Real Food Stories

102. Perimenopause Demystified: The Truth About Women's Health with Stacy Brix

• Heather Carey • Season 3 • Episode 102

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Stacy Brix, a board-certified family nurse practitioner with a passion for perimenopause, joins Heather to challenge outdated misconceptions and bring clarity to a critical phase in women's health. Discover how her professional journey and personal experiences have led her to focus on hormone replacement therapy (HRT), shedding light on the often misunderstood benefits it offers beyond symptom relief.

Together, we aim to equip women with the knowledge and confidence to make informed decisions about their health, while addressing common hurdles like misdiagnosis and inadequate care that many women face. By tackling the persistent fears linked to the Women's Health Initiative study, we highlight the broader health benefits of HRT, encompassing heart, bone, and mental health improvements.

Navigate the perimenopausal journey with evidence-based support as Stacy shares essential insights on questions to ask your healthcare providers. Discover why many women might not need to seek out expensive specialty clinics or hormone tests and learn how primary care providers and gynecologists can often offer the necessary guidance. Stacy's commitment to holistic health coaching and lifestyle changes provides a fresh lens through which to view the often perplexing wellness space. With valuable resources and contact information, including her Instagram handles, Stacy reinforces the importance of informed voices in the wellness industry, leaving listeners empowered and inspired.

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Heather Carey:

Hello everybody and welcome back to the Real Food Stories podcast. Today I have a woman with me who is an expert in perimenopause that in-between time of having your period before you go into full-blown menopause, which is when you stop having your period for one year. Perimenopause is a really confusing time and in my experience, many women do not get the care or information that they need. So I'm going to go deep today with Stacey Bricks, who is a board-certified family nurse practitioner with over seven years experience caring for women and whose expertise lies in guiding women through the significant life stages of perimenopause. Stacey took her training further and completed mindfulness training at the Mindfulness Institute at the Jefferson Myrna Brind Center of Integrative Medicine and is currently pursuing a specialty certification as a psychiatric nurse practitioner. Stacey also has a certification as a health coach specializing in working with busy women going through the wild ride of hormones in midlife. Her background informs her holistic and evidence-based approach to her transformational group coaching program for women in peri and menopause. Stacey's goal is to empower clients to navigate this transition smoothly while transforming into the best versions of themselves.

Heather Carey:

So hello, stacey, and welcome to the show. I'm so happy to have you here and I'm always happy to speak to other women in the wellness space that take this time of life peri and menopause seriously, because in my experience there have been many medical professionals as well as uninformed wellness professionals that are not up to speed with the proper care women need at this time. So we talked off air earlier about the need and desire to care for women in perimenopause and how this came from your own personal need to get your own support going into perimenopause. So why don't we just jump in? I want to hear a little bit more about your professional experience but definitely your personal experience and where you got the inspiration for this.

Stacy Brix:

Sure, and yeah, heather, it's exciting to be here. As you said, I'm a family nurse practitioner and have extensive experience in women's health and you know, I've been working in primary care for a while but have noticed in my own life some transitions, physiologically and in terms of mental health, that didn't seem purely mental health related, you know, and in terms of mental health that didn't seem purely mental health related, you know, and learning a little bit more about perimenopause, realizing that there may be a more complex system at play. You know hormonal changes. And then I, you know, could also see that in my patients who may have been treated for, you know, instead of being treated for perimenopause, they're treated for insomnia, or instead of being treated for perimenopause, they're treated for depression or anxiety, you know, in a very direct, one, directional way. So I just really started to understand the complexity of it and address it as such.

Stacy Brix:

And in my own community I know it's a lot of women who are getting older, like myself, realizing that we're a little bit lost when it comes to navigating the transition or the life changes. And even if we're really successful in our careers and maybe educated and know how to use tools and read books and all those things. It's still really confusing and it's a lot to sort through. And not only that, it's really hard to navigate healthcare. So it really I realized that I could share my knowledge to meet this need and hopefully help people find some direction.

Heather Carey:

Yeah, I totally understand that confusion and knowing that there are smart women out there right, we are I feel I'm a well-educated, smart woman and think I'm going through this or I'm having some vaginal dryness and her telling me exactly what you said, that it's maybe having depression, anxiety she wanted to put me on an antidepressant. I went to my gynecologist and mentioned some of these other symptoms I was having and the last thing that she wanted to do was even talk to me about hormone replacement therapy, which now, looking back on it, is just nonsensical to me. Because hormone replacement therapy which now, looking back on it, is just nonsensical to me because hormone replacement therapy solved a lot of my problems, right. So I think a lot of women go depending on your doctor and maybe even their personal feelings about hormone replacement or just menopause in general, or their lack of knowledge gets infused into their patients. Do you agree with that? Do you think that that's?

