In this episode of the Everyday Wellness Podcast, host Cynthia Thurlow and orthopedic surgeon, Dr. Vonda Wright, delve into navigating perimenopause and menopause, emphasizing the importance of menopausal literacy, particularly for younger women, and we also discuss generational differences in understanding menopause. Andrea Donsky joins us to discuss her ongoing research on the 103 reported symptoms of menopause.
I am confident you will enjoy the informative conversations with Dr. Vonda Wright and Andrea Donsky and find them as engaging as I did.
IN THIS EPISODE YOU WILL LEARN:
Strategies for navigating perimenopause and menopause
The concept of "musculoskeletal syndrome of menopause"
Impact of estrogen decline on women's musculoskeletal health
Importance of menopausal literacy and awareness
Common symptoms experienced during perimenopause and menopause
Role of nutrition and exercise in managing menopause symptoms
The significance of maintaining muscle mass and addressing insulin resistance
Proactive health measures for women in their 40s and beyond
Encouragement for open discussions about menopause to reduce stigma
Importance of self-advocacy and education in women's health management during menopause
Connect with Cynthia Thurlow
Follow on Twitter
Check out Cynthia’s website
Submit your questions to support@cynthiathurlow.com
Connect with Dr. Vonda Wright
Connect with Andrea Donsky
Transcript:
Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives.
[00:00:29] Today is an extra special episode completely devoted to essential tips for navigating perimenopause into menopause from top experts including Dr. Vonda Wright, Dr. Mary Claire Haver, Dr. Stacy Sims, Dr. Mariza Snyder, as well as Andrea Donsky, and last but not least, Dr. Suzanne Fenske. I know this will be an invaluable discussion packed with great actionable information for women in middle age and beyond.
[00:01:03] I would love to really start our conversation today around menopausal literacy. I think that this is certainly something that most of us did not learn during our training and I feel like in many ways this generation of women are really changing the narrative about building awareness for women prior to going into perimenopause and certainly perimenopause into menopause. But how do you define menopausal literacy as a clinician.
Dr. Vonda Wright: [00:01:33] No one has ever asked me that question before. I really love that. [Cynthia laughs] And I think the answer to that is generational. My 84-year-old mother never talked to me about it, but she was put on hormone replacement therapy and then she was one of the ones that she was put on it, it was taken away and when she was maybe 68 or something, I sent her to a doctor where we were living at the time in Pittsburgh, who was a hormone specialist and she put her right back on. And thank God, because my 85-year-old mother has a normal bone density which is unheard of. And so, there's that generation who’d had it, it was snatched away. But then, oh my gosh, the baby booming generation.
[00:02:20] If I were 63 or older I would be so angry because that is the generation that never got it and maybe never will. So, they are now coming to the place of frailty saying, “What happened to us? How come nobody ever told us?” And then my generation, I'm 57, so I am an X-er and I am the generation that was raised to believe. And at least this is what my parents told me, that I could be anything I wanted if I worked hard enough. What I didn't realize is that I could have anything I wanted, but I could not have it equally. So, now my vision is to not lie to my daughters. I have a 29-year-old daughter and I have a 17-year-old daughter. I am working hard so they can be not only what they want to be, but equally. And that means in their health care, they deserve to have equal access to research dollars. They deserve to have equal access to research dollars. They deserve to before they go into perimenopause, when helter-skelter breaks out, to know it's coming.
[00:03:33] And so, when we talk about menopause literacy, which I love that you've even named it, I think it's generational, but I think that when I get millennials in my office, I give them the resources. Here's how you're going to make your estrogen decision. These are the three books I recommend. So, it's the Generation X of us. I don't know how old you are. You may be much younger than me. But millennials and Z people, I hope as they're coming up, they will not have to explore in the way X-ers are currently exploring. They're going like, “Oh, yeah, because I use this language yesterday on a 41-year-old. I said, “Listen, this is coming. You cannot avoid it, you need to know it and you need to get in front of it.” And I think she was like, “What?” I'm like, “This is coming. You may not be feeling it now, but give yourself 5 to 10 years.”
[00:04:30] That's such a long answer. You'll find that, Cynthia, I tend to just drone on and on, but I think it's generational. I think those of us hot in the middle of it right now have an obligation to our daughters. But I'm going to tell you for sure, the majority of the women that I encounter in public, even at a birthday party the other day, have no idea. No idea, and are still whispering about it. And sometimes I feel like everybody knows because you and I know and because we're talking about it all the time and everybody in the menopause is talking about it all the time. It feels like the world knows. But the truth is only 7% of women are prescribed hormone replacement, which means that even less of them have probably been told about it or even know what menopause is. Gosh, there is no direct answer, but I think that is how I think about it right now.
