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YHM 068 - Perimenopause & Menopause with Dr. Maille Devlin
37 Plays2 years ago
Join us today, as we delve into the world of menopause with special guest Dr. Maille Devlin. Learn about menopause demographics, symptoms & health risks.
Discover common treatment options for managing menopausal symptoms, from Hormone Replacement Therapy to lifestyle changes.
Follow Dr. Maille:
@dr.mailledevlin.nd
www.mailledevlin.com
Recommended
Transcript
Introduction and Focus on Women's Health
00:00:11
Speaker
Hello, everyone. Welcome to another episode of Your Health Minute, brought to you by Aqua Omega, a show where we discuss important health topics that can have a significant impact on your health and your loved one's health. I am your host, Max Mirian, and with me, as always, is my co-host and moderator, Cal Temoro. Hello.
00:00:30
Speaker
And with us today, we have a very special guest, Dr. Maley Devlin. Welcome to the show, Maley. Hello. It's so great to be here. Be back after a while. I'm very excited for a chat today.
00:00:42
Speaker
Yeah, it's great. It's been a really exciting season. We've had some great guests, some fantastic topics, and I'm really excited about today's topic.
Dr. Devlin's Journey and Expertise
00:00:50
Speaker
And that might sound funny, but we are going to be talking about menopause, and specifically women's health. Before we dive into this topic, Dr. Mele, why don't you give our new listeners a little background on yourself, and also how you came to become a naturopathic doctor in your interest in health.
00:01:10
Speaker
Oh, all right. We'll try to keep this brief. So a little background about me. I am a naturopathic doctor. I practice virtually all across Ontario. Started doing that in pandemic when we switched to virtual and I loved it. So I stayed virtual. My focus in practice has really shifted to focus on menopause, perimenopause and people going through that transition as well as
00:01:37
Speaker
metabolic health, cardiovascular health, so things like diabetes, heart disease, and then overall healthy aging. So I love working with people who are looking to optimize their health and people who are going through midlife and starting to really pay attention to their health, they're noticing changes and want to get their health in check before it's too late. So I love working with those types of patients.
Understanding Menopause
00:02:03
Speaker
For me,
00:02:04
Speaker
My journey to naturopathic medicine, I've always been very interested in healthcare, started out, wanted to be an obstetrician gynecologist actually, shadowed one. It was an amazing experience, saw a lot of births, surgeries, it was a fantastic experience. But I realized that there wasn't enough people in it and enough of the talking conversations around health
00:02:32
Speaker
Uh, so that I wanted to be a GP shot at GP. Same thing. I talk a lot. There's not enough time for me to talk in those. So I had to dive a little deeper, found out when naturopathic medicine was and loved that. It really gave me the opportunity to sit down and chat with people about health all day, basically, and set goals and plans. And it's kind of the fun side of health where we get to focus on prevention. We get to think long-term, we get to work in, uh,
00:03:01
Speaker
less of a high stakes environment. So it's more of a conversation and goal setting rather than we have to do this now, this is your only option. So I really enjoy it. And that's kind of what brought me to the field of naturopathic medicine. I love it. And I can, I can say to our listeners that are listening now, I myself have personally work with Dr. Maley and so has my wife and it's been a wonderful experience. And we've had all kinds of fantastic insights and, you know, always working to improve our health.
00:03:30
Speaker
Um, let's dive into the show. Let's talk like you
Hormonal Changes Explained
00:03:33
Speaker
mentioned it. And like, when you were talking about, about, uh, menopausal health, uh, you, you talk like, I think it's often referenced as the change. Um, but the change doesn't just happen, you know, right away. There's all types of hormonal health through the entire progression of, um, a woman's lifetime. So why don't we go into like the perimenopause menopause and postmenopausal health?
00:03:57
Speaker
Yeah, I think that's always a great place to start because it gets very confusing. Even patients who are in the transition themselves, I find it
00:04:04
Speaker
They don't know the correct terminology to explain it. And then you can be googling something and getting the wrong results. So someone's impairing them. Don't Google. So it gets very confusing. So what happens is women's have menstrual cycles throughout life. And we have a very typical pattern as long as there's no pathologies. We have a very typical pattern of
00:04:27
Speaker
estrogen and progesterone rising and falling throughout the cycle and this causes menses or bleeding every month and what happens is as we get closer to menopause which is the stopping of this cycles change and we see a lot of changes in
Menopause Symptoms and Impact
00:04:44
Speaker
this period called perimenopause.
00:04:47
Speaker
So perimenopause can start in, usually starts in like mid forties, but can also start to happen in thirties. Um, and this is where cycles get longer. You get longer between each cycle. Well, that's happening can also get shorter for a while can get longer cycles can get heavier. They can, they can be shorter. They can be lighter.
00:05:05
Speaker
symptoms can change. PMS usually actually gets worse during this time. So it's not this graceful transition into, oh, I just don't get my period anymore. Awesome. It's actually a little bit of a hormonal roller coaster. And so what happens is the thing that starts at ovulation, which triggers that whole regular menstrual cycle is ovulation. And when ovulation doesn't happen, so in perimenopause,
00:05:32
Speaker
we skip ovulation sometimes. So that starts to happen less and less. That's leading to menopause. And so in our bodies, fertility is no longer important, so we stop ovulating. But that decline in our hormones that are released with ovulation signals to our brain to stop releasing those trigger hormones, so things like FSH and LH. And so our
00:05:58
Speaker
sorry, releasing our estrogen progesterone. So that decreases. So our brains then will kind of yell down to our ovaries and say, hey, we need those hormones. So then your FSH, which is a follicle stimulating hormone,
00:06:14
Speaker
increases. And so that is coming down from our brain, down to our ovaries and trying to signal this ovulation that's not happening. It's like troubleshooting. Exactly. It's trying to troubleshoot. This hormone is not coming from our ovaries, so our brain is the one in charge saying, oh no, we need to signal that to happen. So this FSH is slowly rising while those other hormones are decreasing.
