August 8, 2023

Personalize your approach to menopause with Dr. Heather Hirsch

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On episode 602 of the 40+ Fitness Podcast, Dr. Heather Hirsch and I discuss her book, Unlock Your Menopause Type: Personalized Treatments, the Last Word on Hormones, and Remedies That Work.


Let's Say Hello

[00:02:51.430] – Allan

Hey, Ras. How are you?

[00:02:53.400] – Rachel

Good, Allan. How are you today?

[00:02:55.320] – Allan

I'm good. I'm back in Bocas where I like to be. It was great to visit family. Don't get me wrong, that was a great catch up and I'm glad I did it, but I'm just happy to be home.

[00:03:08.170] – Rachel

Yeah, I hear you. It's hard to be away from your own home, your own habits, your own kitchen, your own bed for so long.

[00:03:14.940] – Allan

And my dogs. Those little things.

[00:03:20.750] – Rachel

That's right.

[00:03:22.110] – Allan

How are thing up there?

[00:03:23.570] – Rachel

Good about the same. I'm doing the same thing you are. I'm squeezing every moment I can with family. When I get it, we're trying to get some vacations planned and just being as busy as we can. Summertime just feels like it goes by so fast because we aim to spend a lot of time together. Because I'll tell you right now, in the winter time, I shut down. I do not want to drive in the snow. I don't want to be outside except to run where I can at least generate some steam, some literal steam. Yeah, but, no, I'd like to spend as much time with my family as can.

[00:03:59.600] – Allan

So, yeah, Tammy and I are planning our September holidays because we're going to close Lula's down for the month and just go explore. So we're going to take some time off and just travel around this country. And Mexico. We're going to go up to Mexico for a little while, but that's kind of the plan for September. So we're putting that all together right now. But this trip will be the two of us together. To be better.

[00:04:25.330] – Rachel

Yes. Oh, that's wonderful. I'm glad you get the time to do that. That's great.

[00:04:30.330] – Allan

All right. And I mean, guys, guys, because I don't normally say this kind of thing, but look, the topic we're going to talk about today is menopause. And if you've listened this far, you need to keep listening. The health of the women around us is important to the quality of our lives, too. And so just recognizing that, no, she's not crazy, she is going through something, maybe seeing these buckets and that we're going to talk about in this interview and just saying, hey, that's her, that's her. And maybe this book will give her some options that will help her, I think that'd be a very valuable thing for both of you. So don't tune out just because this is a menopause issue. There's a lot of education in here that can help you, help the people around you and your relationships. So please do listen on.


[00:06:06.310] – Allan

Dr. Hirsch, welcome to 40+ Fitness.

[00:06:09.590] – Dr. Hirsch

Well, thank you so much for having me. This is so exciting.

[00:06:13.510] – Allan

So your book is called Unlock Your Menopause Type: Personalized Treatments, the Last Word on Hormones, and Remedies That Work. Now, my wife has just recently gone through menopause and so I've experienced this side of that relationship thing. I haven't experienced it, obviously. I've had a lot of conversations with experts in the field and in talking to them, particularly women that have experienced it, there's this concept that every woman experiences perimenopause and menopause differently. But your book took them and kind of said, look, we can group these into buckets, if you will, and within that, basically now you can be a lot more specific about how you address your health and wellness and mental everything by knowing kind of what your type is. I really like that idea because I think so many times people think, well, what's the answer? The answer? And it's a lot more complex than that.

[00:07:16.170] – Dr. Hirsch

Right, exactly. Wouldn't that be so easy? I'm glad you liked the types because certainly it was meant in many ways to really help women really help better target their symptoms by thinking through what are the predominant symptoms or what is the predominant health history I have leading up to menopause. So did I have surgery or cancer or did I never have a hot flash at all? Because if you never had a hot flash or an outward symptom, it may not even be on your radar. And therefore, actually your health could be really deterred by not knowing what that means. And so I also love The Buckets because I think truly there's not one size fits all. But I couldn't write a book that was like the million types of menopause that could add into limited at some point.