Cynthia Thurlow: [00:05:23] Yeah, I love your answer. And I'm part of the generation. I'm 52, so I am part of your generation. But when I think about my mom, who's 78, and when the Women's Health Initiative came out. She went from being on hormone replacement therapy to being taken off of it. And I've watched my mom and her sisters navigate menopause now 20 years in, 25 years in, depending on the individual and the net impact on their bones, their brain, their cardiovascular risk, their mood. And they have given me permission to talk openly about this. So, I'm not sharing anything that they're uncomfortable with the community knowing. But I do think that, that generation lost out on so much protection from HRT.
[00:06:09] And my hope is that our generation is actively talking much more proactively than any other generation has had the opportunity to do so. So, things will be different for your children's generation, my children's generation, and certainly helping to build awareness so that conversations are started. My mother never spoke to me, even though my mom was a nurse, never ever had a conversation with me about perimenopause, menopause. There was so much shame around that loss of fertility and yet there shouldn't be. I mean, it is, you live long enough, this is what's going to happen, [Dr. Vonda laughs] So, there's no shame. [crosstalk]
Dr. Vonda Wright: [00:06:49] Thank God. Who wants to be fertile till you're 70?
Cynthia Thurlow: [00:06:52] No, thank you. [laughs] No, thank you. Absolutely. No, thank you. But one of the things that I love about your work, number one, the advocacy, but also bringing awareness to some of the changes that will occur in women's bodies if they're not proactively working against it. And you're an orthopedic surgeon, and so you've coined this phrase, Musculoskeletal Syndrome of Menopause. Really pivot a little bit and talk about this because it is relevant to everyone that is listening.
Dr. Vonda Wright: [00:07:22] You know, when I was going through my own menopause, I had what people have, I brain fog such that I would ask for an instrument in the OR, and I would say, “I need this thing.” I need the thing that I could describe it. Adjectives never went away, nouns went away. So, I had the brain fog. I had the night sweats. And I have a story for each one of these symptoms. But the thing that devastated me was I am an athlete. I've always been active, whether I was truly an athlete or just running around. Because being an orthopedic surgeon, is a physical job. I can lift all the 300 pounders I need. But the Musculoskeletal Syndrome of Menopause, primarily the symptom of arthralgia, which is total body pain, I could not get out of bed. I would swing both legs over and slowly push myself out and then shuffle until I warmed up enough, that was new to me.
[00:08:22] And then as I became more of a self-advocate and a student of this, because you believe me, nobody taught me this in medical school or orthopedics where 96% of all my peers were born with the dysfortune of not having ovaries. So, how would they even know, right? So, anyway, as I self-educated, I learned that it was not only total body aches, but the frozen shoulder and the rapid progression of arthritis in women after 50 and things like loss of lean muscle mass, I truly began to understand osteoporosis. I'm a bone doctor. This is my responsibility. And then I experience the redistribution of fat from periphery to visceral.
[00:09:13] Those are all the tissue specific results of estrogen walking out the door and never looking back when it comes to the musculoskeletal system. And it's all because of the same reason we have symptoms other places. Estrogen is ubiquitous in our body. Every organ system has receptors. This is my little basket illustration. An estrogen receptor is like a basket and estrogen fills it. And when it fills it, it causes a shape change that allows all the downstream amazingness that estrogen does for the musculoskeletal system, whether it's inflammation, cartilage, muscle, bone, fat. You know what if somebody came to me, I'm sure it's to you too. When you see patients came to me and said, “I have these six different things.” Gosh, that is hard to do in 15 minutes. And I would probably glaze over.
[00:10:09] So, I wanted to give women a nomenclature such as, “Okay, clinician, I have the Musculoskeletal Syndrome of Menopause because my estrogen is, has gone and choose a symptom. I'm primarily having arthralgia. I'm primarily having shoulder frozenness” so that we could advocate and communicate better. But part of that is advocating women, consumer women, patients. Part of that is educating our own disciplines. Because only one very, very brilliant orthopedic chairman has invited me to come do grand rounds on the musculoskeletal syndrome of menopause. She's a woman. She heard me talk about it in a little sports medicine group and she's like, “Oh my God, I've got to get all the departments together to talk.” And it's not because the others are reluctant. They just don't know.
[00:11:07] So, as I advocate, as I produce papers on this, part of my job is to educate my own field so that they treat women better and don't just dismiss them and say stupid things like, “Oh, it's just part of getting old.” I mean, so is erectile dysfunction. But nobody tells the men that, do they?