00:06:38
Speaker
But what happens is then we get kind of this little bit of, of estrogen or a little bit of progesterone. And so, and then we see it's a little bit messy. It's not this slow, beautiful decline. And so what happens is cycles change, but there's symptoms that accompany this change as well. And so the very typical one we hear about our hot flashes and hot flashes is a major symptom of menopause where we have
00:07:06
Speaker
low estrogen and we can go into what's causing that. But I wanted to touch on some of the other perimenopausal symptoms because I think these are really lost sometimes. And so things like a very common one is sleep. So if you've always been a pretty good sleeper and now you start to wake up in the middle of the night or every morning you feel like I cannot sleep past 5 a.m. What's wrong with me? That could be a sign. Mood is a big one. So anxiety, feeling anxious for no reason at all.
00:07:35
Speaker
especially if you've never been anxious before, lower mood, mood swings. We think about, go back to the hormones, your hormones are all over the place. So you are then
Societal Neglect of Women's Health
00:07:44
Speaker
going to feel those reactions that are happening. And so those are the very common pieces that we see during perimenopause. Then what happens is as these cycles get farther and farther apart, we start to head into our, what we call our menopausal year. And so let's say you got a period April,
00:08:05
Speaker
And it's now June and you've had no period. You are still not in menopause. You might be in your menopausal year, but you have to go one full year with no period to be considered menopausal, postmenopausal. Wow. It's a full year before you can say, I've gone through menopause. I did it. But so we call that kind of your menopausal year.
00:08:27
Speaker
But then what happens is as soon as, let's say now it's April of the next year, you immediately are post-menopausal. So when people say I'm in menopause, it's a general blanket word for that old transition. But you are perimenopause and post-menopause. And then before any of those transitions, we call that pre-menopause. So when you're cycling.
00:08:50
Speaker
So whenever you were talking about those symptoms that you get, is that pre-menopause? Like when they first start coming, the lack of sleep or? So that would be perimenopause. That is perimenopause. Perimenopause. So yeah, so those are the common ones, but there's tons of other symptoms. So as you head into that menopausal year as estrogen and progesterone, so the decline in progesterone is largely what impacts things like sleep and the anxiety.
00:09:17
Speaker
estrogen as this gets lower and lower, hot flashes, night sweats are the most common, but it can also trigger other symptoms. So things like vaginal dryness is a big one. I was going there. I was just waiting and I was going to ask about sex drive because those are the two things I hear about a lot when we're talking about it's like zero sex drive, vaginal dryness,
00:09:39
Speaker
The mood swings, the sleep, things like that, but I was like, it's got to be coming up here. Yeah, absolutely. And so that vaginal dryness, we don't usually see right in hairy menopause. We usually see that more in menopause and post-menopause.
00:09:54
Speaker
because that's when estrogen has been low for a while. So estrogen is a really big factor there. So you said two things, Max, you said libido and vaginal dryness. And I want to point out that they're separate. So obviously libido can impact vaginal dryness, but you can have vaginal dryness and have a fine libido. And so that's what some find frustrating as well. And so vaginal dryness is also important outside of intercourse. So
00:10:23
Speaker
vaginal dryness can cause irritation, it can cause pain, but the change in that mucosal layer also increases risk for urinary tract infections, yeast infections. And then outside of that, there's also the urinary incontinence piece. So the estrogen is very important for the whole genital urinary system. And so that's why you might hear postmenopausal women
00:10:49
Speaker
say like, oh no, they're laughing. And they feel like, oh no, I'm going to pee my pants, right? Or there's that urgency piece or feeling of that they're not vacuuming fully. So there's that piece, the genital urinary piece, there's the libido piece, and then there's also vaginal dryness. And vaginal dryness can be irritating, but also have health implications.
00:11:14
Speaker
And the libido piece, estrogen is a huge factor there. But then if we think about those other symptoms, fatigue, you're not sleeping, mood swings, there's also things like joint pain, right?
00:11:29
Speaker
If even if estrogen didn't directly impact libido, you can see how sex is not very important for that person right now, right? 100%. Yeah, they're going through a crazy amount of changes in this year. It's unbelievable.
Advocacy for Menopause Awareness
00:11:42
Speaker
I have no idea. Calvin, I don't know about you. I'm sitting here fascinated, one. I think it's very interesting. Are you really relieved? Yeah, that's where I was going next. I was like, number two is like, we are very simple creatures compared to women.
00:11:55
Speaker
It's so simple, yet it feels like, and we were talking on this pre-show, like andropause or like male libido, rectile dysfunction. There's been so much attention that's been put to that because I think there's a lot of money to be made in it and very little attention or education when it came to perimenopause or menopause or postmenopause. Why do you think that is, mainly?
00:12:19
Speaker
I mean, I think men's health has always been a little bit more important than women's health in terms of because it's simpler to it's like it's just simple like it's simple. Yes. But I think women's health in terms of women being added into randomized controlled trials has not been important and prioritized for very long.
00:12:40
Speaker
should be so important. I know. It's, it's so much more, there's so much more to learn and to understand. And I think what's important is that we're talking about the libido piece. And we talk about menopause when when it's talked about and it's starting to become more of a popular topic. We talk about things like the health risks. And we talk about, you know, what happens with cycles and fertility and all of that, which is very important. But this sexual health piece
00:13:06
Speaker
is always brushed aside for women. It is never an important topic. Whereas if a man is struggling with erectile dysfunction, we have a drug for that. It's covered by most insurance plans. Whereas when we look at hormones,
00:13:22
Speaker
hormones, we're just starting to add those in and people are just starting to get comfortable again with adding in hormone replacement therapy. And again, we always look at is this beneficial for, we always look at osteoporosis and the health benefits, which are extremely important. But I think the value and the importance of sexual health for women, especially older women, is always deprioritized. And it's never really considered a health issue.
