Hormone Tracking through Perimenopause with MiraCare

It’s common to think about hormone tracking as conception tools, but your hormones don't clock out once you’ve had a baby or are entering perimenopause. 

Rose MacKenzie, Clinical Manager at MiraCare, returns to Health Youniversity to talk about the benefits of tracking hormones during perimenopause.

She explains why one hormone test can miss important patterns and why the standard ”day 21” blood draw can be on the wrong day. She also explains why a high FSH result matters for a lot more than just fertility. 

This episode is for you if:

• you're in your mid 30s to mid 40s and want to know the state of your hormones 
• you've been told your FSH or AMH numbers "aren't great" 
• you've had a blood test come back confusing 
• you're curious how  tracking hormone over a cycle provides better data
• you think perimenopause deserves your and your medical team’s attention 
• you're supporting a patient, partner, or friend through this stage

Support your fertility journey with Preconception Plan at Health Youniversity. Learn more here: https://healthyouniversity.co/programs

Learn more about MIRA Fertility Tracking at miracare.com 

💻 About Susan Fox: https://www.healthyouniversity.co/about

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Detox to De-Stress:  View the FREE Masterclass on the importance of detoxification to prepare for a healthy pregnancy:  https://susanfox1.easywebinar.live/gentle-detox

Learn about our program entitled Your Fertile Health: https://www.healthyouniversity.co/programs

Schedule a Fertile Health Assessment: https://www.healthyouniversity.co/your-fertile-health-call

Let us journey with you as you navigate your fertile health. Connect with me:

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Transcript

SPEAKER_01 1:25

Hello and welcome to today's episode of Health University, where we talk all things fertility, pregnancy, and postpartum, and what I call the pre-perimenopause menopause phase, which are barely a step across the bridge of hormonal life of women ages 35 to 45, something like that. And today we're going to cover that pre-perimenopause timeframe specifically, but it does relate to, as I say, the fertility patient or postpartum person. And I'm delighted to have with us today once again Rose McKenzie. Rose brings up to us her expertise through the MERA fertility tracking system, clinical manager at MERA, and assists healthcare professionals and providers to successfully use MERA with their patients. With more than 10 years' experience as a natural family planning expert, she has extensive experience assisting women using the MIRA monitor for hormone monitoring and health promotion. When's the LH surge? So this helps women who are tracking their hormones with regular cycles, irregular cycles, postpartum amenorrhea, and pre-perimenopause and perimenopause. And Mira is a medical device that tracks four hormone markers using fluorescent technology to achieve sensitive changes to hormone fluctuations. Welcome, Rose. Thanks for joining us again. I always get a little bit smarter every time we have a conversation. So I'm looking forward to this one.

SPEAKER_00 2:52

Yes, thank you. Thanks for having me here again. It's always a pleasure to empower women to understand what their hormones are doing.

SPEAKER_01 2:59

I agree. And I'm going to put a little future plug in it at the very beginning, and we'll remind people at the end that Mira is, as as it we would want it to be, expanding its capability and is looking forward to maybe by the end of the year or the beginning of next year adding yet another hormone to track that is critical to the female reproductive hormones downstream, and that is cortisol. So I think that that's going to be really, really key. And so we maybe we can touch upon what that might look like. And I also wanted to add that our recent conversation with Dr. Ferris and yourself talked about what was then referred to as PCOS, polycystic ovarian syndrome, which we now know as PMOS or PMOD, polyneuroendocrine metabolic dysregulation. And our conversation actually did the deep dive into really correcting that misnomer of PCOS. But MIRA is really exquisite in helping to identify this metabolic dysregulation. And I anticipate that the cortisol, as an add-on, will be even more amplifying as to what's taking place at the metabolic level that is affecting female reproductive hormones. So once again, thank you for joining us. Let's have this conversation. We're going to kind of step into the pre-perimenopausal time frame. We've covered hormone tracking for fertility, we've covered hormone tracking for that postpartum time frame. And again, it's just one little step. It's all we're we're really in the same uh demographic of ages 35 to 45, when we would be remiss, not to say that sometimes sounding like a dreaded word, the perimenopausal timeframe, but it's a natural occurring phenomena that we would expect. So why not be prepared?