[00:08:14.770] – Allan

Yeah, your editor probably would have had a problem with a million types

[00:08:19.020] – Dr. Hirsch

she would have. Yeah. Actually, my agent actually, before I got to my editor, I said, I really want to write a book on why nobody cares about menopause. And she said, Well, I think that might make a better blog post. And actually we spent a lot of time thinking about the menopause books that were already on the market and what would make mine different, because there are good books, but I really also felt that there weren't inclusive enough. So I talk a lot about depression and anxiety. Younger women, women with cancer, seemingly kind of get left out of the equation because they just don't fall into the cookie cutter, 51 year old with hot flashes.

[00:09:01.150] – Allan

Yeah. Now, while we're on it, let's just briefly go over the six types and what kind of makes each of them unique.

[00:09:11.020] – Dr. Hirsch

Yes. So the first type is the premature type. And actually this is one that is a medical diagnosis. There is something called premature menopause, and that is when you have menopause before age 40 and early menopause is menopause between ages 40 and 45. Meaning really simply whether it's surgery and your ovaries were taken out or your period stopped and you had lab levels that showed menopause about one to 5% of the population has early menopause. And I had a patient last Friday she was sitting with me in my New York City office, and she said, how rare is this? And I said, Well, I think I did the math. And I said like 1%. I'm going to get this wrong, but 1% of 5 million is 50 million is 1% of 50 million. I don't know what the number it was either. How much is it?

[00:10:12.360] – Allan

I think it's 50,000.

[00:10:13.640] – Dr. Hirsch

50,000, right? Yeah, 50,000 women a year, and that's just 1%. But we could go up to 5%, right? So I said 50,000 women each year is not nothing either. And I also think that that number is dependent on getting lost in the weeds here. But I'm really passionate about this. I think that number is also getting lost in the weeds because she said also I haven't seen a doctor in a really long time, and I don't even know if my doctor really even considers the fact that I haven't had periods anymore. So that number 1 – 5% is probably an underestimate. Okay.

[00:10:45.070] – Dr. Hirsch

The second type is the sudden menopause type, often due to either something suddenly happening. I think of chemotherapy for cancer treatments. I think of surgery for maybe endometriosis or cysts or cancer, again, thinking of lupron or certain medications, even high dose steroids. I had a lady who went into menopause after a traumatic car accident. She had a traumatic car accident. Boom. Never got her periods again. And so for most women, the sudden menopause type is potentially where hormone therapy is not indicated because there are patients here who are suddenly waking up and taking chemotherapy for cancer.

[00:11:29.040] – Dr. Hirsch

And so this type really talks a lot about, in my book, non hormonal therapies, but also different ways of exercising, different ways of treating your body with a sudden type of menopause.

[00:11:40.930] – Dr. Hirsch

A full throttle menopause is exactly what it sounds like. Symptoms from head to toe, hair loss and night sweats and waking and fatigue and lack of motivation. And every single symptom you could think of is really your full throttle menopause.

[00:11:57.750] – Dr. Hirsch

The mind altering menopause, which is type four, is really near and dear to me as well because I think there are many women for whom their symptoms are really more mental health hearing, whatever that means. So there still could be a big shift in hormones, and they may get either misdiagnosed with depression, anxiety, bipolar, and there certainly could be multiple factors, but the shift in hormone there is huge. And this is actually one where I say movement really is medicine. There's the lingering menopause type, which is symptoms that just sort of never seem to go away, never as terrible as full throttle or as obvious as sudden menopause. But too many women let menopause symptoms go on for many, many years without feeling as though they are worth treatment or they're worthy of treatment, or they're just taking care of too many other people.

[00:12:55.530] – Dr. Hirsch

And then silent menopause type is really what I touched upon is that even if you never had a symptom, your body still changes. So what are the exercises you need to do? What are the health tests you still need to do? Because women with silent menopause type may seem lucky on the outside, but if that doesn't remind them that their body is still changing, they may be left at a disadvantage.

