00:36:58.000 anxiety the brain fog do tend to get
00:37:00.960 better two years after your last
00:37:03.319 menstrual period and and same with night
00:37:05.599 sweats and hot flashes they typically
00:37:07.280 get better I mean that’s a long time I
00:37:09.280 know I mean I I think of struggling for
00:37:11.000 like two years after your last period
00:37:12.640 but typically symptoms do get better on
00:37:14.800 their own after that point but having
00:37:17.839 like when I when I said earlier like
00:37:20.359 you’re never done it’s like low hormones
00:37:23.480 we know that um that can have an effect
00:37:25.960 on our heart and our brain and our bones
00:37:29.160 so um I always we have to focus on that
00:37:32.839 piece too because even if your symptoms
00:37:34.640 are better and your brain is working
00:37:36.720 again and um you’re not getting night
00:37:39.319 sweats like the lack of estrogen um
00:37:42.960 certainly has a its toll like the number
00:37:45.400 the number one killer of women is is
00:37:47.359 heart disease and part of that is
00:37:48.800 facilitated by the lack part of that is
00:37:50.960 the hormone piece so um you still want
00:37:53.720 to be mindful of of other things that
00:37:56.000 can be happening behind the scenes even
00:37:58.079 if your symptoms are better and like
00:37:59.960 studies do show that women’s quality of
00:38:02.079 life like increases so much as they get
00:38:06.000 older too like we’re happier the studies
00:38:09.800 show like as we get older which is great
00:38:12.760 like we’re happy with we don’t we don’t
00:38:14.520 you know our tolerance to BS is down
00:38:17.200 we’re comfortable saying no we know who
00:38:19.000 we are like we are happier but like if
00:38:22.079 you’re struggling with symptoms that
00:38:23.599 that pulls us back this is why I’m like
00:38:25.520 let’s take advantage of like being Where
00:38:27.200 We Are are in our life and the
00:38:28.319 confidence we build and all the
00:38:29.680 experiences to make us who we are and
00:38:32.000 let’s also feel like amazing um I think
00:38:35.000 I digressed but let me um I have a
00:38:38.560 question Dr n from info from it’s from
00:38:41.280 Jenna can menopause affect sexual health
00:38:44.599 and how can women address these changes
00:38:47.160 oh my gosh yes such a um so um yes yes
00:38:52.400 in many different ways so one is a lot
00:38:55.599 of women experience um Chang in their
00:38:58.079 vaginal tissue like vaginal dryness so
00:38:59.920 sex can become more painful that can
00:39:02.400 absolutely be addressed like vaginal
00:39:04.359 estrogen is like so helpful for that I
00:39:07.839 feel like it’s um not offered enough to
00:39:10.280 women but um so that that can affect
00:39:13.400 sexual health and then lower hormones
00:39:15.400 estrogen and testosterone can affect
00:39:18.520 libido for sure it’s it’s big I mean I
00:39:21.480 feel like men well a lot of men are just
00:39:23.760 like addressed so easily for like
00:39:26.079 erectile dysfunction they’re given
00:39:28.040 Viagra so easily and like the discussion
00:39:31.880 to like how their partners are and if
00:39:33.720 their Partners wanted or if their
00:39:34.880 partners are even able is not had so I
00:39:37.960 feel really passionate about the sexual
00:39:40.000 health piece um there’s actually two FDA
00:39:43.160 approved medications to to treat low
00:39:45.599 libido in Perry menopause that are very
00:39:49.520 underutilized um one is a medication
00:39:51.680 called Addie and it’s safe and you can
00:39:53.720 take it at night and it’s FDA approved
00:39:55.359 to treat low libido Perry menopause but
00:39:57.440 like who’s heard of that um but Viagra
00:40:00.880 um they had a really good marketing
00:40:02.720 campaign I mean it used to be called
00:40:04.520 impotence impotent um and like someone
00:40:07.760 the Viagra people came around and
00:40:09.359 they’re like it’s called Ed and we’re
00:40:11.280 going to but get that man in a suit and
00:40:13.119 he’s like sexy and he has Ed right and
00:40:15.720 like I don’t know anyway I obviously can
00:40:18.560 talk about that for a long time but yes
00:40:20.119 um menopause can affect Sexual Health
00:40:22.280 there are therapeutic options pelvic
00:40:25.200 floor PT can be helpful especially if
00:40:27.400 there’s been pain and like muscle
00:40:29.040 tension um the vaginal estrogen um