SPEAKER_00 4:59

So of course. Yeah, I think it's really best, I think it's best described as almost like a reverse puberty. Everyone goes through puberty, everyone goes through perimenopause. So it shouldn't be something that we shy away from. We really should be focusing more on how do we help women through these different hormonal changes that they will go through in this continuum. So really hormone tracking is important for any woman who has ovaries. That's between puberty and menopause, because we know that hormones matter and it's a centerpiece of what your body is doing. And if you understand what your hormones are doing, then everything else starts making a lot more sense of why you seem more outgoing and ready to go to a party, part of your cycle. And then the other part, you're like, I'm just gonna stay home. That's right. I like to just cozy up.

SPEAKER_01 5:49

Absolutely. I think that that's really wise. And again, in past conversations, the person we've been speaking to is really interested in this cycle and the next cycle, and the next cycle because she's interested in that positive pregnancy test. But the information that can be derived from Mira over time, that longitudinal uh data collection can really tell an important story. So tell us about that. Tell us about what you've learned and what your providers and patients have learned with regard to the value of collecting this data over a longer period of time.

SPEAKER_00 6:25

Of course. Well, if someone has their baseline, so maybe you had tested when you were trying to conceive, and then you tested when you're postpartum, and now you enter into that pre- or perimenopausal time. You have your own history to know this is not what I used to be. This isn't what my hormones used to do. So that when we see something, we're like, that is actually a change for you. Whereas for the next person, maybe that's how they always were. So I'll give an example of someone with um maybe low progesterone. If you know you had low progesterone when you were actively trying to conceive, and now you're entering that perimenopausal time, you already know that that's an area that we're gonna have to focus on because it's been uh maybe a challenge for you in the past. Whereas the person who had no issues with low progesterone, now they enter perimenopause and they experience it for the first time. One, they may have symptoms that they don't know what it means, or we're starting to see these slowly creeping up patterns and maybe symptoms in how they feel, how heavy their periods are. Well, for them, it's length of their period. The length of their cycle, yes. Exactly. So for them, they may have no idea why this is happening. But if again, they have a baseline and now they see their data, they're like, oh, I have lower progesterone, maybe this is contributing to why I'm having a different bleeding pattern or different symptoms, things like that. So it just gives us more information. It's kind of like if you know what your blood pressure normally is, and then now you're getting it checked, and you're like, if you have no baseline blood pressure and they tell you it's 120 over 80, you're like, great, it's normal. But if it's me who my blood pressure tends to run 90 over 60. Oh dear, that's low. I do, I tend to be a little on the low. I have to be careful when I stand up so I don't get lightheaded. So if I'm the person who's never had my blood pressure checked and I get it checked for the first time when I'm 50 and they say it's 120 over 80, I'll be like, great, I'm good. When actually that's about a 30-point difference for me.

SPEAKER_01 8:22

Right.

SPEAKER_00 8:23

Good point. So having your own baseline is really important.

SPEAKER_01 8:26

Good point. And if you don't mind, let's go through these four markers so that so that people listening really understand what it is they're looking at and what it is that these values might be telling them to look for, you know, deviations or aberrations in their cycle.

SPEAKER_00 8:44

Yeah, so we test four of the main reproductive hormones. Of course, you can test, there's lots of things out there you can test. But we chose these four because these are the ones that dynamically change within the cycle that are easy to track in urine. And so we track estrogen and we specifically measure the breakdown of serum E2. So on our, like if you go to our website, we'll say E3G, and people are like, what is that? Yes. I'm like, we got to go down the chemistry pathway for a quick second, but it's the breakdown of your serum estrogen. And we measure estradiol, which is really specifically estrodiol.

SPEAKER_01 9:17

That is what the you know the the IVF doc or the reproductive specialist is looking at. So it really is an apples to apples comparison. It is just metabolites versus protein-bound blood.

SPEAKER_00 9:30

Yes. And I do like to, you know, since we're on this topic, I like to quickly tell people when you say apples to apples, it is measuring the same thing, but I want to be careful to say that one happens first, right? Your serum, that hormone is floating around in your bloodstream. So if you get it drawn, that tells you right now, like um, I like to say a still shot, like um a picture. Whereas a mirror tells you the movie, the entire you know, pattern of what that estrogen is doing. And um, like I said, there are two different time frames, but then the actual measurement is different. And so someone will say, Well, this is what was available in my bloodstream. How come my output is not the same? And I'm like, Well, we are measuring two different things here, so be be aware. But we are the breakdown of serum estradiol, not sometimes people are like, Why do you measure estrone or why do you measure estrol? I'm like, that's not what we measure. We measure the breakdown of serum E2, which is again in the fertility space, that's what the providers are looking at. Yes, yes.