[00:13:18.030] – Allan

And I think it's important for them to kind of go through that process of deciding, okay, what's the best approach for me? Because there is no one size fits all. So here's an opportunity for you to do a lot of different things. And one of the things that's going to come up unfortunately or unfortunately, I guess it's unfortunate, is there's kind of this confusion about hormone therapy, because there was the nurse's study, and so we have information from a nurse's study. And that's what most, I think probably most general practitioners and maybe even a lot of gynecologists were taught was okay, this was the science. But we've learned a lot since that study. So pros and cons, should a woman consider hormone therapy or not?

[00:14:04.510] – Dr. Hirsch

So absolutely a woman should consider hormone replacement therapy. And I always like to preface all of my either talks or podcasts with again, I still don't think one size fits all. So it's not h or T or bust. But there are so many indications and there is so much now we know about the safety and efficacy. So I kind of think about it like this. If a person was diagnosed with hypothyroidism and they were feeling sluggish and slow and their hair was falling out, we wouldn't say to them, oh, well, just set your alarm earlier and meditate like you'll be okay. We would give them thyroid hormone. We would replace their medication because they're missing a hormone that is crucial to their entire body. And truly, estrogen is very similar. Now, biologically, women were meant to go through menopause. I don't know how long women lived postmenopausally, probably not as long as we do now. Maybe five years, ten years, I don't really know. And I actually think there is an evolutionary basis to being in menopause. You could help your children and then they could help their grandchildren. So I actually think there is an interesting evolutionary basis for menopause.

[00:15:26.880] – Dr. Hirsch

But now we live very, very long and our symptoms can be really quite severe. And now midlife is the peak of a woman's functionality in terms of intellectual capability, financial capability. And so not that all women need hormones or hormone replacement therapy, but for so many women it's just like that hypothyroidism, they lose their estrogen, progesterone, testosterone, and yes, things like meditation and gratitude and journaling, they can certainly help. But just like that example I gave you, oftentimes when I give them estrogen back, boo, it's like night and day, they're back to functioning and feeling so well. And we should not demonize an endocrine dysfunction or disorder. Now people get all up in arms. You ask the simple question about is it safe? But truly it is. And the thing about the safety of HRT back to your original question, is, it is so peppered with cultural and societal norms about menopause and whether we should take hormones or not. But anyways, it's not necessarily that menopause is a disease, and yes, it is a natural part of life. But when you are a doctor, when you see what I've seen, that the majority of women really feel so much better almost instantaneously, not all of them.

[00:16:46.850] – Dr. Hirsch

It really does. You really just see at the basics of this, you lose a hormone, I replace it, you function well again. So we know from the Women's Health Study, as well as some of those longer studies, right, the Nurses Health Study, lots of studies about HRT, that there is an immense amount of safety data, particularly for women who start within ten years of menopause. That's the one thing that the Whi scared people about. And the idea that hormone therapy increases the risk of breast cancer has also been demystified. And that if we use certain formulations, estradiol and prometrium, which are FDA approved, which you should absolutely get FDA approved, we don't see statistical increases in breast cancer. And we do know that women who do take FDA approved hormone replacement therapy live longer, die less from all causes, have less diabetes, gain less weight, have improvements in quality of life, better bone health. Oh, stops your symptoms, I forgot to say work longer, retire later. So many benefits from hormone replacement therapy. So before I get off my soapbox, my last thing is you're not doomed if you don't take hormone therapy. It's just that the last statistics showed that probably about seven to 10% of the US population is taking hormone replacement therapy. And if we can even get that numbers to 20%, at the peak before the WHI, it was 45% to 55% of women. I just want women to be able to have better conversations with their clinicians, with themselves, and to think about HRT as a valid option.

[00:18:27.730] – Allan

Yeah. And I think that's what's really important here is that you educate yourself. You're your own coach. I mean, you're your own CEO, and you have to make the best health and life decisions for yourself. And if you just go at it like a knee jerk, oh, no, that's bad, without really looking at your particular situation and what it would mean, and talking, of course, to your medical advisor, your practitioner, your gynecologist, and having those conversations, then at that point you can make an educated judgment of what's best for you.