Stacy Brix:

Yeah, absolutely. A lot of us have heard of the. You know the study that came out in the 90s and how it led to a lot of misinformation. That has most people still in fear of menopause hormone treatment and I think that that's changing slowly. But we also understand how many systems that hormone replacement therapy can impact in a positive way heart health, bone health, mental health, you know, muscle health. So I think that this really we ought to start thinking about it more as preventative care than just helping women's vaginal dryness or helping their skin look and feel healthier longer. You know, it's not a thing of vanity and I think sometimes that is how it's treated.

Heather Carey:

Yeah, I wish that Women's Health Initiative study would just really just go away and be something that we talk about like, oh, remember that 100 years ago, because it's so outdated, that study has been completely debunked, we know that. But a lot of doctors, like my primary care doctor, was still stuck in that study. I mean, she actually said to me I would rather go to jail than go on hormone replacement therapy. I mean, it's crazy. This is my medical doctor, so this is just, you know, crazy. I wish that study would really slowly die out, because I think it did lead to so much fear around the option to take hormones and I think you just had.

Heather Carey:

Another good point is that I think a lot of women don't understand that in perimenopause and menopause, what you can go through is not just hot flashes and night sweats, which is like the typical, but estrogen and your hormones affect your bones, your heart, your skin, your brain. I mean, estrogen affects everything, right From head to toe. Yeah, absolutely Gut. Health too, everything, yeah, so it really it just plays such a major role. And so let's talk about perimenopause, though, like in exactly what happens, because I think that you know the word on the street when you're talking about menopause is menopause, and I don't know if a lot of women and just for just my audience, let's explain what perimenopause is exactly versus being in menopause.

Stacy Brix:

So perimenopause is the transitional time where your ovaries start producing, you know, decrease the amount of estrogen that they're producing, which changes the hormonal shifts within your body. It's, you know, we, our estrogen is always kind of shifted throughout the months with menstruation, but it starts to just decrease and it doesn't decrease in a gradual, clean way. It kind of feels and looks more like a roller coaster for for us. And so that is what we can attribute all those awful symptoms to, the hot flashes and the sleeplessness and the, you know, waves of anxiety or even depression. So the estrogen slowly, you know, put out less and less estrogen and, you know, eventually we go three, 12 months without a period and that's when we are considered to be in menopause.

Heather Carey:

So before that 12 month period of not getting your period, we can be in like a wild ride, right, I mean for somewhere like up to 10 years, sometimes, correct, I mean that's which, which I had no idea, I mean when I was like going into it. I mean, I mean, you're still getting your period, Maybe you're getting it intermittently, yeah right, and I don't even know if I knew, like, exactly what perimenopause was. I just didn't, I mean, because no one's talking about it, yeah, absolutely, and it can happen even when we're still getting regular periods.

Stacy Brix:

It can happen in early 30s. So yeah, it's definitely not on a lot of our radars. And these changes, the symptoms, happen in a slow way, before we know it. A lot of women will say I just feel like a different person than I was five years ago and if there was no one moment, there was no one day where everything changed, it just slowly happened and all of a sudden they feel awful because of the perimenopause. But yeah, it can happen, even when you're getting a regular period. It can happen as early as your late thirties.

Heather Carey:

Yeah. So, that's why I think like perimenopause should even be more the focus than menopause in a way, because by menopause you're sort of like your estrogen is just more or less evened out, Right, but perimenopause you're like it can feel like a rollercoaster sometimes, Absolutely, Absolutely. I mean I're like it can feel like a roller coaster sometimes, Absolutely, Absolutely. I mean I've heard that it's sometimes called puberty in reverse.

Stacy Brix:

I've never heard that I've also heard it called that, and you know, when I speak to women who had children at a certain age and all of a sudden they're like I feel like I'm going through puberty and my kids are going through puberty and my adult parents are aging, I, it's just a perfect storm. So and that's not something people are mentally prepared for a lot of the time and one thing that was really surprising to me is a lot of women who feel like they have a great you know network of friends or a great community, still feel pretty isolated in the experience, for whatever reason. Other they're like I can talk to my friends about anything, but when it comes to this, it's just not, they don't get it or we're just having very different experiences. So a lot of people feel really isolated.