00:40:31.960 vaginal dhda there’s like an FDA
00:40:33.880 approved it’s called intr Roa that that
00:40:36.079 works really great and then libido side
00:40:38.680 and libido is not just like necessarily
00:40:41.079 low hormones that go into libido but
00:40:43.319 it’s it’s everything right like it’s the
00:40:45.480 hormones it’s our stress it’s you know
00:40:48.079 how we feel about our partner so there’s
00:40:49.560 a lot of variables but the other thing I
00:40:51.440 want to say about libido um is because
00:40:54.119 it’s so common it’s so common that like
00:40:56.359 I’m surprised when some like I have a
00:40:57.880 good libido like I hear low libido all
00:41:00.200 the time the one thing that I’d like to
00:41:01.920 educate people on just to be aware of in
00:41:03.920 case this helps is that spontaneous
00:41:06.800 desire does change and that is normal
00:41:10.000 normal normal normal spontaneous desire
00:41:11.960 is like you wanting to like rip your
00:41:13.520 partner’s clothes off like you know in
00:41:15.319 the elevator like that burning desire
00:41:17.400 like that does go away and that’s normal
00:41:20.560 but a lot of women because they don’t
00:41:22.240 have that or they used to have it think
00:41:24.079 something’s wrong with them but it’s
00:41:26.319 there’s nothing wrong that Happ to both
00:41:27.720 men and women what’s important is if
00:41:30.200 like once you’re having responsive
00:41:32.319 desire meaning once you’re in the act of
00:41:34.480 being intimate that you actually do
00:41:35.920 enjoy it um so some people get so caught
00:41:38.520 up on that like spontaneous desire not
00:41:40.800 being there that they think something’s
00:41:42.680 wrong with them but it’s that’s can be
00:41:45.079 normal and when we normalize that and we
00:41:46.839 focus more on like feeling the the way
00:41:48.800 you feel after um that closeness or
00:41:51.960 during then that’s okay so I just like
00:41:54.240 to normalize that piece and that
00:41:55.720 sometimes helps people so asked what
00:41:57.760 brand of creatine do you what I was
00:42:00.480 saying yes I missed that question thank
00:42:02.319 you okay yeah what brand of creatine do
00:42:04.160 you suggest well there’s a few but I
00:42:05.640 like thorn thorn makes a good
00:42:07.960 one can you be prescribed progesterone
00:42:10.960 only yes and no estr or does this depend
00:42:13.800 on the individual oh totally it’s it’s
00:42:15.760 individualized but yeah a lot of times
00:42:17.480 during per menopause I do stagger
00:42:19.200 hormones in I I rarely like introduce
00:42:21.839 like all of them at once um um but
00:42:25.079 progesterone is often sometimes I’ll
00:42:26.720 just use that during per menopause when
00:42:28.839 they’re like having more ruminating
00:42:30.240 thoughts and insomnia or sometimes
00:42:31.920 spotting in between periods um we’ll
00:42:34.559 start with some progesterone for sure
00:42:36.480 and sometimes I’ll use progesterone and
00:42:37.920 testosterone you know like there’s
00:42:39.440 different combinations based on your
00:42:41.000 symptoms and how you’re
00:42:45.960 responding asking about iron yeah is
00:42:49.680 testing high in iron concerning or also
00:42:52.720 normal well I wouldn’t say it’s normal
00:42:54.640 but like and it’s not necessarily
00:42:56.200 concerning concerning dep How High um
00:42:59.359 you know you want to make sure you know
00:43:01.160 medically you don’t have like an iron
00:43:03.079 storage issue which is um there’s
00:43:05.359 something called hemocromatosis so like
00:43:07.000 if I see someone like a lot of high high
00:43:08.880 iron I’d want to rule that out um
00:43:11.839 sometimes cooking with a cast iron pan
00:43:14.480 can cause high iron so just a lot of
00:43:16.480 people are doing that so you just want
00:43:17.599 to be aware of that and then like taking
00:43:20.079 a look at like other markers like
00:43:21.800 percent saturation and fertin levels
00:43:24.480 just to compare it so no it’s not not
00:43:27.359 it’s not normal for per menopause um I
00:43:29.880 don’t know how long it’s been going on
00:43:30.920 for you like sometimes I’ll see it I’ll
00:43:32.119 recheck it it’s normal um if it’s like
00:43:35.200 chronically high for a very long you
00:43:37.160 know for over a period of time and I
00:43:38.760 don’t know why um and you’re not taking
00:43:40.680 it sometimes look at your supplements or