Cynthia Thurlow: [00:11:27] [laughs] No, absolutely not. It's interesting. I think it was Avrum Bluming when I interviewed him that said, “Cynthia, if men had a catastrophic hormonal change like women do when they go into menopause. I mean, men go through andropause, but I don't think it's nearly as dramatic.
Dr. Vonda Wright: [00:11:44] I don't think so.
Cynthia Thurlow: [00:11:44] Men would never stand for it.” And he's like, “Women are having a moment, people are paying attention. Women are talking about these things. Health care practitioners are being forced to have these conversations and/or refer out to appropriate people.” So, I love that you are coming at this as a clinician, as a woman who's navigated the transition into menopause. And you know, one of the things that I find really interesting about the changes that are starting to really occur around age 40, this loss of muscle mass and loss of strength. And for you as a clinician, I would imagine that you are seeing many, many patients, male and female, that are frail. And maybe this is where we pivot and talk about why frailty is a concern and the concern about falls and fall risk.
[00:12:33] And so I think, unfortunately, as a country don't properly educate patients that, you know that process really starts in our 40s and 50s and maybe it doesn't show up until latter stage of the 60s into 70s but this is why. I was an ER nurse before I was an NP. And I mean, the amount of falls that I saw, sometimes just breaking a hip or a bone, but more often than not, blunt force trauma to the head, head bleeds, things that sometimes can have really unfortunate consequences. So, for you as a clinician, that loss of strength and muscle mass oftentimes precedes the frailty piece. What are some of the things that you talk to your patients about to help educate them? Obviously, lifestyle piece is important, but I know that you're probably starting earlier than the average clinician having those conversations.
Dr. Vonda Wright: [00:13:24] You're so right. Because what we don't realize unless we're thinking about it, is perimenopause is the start of our estrogen decline. I mean, we have estrogen dominance for a while, but it be it's because our ovaries are retiring. What we don't also realize is that around in our 40s, women lose 50% of their total testosterone, which is critical in the musculoskeletal system. And even though, we haven't worked out the exact dose response pathways like we have for men, because what we have to do for testosterone in women, we have to infer from the male data because there's just not enough research. But my point being, it starts happening in our 40s. And so that's when I want people to start thinking about it.
[00:14:10] And here's another terminology that I throw out there all the time is there's a decade that I call 40-ish, 35 to 45, you have enough hormones to make a difference. I say that it is 40-ish, is the critical decade to get our health shit together. Sorry to have sworn at your audience, but listen, people, it is the adulting time. We have been out of college long enough. Maybe we've settled into our careers, maybe we have littles that we're frantically trying to raise. But it is time to turn some light back on ourselves because it is the critical time that our bodies are going to enter into midlife. And we can stop worshiping our youth because frankly, it may not have been that amazing anyway.
[00:14:59] We just think it was and pivot, like literally pivot to face the future of midlife and beyond. So that begins in 40ish, 35 to 45. Then what we have to realize is as our hormones plummet, both estrogen and testosterone levels change, everything changes. That our health span on average lasts until 62, that time in our lives when the ravages of chronic disease are quiet. At 62, the diseases that kill us are demanding attention. And many people tell me, because I see them a lot and as the more general practitioners will tell you, that's when people start going to three doctor’s visits a week. Health span, 40ish, 35 to 45, 62, health span becomes really apparent that it's ending. And here's what happens, Cynthia, because I still, even at this age in my career, take trauma call.
[00:16:00] I am called to the emergency room or to the hospital room. And lying before me is the future of women if they do not pay attention. I see the future of women today every call day and what is it? Typically, the woman is laying there 75, 85, 93. A couple months ago, she has broken her hip doing nothing. She's not out in a spartan race. She's going around her house, she trips over the rug or my office is next to the airport. She trips over her own bag and she breaks her hip. And she's laying there in the hospital bed. Bones are silent until you break one. Particularly, here's my femur. I always pull this out. Here's the femur. You break your femoral neck. It is excruciating. So, they're laying there not moving because it doesn't hurt when you don't move.
[00:16:54] She is incontinent because she has not had estrogen since she was 50. And she has the gyneco-urinary syndrome of menopause with the fragile mucosa. She has recurrent bladder infections. Her uterus is prolapsing. She's incontinent. She's laying there in bed with one of those weird devices probably developed by men. It looks like a hot dog to catch the incontinence. Incontinence is one of the number one reasons women are moved to nursing homes, broken hip, incontinent. When I asked the medical people to clear her so I can take her and fix her hip, she has so much cardiac disease that they have trouble clearing her, or they have to do an entire cardiac workup and optimization, that's your job, to give me 45 minutes to put metal in her hips so she can walk again.