[00:19:03.630] – Dr. Hirsch


[00:19:05.950] – Allan

Now, this is not all about getting a shot or pellets or whatever else, creams and everything else. There are things you can do every day to help symptoms help yourself feel better, to get through this easier and come out stronger. And we call those diet, exercise and self care. Can you talk a little bit about how those play into this?

[00:19:30.150] – Dr. Hirsch

Yeah, I think they're really crucial. And even to come off the backbone of talking about medication, sort of right off the bat, I do think that diet, lifestyle, mental health and sleep really lay the foundation for adding a medication on top of this. Because whether you take that medication off or on or you change the dose, these are the things that set up good habits for the rest of our lives. And once we're postmenopausal, we're always post menopausal. So to keep it brief, I will say one more plug for my book is which is incredible that I was even able to do this, but for each of those different types, I talk about the best types of diet, lifestyle, mindsets and foods for each one, which is really crucial. So let me give you a little window. The sudden menopause type, we talk a lot about anti inflammatory foods because I'm thinking if something suddenly brought you into menopause, perhaps you have cancer or you're taking chemotherapy. And when we talk about exercise, I'm talking more about like graded exercise, stretching, mobility, flexibility. When we talk about the mind altering menopause type, I feel as though because of that loss of dopamine, there are certain foods that can include those feel good that could increase not include increase those feel good hormones in the mind type of menopause.

[00:21:02.730] – Dr. Hirsch

I think that exercise is really medicine here. And getting your body moving, getting your cardiovascular system moving is so, so crucial to also help you release dopamine, serotonin and those happy neurotransmitters. And for the silent menopause type, I talk a lot about weight bearing exercise. And actually, of course, I should say across the board, weight bearing exercise for women as we get into our 40s is absolutely crucial.

[00:21:33.070] – Allan

Thank you for thank you for saying that.

[00:21:37.330] – Dr. Hirsch

Yes, it does not have to be going to CrossFit, does not have to be. But really, if you're new to it, starting with weight bearing exercises, squats and then picking up your milk and doing deadlifts with that, and upper body, your shoulders, your back. In my book, I talk about a lady who had silent menopause. She had a BMI of 20, played tennis two, three times a week, and as she was getting the turkey out of her Thanksgiving, out of the oven for Thanksgiving, she stood up, fractured her spine, and she hadn't been weight bearing, hadn't been told about osteoporosis at all. And so the weight bearing is so crucial, not just for the silent, but for all women post menopausally.

[00:22:21.780] – Dr. Hirsch

It really has to be incorporated in some way, shape or form. When we think know, I am not a bona fide nutritionist. I actually had Elizabeth Ward as a dietitian who wrote a wonderful book, a great companion book called The Menopause Diet Plan. And there are really certain foods that are so important that we should be getting for vitamins like zinc and iron and magnesium. Now, iron is not as important postmenopausally because you're not bleeding anymore. But perimenopause in your 40s, it's really crucial because it can lead to a lot of fatigue. And me, I always recommend a diet with at least 80 to 100 grams of protein a day. I have tracked macros once in my life. I personally hated it just because it just made me feel so crazy about it. But increasing protein in midlife is so important. So weight bearing, exercise, increasing your protein intake. And then we can talk a little bit more about some of the other lifestyle tips like sleep. But these are really such foundational backbones to thriving and feeling well because how you treat your body between ages 40 to 60 really sets up how you're going to spend the rest of your time on this planet.

[00:23:46.630] – Allan

Now, one of the topics that's come up, it's like why is a guy interviewing and reading all these books on menopause? Because I try to do at least one per year.

[00:23:57.290] – Dr. Hirsch

We love this. We love this.