SPEAKER_01 10:29

And so and and this estradiol is what is growing and uh uh increasing while follicles are growing to ovulation.

SPEAKER_00 10:38

Correct. And so that's why it matters to us because it's then we know you're having the appropriate change of estrogen as you're approaching ovulation. So that should mean that you have appropriate follicular development, um, your ovaries functioning how it should, and then it's um in communication with the brain, where the brain sends out the LH Surge triggering for the follicle to be releasing the egg out of it. So we need, you know, hormones do um a coordinated dance, or some people describe it as a harmonious song, you know, and and when one thing is off pitch, it really can throw off the entire system. And so that's why it matters that you have uh to answer your question, the four things we measure estrogen, LH, breakdown of progesterone, and FSH. So they all have a critical um role to play in that coordination of the hormones to have a normal menstrual bleed, normal recruitment of the follicle, releasing of the follicle, and then of course the corpus lutein formation, and then the next bleed to happen.

SPEAKER_01 11:37

So excellent, excellent. And so if someone were tracking this, say for you know five months and they are in their pre-perimenopausal timeframe, would it be air quotes normal to see some deviations from cycle to cycle? And I say this because sometimes people get a little too um focused on uh-oh, there's a change, and that must mean something really, you know, dreadful is occurring.

SPEAKER_00 12:07

Yeah, so that's actually why it's great to be able to see it because it let's say you have five cycles and you had one odd cycle. Well, was there a reason for that? Did you change medications, change supplements? Did you have a really stressful month and it caused an abrupt change in your cycle, but then it went back to how it was? Then it's okay. It is it's passed, it's gone, it's done. Versus if you see a change and it continues to be that change, is it a good change or a bad change? So we always want to look at things over more than one cycle. Whenever I'm educating a provider, I say, really, two cycles tells you a lot more than one. Because what if that one cycle was the off cycle? And you thought, oh no, there's a lot of problems, or I've seen that myself.

SPEAKER_01 12:50

I've I've been I have been guilty as charge where the patient will come in for the first time with a month, you know, uh of to uh of data to look to show me, and I'm my eyes reel back in my head thinking, what is happening here? And then there you there there is some some history of an event or sequence of events that occurred that cycle, and then the next cycle, it looks picture perfect. It looks much better, yes.

SPEAKER_00 13:17

Yes. And so I always say there's data is data, it's super helpful to give us context. So once you then hear the story of, oh yes, I had a really stressful month, then we're like, let's give it another cycle. Let's see what your next you know month of hormones are doing. And we also need to know that hormones generally take time to be improved or to worsen, generally. And so we never want to think, oh no, and lose all hope with one cycle of data. Right.

SPEAKER_01 13:48

We really want to see falling off a cliff. This whole, this whole uh statistical data point that we hear is that, you know, after 35, you know, the interpretation is all hope is lost. You know, after 35, you're no longer uh, you know, your eggs are no longer viable. And so, you know, that's that's the that's not everybody, but it is oftentimes through the IVF communication that this is what the patient here hears. Um maybe they're not saying those words exactly, but this is what the patient hears. And I have to kind of yeah, I have to kind of soften that blow a little bit and saying, you know, there is a reason for data, there is a reason for statistics. We don't want to be ignoring it, but you individually are not that that statistic. So we need to we need to do a comparison of you individually to that statistic and see is it lining up or is it not?

SPEAKER_00 14:40

Yeah, that's exactly. So we have four providers, new reference ranges that we just put out into our dashboard and we give a category of 18 to 35 year olds. So if you do go past the 35, we put you in a new bucket, right? The next age bracket. But what I love about it is at the provider, you can click back to the other reference range. So you can see your patient's data compared to the 18 to 35 year olds who did successfully conceive on that cycle. And so you can show your patient, although you just turned 36, you still fit the normal hormone profile of people that successfully conceived. And so um, you know, I I think it's um, you know, in that space, oftentimes there's sometimes a little bit too much emphasis on, you know, you you turned a year older. Whereas let's look at it. Yes, let's look at everything together, right?

SPEAKER_01 15:32

That's brilliant. So so let's talk FSH a little bit. So because again, this is it, you know, it used to be cycle day two or three, FSH and Estradial was the gold standard. I still like to see those with with serum because I think that they tell uh uh one half of the story, if you will. I say it's almost like two sides of a coin. The AMH is telling one side of the story, but the FSH is either confirming that or supporting that, that AMH uh level, or not. So let's talk um FSH in the mirror care um analysis.