Heather Carey:

Absolutely. I mean, I know I knew that I had been on birth control pills for a while, so I just knew intuitively that hormone replacement was going to be for me. You know, like I just kind of know my hormones and I knew that that was just going to be a it's just a transition was going to go on it. I didn't know. I mean I didn't know that you started in perimenopause, that you can go on hormones as early as you know, like while you're still getting your period, and so I and I know I remember going on hormones and I'd say the majority of my friends that like, yeah, no, everyone's so scared of it, and that I really didn't have too many people to talk to about it. I feel like the conversation is getting bigger now, but it's. But back then, yeah, wasn't something that a lot of people wanted to like here they're very scared about it and wanted to try natural herbs and and other things like that.

Stacy Brix:

Yeah, absolutely, natural herbs and and other things like that yeah, absolutely. I mean, I think that we're just starting to understand, or the general population's just starting to learn, how much it really does impact all systems of the body. And I think that we had also talked a little bit about how considering perimenopause as a component or one of the causes of any symptoms that a woman is having, for example, in a well woman visit, you know why aren't we considering perimenopausal symptoms or hormonal shifts as being part of the equation. You know, if this is an important part of a woman's health trajectory and even the preventative care that we're trying to offer, then you know we should really be screening for some of these symptoms, just like we're screening for, you know, whether or not they're having urinary symptoms, frequent urinary tract infections, or, you know, constipation or diarrhea or chest pain, palpitations, muscle aches, anything like that. It's part of the whole body.

Heather Carey:

That's another good point that getting frequent UTIs that people do not link this with that dip in estrogen right, Because that can absolutely aggravate UTIs. Why do you think this is? I mean, why do you think that you go to get your physical or to a well visit or whatever, and that doctors don't ask these questions? Because you're asking these questions, right? I mean, you are definitely on like something on the forefront of making sure that when, if you see a woman in your practice, right, that you would be definitely asking and mindful this question. Why do you feel like a lot of doctors don't Like? What do you think's behind that?

Stacy Brix:

I two things. I really don't think that perimenopause is on the radar of many, many providers, as you know, at least those who are in primary care. I just don't think that they're thinking about it or considering it. I think that a lot of providers you know, at least according to my experience seem to think that perimenopause is as simple as having hot flashes, some mood shifts and vaginal dryness, and it's not really. I just don't think it's considered as much and I'm not really sure why. I think it's just not on the radar. And also, our system is really overwhelmed. Our healthcare system's overwhelmed, especially primary care. Every clinic I've been to or worked at has, you know, struggle with staffing issues, especially after COVID. It's just it's. You know, everything is shifting and you know, I think, that every good clinician is responsible for providing good care and I think that, you know, almost everyone wants to provide good care. I don't think it's for lack of want, but it's, it's, it's a systems issue too.

Heather Carey:

It's a systems issue too. I'm excited for it to get more notoriety and more attention, because every woman on this planet not one single woman is immune from going through perimenopause and menopause, so it's a huge health issue it is.

Stacy Brix:

And I wouldn't want any of these things to get in the way of women actually accessing good health care or having their needs and perimenopause be met, or at least have that be considered, as they're being treated for depression, anxiety, insomnia you know even heart palpitations, or you know shoulder pain, anxiety, insomnia you know even heart palpitations, or you know shoulder pain, you know.

Stacy Brix:

So one of the things that I really want to do for people is have them equip them with the language to have the conversations they want to have with their healthcare team and then also find the people who are going to help them if that's something they need help with, because it's not easy to, especially if you feel a little bit overwhelmed by the topic of perimenopause. It's really hard to have that conversation with your clinician who's in a rush, possibly, or wants to talk about all the other health screens or check some other things off the list, you know. So having the language to have that conversation, to have specific questions answered, to even know what questions to be asking, I think is really important for people. Despite the system, the problems with the system, you should still be able to get what you need.

Heather Carey:

Right, absolutely. So that's a good question. What questions should a woman bring to their visit with their doctor? I mean, are there questions that stand out for you more than others? You know that they should that would get the attention of their doctor. I get it. I mean it's you go into a doctor's visit and like you get like your 15 to 20 minutes and like you're, you're done and out the door. So are there, are there questions that would stand out to you as like important to ask your doctor?

Stacy Brix:

Yeah, I. So I think one question that's helpful for women to ask is what is your experience in treating perimenopause, for example? Or, you know, do you think any of my symptoms are related to that transition? If so, why? If not, why, Based on my health history, my medications, what are my options? And if they don't really are unable to discuss it with you for whatever reason, then there's a lot of other resources out there and they should not be limited to specialty clinics, because it really is not that complicated. So you know, my hope is that other general practitioners will more and more be treating this.