00:13:51
Speaker
And so I think that's a big issue, whereas in men's health libido, it seems like it's more important than in women's health. And so we're starting to see a change here, actually starting to see a little bit of a change in terms of research and also popularity. And just on the point about men's health, it's also that decline in testosterone that happens with andropause
00:14:14
Speaker
actually happens with women as well. So we talk about progesterone and we talk about estrogen. Testosterone also decreases a lot for women as well. And so you can also replace testosterone in women. But there is actually no FDA product that has kind of been made for that. So when women are prescribed testosterone, they're usually used an off label or it's compounded a compounding pharmacy.
00:14:39
Speaker
And so it's another way that it shows. Crazy. So just at the risk of sounding ignorant, is it just because it's been like a very male dominated industry? And so because the research and the focus goes into male focused and male driven products, like what it makes no sense to me. It makes no sense to me. Like it's so much more complicated that you'd think that there would have been so much more research that would be done on like such an important
00:15:09
Speaker
topic that literally every women is going to go through at some point in their life. Yeah. And, and so on the, I think you kind of started product side and then you got to research. So it all starts with research and do we have research? Right. And don't quote me on this. I think it was the, I think it was 1990 was when it was mandatory to actually have, um, women in randomized control studies for
00:15:35
Speaker
like to make sure there's enough women representatives. Like it is- Mandatory, really. Yeah, so it's, I need to double check that stat. But it is incredibly new still, prioritizing women's health and reproductive health. And women were always, it was always the reproductive piece, right? So fertility, because that's what was really important for women, society. Right? Society. Was there like a sense of like,
00:16:02
Speaker
embarrassment? Why wouldn't there be more interest in getting involved in that type of research? Why would we have to mandate it from the women's side? Wouldn't there be more interest in like, yeah, I'd love to get involved in this and see? Or is it because a lot of times, even when we talk about any type of women's health issue, there seems to almost be
00:16:27
Speaker
Like it's not taboo or not discussed, you know, like postpartum things like that. You don't want to talk about it. It's like, it's almost bad if you have it. Is it because it's been changed? I don't understand why we wouldn't want to research that. I think you're like, if you're talking about participants, why wouldn't women want to go? I don't think lack of women wanting to participate. I think it's a lack of when, when you run a study, you recruit, right? And I just think it wasn't those types of studies.
00:16:53
Speaker
So the Women's Health Initiative is like the big, large study that we always reference when we get back to hormones. But other than that, there's just in general, now I'm broadening this to women's health in general, there just has not been enough research, especially around menopause, because it hasn't really been seen as a health issue.
00:17:14
Speaker
What is that? It's natural. Everyone goes through it. So it's kind of like people think that's what happens. So this idea that menopause needs just acceptance. It was just accepted for and tolerated for a long time instead of research and see how you can improve it. Yes, because it was this is what happens to women. You get your period and then you get old. You lose your period. It was not a priority to investigate that whole
00:17:43
Speaker
what's happening there. And so the idea of, you know, why were people not doing that? It's because it wasn't seen as a health issue and wasn't seen as something we need to really zone in and treat. And so now that's something I will run into with patients sometimes is this almost self gaslighting where it's, yeah, I know. I just, I'm exhausted. I didn't sleep at that. You know what?
00:18:08
Speaker
That's menopause, right?
Genetics and Lifestyle Influence
00:18:10
Speaker
And we hear that all the time and it's ingrained into our culture in movies and different things where it's like this little bit of a lunatic mom who is running around and just like forgetting everything. Yeah. The way they portrayed it in movies or TV shows. It's almost been mocked or made fun of. It's funny. It's not funny. I think I've got two girls at home and every time we do like
00:18:33
Speaker
a woman's health topic, I just think like, man, what can I do to help like, like give them the best kind of like chance at like, having a good regular cycle, you know, avoiding some of these potential health issues, like, even like this, I'm thinking about my, my wife, who's going to be going through, you know, this change eventually, and it's like, okay, like,
00:18:55
Speaker
Let's learn. Like, let me figure this out so I can help support you while you go through this. Yeah. And I mean, if we look at this as a society, it's half our population and that, you know, if we're talking mid forties and people was when we start pay menopause, 51 is the average age when someone goes through menopause. Women are at the peak of their career usually there, right? Like you women in a board room leading a meeting and
00:19:20
Speaker
If she's going through menopause, it's not only there's health risks, there's symptoms, but it's impacting her work, it's impacting her career, all of these things she's worked for her whole life. And then it's sabotaged by mood swings or really heavy menstrual cycles. Or another one I haven't touched on yet is
00:19:41
Speaker
Um, people forgetting words, so lack of concentration and focus. And that's a really scary symptom for someone midlife because that's usually also when early onset dementia is, is caught. So what happens is people can't find their keys. They set something down there. They're losing track and losing focus of things.