SPEAKER_00 16:08

I like your coin analogy, but I would like to say that it's more faceted than that. So maybe it'd be better to say, you know, more like a sphere. We need to see this full circle. And so I love FSH because um it really gives us much more usable data when we see FSH in an ongoing pattern, because in the past, FSH was typically drawn once, cycle A, two, three, four, somewhere around there. And a lot of weight was put on that one result. The same with AMH. Correct. And I see time and time again, especially in we'll say the little bit older population, that one cycle their FSH looks fine, and the next one it might not be. It might be a little high, and then the next one it's fine again. And so FSH is dynamic just like estradiol and LH and progesterone. Now, does it give us a cue that you're I like to say your body's trying a little harder? Yes, if it's elevated, but it's not um going to continue to stay high. Like it's not an automatic, if it's high, it just stays high. Right. It can be cycle specific or even situation specific.

SPEAKER_01 17:18

Exactly. And and and I really liked I want to sort of highlight, amplify that, because once again, you know, in in the not so far away back machine, you know, the highest FSH was the data point that the IVF clinics would use and say, you're only as good as your highest FSH, which is you know, really defeating and and inaccurate. So yeah.

SPEAKER_00 17:43

Yeah, I've actually um we have a case study of a provider who uh the patient's AMH was um not very good. And over the course, they actually improved her AMH over time, which I know historically it's changed, but historically people thought your AMH just continues to drop. It's a downward sloping value. And you know, we really are seeing that you can support the system, reverse just like you can reverse inflammatory markers, you can reverse AMHs, you can reverse um that increasing FSH. And so it really is, I would say it much more encouraging that yes, this is a data point, but let's look at this in context to your entire situation. So don't use a you know, FSH, don't give it as much credit as uh some people have historically.

SPEAKER_01 18:30

Right, right. It is there's not an equal sign to your FSH and your fertility. There is an indicator, but it's not an equal sign. Yeah. Please connect with us for a fertility assessment call at the link below. We'd love to learn a bit about you and share our resources. And make sure you subscribe to our YouTube channel so that you never miss an episode. So you mentioned that it's always good to have more than one, you know, cycles testing in a poor of course. Is there an optimal um, you know, like an optimal minimal number of cycles that you would say, you know, give it this much time. And is that sequential, you know, sort of one month to the next month to the next month?

SPEAKER_00 19:12

Yeah, some people would rather test at a baseline, and then maybe they're doing a bunch of fundamental work to improve their situation. And some people would rather pause testing during all that hard work. Like if you have a six-month plan laid out with your provider, some people would prefer to stop testing and then test afterwards and see what changes they've made. Other people like to see the progress as it happens. So there's not a perfect answer for that. It really depends on your situation, um, what your provider wants, what your budget is, that sort of thing. I'm a numbers nerd, you know, a science nerd. I just love to see it. So, like I love the patient who gets started. They have already two cycles of data. We begin interventions and we see the transformation happen and then the outcome. Um, because sometimes it is really fun to see the the in-between, but it can sometimes stress people out when their data gets a little bit worse before it gets better. So I'll give an example of that. Yeah, we had um a case with um Dr. Kara Fitzgerald. Um, I'm sure many of you are familiar with her. She had a patient with a very difficult case of a PMOS. And as she describes it, this person could only get their cycles regulated, their hormones regulated if they were really strict, like not the 80-20. Like she had to be like 80 um to 90 percent, actually, probably higher than that, like 95% compliant with all of the things for her cycles to be regulated. She was really resistant, very resistant, and um, you know, it's really hard to maintain that over a very long period of time. And so they did discuss her options and they decided to do a GLP one. And when they did the GLP one, it's a little bit fun to see her data actually got worse and then got better. And but by worse, like she had long irregular cycles, but it situationally got her estrogen got a little erratic, and um, but then it normalized. So I I believe it was over the course of three cycles. And before, you know, she was having like a 70-day cycle. So you could argue that really it was only like over a cycle and a half that it took her to to kind of normalize herself. So it's from a science standpoint, it's fun to watch data transformation. But for the patient riding, you know, the wave, sometimes they're like, I'd rather not see it. I'd rather not see it. So so there's no straight answer to that, is what I'm getting at. That um, you know, it can be a discussion and a pros and cons list to decide do we want to keep tracking or not. But to give the simple answer, I like two cycles um of of kind of baseline, then intervention and then outcome. But there's caveat to that, you can be mid-intervention and still start up testing. Like don't think, oh, I have to stop everything I'm doing, get my baseline, see where I'm at. No, no.