00:43:42.160 surprisingly sometimes iron thrown into
00:43:43.960 things and maybe just see like a
00:43:45.680 hematologist to try to understand why
00:43:47.480 but it’s nothing terribly concerning um
00:43:50.880 the reason why at all it ever is is like
00:43:53.280 you just we don’t have a way to we we
00:43:55.599 don’t have a way to lose IR iron so a
00:43:57.960 lot of us are like anemic you know or
00:43:59.960 many women have low irons because
00:44:01.359 they’re bleeding every month so once
00:44:02.800 that is less frequent you know you’re
00:44:04.920 not shedding your blood you can have
00:44:06.599 more iron buildt up um but but yeah
00:44:09.400 anyway I would have it just checked out
00:44:10.760 but it’s not like terribly concerning
00:44:12.680 and um just yeah have a look at the
00:44:15.520 fertin the percent saturation as well
00:44:18.040 any other
00:44:19.079 questions yes um yes what are some
00:44:21.960 natural or alternative treatments for
00:44:24.480 menopause symptoms well there’s a lot of
00:44:28.000 herbs and you know I I like Maca a lot
00:44:32.440 um it’s an adrenal adaptogen it can help
00:44:35.000 with certain menopausal symptoms so I I
00:44:38.680 might use that and there’s like a lot of
00:44:40.599 other herbs that um that I might use um
00:44:44.040 to see if they bring some symptomatic
00:44:45.760 relief so like there’s red clover or
00:44:48.040 dwai or um Chase tree berry or black
00:44:51.839 cohash some so it is sort of like try
00:44:54.359 trying a product and see how you work I
00:44:56.880 didn’t didn’t really talk about this but
00:44:57.839 you do want to just make sure everything
00:44:58.960 else is like good in your health like if
00:45:01.520 you have GI issues you definitely want
00:45:03.400 to like make sure that’s been looked at
00:45:06.000 heavy metals you want to make sure like
00:45:07.839 that’s not going on because when you
00:45:09.800 address like the other aspects of your
00:45:11.599 health it can make it can help improve
00:45:13.319 your overall health which can help make
00:45:14.520 the period menopause Journey a lot
00:45:16.079 easier and what are the most effective
00:45:19.359 treatments for managing hot
00:45:22.079 flashes
00:45:23.880 estrogen okay
00:45:27.559 thank you there’s um there’s a few FDA
00:45:30.599 approved um treatments for vasom motor
00:45:33.000 symptoms one is a form of peroxin which
00:45:36.400 is um like paxel but a lower dose of it
00:45:39.440 um which is a type of SSRI and there’s
00:45:42.520 um phoa which is a new one stops the hot
00:45:45.240 flashes and night sweats it’s pretty
00:45:46.559 good at that it doesn’t do the other
00:45:48.280 benefits of estrogen like our bone
00:45:50.079 health our heart health our brain health
00:45:53.839 um but those are other like FDA approved
00:45:55.800 and then again like a whole to
00:45:58.040 supplements um we aasha has a product
00:46:00.760 called and I’m I’m just hoping I have
00:46:02.240 the name right because I know the
00:46:03.160 ingredients but estrobalance I believe
00:46:05.079 if I have the name wrong but we can put
00:46:06.599 the link there that also helps a lot of
00:46:08.599 women because it addresses some of it
00:46:09.960 has like the bees and the magnesium and
00:46:12.040 or nutrients to help support estrogen
00:46:14.200 metabolization so that’s another um
00:46:16.319 option as far as like a natural product
00:46:18.680 but I guess you didn’t say natural I did
00:46:21.240 so you said in um alternative I will say
00:46:24.240 just because we have a minute you know
00:46:25.720 I’m a naturopathic doctor but some
00:46:28.160 people will come see me like well I want
00:46:29.520 to approach this naturally without any
00:46:32.240 meds without any hormones because this
00:46:34.040 is what our body is supposed to go
00:46:35.480 through but I challenge everyone to be
00:46:37.400 like what is natural anyway like we used
00:46:40.400 to die in our 50s and 60s so our life
00:46:43.599 expectancy is so much longer and our
00:46:47.559 hormones are just so important to like
00:46:49.599 feeling good mentally and physically and
00:46:51.880 like to expect to have the same level of
00:46:53.640 energy and vitality and productiveness
00:46:56.599 with without hormones is just not
00:46:58.920 realistic for most of us so like is it
00:47:01.680 normal and natural for us to live to
00:47:03.359 like 90 and 100 now you know glasses are