00:20:00
Speaker
and they feel like they've got this foggy brain. And that's actually a menopausal symptom. And the good thing is it doesn't, I think a lot of women get scared that that's going to progress the rest of their life. But what we see is actually when you come out of it and your postmenopausal hot flushes go away, it actually comes back. So it's not like this decline that you would think, but it's a scary symptom to, to feel. No kidding. Has, has, has the age
00:20:26
Speaker
Like you mentioned 51 is like the average age. Has that gone up or down with, you know, women tending to have children later on in life or does the age that you have children have an impact on when, when you might start menopause? Um, no, your, it's actually the opposite in that your, um,
00:20:48
Speaker
The year you go through menopause is actually, it's more genetically related and then that actually has more of an impact on your fertility, right? The issue is we don't know that. We don't know, okay, I'm going to go through menopause at age 53. I can back cast when I can have
Diet and Lifestyle Changes
00:21:01
Speaker
kids. So I think the issue that we see is that some women start to enter this perimenopause early in their 30s. So then if someone waits until their mid 30s and they start to
00:21:13
Speaker
Try for kids, but then they're also going through this perimenopausal transition is where we start to see issues with this overlapping with fertility. So has that is that like the the menopause starting earlier has that been impacted by like diet, nutrition, behave like is there an is there a correlation there?
00:21:32
Speaker
Between that, I don't know about that. I don't think so. I think the severity of menopause and how someone experiences symptoms can be impacted absolutely by lifestyle. In some cultures where soy is a bigger part of their diet, so in some Asian cultures where there's a lot of soy, we see that actually diet-rich and phytoestrogens
00:21:58
Speaker
symptoms are less severe and less frequent in terms of that transition. That's interesting. There's so much soy in all of our food now anyway, like it's used as a
00:22:08
Speaker
Well, it depends on the form of the food. I think if we take a hyper-poutable processed fake meat that has soy in it and then 17 other ingredients versus looking at soy milk that's a scent or edamame, plain soy that's just the soy itself, also phytoestrogens through things like ground flaxseed, looking at that form of soy itself.
00:22:37
Speaker
non-processed, non-ultra-processed materials or ingredients. That makes a lot of sense. And then other things that impact would be things like weight. We haven't even talked about the impact of weight gain.
00:22:50
Speaker
Hormones on weight and weight and hormones and I think that's another piece is that's got to be frustrating on its own, right? It's one of the major reasons I say that hot flashes and weight gain are what bring people into my office and then I start to pull them through like we should look at your cholesterol and your blood pressure are the things that no one cares about but weight gain is probably one of the most frustrating symptoms for women at this time because again,
00:23:15
Speaker
I think it's hard when someone, it's not a priority for, let's say their GP, they're not going to go in and say, I'm gaining weight. And their practitioner is going to say, okay, eat less. And that's one of the worst things you can do at this time, because what happens with age, and we're all pretty familiar that with age, muscle mass declines, right? That's happens in men and women, but so muscle mass declines, estrogen itself, uh, impacts our energy expenditure. So when we have some muscle mass,
00:23:43
Speaker
The more muscle we have, the more calories we're burning, even as we're sitting at rest. So a body that's higher fat percentage, less muscle, it's not gonna burn as many calories that a body has higher muscle mass and lower body fat.
Menopause and Health Management
00:23:56
Speaker
So we know that with muscle mass is important, that declines with age. Estrogen further decreases this directly with that resting energy expenditure. The third thing is that estrogen indirectly impacts us further because estrogen, low estrogen,
00:24:12
Speaker
also impacts our muscle loss directly. So the decline- So you lose more muscle? Lose more muscle with less estrogen. Oh no. Yeah. So the less estrogen is important for muscle mass as well with women. And then on top of that, we have, let's say you've got someone who is always, you know, goes to the gym four or five times a week. High energy loves it. They start going through this transition. They're not sleeping. They have hot flashes every time they exercise.
00:24:41
Speaker
they're exhausted, their mood is really low, and they've got really bad joint pain. That person's probably not gonna have as good of a workout.
00:24:51
Speaker
as another person who is feeling awesome, right? It's so frustrating. Yeah. It could discourage you from going in general. Yeah, fatigue is huge there. Um, and I think, and I mean, that's throughout that whole menopausal year. But then even if we bring it back to perimenopause, something else I see all the time is, uh, women get really heavy cycles. So they're losing a ton of blood.
00:25:16
Speaker
So they're irons low as well and so they're really fatigued and so having that fatigue and then that kind of overlaps with some of those brain fog symptoms and then you're out of breath you're you know so it's really hard to push yourself to build up that muscle mass and so this is why
00:25:34
Speaker
if you can start to build a really good foundation going into perimenopause, you can really help yourself out there. And something I always tell my patients is a little bit helps, right? And knowing that you might gain a little bit of weight in those years, because everything that's happening is like we said, you probably top of your career. You're probably really busy professionally. You might have a family. You might have kids. You might have kids that are now teenagers and then parents that are aging.
00:26:01
Speaker
So your responsibility. And just stress and just stress of life. So you've got mortgage rates increasing. You've got stress of life. You've got professional stress. And then you've got all of these physiological changes happening in your body.
00:26:16
Speaker
mental changes and Sounds like you should get the year off when this happens like in my it's like man You need to you need to focus on this. This is intense Yeah, and I think and then people just say well everyone goes through it So, you know what? Why am I gonna complain about it? And then do and I think a big thing is that not only is there a lack of treatment? But there's actually a lack of women going to their doctors about it
00:26:40
Speaker
And, you know, let's take hot flashes. That's sad. Yeah, I can imagine they'd be like, Oh, I should go to the doctor. And then they find it. Oh, it's just like, very month pause. And they're like, Okay, that's what it is. I'll just stay home and yeah, it'll only be you know, like
00:26:55
Speaker
So it's six months to two years. So some of them experienced hot flashes for 10 years. Like 10 years. Oh my God. Yeah. Um, and there's actually research now that the intensity of your hot flashes, so how severe your hot flashes are, are actually correlated with your cardiovascular risk. And so we don't know why, but it makes sense. If you think of what happens when you're having a hot flash,
00:27:24
Speaker
You know, your heart's racing, blood's pumping, like it might be due to vessel damage, it might be due to the stress piece, or it might be that the hot flashes are just a marker for how low your estrogen is impacting your cholesterol profile. So there's lots going on there, but we know severity of hot flashes is correlated with severity in cardiovascular outcomes like heart attack and stroke. So I always tell patients or anyone that
00:27:51
Speaker
If you're experiencing the symptoms, not only are they bothersome and annoying, but your healthcare practitioners should then be signaled also to investigate your health a little bit more. What's your blood pressure like? What, because there's a lot of health changes that happen at this time and it's a really good time for women to check in with their health. And so whether, you know, because they're concerned that they're on this postmenopausal side where things have changed or they're about to go through this change, we want a good baseline.