SPEAKER_01 22:00

Absolutely. I would I would venture to say, don't stop your intervention.

SPEAKER_00 22:05

Don't stop what you're doing.

SPEAKER_01 22:07

Because then you won't know is it working or not? Because depending upon your lifestyle and your and potential resistance or interesting.

SPEAKER_00 22:15

I would call it baseline where you're at right now. Like whatever you're doing right now, that's the baseline. I mean, I get asked that question too, of like someone who's on hormone replacement already. They're like, should I come off of that to see what I'm doing? And I'm like, well, well, it depends. Are you trying to come off of it? Because if you're not trying to come off, then don't stop it to see what your body does without it, because that's not your end goal.

unknown 22:35

Right.

SPEAKER_00 22:36

So stay on what you're on. Let's test, see how your body's responding to that intervention, and then we can move on from there. So hopefully I've given a long-winded answer to how do you test, how long you test it.

SPEAKER_01 22:48

That was a that was a great answer because they're really it it what you're saying is that there's not a simple answer, that it is, you know, unique to the patient, the presentation, and their goals. I mean, so again, if someone is in this pre-perimenopausal time frame and still family planning, that is going to be a different scenario than if someone's just saying, you know, I kind of just want to anticipate perimenopause and do what I can now to sort of modulate and mitigate some of the symptoms that you know my sister or my friend, you know, was concerned about. Got it. So then if if someone is doing the miracle. Care and getting their testing, do they then need to do serum testing as well?

SPEAKER_00 23:34

Yeah, so I like to explain that we don't replace serum. If what you need to know is what's available in your bloodstream right now, today or this morning, then still do your blood test. But where mirror really helps you is to provide that context of that blood test. So if we think about most blood tests are either not timed, or if they are timed, it's typically cycle day two, three, four, five. Around there is where if anyone's been told to go do a blood test at a certain time, that's what they're told. Right. The next step, sometimes we get told cycle day 21. Or so let's talk about six days post-ovulation, yeah. Correct. And so I really like to challenge that day 21. I'm like, that's not anchored to anything but the period.

SPEAKER_01 24:18

Yeah, it's not anchored to anything but a 28-day cycle.

SPEAKER_00 24:22

Correct. Correct. And so what is day 21 if you're not indexing it to something that matters? So indexed to the period makes sense for day like two, three, four, five. That makes sense. But anchored all the way into day 21 to a period really does not make sense. And I like, I was listening to um Dr. Kalia Waddles and her she, I forget the name of her new book that came out. But anyway, I was listening to her present at IFM and she said, let's put cycle day 21 labs in the garbage. And I said, Oh yeah, I agree. I completely agree. Let's do a movement around this. So um you already said what is the better option, right? Five to seven days after ovulation. Because what are we actually trying to capture is someone's midluteal results, and that's the only time progesterone to hold that potential pregnancy or to hold the cycle for the second two weeks of the cycle. And so really estradyl and progesterone, seven around seven days after ovulation is what most people are looking for. And we just unfortunately historically, we say, well, that's too hard for people to figure out. So just go on day 21. Just go on day 21.

SPEAKER_01 25:31

It's it's silly because if you've if you've ovulated on cycle day 18, you're not capturing correct data. Yeah.

SPEAKER_00 25:38

I I have tons of chart examples where you know the patient's actually ovulating on day 21 and they go get their blood drawn, then they get told your progesterone's lower, you're not ovulating. And I'm like, they didn't ovulate yet. Right. Or they didn't produce enough progesterone yet because you tested uh too close to ovulation. And so it's not mid-fluteal.

SPEAKER_01 25:56

Yeah. And it's interesting because again, when when working with the conventional, you know, uh REI community, you know, serum is their gold standard. They they tend to wrinkle their brow a little bit at the metabolite testing. Um and yet when they can see the the the sort of correlation, it you know, then then they're then they're they're bought in a little bit and saying, okay, now we can see that actually we're getting uh similar data at these different times of the cycle. And so so it they're then not telling the patient, you're wasting your time, you're wasting your money on these urines, urine strips.