00:47:07.520 they natural but like of course we’re
00:47:09.119 going to use them to see so it’s like
00:47:11.240 challenging our our mind our world view
00:47:13.920 or our thought pattern over like what’s
00:47:15.839 natural what’s not natural and and the
00:47:18.480 choices we make it’s like how do you
00:47:20.200 want to live it also I think we used to
00:47:21.680 like slow down when we were you know in
00:47:23.839 our 50s or 60s but like who want if you
00:47:26.280 I don’t want to slow down you know ever
00:47:28.480 so I want to keep hiking and traveling
00:47:30.760 and like for many of us we still need
00:47:32.359 the hormones to be able to do that I you
00:47:35.040 meant fem balance fem balance yes yes
00:47:38.280 okay cool um there’s a few more can can
00:47:41.359 you be on per per in perimenopause even
00:47:44.520 if you have a high follicle count sure
00:47:47.079 yeah do you have treatments effective
00:47:49.520 for lyan sclerosis that can Spike I
00:47:52.359 don’t think I understand the question um
00:47:54.119 do have treatments effective for lyan
00:47:55.760 sclerosis usually you know we I topical
00:47:58.920 cortical steroids or you know sometimes
00:48:00.800 topical estrogen can be helpful but I
00:48:02.920 don’t know what that’s Spike during pofs
00:48:05.880 I mean it’s it’s always good that’s I
00:48:07.920 yeah I don’t quite know what if you want
00:48:09.280 to am I answering your question right
00:48:10.680 like usually if like you see a you do I
00:48:12.480 like women to see a specialist because
00:48:15.000 but but like usually like either a
00:48:17.000 topical cortical steroid and vaginal
00:48:19.160 estrogen can be can be helpful for that
00:48:21.800 and yeah it’s more likely I see it in in
00:48:24.119 I can see it more often in per
00:48:25.640 menopausal menopausal women any other
00:48:28.960 questions I do have a few from info a
00:48:33.119 few more for you from info uh what
00:48:35.599 lifestyle I think you kind of addressed
00:48:37.240 this what lifestyle changes can help
00:48:39.040 alleviate menopause symptoms yeah kind
00:48:42.000 of everything I said from nutrition to
00:48:44.599 movement mindfulness like I feel like um
00:48:49.559 our nervous system I mentioned it
00:48:51.319 earlier becomes more disregulated right
00:48:53.760 so what does that mean like we’re more
00:48:55.680 prone to like feel more stressed or
00:48:57.839 anxious and like anything that we’ve
00:48:59.880 suppressed you know kind of in that
00:49:01.839 subconsciousness of ours like more
00:49:03.799 easily gets aroused during this time so
00:49:06.319 it’s an incredible opportunity you know
00:49:08.599 to look at that that mindfulness piece
00:49:11.200 to making sure we’re living our life in
00:49:13.920 alignment with our like purpose that
00:49:15.799 we’re living true to ourselves um
00:49:18.240 because we can’t deny it any longer like
00:49:21.440 we will We I think so I think that’s
00:49:23.680 really important like we really don’t
00:49:25.480 have much tolerance towards things we
00:49:27.920 don’t want to do anymore so it’s like I
00:49:30.079 said it’s a gift um but I think a lot of
00:49:32.520 times if we’re not in tune to that part
00:49:34.400 of us it can creep up and aggravate how
00:49:36.839 we feel emotionally but yeah so taking
00:49:39.280 care of our Mental Health Sleep is so
00:49:41.960 important morning sunlight is so
00:49:44.040 important like when we talked about how
00:49:45.799 important sleep is and prioritizing like
00:49:47.839 really protecting your sleep at night is
00:49:50.119 so important try to get that s to nine
00:49:51.880 hours of sleep every night and having a
00:49:54.160 good evening routine where you’re
00:49:56.119 dividing day and tonight and doing
00:49:58.200 something calming and again setting up
00:50:00.640 that nervous system to be able to fall
00:50:02.040 asleep stay asleep keep the phone out of
00:50:04.240 the bedro is really important so many of
00:50:06.599 people are like Doom scrolling at night
00:50:08.119 it’s just not good for our like our
00:50:10.000 brain like dopamine and and our sleep
00:50:12.240 hormones um get disrupted so keeping the
00:50:14.799 phone out of the bedroom and then
00:50:16.480 morning sunlight is is important like if
00:50:18.640 you can remember we’d had that 16 ounces
00:50:20.480 of water before your coffee and then
00:50:22.559 getting outside and getting some morning