00:28:20
Speaker
So if you have your, let's say 44 and you know that your mom and your sister all went through and I pause at 49, it might be good in the next couple of years to get a baseline of what does my cholesterol panel look like? Am I fasting glucose and my insulin and my blood pressure and all of that? Because we do see a change because that we see a drop in estrogen impacts things like a lipid profile. So cardiovascular markers, cholesterol, um, we see a decline in the HDL increase in LDL.
00:28:51
Speaker
And your triglycerides also change. So you want a baseline to see, okay, how did this change? Because I've seen women who they've never had an issue with their cholesterol. And then now they've got this higher cholesterol level. Their blood pressure is higher. They're not feeling good. They're not sleeping. And so now not only are they experiencing symptoms, they also have increased health risk as well.
00:29:14
Speaker
And then someone tells them, then they're complaining about their weight and someone tells them, okay, just don't eat or decrease your calories. Not only are they going to feel awful, they're not going to sleep. They're not going to build muscle mass. They're going to gain more weight. That's such bad advice. Yeah. And if they don't gain weight and they're naturally petite, they're going to increase their risk for osteoporosis. We know in an older age, higher BMI is actually protective. Um, so especially for women. So a woman who is really petite their whole life and then goes through
00:29:42
Speaker
menopause and they're post menopausal and not adding in any estrogen, their risk for a fracture increases a lot. And so that directly impacts their mortality. So there's, there's so much with menopause and that's kind of one of the reasons I, I knew this was going to be a great topic, but like, it's like, I'm like,
00:30:08
Speaker
pretty fascinated by this. So what's it sounds like to me, the best thing you can do is to prepare. Yes, I think the best thing you can do to start out with is educate yourself. And I think we did a pretty good job of this, I think, in the last couple generations with
00:30:28
Speaker
young girls about talking about, okay, this is what happens when you get your period. And you go into that, hopefully now, a little bit, we're a little bit more open about it, right? Where we talk about it in some cultures that's really celebrated. And then I think with menopause, it's like this really quiet, no one talks about it.
00:30:46
Speaker
and even in peer groups and with family. A question I ask all my patients is, what age did your mom go through menopause? Or your sister and they think, oh, I don't know, I'll ask them. Like, I don't know. No idea, right? Yeah. And because it's not like, okay, I think the whole one year thing is confusing also. But it's something that's not talked about enough. So I think having conversations, I do think the conversations are happening. It's absolutely, I've seen a shift even in the last year. So conversations are happening.
00:31:15
Speaker
So I think conversations and then conversations with educated people, like on every topic, as soon as something gets big, then you hear tons of different opinions. So making sure you're getting educated appropriately about, okay, what is going to happen? Um, and then also how can I prepare? So things like exercising, building muscle mass.
00:31:36
Speaker
So going into that with adequate muscle mass. I think knowing that some of these symptoms are going to happen and tracking. I'm a huge advocate for tracking. It is extremely tedious, but one of the things is that when you get into hairy menopause, so where everything is really chaotic, on top of that, you can't do a blood test to say, oh yeah, check, you're in perimenopause.
00:31:59
Speaker
Because you don't have a baseline. You don't have a baseline. Well, what happens is in your cycle, you have that every month you have the same thing that happens. In perimenopause, it's all over the place. So if you go to the lab and you have your FSH and your estrogen, your progesterone tested, it could look like you ovulated. It could look like you didn't. It's all over the place. Your estrogen could be within range. It could be not. And it's kind of like, did the brain have to yell down for that to happen?
00:32:27
Speaker
And so you really just get like a little snapshot on time and it's not very helpful.
00:32:32
Speaker
Whereas when you look at post-menopause, someone we know, okay, you are post-menopausal, it's a year with no period, but we will see an FSH value in the post-menopausal range and we'll see estradiol or estrogen very, very low. That doesn't always happen. You might test your estrogen and it looks really high in pre-menopause. So testing isn't helpful. Other testing is helpful, things like iron levels, for example, vitamin D, your lipid panel.
00:32:59
Speaker
a good baseline of where you're at, making sure other health factors are looked after. Um, but going back to that's why tracking is so important. It's really the only way we can get data. And
Treatment Options for Menopause
00:33:10
Speaker
it's really annoying because we've talked about this woman, this woman going through perimenopause. The last thing she wants to do is to now track all of her symptoms and talk on top of her stressful, busy life, but it's really helpful. It's really helpful. So there's something called, um, the menopause rating scale. So what I suggest is.
00:33:30
Speaker
Doing not a baseline, I do that for all my perimenopausal or menopausal patients. And you essentially just go through all the symptoms and you score zero to four. So you get a baseline number. And then I get them to track. So every day when they have symptoms, what's going on, I have a pretty in-depth tracker. I can send it to you guys if you want. You can put it in the show notes.
00:33:48
Speaker
Don't be afraid if it's a little bit intense, but it's a really cool XL tracker that you put in all your symptoms and then it shows you, you know, severity, time of day, month, and then you can put in what happened that day. So you also have triggers for symptoms. So that gives us information of
00:34:06
Speaker
What are your biggest symptoms? How are they impacting your life? And what are you doing to trigger those? So we have these symptoms that are happening naturally, but also they can be exacerbated by things. So for example, night sweats and wine.