SPEAKER_00 26:37

Right. It really can point to the person who um I've seen it in chart examples where their first half of their gluteal phase progesterone actually looks pretty good. And then they have almost like a cliff, their progesterone drops off and Peter's out much too early. And that could be completely miss in a serum value. So if you see that, that would be the patient who can advocate to their provider, I'm willing to go get my blood drawn again. Can I go again? I'll do 21 or better, seven days after ovulation, then I'll do nine days after ovulation, 11 days after ovulation to really see because it might be dropping off too prematurely, which of course we want to fix that root cause. Um, but proving that it's happening.

SPEAKER_01 27:19

Well, we want to fix the root cause, but if if again, if this person is one who is also trying to conceive, sometimes just a little prescription of support through that next two weeks until the positive pregnancy test, and then continued through that first trimester is the ticket that lets that back in. Yeah.

SPEAKER_00 27:39

Yeah, exactly. And I think, you know, if we talk about um in a medicated cycle, often progesterone is used anyway, assuming that you just need it. And so, you know, sometimes my argument for there is I'm like, if you're willing to give it other times, why aren't we willing to give it in these times?

SPEAKER_01 28:00

I I'm I'm gonna venture to name it liability. It's you know, if if somebody is investing the time and resources and and money, especially into an IVF cycle, that that progesterone is just a little bit of like a check, it's a check mark, right? It's like, okay, we we have assured that your that your lining that we checked and can confirmed before transfer that it was, you know, X number of millimeters and trilaminar and all of that. So it's really just almost like it's it's you know, kind of uh helping to deflect any liability for you didn't give it to me and my progesterone dropped, and and this was not a successful transfer. Yeah.

SPEAKER_00 28:42

So I would argue it can probably be used a little bit more other situations.

SPEAKER_01 28:46

Yeah, I you're you're required. I mean, I I will often, you know, just again, and I will use serum because I I can't prescribe progesterone, so I'll use serum and then say, take this to your your doc with the with the Mira test. So you can see that yes, they both are showing that progesterone was fine at seven days post and then it fell off. And again, it's progesterone is such a a, in my opinion, a benign um prescription. We clear it if we know if if if it's not a successful you know pregnancy cycle, if that's the goal, we clear it in no time. It's we don't have to worry about this, you know, hormone, right, and and and long-term impacts.

SPEAKER_00 29:27

I've also I just want to touch quickly, you said like it'd be a good solution, or I use the word bridge. I've heard some providers describe it as a good snowball. Like you're when you give that progesterone, you're training the body what to do. And sometimes it doesn't have to be long-term, but we're we're um building up better cycles for the future by having those good progesterone levels. So while you do the root cause, uh I'll call it kind of like a cheat card, you're fixing the root cause, but you're also doing the bridge at the same time so that you build up that good snowball ready to do its own thing when you maybe stop the progesterone.

SPEAKER_01 30:01

I love that. I love that image. Yeah. So I'm I'm go it. I might be jumping the gun here, but but with cortisol, even though it's not you know, the test isn't there. Talk to us about, you know, why or why is it there, considering adding cortisol by the end of the year or next year to their to their uh hormone picture?

SPEAKER_00 30:23

Yeah, so we've looked at what are things that we can track in an at-home setting that would really make a difference for people. And you know, there's a lot of things you could test, but what things change rapidly? Um, so you know, we've talked about, well, what about thyroid? Because thyroid is something that impacts. What about you know, some of these other also hormones? Um, but what are things that if we track it more closely, could we really make a difference? So if you think about like a continuous glaucoma that really trains someone on, you know, if I do this, then it affects my blood sugar in a positive or negative way. Same with your hormones. You really can you can make action on them. And so cortisol is another one. I like to explain um the hormones as, you know, like a group of friends, and there's there's kind of the the bullies of the group, you know, they have a good role, um, but cortisol and insulin can be a little bit of the bullies in the group where if they get their way, they really can throw off, you know, I'll say the friend group, make it break up and make the cycle not go well. And so we really need cortisol and insulin to be in check and doing the correct thing at the correct time. Like a lot of people always label cortisol as bad. And I'm like, no, it has a really good role. We really need cortisol.

SPEAKER_01 31:33

Yes, but we really do cortisol and sustained elevated cortisol is what is air quotes bad. But without cortisol, we would die.