[00:24:00.760] – Allan

Well, to me it's important to understand what's going on in my wife's life. And I know there's a lot of women out there that need this information. Me being a guy, that's not a valid reason for me to say I don't need to know this. But I've read some statistics. I couldn't quote them right now. But there's a lot of divorces that happen during perimenopause and during menopause and a lot of it can probably be traced back to just changes in behavior, changes in what's going on in your life. And as a result, there's a disconnect in your relationship. And there's a lot of other things that probably play into that like kids moving out of the house and other things. But I think it's just really important and I wanted to bring this up is that you have a conversation with your significant other, with your kids. I'm not screaming at you because I hate you. Maybe I'm just going through something here and helping them understand it. Could you talk a little bit about how someone can start that conversation? Particularly once they know they're tight?

[00:25:03.570] – Dr. Hirsch

Oh my gosh, 1000%. And really I got so excited and clapped. Is because it's so fundamental that men really understand this. And I think that it's easy to look at this now. We're in 2023, right? In terms of your partner being pregnant, certainly there are some nowadays I'm going to make some assumptions and a heteronormative relationship. So an assumption there, and that's not always the case. But in this assumption, or this scenario, men now are expected to go to some doctor's business, not all because that would be bizarre and touch the belly and help build the crib and take maternity pictures and help if their wife is and learn about and learn about breastfeeding and all of those things, right? There is no difference here. There is no difference here. There's not a big belly and there's no crib that needs to get built. But the process is so uniquely similar. We're going through a complete hormonal shift that we do so that we can reproduce for the species, right? And for men to be inquisitive, to want to learn, for their partners, to want to educate too, and educate other men or women, who knows?

[00:26:25.210] – Dr. Hirsch

And I actually think that men find this very interesting because as much as women have been shut out, they certainly feel shut out and also feel like same thing in the hospital when the baby's being born. Like, what can I do? What can I do?

[00:26:41.730] – Dr. Hirsch

I think you asked me what are tips for women to start the conversation. But gosh, I think that if men also were there for the conversation or almost even said actually men should say nothing. Women should take the lead maybe, right?

[00:26:59.370] – Allan

Well, that's what I'm thinking. You know, one of the things is at this point of this show, my guess is that our listenership is all women. Most of the guys tuned out the first minute when I said we're going to talk about menopause unless their wife was going through it or they thought they were going through it, most men are going to tune out. If you didn't message me, let me know. I'd be very interested to hear otherwise. But I think it's incumbent on the woman to recognize that as she changes, as hard as it is having conversations, because I've heard of women unable to complete their jobs. They have to quit their jobs because of the symptoms they're experiencing. And that's so unfortunate because it's a medical condition. And so they need to have a conversation with their employer and say, okay, I'm going through a medical situation. I'm treating it. I'm working with a doctor, and then you have certain protections that you wouldn't have otherwise. But I think it's just that point of saying, okay, I need to start these conversations because this is not just a thing I'm going to just breeze through and accept this could change me.

[00:28:03.340] – Allan

It is going to change me at some level, but it could change me drastically. And I need my partner to know that. I need my children to know that. I need my work to know that so that I can live a whole full life and not let these symptoms take me down.

[00:28:17.870] – Dr. Hirsch

I couldn't agree more. And I think that there may even be shows like this, for example, that they could sit down with their significant other to say, I think I could be entering perimenopause. There's probably some cute, humorous things that can light heartedly bring up the conversation. I have a small section on this, on my book, too, and telling not even just your partner, but also if there's children still at home, which sounds kind of silly, but it can help your children better understand that there's just…

[00:28:53.610] – Allan

Mommy's not crazy.

[00:28:54.190] – Dr. Hirsch

That there's a transition here that's not them. But women can have shorter fuses, feel more irritable because they're having trouble sleeping, because they don't feel good, and they're so used to more often taking care of the whole family. So there's also guilt and there's worry and anxiety there. But even just sitting down at the dinner table one day and talking a little bit about it and the physiology books are always great, unlock Your Menopause type is a great one. Podcasts like this show can be great for partners to listen to because it's so nice sometimes to hear a guy's voice. I did another interview on a Boston radio show with two male hosts, and it was just great because I love having men as hosts. These can serve as bridges, and it's so crucial.