Heather Carey:

What would be a specialty clinic? What do you mean by that?

Stacy Brix:

Well, I think I've encountered a lot of women who feel like they, in order to obtain menopause hormone treatment, they need to be seen in a clinic that specializes in perimenopause. But really it doesn't require a specialty. But really it doesn't require a specialty. That maybe where they're experts and knowledgeable. But you know, this is something that a primary care provider could be able to prescribe and pretty much should. Maybe they need a little bit more education, maybe they're not comfortable yet, but you know it's not, it's not really a specialty in that way. I guess my point is it's okay to ask have the conversation with your general practitioner instead of just feeling like you have to. You know, some women are traveling to New York city from where I'm from to get treated for this with a specialty clinic, and it's. It just shouldn't have to be that way, and they're waiting 10 months.

Heather Carey:

Yeah, I agree, I mean, or your gynecologist I mean so your primary care or your gynecologist can, can and should have this conversation with you. But I think what, if I'm understanding you correctly, like a specialty clinic would be, as I know, and like remember some of these places where you pay lots of money in cash to get tons of hormone testing? Is this what you're talking about, or are you familiar with these?

Stacy Brix:

Maybe part of them, but there are also a lot of great individuals who really know all the ins and outs of perimenopause and they're doing fantastic work and they're doing a lot of education and they're providing evidence-based treatment too. But, you know, a lot of the time they have long, long wait lists because there's a there's a long demand, a huge demand. So, yeah, there's all different kinds of clinics and individuals treating these things. But I guess I just want women to feel empowered to have the conversation with their general practitioner or their gynecologist. And, you know, try to have the conversation with their general practitioner or their gynecologist. And you know, try to have that. Yeah, have that conversation. And also a lot of. You know, primary care providers and gynecologists really want you to feel good and they want you to feel taken care of. So that gives them an opportunity to know what's on your mind and what you need directly.

Heather Carey:

Yeah, so you don't need to go travel hundreds of miles to go see someone to prescribe you estrogen and progesterone. I mean you don't need to, right, you could do that right in your own town. Nor do you need to pay. I mean, I know some of these clinics where you pay thousands of dollars in cash to get all these crazy wacky hormone testing and you don't even need to get your hormones tested, correct. I mean to find out if you're in perimenopause or menopause. I mean you are in. You are in menopause after 12 months of no period. Then you're in menopause, right, and the time before that is perimenopause, you don't. I don't think you need to spend any extra money getting any more weird tests or taking any wacky sort of hormone formulations, right?

Stacy Brix:

Right, and this is another part of why it's so confusing. And another thing I really feel strongly about is providing evidence-based information, which is, it's, really hard to figure out. Well, do I need a test? Do I need a urine test? Do I need supplements? How's my diet supposed to change? Your diet doesn't need to change necessarily. It's important to you know. Maybe learn a little bit more about what a healthy diet is for you, but you know it's again, it's a lot to navigate. I don't know special. Those special expensive tests are not necessary. Hormone testing generally is not necessary. There are a few cases where it's helpful to support the clinical diagnosis of perimenopause, but most of the time you can't in perimenopause. Your labs can be completely quote-unquote normal. That doesn't mean you're not in perimenopause. So, yes, it's not beneficial most of the time.

Heather Carey:

Right, and also, depending on the time of the month, that you get your hormones tested right, Because your hormones are fluctuating every single day of the month, so that roller coaster, you don't know if it's up or down Right. So it's yeah. There's just so much. There's a lot of misinformation, a lot of confusion. It's people like you, I guess, who would, like you know, really be at the forefront of just providing that evidence-based information, right to get women clear on it. So, on that note, let's talk about your program that you have. So you're a nurse practitioner, but you are also now doing a dual role as a health coach to help women. Tell me about your program, because this is very exciting, because we need more people out there who can give really credible support to women that is evidence-based. It's not like that wacky. I mean you go on social media and there's drives me crazy. There's so much misinformation. So tell me about your program.

Stacy Brix:

I'd say most of it's misinformation. Yeah, I mean, part of the reason I am doing this is because I just saw what a struggle it was for my community, my friends and my patients to navigate this season all the information that's out there, most of it conflicting right. So I wanted to be able to provide evidence-based information that women could use to make their own best decisions. And you know, you can read books, you can listen to podcasts, you can do your own research, but it still can be really overwhelming, especially if you're, you know, a busy woman in midlife with a lot of responsibilities and maybe you're not feeling your best. So that's my main goal, and I also wanted to give women a chance to have some connection with other women who were in a similar position, so they could share resources and experiences in a different way. And I don't give medical advice in this program but, like I said, it does allow women to find their way and navigate their own healthcare and their own perimenopause experience in a way that's more efficient and less stressful and more effective.