[00:17:49] Broken hip, incontinent, cardiovascular disease so serious that it takes an entire cardiac workup. And then you know what's next. She either has a touch of dementia or she has frank Alzheimer's.
Cynthia Thurlow: [00:18:03] Now, when we're talking about bone health, obviously there are things we can do now, but I'm thinking about our younger women, many of whom are appropriately put on oral contraceptives so that they have choices about when they choose to become pregnant. What are some of the risk factors that you're aware of that impact bone health before we go into perimenopause and menopause? Because I think these are important to talk about, because these are reasons that may impact many of the listeners.
Dr. Vonda Wright: [00:18:32] I love that you asked me that, because of late, we're in Olympic trial time right, so we're parading out all our young champions who have worked their whole lives to get to where they are. It's a really timely question. But what happens along the way for young women and also because, honestly, we in the United States, we've had Title IX for about 52 years. So, women have been equalized in sport or trying to get there in terms of access for 52 years. Well, female athletes very commonly live in a state of relative calorie deficiency, meaning either they're working so hard all the time and they're underfeeding, they just can't get enough calories in or they are purposely under calorie-ing because they want to be little, like our pinkies we're told to be little, especially if you take care of gymnasts and dancers and runners.
[00:19:33] So, what we're having now, and I also have these patients in my clinic, are young women in their 30s coming in with osteoporosis because they never laid down enough bone when they had the opportunity due to relative calorie restriction, overuse, or not athletic calorie restriction, but they just want to be skinny. So, it's a real problem. So, my poor 17-year-old and my 29-year-old and all of her friends hear me constantly talking about the fact that are you out there bashing your bones? Are we jumping up and down? Are we doing impact exercise? Are you feeding yourself enough? How much protein have you had?
[00:20:14] Such that my 17-year-old is very conscious about getting enough protein in which I'm so glad because she was a ballet dancer most of her life. And she is teeny tiny. So, the osteoporosis is not a disease of old women, it is a disease of people because 2 million men in this country have osteoporosis. Now theirs is a little bit characteristically different than women's but when men fall and break a femur, it is devastating because they're usually older. So, to get back on track, bone health is a concern of all women. It should start when they're teenagers. Are you getting off the couch? Are you exercising? Are you eating enough to build the muscle and bone you need for a lifetime?
Cynthia Thurlow: [00:21:02] I think it's such an important message. And certainly, I think about many women that go without menstrual cycles for years and years and years. And don't think of it as being a cautionary tale. I remind women that our menstrual cycle is really another vital sign. And if you're not getting your menstrual cycle, the question is why? And it's interesting. Even with the rise of social media, I'm seeing 27, 28-year-olds that are, premature ovarian insufficiency. So, they're literally positioning themselves to have the magnification of every potential side effect of going into early menopause times a hundred because it's not as if they're 57 or 47 or 50. But being that young and that long without those sex hormones is a huge concern.
[00:21:50] You're talking to your patients about bone health and talking about how we build bone, how we break down bone and the interrelationship of estrogen or estradiol and progesterone. Can we just speak to osteoclasts and osteoblasts. Because I do think this is interesting how the bone breakdown accelerates within that setting of that loss of estrogen.
Dr. Vonda Wright: [00:22:13] Yeah. Bone biology is a multistep process with multiple cellular processes and stimulates. But if we break it down to basics, we have multiple kinds of bone cells. The two that I want to talk about today is the osteoclast. And I always do this as if I've got my bone cells on my femur here. [Cynthia laughs] We have the osteoclast whose job is to go along the bone and when it receives stimulation from the body that, “Oh, we need some minerals. Oh, I've seen some deficits everywhere in our body. I need some of the things in the storehouse of the bone.” The osteoclast comes along, digs out the minerals, leaves a little hole so that those things can go off and work. Coming closely behind is the osteoblast, B for build.
[00:23:04] It's like, “Oh, my God, there's a hole in the bone. Let's fill it in.” And so, these two cells work in tandem and they crawl along the bones. And so, throughout our lives, there's a relative balance of breakdown for supplies and rebuilding because our bones replace themselves every 10 years. What happens in menopause as estrogen walks out the door? Estrogen is an osteoclast regulator. It keeps the osteoclast in control. The osteoclast is a crazy-- If you want to personalize these cells, little crazy cell, it's going to go out and go roughshod unless things control it, like estrogen. So, when estrogen leaves, it's not that the osteoblast stops working, it continues to work and build. It's just that the breakdown outpaces the osteoblast. So, instead of working like this, they're working like this.