SPEAKER_00 31:41

Yeah, we kind of need that. So I always like to say that, you know, melatonin and cortisol do a little dance every day. And what a lot of people don't realize is you should have a nice buildup of cortisol in the morning. And you know, that's telemelatone, and your turn is over, and now it's cortisol's turn. Um, but it's when there's that um excessive or wrong balance, wrong timing of cortisol, then that really can cause problems. And so um, again, cortisol is an important thing to track because it can help you to make important changes in your current life that can set you up for more success. We really are moving into that uh again, wellness space where if we knew things about our body, we would make different choices and and and decisions.

SPEAKER_01 32:23

So if I may add, the that that sort of constant excess elevated cortisol has then the effect of influencing negatively insulin, which then has the effect of domino of the down of inf in infiltrating downstream hormone, you know, like symphony as as or the song, as you say. And and you know, it's it in in the infl insulin is an inf can be an inflammatory marker over time. We talk about insulin resistance as you know, the prediabetic condition, which is oftentimes happening to women who are in this perimenopausal time frame. They're kind of like, how did this happen? But if you could test it, if you could see it, then you could probably anticipate like, oh, that's how it's happening. It is that glass of wine with dinner, or it is that, you know, whatever, whatever else, you know, my my choice to, you know, kind of get up and do high-intensity interval training at 5 a.m. or, you know, while it's still dark o'clock, you know, these these lifestyle things uh things that are that are adversely affecting can be can be shifted. And then, as you say, continuing the testing, you see the the beneficial changes. Yeah, that's excellent. So is there anything about for the this you know, pre-perimenopausal perimenopausal person? And again, I we talked off off camera a little bit about, you know, there might be part of the viewing audience who wants to stick their fingers in their ears and say, la la la la, don't say that nasty word to me. And yet it is not a nasty word. It is a life, it is a life event that if we uh get to live long enough, we we get to experience it. And if we get to anticipate it and do the right things, we get to experience it without the ill effects. So is there anything else that that we haven't touched upon that you want to say, oh yes, and this?

SPEAKER_00 34:11

Yeah, I would say we kind of touched on it already, but you can start seeing some of those subtle changes, and that feeds in what you were just talking about is maybe you can't get away with some of those things you did when you were younger, like you know, working an 80-hour work week and then trying to travel and then plan something big, and your body's like, no, that's not going to work for me anymore. Yep. And so, you know, the our body always wants to have an optimal cycle that really that is obligatory, that's its goal, but it will not if it doesn't have what it needs. And so what it needs can get a little steeper as we age, like it's um, I don't want to say it's demands, but it won't settle anymore. Whereas when we were 20, the compensation mechanisms have been used up. We we've used that trust fund. Yep, too long uh for some of us. And so now it really is our hormones that are telling us like you might want to reconsider some of your life choices. And instead of seeing that as like a negative, I would say instead we need to really retrain ourselves to say, this is a feedback to myself. My body's telling me something that I should listen to instead of just continuing to ignore and suppress it and you know, the the things that we've done for many of us for too long.

SPEAKER_01 35:27

Yeah, yeah, yeah. Because, you know, that continuing to ignore and suppress and you know run on our adrenals and things like that will have a an a real serious outcome further down the road. And our and our and our sort of our estrogen, as we know, is important far beyond baby making years. You know, our ovaries are important far beyond baby making years. They are communicating with nearly every organ in our body and providing important nutrition, if you will, for our brain and our bone and our gut health and our immunity. So being able to get this feedback, it's almost like a report card, right? You know, like if you like a mid-year report card. If you're kind of, you know, if you're kind of slipping, you know, you kind of want that mid-year so you can do some correction and and then see that, oh yeah, we got this.

SPEAKER_00 36:16

Yeah, and I would say um we touched on this earlier, but I forgot to bring it up that FSH is tended to be looked at as like a a screening. If it's fine, you're like, great, you check the box and you kind of moving on. But something that I wanted to address was the research that's showing that high FSH has a negative outcome on things that matter to us outside of fertility. And that is we see, and this is independent of estradiol, meaning that this is its own risk factor. So high FSH carries risk with bone turnover. So we think like fracture risk and losing our bone density. Interesting. We think about neurological and cardiovascular, those things matter to all of us.

SPEAKER_01 36:59

Absolutely.

SPEAKER_00 37:01

And so we we really have to change our mindset around FSH as just uh looking at from a fertility standpoint, like it's okay, and then you move on. Instead, FSH really is a window into the different risk that you might have when you enter those older ages that again, like a blood pressure that is really telling us, like, or maybe I should use cholesterol or other measurements that we know are you know a kind of a risk to us. Um, your FSH can be too. So this the research is there, we need more, but um again, independent of estradiol, high FSH has negative risk.