00:34:23
Speaker
huge, huge impact. And you'll hear any type of alcohol, right? Yes. But so any type of alcohol, you're right. Wine is one of the worst ones I hear. And I think it's also just because this demographic tends to drink wine more often. But wine really impacts hot, hot flashes, night sweats and sleep and that anxiety. And so I find tracking helpful because I would rather a patient come to that on their own terms of, Oh,
00:34:53
Speaker
wine really impacts me rather than me saying, hey, you should probably not drink wine.
00:34:57
Speaker
It's a lot more effective if someone comes up with it on their own, rather than their doctor saying, hey, reduce your alcohol. Nobody likes to be forced into it. That's the only thing that gives me a break. Well, that's the thing, is that these women also go to wine to say, oh my gosh, it's the only thing that relieves me of stress. And you hear that all the time of, oh my gosh, can I not have this one thing, right? And so that's tricky.
00:35:24
Speaker
Um, but the tracking is really helpful there. The other thing is that people respond differently, like any other part of medicine, right? So, um, some people, for example, like spicy food is another obvious hot flash trigger. Anytime you, your environment changes a little bit, it's more that your hypothalamus, like your thermostat is more sensitive to heat. So, um, spicy food, food that's the temperature is hot, hot drinks, things like that. So you can look at, oh, caffeine's another one.
00:35:54
Speaker
So, okay, I always got hot flashes at 10 a.m. Oh, I always have my coffee at 9.30, so maybe it's, oh, can I try switching to a decaf, or maybe even switching to an iced coffee, right, or a half-caf, or, you know, so we can look at, okay, where are these things happening, and how can we edit your lifestyle a little bit to at least make you more comfortable? And then, if things are pretty severe, let's say someone's going through menopause and we're adding in a therapy, like,
00:36:22
Speaker
a supplement or a hormone replacement therapy. It's good to have that tracking to see what's going on. And that's why I like that baseline with the menopause rating scale. What we'll do is we'll do that track and then do a menopause rating scale, usually about like eight weeks, 12 weeks.
00:36:39
Speaker
And then we have raw data to say, did symptoms get better or not? Is this protocol working for you or not? Because I think something that happens during this time is so overwhelming. We've talked about probably 25 different things that happened to women at this time.
00:36:54
Speaker
I'm overwhelmed. I'm overwhelmed and it's not something that's going to happen to me. It's like, wow, this is a lot to digest. Don't you feel something? I'm going to change my thought on it. I went from being relieved to now being like, okay, I need to find out what can help so that way I can be that supporting role to make sure that my life's life is going as smoothly as it possibly can when it's in total chaos. Yeah. And it will probably make your life a little bit easier too.
00:37:22
Speaker
There's that as well. So I'm dying to know, cause it's been like a lot of doom and gloom, but like what, what kind of things can help with, uh, with someone? I was going there too. Like what, what can you do to help? And at what point would you recommend like hormone replacement therapy or, or, or like, you know, more, uh, more kind of Western medicine approach?
00:37:44
Speaker
Yeah. So I think if someone is struggling with symptoms, it's never too early to intervene.
Hormone Replacement Therapy Details
00:37:51
Speaker
Whether that's hormones or not is a discussion on an individual basis. But if someone is really struggling, let's say they can't sleep. We don't need to jump. And let's say they're in perimenopause, we think. They can't sleep. They have anxiety, low mood, but they're still having regular cycles or maybe they're spaced out a little bit.
00:38:10
Speaker
I would look at, okay, what's most important here? We add in the lifestyle changes, but we look at in terms of supplements, I would look at things like ashwagandha, right? Because that's going to help calm nervous system, help promote sleep, things like magnesium. So I think sometimes we get too zoned in on just hormones where we have lots of other things that can help promote more of a holistic approach, right? So how can we support sleep itself? How can we, because what's happening is that low progesterone is making a woman a little bit more anxious and impacting
00:38:40
Speaker
So can we support sleep in another way? And if not, if a woman's still cycling, we can give, this is where we get into hormones a little bit and can get complicated, but we can give progesterone without estrogen. So someone's just really struggling with sleep. We know their perimenopausal. We can actually give a little bit of progesterone
00:39:00
Speaker
helpless sleep and to help calm that anxiety. Whereas when we talk about adding an estrogen, if someone has a uterus, we have to give them progesterone. So if you give estrogen, you have to give progesterone, but if you give some progesterone, you don't have to give estrogen. So that's like a little workaround with those. How is it given? Is it like a pill or is it an injection or topical? I'm just curious. Great question. So the progesterone, there's different options. So with progesterone,
00:39:26
Speaker
Um, orally as a pill, you can, is probably the most oral, uh, micronized progesterone. So there's progestins I N and then there's progesterone O N E. Those are different. So the birth control pill, for example, you can have a progestin only oral progesterone is not the same thing. And that's something that you, that's what we hear as a bioidentical, uh, oral progesterone. So, uh, you can get that orally.
00:39:52
Speaker
You can do that vaginally. You can do that topically. You can do injections, which don't happen as often anymore. With estrogen, we mostly do topical. You can do oral. The side effect profile is a lot worse for oral. It impacts things like liver. That's where we start to see some of the data looking at things like clotting, higher risk with oral. So that's usually not done. But topical or a patch for the estrogen.
00:40:20
Speaker
Does that first like slow release, like from more of a gradual or slow release on a patch? Yeah. And so the other thing is that you only have to change it every week or two weeks, right? So where is a gel or a cream? You're putting that on every single day. And the other thing with gels and creams that you have to be mindful of is are you sleeping in a bed with someone else who cannot, who doesn't want that estrogen? Do you have kids? Do you have pets, right? Every time we have a gel or a cream, we have to be mindful of that with both progesterone and estrogen.