[00:24:00] Now, this is a gross oversimplification and sometimes I think bone biologists are going to write me hate mail. But for those [Cynthia laughs] of us who deal with the general public, it's a very visual way to see what's dampening the osteoclast. So, to answer the question, “Can you build bone?” You continue to build bone, but you break it down more. And we know this, we know that we can build better bone in the presence of estrogen. We know that we can prevent osteoporosis with the presence of estrogen. It's the one reason the FDA has approved estrogen easily. If you say this person has osteoporosis, it's easy to prescribe. But there are other ways to get around bone density problems in midlife. So, estrogen is one of them. Lifting weights is another.
[00:24:52] Everybody always asks me, “But what if you already have osteoporosis, can you lift?” And the answer is yes. And you can lift heavy if you're careful. There's a study that has shown, it's called the LIFTMOR study that under supervision, in a careful way, you can lift heavy even in the presence of bone deficit. So, we need to lift weights, we need to impact our bones. I prefer jumping with a jump rope, running up your stairs. You can also rebound on a trampoline. That's what astronauts do when they come back with bone deficit. NASA has done great work that you can rebound on a trampoline. Weighted vests are all the rage right now, then I get the question, but wait, if I've got osteoporosis in my spine, should I be overloading my thoracic spine with a weighted vest?
[00:25:43] Well, my suggestion to that is, well, let's put the weighted belt around our waist because it's our lumbar spine and our hips that need to see the extra load. Our shoulders don't need the load, our hips and our spine need the load. So, let's put it there as a weighted belt, for instance. So, there are still lots of ways that we can address our bone health even before we get on to the dreaded pharma alendronate. And there's a whole list of different drugs that I usually send my patients to an endocrinologist who's really an expert at that before we have to do that. So, we're not without hope, as estrogen leaves our bone regulation a little bit pell-mell.
[music]
Andrea Donsky: [00:26:29] What are the top symptoms? Number one symptom-- Actually, I'd love you to guess and you tell me what you think the number one most common symptom is in perimenopause and menopause if you had to guess.
Cynthia Thurlow: [00:26:39] Clinically, I would say some alteration in sleep. So, insomnia or I would say bloating, because it seems like insomnia, bloating and weight loss resistance are like the triad of the things that make people pretty miserable. They can deal with other things. But those are the ones that seem to have the most expressed concerns. Frustration, disappointment, anger any constellation of emotional response to the symptoms themselves. So, I'm curious where those fall.
Andrea Donsky: [00:27:14] So, I will tell you. So, the number one most common symptom across the board, whether you're in perimenopause or menopause, is fatigue, exhaustion. Over 70% of women reported feeling really tired, can't get out of bed. Number two is brain fog, with over 66% of women. Number three are sleep issues. So, it is absolutely in the top three. Then we have memory loss, anxiety loss, or low libido, joint pain, lack of concentration, lack of focus. Then hot flashes, number 10, which that really surprised me that it's actually number 10 because when we think of menopause and when I ask a room full of people, when I'm speaking, I'm like, “What is the number one symptom?” They are like “hot flashes.” So, it's because we think it's like so synonymous. And that's what actually made me think about perimenopause and menopause but it's number 10, lack of patience, number 11. Then we have night sweats, slower metabolism, changes in body shape, and then digestive problems.
[00:28:11] So, the gas, the bloating, the indigestion, the loose stools, constipation, all of that, that's number 15. And then we have dry itchy skin, itchy ears, lack of or low self-esteem, pain, and then headaches or migraines. So those are the top 20.
Cynthia Thurlow: [00:28:25] That's quite a constellation of symptoms. And it's been my clinical experience that depending on the person, if they're feeling tired, I feel like a lot of type A women, they just push through it. They're like, I'm not tired.
Andrea Donsky: [00:28:38] Not tired. [laughs].
Cynthia Thurlow: [00:28:40] Not to mention the fact, the word finding issues that people will experience, which is oftentimes a reflection of estrogen changes. And I know and my listeners know that we have some of the most wild fluctuations of estradiol throughout perimenopause and even higher than when we're in our peak cycling years. So, it's those alterations that can create that. But what I find most interesting is that if I were to pull my listeners, those are my top three. But I think that it really speaks well at 5,000 is a quite a significant number. So, listeners, we talk about statistical significance and I think about you have to have an N or quantity of at least a hundred to feel like you've got a good representative population of data. So, 5,000 is incredible. And so, when we're talking about these symptoms, how many women listening have expressed that they're tired to their healthcare team and they've been told it's all in their head? [laughs]
Andrea Donsky: [00:29:43] Oh, a lot actually we have another survey, so it's called Doctor's Visits. Actually, four of our surveys out of our 10 right now and we'll be submitting more, are going to be the abstracts are going to be published in the journal Menopause in December. So, this is very exciting that I'm going to be a published researcher in this symptomatology. So, one of them is our Doctor's Visit survey. So, to answer your question, this was based on 1050 women and all of these surveys are ongoing. I'd love you to put a link below so your listeners can go and fill them out because the more that we know, the more that we can help women. And then we can also help to educate the doctors and healthcare providers.
