The Air We Breathe: Finding Well-Being That Works for You
The Air We Breathe: Finding Well-Being that Works for You is a podcast created to help you establish a trusted foundation of doable healthy habits and smart self-care skills that can endure every season and last you a lifetime. I'm your host, Heather Sayers Lehman, and my guests and I will share ways that you can focus on your physical and mental health with purpose, flexibility, and ease. The Air We Breathe is here to help you find out what’s most doable, frictionless, and effective for you and release everything that’s not. Find more information at HeatherSayersLehman.com or @HeatherSayersLehman on IG.
The Air We Breathe: Finding Well-Being That Works for You
E57. Menopause, Hormones, and Mental Health: Oh My! with Menopause Specialist Dr. Leigh Lewis
Did you get the instruction manual for menopause? 📕 ME NEITHER!
I’ve got a great episode wit some direction and clarity to guide you through.
Today on the pod, I have Dr. Leigh Lewis, a certified menopause practitioner credentialed through the North American Menopause Society and a naturopath.
We discuss what perimenopause and menopause look like today and Dr. Lewis’ approach to helping her patients have a better understanding of menopause.
We explore what to look out for when it comes to misinformation and menopause, turning to sources and people who have extra certifications and training specifically in menopause.
This conversation around misinformation leads us to discuss weight and menopause and how closely they are tied together (because people love to profit from weight loss).
In the end, we talk through how mental health will come into play with menopause, mainly if the person has dealt with mental health during puberty, PMS, and childbirth.
Dr. Lewis also recommends a few resources that can help people through mental health struggles during menopause.
I hope you find this episode with Dr. Leigh Lewis as informative as I did!
Even if you are not currently experiencing the effects of perimenopause or menopause or never will, you’ll be in the know and can be a support system for others.
Resources:
Massachusetts Center for Women’s Health weekly newsletter
International Association for Premenstrual Disorders
Instagram: @dr_leigh_lewis
…..
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It's not how high or low your estrogen progesterone is. It is the fluctuations that are happening, and we know that these hormones fluctuate naturally during our menstrual cycle and in pregnancy and postpartum, and then again in perimenopause that fluctuation becomes pure chaos. So it's kind of like this perpetuation becomes pure chaos. So it's kind of like this. And so some women are just exquisitely sensitive to those changes from high to low and that can really set women up for having anxiety and depression, in particular sleep problems. I kind of lump together with mental health issues as well.
Speaker 2:Hi and welcome to the Air we Breathe finding well-being that works for you. I'm your host, heather Sayers-Layman. I'm a National Board Certified Health and Wellness Coach, certified Intuitive Eating Counselor and Certified Personal Trainer. I help you get organized and consistent with healthy habits, without rules, obsession or exhaustion. This podcast may contain talk about eating disorders and disordered eating. There could also be some adult language here. Choose wisely if those are problematic for you. Hi everyone and welcome to this episode of the Air we Breathe.
Speaker 2:Today I'm talking to Dr Lee Lewis. She is a certified menopause practitioner, as credentialed by the North American Menopause Society, as well as a naturopath. We talk a lot about perimenopause and menopause today. Don't run away if it's not happening to you, because if you are administrating female, it will, and it's good to know this information so that you don't suffer, because that happens a lot. This stuff shouldn't be a surprise. It's all how it is.
Speaker 2:Anyway, we go over like flags for anti-science content because I think it's so hard to tell who's the real deal and who is just selling you some garbage. So we dive into that. We talk about weight and menopause. I think this is always a big topic and not a lot of clarity around it, so I wanted to cover that with her. We do discuss some mental health with times that our hormones are changing Perimenopause, puberty, childbirth and I really wanted to get into some facts about our mental health during these times. I feel like many times we can get dismissed or not believe ourselves, and it was good to really chat with her through that and also the last part about believing women and how treatment for menopause can absolutely be symptoms-based. So just imagine a world where you tell someone here's what I'm going through, they believe you and they free you for it. What? All right, I hope you enjoy this episode as much as I enjoyed recording it. All right, well, I'm very happy to be here with you, dr Lewis. So why don't you go ahead and introduce yourself?
Speaker 1:Sure, my name is Dr Leigh Lewis. I'm a naturopathic physician and I work here in Phoenix, Arizona, but I provide telemedicine all around Arizona and even to some other states as well. My specialty is perimenopause and menopausal hormone therapy Mainly. I also do a lot of the lifestyle work around menopause as well, and that's my first love.
Speaker 2:What is it that attracted you to menopause?
Speaker 1:That's a great question. I was. I went and this, I think, speaks to a lot of what I really like about working with menopause and with women and hormones is I actually started as a psychiatric case manager right out of college and I really always saw the value in psychiatric medications and a lot of people think that's very strange that I then went on to become a naturopathic physician. That is a long story, but I never really liked the fact that in medicine we especially in this country, we really do separate out mental health and physical health and I think when you're working with women around hormones you have to really focus on both or you're only going to get so much benefit from the treatment that you're working with.