Heather Carey:

That sounds great. So are you doing group programs versus one-on-one or do you do both?

Stacy Brix:

three months long um. Women will have some health coaching, identify symptoms that are bothersome to them or goals that they have with their health, things that they want to feel better with or grow in and, you know, work towards those, work towards meeting those goals, while also getting evidence-based information about perimenopause so that they can really have clarity by the end of it and not feel so disoriented and so that where they feel like they can navigate their own healthcare in a more effective way, like I said, and they'll also have more of a sense of community, where they feel like they're sharing the experience with other people in some ways.

Heather Carey:

So people have really said that that's beneficial some ways, so people have really said that that's beneficial. That sounds amazing, because I think women need to feel like they're not alone, just like we had said before that they need community, and I think that that sounds fantastic to get evidence-based information from someone who knows what they're talking about. What about, besides hormones? We talked a lot about hormones and the possibility of taking estrogens. Are there other lifestyle recommendations that you have for women? I know this is a very general question because all women are individual, but any other, just you know those lifestyle, food, movement, exercise. What do you think?

Stacy Brix:

So I I was in the health coach training that I did. You know it has lifestyle medicine as a foundation, which is also evidence based, and the kind of coaching I do is also evidence based. So you know this. To answer your question, in lifestyle medicine we prioritize several things so eating healthy food, moving your body, avoiding harmful substances, you know, and developing really healthy relationships, which is more and more important. We're understanding the importance of good relationships and social connections on long-term health.

Stacy Brix:

So all of these things seem really really basic, right, but when it comes to really tuning into them and fine-tuning your health, when you're maybe busy and overwhelmed, it helps to have some help, and I don't recommend supplements, I don't recommend any fancy diets. Um, sometimes people just need to feel more inspired when it comes to eating and a lot of women have some, you know, can develop some struggles around food in midlife because they feel like they need to restrict more and more to keep the weight off that's building because of the shifts in estrogen. So having a healthy relationship with food is really really important and central in the program. So we talk a lot about intuitive eating so that you can feel good about your relationship with food instead of like you're battling your body and constantly fighting cravings or, you know, just struggling with enjoying food yeah, I agree with you.

Heather Carey:

I think that this is a time that they get scared because their bodies might be shifting, gaining weight and or and weight is shifting, that redistributing right in your body and it's it can trigger a lot. And then then here come the diets and the supplements and the like. You know that that whole industry that's that doesn't give you any long-lasting good solutions, right. So, really, that the best things to do right are focus on your food and your lifestyle things, movement, and I think one thing that you didn't mention, and I'm sure you would mention it, is your sleep, which has become like the highest of all priorities for me. I used to take my sleep so for granted, and now I'm like I don't get like my eight hours of sleep. I'm like it, and now I'm like I don't get like my eight hours of sleep.

Heather Carey:

I'm like a little day is like in a tizzy the next day?

Stacy Brix:

Absolutely, and you know not we're. We've talked a lot about hormone replacement therapy, but not everyone wants to, to is going to choose that and you know managing their perimenopausal symptoms, and that's, of course, okay too. So this program really helps them find non-pharmacological ways to manage their symptoms effectively and to manage them as they change year to year.

Heather Carey:

Well, that sounds fantastic, I mean, especially coming from someone with such a medical background, and then also incorporating your you know, all the other lifestyle changes. I think is a really nice combination for women. So you said your program starts in.

Stacy Brix:

January right, but I would love it if people reached out to me between now and then, and I, you know, do offer one-on-one coaching between now and then. So, yeah, I'm really excited.

Heather Carey:

Okay, that sounds, that sounds fantastic. Where can people get in touch with you? Okay, that sounds fantastic.

Stacy Brix:

Where can people get in touch with you? They can reach out to me at menopauseonthemind, on Instagram or brickswellnessnp, as in nursepractitionercom.

Heather Carey:

All right, fantastic, I will put those links in the show notes. And, stacey, it was fantastic talking with you and really nice to know that there are people out there who are really focused on evidence-based lifestyle changes, and that's versus just the crazy wellness space that we sometimes love, which I think it just contributes to all the confusion. So we need more people like you.

Stacy Brix:

I appreciate it. Thank you so much, Heather Sure. Have a great day. Thank you.