SPEAKER_01 37:40

That is fascinating to me that it's independent of estradiols. I mean, because I always think of them as sort of you know twins. Yeah, yeah, because one is kind of triggering or you know, or or evoking the other to be at its you know optimal levels. But I think that that's really something that I really want listeners and viewers to like just take take take in, take to heart and share that FSH as an individual marker is indicative of your longevity and your health.

SPEAKER_00 38:10

Yes. And we know again, more research is needed, but there's different trajectories of FSH. So there's the women who um have like rapid rise, and that's potentially um damaging. And we know that a sustained high is also potentially not good. And so um everyone's FSH may be different. So although a lot of people think, well, I'll, you know, I'll use my symptoms. If I don't have symptoms, then I must be doing kind of okay. And and really we're starting to see that we can't not test. Yeah. Because even if, you know, I know patients who are out there who for various reasons are not going to do, let's say, hormone therapy, um, but they then know their risk. So when more research comes out, they can see, oh, this is putting me maybe in this higher uh risk bracket that might make me consider other things to maybe balance that out or try to to um and negate that risk.

SPEAKER_01 39:10

Yeah, I think that's brilliant. Yeah. All right. So I'm going to have in the show notes for people to be able to, you know, access mirror care. And is are they able to access uh support at, you know, um, you know, if they have questions, um, will will I be able to do they just go to the mirror care, you know, main site and look for um the drop-down menu that says, you know, if you got a question or a chat.

SPEAKER_00 39:35

Yeah, you can go to it's mirrorcare.com. That's our um patient-facing website. If you're a provider in the room, um you have a different website and different resources, as me and my clinical team do. But as a direct to consumer, as a patient, go to mirrorcare.com. You can read about what our product is, read the research, choose what product you want to buy. And sometimes people get overwhelmed by the options. Yes. I'll simplify it for you.

SPEAKER_01 40:00

Yes, please.

SPEAKER_00 40:01

It's one device, and then there's different ones, and depends on what country you live in. Sometimes you see different things, but really it's um we have earlier developed wands that test less, and then we have our newest developed ones, which tests all four. So for almost all situations, it's the ultra four one that tests all four things. So um again, really it's um a minimal cost increase from our earlier developed wand to our newer one to give you that FSH each day.

SPEAKER_01 40:29

Yeah, I think that's really smart. And and yeah, I'm gonna I'm gonna hop on the on the uh the the train that recommends testing all four so that you're really then you're not left qu wondering, you know, if there is something you know wonky in a in uh a cycles testing and you've missed one variable that could have answered the question. Well, then that was you know that cost of not adding all four is higher than the cost of adding all four. Yeah, yeah. So well, Rose, thank you so much. Again, I always get smarter when I talk with you and viewers, listeners, I'm sure that you feel the same way. Thank you for your time. Please share this with friends or loved ones. You know, again, we've talked in the fertility field that it's one in six, but you know, it's it's every person with O freeze who will go through perimenopause and is uh it and is a good candidate to start now getting a baseline kit and then seeing what you know where do you want to go from there and working with your provider, or if you don't have a provider nearby, thankfully Meritcare has its own, you know, patient-facing website that you can just get your needs met. And then and then maybe you take that information with you too. Yeah. I mean, that happens a lot for me. I've shared with you that that walk in my door already having done, you know, you know, a month or several months, and and frankly, they're doing me a real favor because then I can give them a much better, you know, sort of diagnosis and treatment plan if I've got all that data to to work with.

SPEAKER_00 41:58

It's something that a user can do for themselves already. Like, yeah, that's why we're so passionate about this, is women deserve to know what their hormones are doing.

SPEAKER_01 42:08

Absolutely. Absolutely at every phase of their life. So thank you once again for your time. I know it's precious, I know it's valuable, and I'm really grateful that you're always willing to share your expertise with us. And I'm looking forward to December, January when the when the when the yet even more new and improved test comes out and we can test cortisol as well. So, viewers, listeners, thank you for your time. Uh there'll be show notes that you can review. There'll be links within the show notes to get to Miri and uh get your needs met. And I think there's a discount coupon that we'll be offering there as well. So until next time, we always close our health university classes with the phrase class dismissed.