[00:30:24] So, we know, according to our Doctor's Visit survey that 90% of women, so 89% of women go to their doctor complaining about their symptoms. And how many times did they have to visit their doctors before the connection was made between their symptoms and it being perimenopause and menopause? 40% of women had to visit their doctor between two and three times, which is a lot. Only 25% of the women said they went once, 18% went four to five times and 17% of the women went five or more times and in many cases still don't have their answers. I mean, these are massive statistics. 75% of the women out of the 1050 had to go between 2 and 5 plus times to actually make the connections. So, yes, we need to educate doctors and healthcare providers. So, what are these symptoms? And that's what we're doing.
[00:31:13] We're providing the list of the 103 symptoms. We went to the Menopause Society conference where I showed four posters of our research. And what was interesting is a lot of the comments from the doctors and the healthcare providers were like, “Wow, that is so many symptoms.” Because if you Google like, Cynthia, what's so interesting to me. So, like you, I'm in the midst of writing a book right now, and I was trying to find who came up with the 34 recognized symptoms, it was really hard to find. We found it in like a paper. One person who had mentioned in the paper in 2013. It is not anywhere in the literature. So that really surprised me. And I even asked the Menopause Society, like, “Where can I find the source?” They're like, “We don't know.” [laughs] And I was like, “Wait.” We're all quoting these 34 recognized symptoms, yet we don't know where it came from.
[00:32:03] So, now we know it will be in the journal Menopause 103plus symptoms. So, no more of the 34. We know that there's that many. But what's also really interesting from our survey is that 40% of the women said that when they brought up menopause or perimenopause as a possibility for how they were feeling, said that they were dismissed by their doctors or healthcare providers, and only 10% brought it up with their patients. So, we have so much work to do to help educate now, someone like yourself, who understands, focuses on menopause. We need so many more professionals like yourself because it'll make a huge difference for women.
[00:32:43] We won't feel gaslit, we won't feel dismissed. Also, the amount of time and energy and anxiety around our health, there's so money that is being spent. There's so much that we can do to improve how we can treat women, how we can support women, how we can validate women in perimenopause and menopause.
Cynthia Thurlow: [00:32:43] Yeah, it's interesting for me because up until eight years ago, I worked in clinical cardiology, both inpatient, outpatient. And I remember what it was like post WHI because there were a lot of female patients crying in the office to me or crying in the hospital talking about how they felt so much better on estrogen, they felt so much better on progesterone. And at that time, as a young woman, I was a young nurse practitioner, I was like 30. I recall that I didn't fully appreciate because I actually went back and looked in my physiology text from my nurse practitioner program and huge anatomy in physiology text . And honest to God, there was all this discussion about women's menstrual cycles and there was probably two sentences on menopause.
[00:33:45] It's like a woman goes into menopause at the age of 50 and falls off a cliff. I mean, that was the amount of exposure that I had. And I recall over years and years and years of working in cardiology, I was like, “What is going on with women in their 40s?” Because, I believed what they were experiencing, that was not my area of expertise. I mean, I had a constellation of functional integrative physicians, nurse practitioners, even GYNs and midwives that I refer out to. I was like, “I think you need to go see someone and talk about what's going on.” But it was so apparent to me that there was this lack of education for healthcare providers.
[00:34:19] I think even if I were to speak to my GYN and my nurse midwife friends and nurse practitioner friends, with very few exceptions, they would also agree, even as dedicated women's health experts, even they didn't have the scope of information. It's interesting, my current GYN is young. She just finished her residency. She loves middle-aged women. Do you know why she loves middle-aged women? Because there's not the complication of dealing with deliveries. She said, I love serving this population because most of these women are done having babies. They're really focused on themselves. She's like, “I love being their advocate.” And I said, “This is great.” I'm so glad to know they are young providers that are interested in focusing in on women of this age because I think for so many of us, we felt like we have lost our voice.
[00:35:09] In fact, I'll give you the example. Oh, this is probably 10 years ago, so early 40s. And I just recall I was talking to my then GYN that was in Northern Virginia, who I liked fairly. I mean, you didn't get a lot of time with her, but you could go in and have a conversation. And I remember saying to her, “I have very heavy menstrual cycles. In fact, today my period started.” And so, she did an internal exam and then she looked at me, she goes, “Oh my God.” And I said, “What?” She said, “You weren't kidding, it was heavy.” And then she said, “That's okay. Here are options.” We can put you on the pill, we can give you an IUD,-
Andrea Donsky: [00:35:43] IUD.