00:50:24.680 sunlight um that morning light if you
00:50:27.280 have it like without sunglasses getting
00:50:29.280 outside within the first 60 to 90
00:50:31.319 minutes of waking really helps to
00:50:33.240 Kickstart our circadian rhythm today and
00:50:35.440 our cortisol Rhythm during the day so
00:50:36.960 it’s like these simple things that are
00:50:39.240 can have really profound differences um
00:50:41.839 you know we’re more prone to um being
00:50:43.400 more insulin resistant more inflamed
00:50:45.440 having more blood sugar disregulation so
00:50:47.799 really like again lifestyle wise
00:50:49.400 focusing on that on eating real Whole
00:50:51.520 Foods getting enough protein fat fiber
00:50:53.599 dark leafy greens are all so important
00:50:56.280 what role do regular checkups play
00:50:58.280 during param menopause and menopause
00:51:01.240 well they’re very very
00:51:02.680 important but you need not everyone is
00:51:05.720 trained in this and that you could be
00:51:07.559 seeing like the best best doctor you
00:51:09.960 know ever so well-intentioned so smart
00:51:13.040 but they may not be the best match for
00:51:15.920 supporting you through Perry menopause
00:51:18.280 and menopause because this is not
00:51:20.280 something doctors are trained in in
00:51:22.040 school there’s been numerous reports
00:51:23.799 like studies like that they get like one
00:51:26.200 to two hours during medic schal school
00:51:27.880 less than like 3 hours during residency
00:51:30.799 to support women through this time so
00:51:33.680 you want to make sure you’re seeing
00:51:35.119 someone who is trained and specializes
00:51:39.079 in Perry menopause and menopause um so
00:51:42.839 it it’s not just anybody it’s not just
00:51:44.760 any OB be you know it you really because
00:51:47.680 it’s not like really taught the women
00:51:50.880 the doctors who specialized in this had
00:51:52.799 to go out of their way to be educated in
00:51:55.200 this piece in a woman’s life but they’re
00:51:57.319 very important you do want to check up
00:51:59.799 every at least every year but like more
00:52:02.240 if you’re having symptoms but we’re also
00:52:04.280 like more prone to like you know heart
00:52:06.640 disease and other health you know the
00:52:08.680 chronic diseases tend to pop up at this
00:52:10.359 time so you definitely want to be on see
00:52:12.599 your doctor because like cholesterol can
00:52:14.480 increase and blood sugar can increase
00:52:16.119 all of which doesn’t have to but those
00:52:18.640 don’t always lead to symptoms so you
00:52:20.079 want to get your yearly blood work done
00:52:22.000 so if a patient is having chronic uh
00:52:25.000 cholesterol issues and the doctor isn’t
00:52:27.960 doing anything for them should they then
00:52:31.000 seek uh bioidentical hormones for this
00:52:34.040 or or I I mean it just depends I mean I
00:52:37.119 don’t you’re saying cholesterol yes well
00:52:39.720 it depends how high it is um and I think
00:52:43.160 getting you know a coronary calcium
00:52:44.839 score so you’re looking at the arteries
00:52:46.359 around the heart are very important you
00:52:48.680 know does giving I’ve seen hormone
00:52:51.000 therapy reduce cholesterol and LDL and
00:52:53.440 triglycerides it depends how high your
00:52:55.599 family history
00:52:56.960 you know what your coronary calcium
00:52:58.440 score is all of that okay but um yeah
00:53:02.000 there’s a lot of different treatment
00:53:03.440 options for you know elevated
00:53:05.280 cholesterol and hormones like a piece of
00:53:07.200 it that should be part of the dialogue
00:53:09.559 uh I have a few more questions and I’m
00:53:11.440 just going to go down the list that I’ve
00:53:13.440 um obtained here what are the risk and
00:53:15.920 benefits of using hormone therapy for
00:53:20.079 menopause um well the risk are it’s very
00:53:24.359 safe like the ideas you want to use it
00:53:26.200 or in the menopause transition so you I
00:53:29.280 we recommend using it within the first
00:53:31.000 10 years um when you use it past that
00:53:34.760 10year Mark which doesn’t it’s not
00:53:36.880 really relevant for like per menopausal
00:53:38.559 women but like for menopause that past
00:53:40.559 that 10e Mark the benefits for like
00:53:43.200 cardio protection and brain is are not
00:53:45.920 as strong and I think if you go like in
00:53:47.960 the 15 20 year post menopause there is a