[00:29:46.090] – Allan

Thank you. So, Dr. Hirsch, I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and stay well?

[00:29:56.030] – Dr. Hirsch

Oh, what a good question. Okay, I'm just going to go with what I've been doing. So, you know, not that I'm perfect, but I am certainly just a mere mortal myself. I try to be pretty introspective when I can. So I actually just started going back to therapy. I've been in therapy on and off for many years, and certainly I have no problem saying that out loud. And it really helps me to take off the mental load of I listen to a lot of patients talk about their lives and their histories. And for me to be the best doctor, for me to be the best mom or parent, I need a place where I can digest all of that information so that I could be a better continue to be a better doctor, continue to be a better wife and mother and friend. So for me, that's kind of what I call my mental health. That's my mental health, right? So for me, that's cognitive behavioral therapy, and I'm lucky that I have resources. But another way of doing that is other things that you can do, like journaling or journaling especially. It's basically free cognitive behavioral therapy.

[00:31:06.140] – Dr. Hirsch

For me, it's 20 minutes of exercise most days that keeps me also really feeling my best. I used to be a long distance runner. I used to run marathons. And in this time in my life, actually, I think that would be more stressful on my body if I didn't absolutely love it and have all the resources to refuel my body. And so I like to do 20 minutes of exercise a day, if I can, in the mornings, and it really sets me up for just a wonderful day. And oftentimes I'm either doing my Peloton or some cardio sorry, or some weights because the weight bearing activity is so important. The third thing that I do to be my best self. I would say gosh, I could say so many things, probably I could say sleep. But let's not lie. I love scrolling it. But I like being present, so I like to be in the present moment. So whether my kids are snuggling with me on the couch or I'm reading a book to them, my husband's telling me about his day. I'm looking out, beautiful scenery outside. I'm taking my first breath of air.

[00:32:07.180] – Dr. Hirsch

I'm just trying to live in the present moment that actually keeps me very sane and happy.

[00:32:12.970] – Allan

Awesome. If someone wanted to learn more about you and learn more about your book, Unlock Your Menopause Type, where would you like for me to send them?

[00:32:21.090] – Dr. Hirsch

I would love for you to send them to my website, heatherhirschmd.com. It's got all the resources you could ever need or my social media. I'm @heatherhirschmd across all the platforms.

[00:32:33.930] – Allan

Great. Well, thank you so much. And thank you for being a part of 40+ Fitness.

[00:32:38.450] – Dr. Hirsch

Thank you. It was a complete joy and pleasure to chat with you today. Thank you so much for talking about this topic.

[00:32:46.160] – Allan

Thank you.

Post Show/Recap

[00:32:47.160] – Allan

Welcome back, Ras.

[00:32:48.650] – Rachel

Hey, Allan. Menopause is the topic of the day for me right now. As I mentioned to you and our viewers, way back in the spring, I hit menopause. So I'm postmenopausal now and I'm trying to deal with all these weird symptoms. But I also appreciate what you just mentioned in our intro that for the guys to listen in. And I happen to be married to my husband Mike, and I've been cluing him in on my strange behavior and my questions that I have and all the things that I've got going on. We do have an open discussion and for any of the ladies out there whomever your partner or spouse is, be open and start talking about it because it can be very helpful to get that conversation started.

[00:33:32.320] – Allan

Yeah. Me doing what I do, I talk to a lot of people in the field that are doctors. I try to have at least one menopause issue per year because I think it is an important age related topic for us to get into. But guys, we're going to live with this for potentially a decade or more. They're living with it and we're not experiencing what they're experiencing, but sometimes they're not going to articulate why they are all emotional and going off on you because you didn't mow the yard right or didn't pick out the trash right. Or like, okay, it went out and it's not in here. Sorry, I forgot to put the bag in there, that kind of thing. It's not worth trying to choke me to death, you know, just realize that that could be a symptom. And so it's worth having that discussion. And one of the things that I liked about Dr. Hirsch's book was the concept of the buckets.