Cynthia Thurlow: [00:35:44] -we can do an ablation or you're done having kids. You've told me that you're done, you and your husband, we can just do a hysterectomy.” And I was like, “No, no, no and no.” [laughs] So, we're so quick to fix the problem, to remedy the problem. But there were never any discussions about what's your sleep like? How do you manage your stress now, anti-inflammatory nutrition. I mean, I know these are topics you like to talk about, but I reflect back on that and I recognize and this is not pejorative, the traditional allopathic model is not designed to talk about lifestyle. It is an unusual provider that will think to say to their patient, “Oh, by the way, let's make sure we're having these conversations.” But the way to help women navigate perimenopause into menopause is we have to start earlier.
[00:36:30] We need to start women are in their 30s having those conversations so that they're prepared and anyone that's listening, and I know I have listeners under the age of 40, perimenopause can start that young. It really can. I had my second pregnancy at 36. I'm sure by the time I was 37, 38, I was starting to see some of those inklings and glimmers. I just attributed all of it to having young kids and a husband who traveled.
Andrea Donsky: [00:36:56] Well, we know it could start as early as 35. And I look back on my journey and I believe I started around 35, 36. My first symptom was phantom smells. And that's when you smell things that other people don't. [Cynthia laughs] We did we have a survey on that too, because I was fascinated by Phantom smells. And I remember I would work in an office with 20-year-olds and I'd be like, “Do you smell smoke? Do you smell gasoline?” And they're like, “We have no idea what you're talking about.” [laughs] And I'm like, “I smelt it for months.” And then I had several MRIs and went to my doctor, went to an ENT and they're like, “It's in your head or we don't know what the cause is,” but now we know it's a symptom of perimenopause and menopause.
[00:37:34] Also, I tried to get pregnant in my mid-30s. So, I got pregnant during perimenopause and I lost baby. And then I got pregnant again and then I ended up having, when you're bleeding, a hematoma. I forget what it's called. Anyways, forget what the actual term is, the medical term, but I ended up being on bed rest for 10 weeks with my third, and this was my third, and I was 40 at the time in perimenopause and didn't know it. And that's where I feel like we're doing women such a disservice. And to your point, what you were saying earlier is we have to educate a lot of different people, so we have to educate the women themselves. So, I would love to see education in elementary school or high school. So, our daughters are learning.
[00:38:14] And I looked at my daughter's grade five curriculum. Now she's in grade eight. But I looked at this back when I was doing the work and I was trying to figure out, how do we help integrate this education so that we understand it better. And they teach about, obviously when kids are going through puberty, but they don't teach but anything about perimenopause and menopause and neither in the high school. So, I'm like, “We need to change it at the curriculum level” so that girls, when they don't come into this stage and they enter into their mid-30s or 40s and their 50s, it's not like, “Whoa, what's happening to my body?” It happened to me and probably yourself and so many other women. It came by surprise.
[00:38:51] I mean, I didn't even think about perimenopause. So, I was in perimenopause for a total of 14 years, 11 of which I had no idea, no idea. So, from 35, 36 to 47, I was like, “What's happening to me? Why am I gaining weight and losing weight? I had insane weight fluctuations. Why am I raging? Why am I so awful to be around myself?” I was so angry and the moodiness and the sleep issues, I mean, I could go on and on and on, the phantom smells with no explanation. Now, if women know earlier, okay, this is what you know. These are possible symptoms, speak to your doctor, healthcare provider. Here's what we can do to help. Maybe you need to start hormones earlier. If you want to go on hormones, maybe some supplements, maybe like obviously lifestyle and nutrition for me that's number one and number two, if we women know what they're entering into, they can make informed decisions and they don't have to question themselves and they don't have to- That self-esteem goes down, for so many of us goes down the drain because we're like, “Wait, is this happening?” I'm like, “Is there an alien taking over my body? What is happening? Who am I?” And I feel like we would be able to really do ourselves such a service by being able to be treated earlier, feeling supported, feeling validated so that there aren't so many questions that are circulating in our minds. And then thinking that we're like—[crosstalk]
Cynthia Thurlow: [00:40:19] I think for many of us, our symptoms, we start trying to figure out what exacerbates our symptoms. And I think a great deal about the metabolic changes that are happening in our bodies, how we start becoming sarcopenic. And so, this muscle loss with aging can drive so many of the unpleasant side effects that we experience. It can magnify them. Let's talk a little bit about the interplay between some of the changes with muscle as we're getting older and how that impacts insulin resistance. Because for anyone who's listening and if you are listeners to this podcast, you know, I talk about this a lot. That loss of insulin resistance goes along with that loss of muscle. And so, it's not just about aesthetics, why it's so important to focus in on lifestyle.