00:40:48
Speaker
So you have to think of the time of day you're administering it and progesterone, for example, that you usually always take at nighttime because it can make you feel really sleepy, which is why I can help with sleep.
00:40:58
Speaker
but you usually don't want to take that in the middle of the day. Now, I think it's worth noting that the topical progesterone is usually it's not enough to protect the uterus from the estrogen. So usually we're dosing an estrogen as a topical cream, you would add in an oral progesterone, or sometimes people do with an IUD, but the oral progesterone would be a gold standard of what you do there. But to go back to your question, Calvin, about when,
00:41:27
Speaker
We used to, like, so hormone therapy is the gold standard for creating very severe hot flashes and those symptoms. But usually it's not done until menopause. You can initiate it early. It is actually safe to do. And sometimes you can cycle things like progesterone to match what the cycle would do. So two weeks on, two weeks off.
00:41:47
Speaker
But there are lots of things, and I also have patients who say, you know, I don't want to go on hormones. And we always have a conversation about the risk benefit. There are patients where hormones are not the best option. Um, for, you know, for others it is because it doesn't just have the symptom resolution. It also has the health impacts, right? The things like osteoporosis and all that. But when we look at supplements, there are some things like sage, for an example, the herb sage can be really helpful for hot flashes and night sweats.
00:42:16
Speaker
Now, is taking stage going to help with things like osteoporosis? No. And I think what gets complicated with supplements is we don't want a different supplement for every symptom because that gets exhausting, right? There's great joint supplements, for example, you know, add in some omega-3s, which can be helpful for reducing joint pain, which can be really helpful. But is that going to help with, you know, hot flashes? Well, there actually are some studies that they actually can be helpful.
00:42:42
Speaker
But, you know, looking at specific supplements for specific things gets a little bit overwhelming. So that's where I usually recommend combination supplements. And so looking at, okay, is this, you know, has a mixture of different herbs and different molecules that can be helpful. But I think the other piece, what I mentioned before about things like vitamin D, having that tested, you know, adding in things like ashwagandha, magnesium, because that helps the overall person.
00:43:09
Speaker
As you can see, this isn't just about the uterus. This is about your joints and your bones and your heart and your mood. Adding in someone that can support all of that can be very helpful. How much of an advantage do you have going into perimenopause menopause by optimizing your health as much as you can before the change starts to happen?
00:43:33
Speaker
I mean, it's a huge, I wish I can't put a number on it, but a huge advantage because you're, even if, so there is a part of it that is genetic, right? We know that some, some women, there's those women I said who experienced how much for 10 years. So there is, you know, people who just have this genetic disadvantage, which is unfortunate, but that's someone who, you know, you add in the hormones that can usually help. Um, but lifestyle makes a huge impact. There's lots of data to show things like,
Individualized Naturopathic Care
00:44:00
Speaker
Wait, for example, so someone who is obese would have worse hot flashes than someone who has less body fat. So things like that impact. The food that you're eating, looking at, you never wanna, there's no such thing as a menopause diet. So I feel like that's a big red flag if someone says like, this is the perfect menopause diet, it'll cure your symptoms. That's not gonna happen. But if we- That's when you turn to Google, right? Yeah, exactly. There's a Google answer right there. I don't know.
00:44:30
Speaker
It's like $59.99 a month and I'll give you my plan. But when we look at a menopause diet, it's kind of like fertility, right? We want you to be eating whole good foods, foods that are going to nourish you. When we look at the things that happen, the most important thing
00:44:47
Speaker
When we look at cognitive health, we want things like berries and nuts. When we look at cardiovascular health, we want to make sure that you're having those healthy fats. You're having good amounts of fruits and vegetables, fiber. A huge, huge thing, probably the thing I talk most about with my perimenopausal patients is protein. I don't know why there's this
00:45:08
Speaker
this gap of women and this generation of women who don't eat protein. And it's so hard to do if anyone has tried to lose weight and increase protein at the same time. So you're mindful of your calories, you're mindful of your fats. It's really hard to do. And if you're starting out by eating 30 grams of protein per day,
00:45:27
Speaker
And I'm asking you to eat 130. You got a long way to go there. It's almost shocking to it when you start to track it and you actually measure the amount of protein you're consuming. I have to eat how much more? It's shocking.
00:45:43
Speaker
And I think the mindset also of if you think about someone who was raised in a generation war for you want to lose weight, eat less, less, be smaller, less. And then you're trying to convince someone to eat a lot. It's really hard even if logically you can present the data and someone has that information. It's really hard on a subconscious level and I find this especially for women to convince yourself that, yeah, I'm going to eat more and that's going to be helpful.
00:46:09
Speaker
Is there any danger to, to fasting? Like as people would just say, I'm just going to start fasting. Yeah. This is a population where I usually recommend against it. I have a handful of patients who fast. They love it. They feel great. And I'm like, awesome. That's, you know, good for you because they're really good at getting in the appropriate amount of things they need to do. If I was to say, you know, yes or no, I would say no for this population.
00:46:33
Speaker
because we've talked about how hard is it to get a protein, get protein with three meals. If you're doing one meal a day or even two meals a day, good luck getting enough protein, right? And then the other piece is hot flashes. So low blood sugar levels or not eating for long periods of time can also trigger hot flashes. So changes in blood glucose levels. So some women will say, oh, sugar triggers hot flashes.