[00:34:27.870] – Rachel


[00:34:28.620] – Allan

Because it shows you just how different the different symptoms for different women can be. And here's something we didn't really get into in the conversation, but the woman can be a combination of a couple of these. Actually, when you start reading through the descriptions and getting into a little bit more detail, you can be, well, I'm sort of a little bit that one, and sort of a little bit that one. And you may not be having all of the symptoms. You might only really have one or two, or you might have every single one of them that anyone's ever listed in any kind of thing. It's like, do you have yes, I got every one of them. Check them all off. But again, the book gives you some practical guidance and talks about different solutions and things that you can consider and if it's adversely affecting your life, again, you have to have the conversations and you have to find the relief that you can so that you can live as normal a life. Now, it's not a new normal. And I think that's one of the big takeaways from most of the interviews that I've done is that a lot of doctors in the past have just told women this is just how it is.

[00:35:41.710] – Rachel


[00:35:43.710] – Allan

Okay. And it's not. You do have some treatment options and you should really pay attention to those.

[00:35:50.590] – Rachel

Yeah. I think that's one of the biggest mysteries of menopause is that we all think this is natural. We went through puberty, now we did our childbearing years, now we're going through menopause. It's all very natural. But when things do interrupt your life, when things aren't quite right, there is a solution. And the second part to that, the second tricky part is that we're used to when you get a cold, you take antibiotics. When you break a bone, you get a cast. When you get menopause, there's a big blank after that and that's the hardest thing. So when you're young and in your thirty s and forty s, it's really important to start paying attention to what your body is doing, what's normal for your body. And then as you're shifting into perimenopause, which is when your hormones are all crazy and fluctuating, then you really got to dial it down. Because I think that's where I went wrong is that I'm a very athletic person. So when I'm getting achy and emotional and tired, it's probably because I ran too many miles and didn't eat enough. But that's not necessarily the case. So trying to piecemeal these different symptoms, it can be really difficult.

[00:37:01.830] – Rachel

And before you know it, like in my case, I'm in menopause and now I am really dealing with the carnage of my hormones being all out of whack. So I think that it is important to find a doctor who knows you to pay attention to your symptoms, start tracking some things and then doing some blood work when necessary to see if there's anything that can alleviate the symptoms, but that's part of it is chasing the symptoms. And that can be hard sometimes.

[00:37:28.620] – Allan

Yeah, well, I mean, when most of us went through puberty, a lot of folks really suffer with acne as an example. So what do you do? You look for treatment for acne because, again, it's somewhat debilitating as a 15 year old, 16 year old who's just completely breaking out with acne and feeling self conscious, and that's affecting everything in your life. This is actually maybe even a little bit more severe than that. And so just knowing, okay, I'm going through this. I do not want this to affect my career. I do not want this to affect my relationship. I do not want this to affect my kids. And so, depending on where you are in life, you're juggling a lot of different things, and now, boom, here's

[00:38:13.470] – Rachel

another thing to deal with. Yes.

[00:38:16.080] – Rachel

That highlights everything. It overshadows everything. And like you had mentioned, too, because emotions are often tied with menopause. Like, we are emotional people. I'm an emotional person just to begin with. But anxiety and depression is another side effect of these changing hormones. And if your husband or your partner notices those things and can talk to you about that, that could be another signal to go to your doctor. And we have talked about, or you guys talked about hormone therapy. A lot of people call it hormone replacement therapy, but that is another way to treat some of these symptoms, especially if you're getting super emotional with anxiety, depression, and even anger. Like you had mentioned, sometimes we are quick to get angry. And I noticed that in my own personality, I'm usually a very happy, very patient, very calm person. But since I've hit menopause, my emotions are pretty quick to change, and I've noticed that. So if your spouse or partner notices that, that could be a helpful symptom to chase with a doctor.