[00:41:09] And that's why I love your work, because you really speak to this. Helping women understand how to feed our bodies, how to focus on sleep, how to manage our stress, how to lift weights. Yes, lifting weights, ladies, it's very important. How we navigate these lifestyle issues and how they improve or they can negatively impact metabolic health.
Andrea Donsky: [00:41:28] Oh. As I mean, as at it, as we go into perimenopause and menopause, we are more prone to becoming insulin resistance. And you know, it's interesting when it comes to answer your question about muscle and muscle is what helps to take in the glucose. It helps. That's why it's so important. It helps us to get the glucose into the cells. So, as we go into perimenopause and menopause and we are losing muscle quicker than we're building muscle. I mean, it's important for so many different things. Obviously, insulin resistance being a big part of it. And I do a lot of N-of-1 research, so I'm very much and you're nodding. You're like, “Yep.”
[00:42:00] So, N-of-1 research to me is crucial because in order for me to help educate my community, I need to understand how it's affecting my body in particular. Now, we're all different. We're all affected differently. Our blood glucose is affected differently. I can eat something and be affected. You can eat something. You won't be as affected. But in general, I try to really drive the point home to our community that nutrition is at the basis for so many things. And it is really the number one thing that I want you to focus on when it comes to you entering into this phase of life. And I have women, a lot will say to me, “Oh, Andrea, what do you do?” And I'm like, “Oh, I help women in perimenopause and menopause.” They're like, “Oh, I'm so past that.” And I'm like, “What do you mean? I'm so pass that.” ‘Oh, I'm in menopause already. I've been in menopause for a few years now, or 10 years or whatever it is.
[00:42:46] And I'm like, “Ah, ah I've said now.” I'm like, [laughs] I'm like, first of all, once you're in menopause, you are menopause for the rest of your life.” And it is so important that now more than ever that you are focusing on nutrition. What are you eating? How is it affecting your blood sugar? Are you exercising? How are you managing your stress? We know that we can't cope with stress as well. And we're more stressed now. 66% of us are more stressed now than were before. How are you handling those two? And are you taking supplements to help?” You can't out supplement good nutrition. But what are you doing to help yourself?
[00:43:22] Obviously, I don't get into the hormones, but if the hormones are something that you're taking, what are you doing now to help yourself? And now it's really important that you focus on that. So, when it comes to nutrition and really managing our blood sugar. It's very interesting too, because I do a lot of N of 1 testing. I've been wearing a CGM, which is a continuous glucose monitor for a couple of months now because I was having some blood sugar issues. And I'm like, “Okay, you know, let me look at it from a food standpoint.” So, it wasn't a food standpoint. What are the reasons that are causing it? Is it that my muscles are breaking down a lot quicker and I'm not taking in my glucose? Is it my hormones? What is it?
[00:44:02] So, I'm trying to figure out what is causing it because my fasting glucose was always in a specific range. And now I'm like, “Oh, that's a lot higher than my regular range. What's going on?” So, I'm always trying to figure out, so starting though, and this is why I'm so passionate about looking at what we're eating. Food really does make a massive difference for how our blood sugar is going to remain level or is it going to spike? And it's normal for it to spike and then go down, but how long does it take for it to go down after it spikes?
[00:44:33] So, all of these questions come into play, and that's why I'm like, “Okay, when it's really important, you're the captain of your own ship and you can make your own decisions, You have the power to decide what you're putting into and onto your body. And Cynthia, for years before I really started focusing on perimenopause and menopause, my focus was on what we are eating, what are the food additives, what are we putting in our body. I wrote a book called Unjunk Your Junk Food back in 2011. And so, this is what I've been focusing on for so many years. So, what you're putting in your body can make such a difference to triggering your symptoms, to how are you feeling, to whether it's spiking your glucose or not. So, what are you eating?
[00:45:14] So, I really say focus on eating a good amount of protein. And I know you talk about this too. We talked about it in our interview back in 2021. Make sure you're getting a good amount of protein. Make sure that you are focusing on fiber, those 25 to 35 g of fiber. Eating a rainbow of vegetables. We want to get the different phytochemicals from the different color in your vegetables. Low glycemic fruits, if you're going to have your fruits, berries, sour apples, try to avoid the ones that are going to spike your blood sugar too high.
Cynthia Thurlow: [00:45:47] If you love this podcast episode, please leave a rating in review, subscribe and tell a friend.
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