00:46:58
Speaker
And it's not necessarily true. It's a spike in your blood sugar. So it's the change in your blood sugar. So you can have food that has sugar in it, but we want more of a gradual increase there. But it's this spike. Same thing, though, with a drop. So if you're fasting for even 18 hours, it might trigger more hot flashes for you because you're at that low level there. And then the other thing is, let's say you have a smoothie and you break your fast and you get
00:47:26
Speaker
So that can also be, or if you're having coffee, so you're having a hot drink with caffeine, no food, you're probably going to trigger a hot flash. And there's sugar in it and cream. Yeah. Yeah. I mean, well then you're not even fasting, but then that's another thing people try and get away with. But yeah, I think that's, you know, I would say for this population, when people look at
00:47:49
Speaker
Is fasting helpful or not? And the one group people always go back to are women's hormones, right? And how does that impact your cycle? And so younger women who are still cycling can impact hormones. Yes, things like how severe period cramps are in PMS. If we think about someone who is now in perimenopause, they're gaining weight. Their hormones are all over the place. And their PMS is at an all-time worse. PMS can get much worse during this perimenopausal time.
00:48:18
Speaker
If you then take away their food and they're fatigued already and you're trying to convince them to work out, like that's not a helpful solution. They're going to feel their moods going to be worse. They're going to have less muscle mass. They're probably going to have hot flashes. Like it's just, it's not going to be a good combination. It's going to impact their sleep. So no, I would not use fasting as a tool here. Uh, now if we were to say this is going back to men and andropause, could fasting be helpful?
00:48:46
Speaker
That's a population where I actually find that really helpful because a lot of times with men, when we're looking at weight gain, the issue is usually overeating and taking kind of out of great night eating, all of that, right? Like going to McDonald's, like going to McDonald's for lunch. Exactly. Add a coupon. They pushed it right to my phone. It was terrible.
00:49:13
Speaker
Um, but yeah, like it's, it's, so it's, it's very different. And I think this is where individuality is very important. Um, so we can talk about kind of general, but it's always important to look at, you know, the person we're dealing with as well. Cause as I said, there's some women I have who they're fine with fasting. Um, but that's why I think things like tracking symptoms and you can look at, you know, someone really wants to fast. Great. Let's take your baseline, you know, measurements, your old menopause rating scale, all of that implemented for eight weeks.
00:49:41
Speaker
How are you feeling? Let's track those symptoms. So it's never a yes or no. If you want to do it, sure. But then let's actually track the data to see what changes we're making here. That's what makes naturopathic medicine so great though, right? It's very much that individualized care and having someone, like as long as you're working with a good naturopath,
00:50:01
Speaker
You're going to, you're going to feel like you're hurt and you're going to feel like you're, you know, like you're getting somewhere instead of just being brushed aside or given a pill or something like that, which I think I love it. I think it's amazing. It's like a full on game plan. I feel like I've, I've learned so
Contact Information for Dr. Devlin
00:50:15
Speaker
much. It's like, we got to be having conversations. I've now realized I've learned to support my life.
00:50:19
Speaker
We should have a conversation with her mom and be like, hey, when did you go through this, right? To get a rough idea of when she's going to go through it. Now I know Ashwagandha, Sage, Omega 3s, and then HRT. If we get to that, I'm going to be doing my role and helping support her kind of get through this. One question that we had from our listeners,
00:50:42
Speaker
that I was hoping maybe you could answer is, is there like, they had heard that there was a window for when you can do hormone replacement therapy, and if you miss it, then it's not helpful anymore. So I guess she was just looking for a true or false with that one. Yeah, that's a really great question because they think with, and you know me, I'm not gonna give a one word answer. So with that question, it's like everything, it's always individualized, but the guidelines usually say
00:51:11
Speaker
So let's say someone goes through menopause at age 51. We usually want within about six years to initiate hormonal replacement therapy. What we don't want to do is have that estrogen bottom out. You're really, really low for a long time, 10, 12 years. And then we add in a bunch of estrogen.
00:51:28
Speaker
that's where we start to see a higher risk profile for things like cancer and all of that. So that's, we don't want to let it go too long. And so for example, if I have a patient who's 65 and says, I wish I went on hormone replacement therapy, I'm probably not initiating hormone replacement therapy with them unless it's very severe. And then myself and their GP, um, and, and that patient have a conversation of the risk benefit. Um, but you know, we're, we're really, we, there is a window.
00:51:56
Speaker
And so I think that's why education is so important in looking at, you know, you don't want someone to go through all of this and then feel like, Oh, should I maybe have gone on hormones for my bones and my heart health and all of that? Because I've, you know, and then it's, it's kind of too late. So, so, so important. Yeah. There is, there is a window for optimal, I would say it's not completely locked on either end. Uh, but yeah, in general for best gold standard usage and safety, absolutely.
00:52:26
Speaker
Perfect. Um, so if you're one of our listeners and you had a question for Meili, what would be the best way for them to get ahold of you? Oh, um, they can message me on Instagram, which is, um, I, will you put it in the show notes? I will put it in the show notes. And I'm fine if they want to email me too. Um, so if it's a menopause related question, that's totally fine. You can email me.
00:52:55
Speaker
Um, and I can give you that, but it's just info at mealy.com. Um, and I also have, uh, a menopause Monday newsletter that might be helpful for listeners. So I'm starting to build this community around menopause to just increase that education and awareness. So, um, I can give you that link too. So every Monday I have a newsletter that goes out about a different topic. So we did like a four part series on weight gain during menopause. We talk about supplements and.
00:53:22
Speaker
and hormone medicine therapy, things like that. That's awesome. I love it. Let us know how we can support you with that because that is such a good initiative. I think it can help so many people.
00:53:32
Speaker
And in case you're not reading the description, I did look up her Instagram. It is just Dr. Meili Devlin and Dee. So be sure to follow her on Instagram or send her a DM if you have any more questions. I want to thank all of our listeners who made it this far. And if you did, please be sure to give us a five star rating. Meili, I'd like to thank you again for being on the show. As always, you're such a wonderful guest to have. Thank you so much. This was awesome.