[00:39:26.540] – Allan

Yeah, because you're half aware of what you're doing most of the time.

[00:39:32.230] – Rachel

Yes. Half aware,

[00:39:34.480] – Allan

or you feel it afterwards, it's like, why did I go off on him? Why did I run into the bedroom and start crying? Those kind of things. And granted, I can't say I've experienced that we go through andropause so there is a lowering of our hormones, and we recognize that as we get older, we get a little softer, usually. But it's not that you have to or must do, but it's that you can. And so it's the thinking through, how do I properly treat myself so that I can live the best life possible? Because I say wellness is healthiest, fittest and happiest. And if this is adversely affecting your happiness and your lifestyle, it's a health problem. It's something that you should spend some time addressing. Now, it's not always hormone therapy or hormone replacement therapy, right? HRT, however you want to define it, but that's an option that's out there, and it's worth you having a conversation with your doctor. Now, if you're well out of menopause, you've been in menopause for several years, you're probably not a candidate for hormone replacement therapy, particularly estrogen and progesterone, if you still have a uterus.

[00:40:54.060] – Allan

But just recognize that it's available to most women that are perimenopause or just going through menopause. So while you're going through the heat or hot or everything else of the symptoms, the worst of the symptoms, that's the point where you have an opportunity to lessen the blow and live probably maybe even a better normal life, maybe even a better life than you had before. Because you know yourself and your body so much better when you give yourself the energy and stuff that you had when you were in your 30s. By this hormone replacement therapy, you're capable of moving more, you're capable of thinking clearer, you're capable of better, making better decisions and all that put together, it's kind of like a trifecta of health because you're moving more, you're eating better, and you're feeling better and you're happier. So just look at these solutions and decide what works best for you and your lifestyle. But don't just think you're a victim of your body. You do have a team and some people you can talk to that can help you work through this.

[00:41:59.050] – Rachel

So true. I think this book would be a really great place to start. I really like how she did put the six types, or the buckets of symptoms of menopause. I think that would be a fantastic place to start. And then also, I'm personally working with the women's health department of my hospital network, so I actually have a menopause specialist helping me get through all this. So start with your symptom management. Start taking notes, start journaling with how you're feeling. Get a book like this to maybe kind of put some of those thoughts into a framework and then maybe speak with your doctor and see how it's going. But please don't wait. If you're even thinking something's off, you're in perimenopause. Your periods are kind of wacky. Start now and go see a doctor and figure this out before it's too late. Or not that it's too late in a bad way. But the better you can get started now, the better you'll be later.

[00:42:55.110] – Allan

Yeah, well, the cool thing about the buckets is that then she gives you some ideas of protocols, like how you should be moving, how you should be eating. Hint, it's whole food. Yeah, for just about every bucket. Well, for every bucket. But it's just that concept of you're going to have some tools, some things you can try that she's worked with thousands of patients and helped them through menopause. So she's in a really good position to teach you how you can treat your body to make the symptoms less where you feel better, more like yourself. And yeah, after reading what she has to say about it, if you believe hormone therapy or hormone replacement therapy or HRT, however you want to say it is the right thing for you, then you can have that conversation with your doctor from a point of self education that now you can understand the answers to the question. Your doctor is just poo pooing it and saying no. You'll know, that that's not entirely the case. And you can just ask them if they've read anything since medical school, but just talk to them and you have a team and just make it work for you.

[00:44:04.350] – Rachel

On that note, Alan, I have a general practitioner. Like everybody, you have your main doctor and they know a lot. But when you have something important going on, you find an expert, whether that's a menopause specialist, a cardiologist, anybody out there you see a PT for muscular or other imbalances know, start with your general practitioner. But then when you need to see an, just go right to the expert.

[00:44:30.390] – Allan

Excellent. All right, well, I will talk to you next week.

[00:44:33.910] – Rachel

Great. Take care, Allan.

[00:44:35.440] – Allan


[00:44:36.030] – Rachel

bye. Bye.

Music by Dave Gerhart


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