00:53:50.839 slightly higher risk of getting a clot
00:53:52.960 within the first six months of starting
00:53:54.400 hormone therapy but that’s like if you
00:53:56.559 have been with that hormones for a very
00:53:57.920 very long time and then added in and
00:54:00.000 then it’s just like that’s why the
00:54:01.240 discussion is a little different if
00:54:02.680 you’re coming from that stand um if you
00:54:05.839 had a breast I should say like the
00:54:09.000 there’s always been this concern that
00:54:10.160 hormones cause breast cancer but that
00:54:11.599 has been absolutely um not valid it was
00:54:14.880 it’s from the Women’s Health Initiative
00:54:16.280 study that’s been debunked so we know
00:54:18.559 that hormones we do not cause breast
00:54:21.079 cancer but if you had a breast tumor in
00:54:25.040 you already that was um grew in the
00:54:27.520 presence of estrogen it could stimulate
00:54:29.040 it to grow a little faster but even from
00:54:31.280 all the studies like no one who took
00:54:33.160 hormones died died more or died faster
00:54:36.760 it was like anything was maybe helped
00:54:38.040 them get diagnosed and treated quicker
00:54:40.240 um but so the the risk isn’t to the risk
00:54:43.160 I guess to just be flat out is like if
00:54:44.920 you had a breast cancer that was it
00:54:47.400 could maybe stimulate it to grow a
00:54:48.720 little faster if you take oral
00:54:51.440 estrogen that does slightly increase
00:54:53.839 your risk of developing a blood clot and
00:54:56.520 it can slightly potentially um that
00:54:58.960 because that’s because it has to be
00:54:59.799 metabolized through the liver and it
00:55:00.960 increases clotting proteins um if you’ve
00:55:03.559 ever had a stroke that’s been un or a
00:55:07.240 blood clot I should say that has that
00:55:09.359 wasn’t triggered by something like a
00:55:11.559 surgery or a plane ride or being bed
00:55:14.880 bound and you just like ran that’s
00:55:16.480 called an unprovoked clot then hormone
00:55:19.319 therapy tends is is not recommended a
00:55:22.520 lot of times it’s like a little bit of
00:55:23.640 during per menopause with hormone
00:55:25.039 therapy a little bit of trial and era in
00:55:26.799 a in a very safe way like how does your
00:55:28.640 body respond like nothing is like
00:55:30.960 permanent anything can be shift and
00:55:32.920 stopped and see how your body responds
00:55:35.920 okay and then our last question for the
00:55:37.839 evening if nobody else has any um Can
00:55:41.119 starting treatment for per menopause
00:55:43.720 early make a significant difference in
00:55:45.760 managing symptoms and long-term Health
00:55:49.200 outcomes I mean yes but but it’s
00:55:52.160 individualized you know it’s not like I
00:55:54.880 think for some women it can be a major
00:55:56.839 game Cher it’s it’s but I don’t want to
00:55:59.760 say it’s like this magic potion that
00:56:02.039 everyone if they took it is going to
00:56:03.720 like have the best life ever although
00:56:05.920 I’m like I’m a big supporter of it
00:56:07.799 mostly I’m big into educating because
00:56:10.160 there’s so much misinformation and fear
00:56:12.880 and then you can make the best choice um
00:56:15.200 it’s it’s very safe when used like at
00:56:17.680 the right time and the right
00:56:20.039 formulation um we know that from the
00:56:22.880 women’s health initiative so from
00:56:24.039 studies we know that women who use it
00:56:25.920 have higher quality of life um tend to
00:56:28.680 live three years longer I mean Hello
00:56:30.799 that’s pretty good tends to prevent
00:56:32.280 heart disease so there is a lot of
00:56:34.480 benefits I know for a lot of my patients
00:56:36.240 it’s been transformative and
00:56:37.640 life-changing for others we need to do
00:56:40.319 some other there’s something else going
00:56:41.559 on and that’s why individualize medicine
00:56:43.559 and just working with someone who gets
00:56:45.160 to know you and can look at all the
00:56:47.640 variables that can affect your health
00:56:49.359 are are really important thank you
00:56:51.359 everybody um if there’s no other
00:56:53.839 questions thank you Dr na thank you
00:56:58.119 everybody um Follow Me At Hello Perry
00:57:00.880 the hello Perry if you’re not already
00:57:02.520 because I have lots of good hormone
00:57:03.680 stuff there so grateful thanks for
00:57:06.240 coming everyone