Speaker 1:So I, luckily enough, had this great mentor the first year of school. They always matched us up with a mentor and that mentor went on to do this two-year integrative medicine residency that had one spot integrative women's health residency, sorry and I applied for that and was able to get that. And so when I graduated I moved from Seattle to Portland to do that two-year postgraduate training in integrative women's health and I from there just had so much experience to setting with setting up my all my observations with medical doctors, and so I really got to learn a lot of the conventional side and what the conventional doctors were offering. But I worked with hormone specialists and menopause specialists and reproductive endocrinologists and OBGYNs and general endocrinologists and I really got a great background, I think, in hormones and how it can really impact, or how they can really impact, women throughout their reproductive lifespan, and so that's always been my interest.
Speaker 2:Oh, that is very interesting. I always think it's kind of interesting how, you know, we weave through and do a lot of different things and then all these different places that we land. And I should also say that you are my doctor, and which I think now since probably 2000. So you've been escorting me through the menopausal process and which has been really helpful because I watch a lot of the other content flying around and which I specifically picked you because of your content, because here's a citation and or like here's a public med id, like okay, so I could actually go look at this and it is real.
Speaker 2:Um, because I think that kind of like there's, you know, two issues, I think, because I have worked, uh, or I worked, with a nature path before you and she was very disordered and, I would say, not really following the evidence. So I was delighted to find you. And also you're so vocal on Instagram and sharing evidence, which I think is really important to see and like for you in the field, like are there certain red flags that you think are really important for people to look? Because almost everybody now has at least a website, but usually a social media presence. Like what do you think people absolutely need to look for to be like ooh, this is a no.
Speaker 1:That's a great question. I think that it is really important for people to truly investigate. Like you said, there's a lot of information out there and websites are a great way to get a little bit more information than the pictures and the snapshots that you might see on social media. And I know I for one have done a lot to really make my website. You know I don't want to see people who were not going to be a good fit, so I try to put it all out there that I really do follow the evidence and I have had this special training.
Speaker 1:I am certified by the Menopause Society and I am a naturopathic physician. I lay that all out. I think one of the big red flags that I see on social media is that people will say that they're menopause specialists and they have no extra training. I mean, I actually I think as a naturopathic physician, I had a lot of training in hormones, I think, and especially then with the postgraduate training. But the research changes so much and you know I did when I first got out of residency. I did focus on perimenopause and menopause as part of again that physical and mental health across the reproductive lifespan, but just this year I've decided to focus solely on perimenopause and menopause, because there's so many people out there who need this help and it is more fulfilling to me as a physician. I really like to educate people and so I see my website is doing that. I, you know, really try to put the information out there so that you know if someone is looking for just something different than what I offer. I want them to be able to know that maybe I'm not the right person for them. So I don't want to waste anyone's time or money by, you know, having an hour long appointment and then just realizing that the treatment plan I'm offering is not okay. So I think people can really look for that.
Speaker 1:I think also for red flags is you'll see like and again, we all have our different places in medicine, but you'll see chiropractors and physical therapists and maybe even some people who did like a nutrition session. You know calling themselves like menopause specialists. In this specific area, pretty much it's standard practice in medicine. You really don't call yourself a specialist unless you've had extra training and certification in that. And if there is certification available, then why isn't that person, you know, taking the time and putting in the effort and the money to go ahead and get that certification to set themselves apart, because it does mean something. I at least I think so, and so you know that to me is a big red flag as well If you are looking at someone's website and they say they treat cancer and they treat autoimmune conditions and they treat thyroid problems and they, you know blah, blah, gastrointestinal specialist and all this stuff.
Speaker 1:You know it's kind of like that saying you know, master, oh my gosh, now I'm going to forget the saying, but you can't do it all. Unfortunately, you just can't. I mean, I would say too that if you look at my website, in the resources on the menopause page I have I've been listing all of the really recent research that has come out about menopause and you'll see, in April and May there were 10 kind of groundbreaking menopause research articles that came out that you just can't possibly keep up on that type of frequency of research unless you truly are specializing in it, and I think there's probably a big financial interest in not necessarily keeping up, because I'm assuming a lot of people that are not as evidence-based have a program or a protocol and so they're gonna recommend this thing and it doesn't behoove them to come up with any or, you know, to read any information.
Speaker 2:that's like, oh, you know what, now we found out we're doing it a little bit differently. So I could see, um, cause I do see a lot of like fixed programs and here's the thing, or here's the way to eat, which, you know, I definitely see the way to eat always like is so glaring to me with menopause. It just seems like one of those kind of vulnerability, like profiting just off of somebody's vulnerability, I guess.
Speaker 1:Profiting just off of somebody's vulnerability. I guess, yeah, that's something very specifically that I do end up posting a lot on, because I you know, and I don't really want to use the word malpractice, but I do think that some people put them out there themselves, out there as specialists, they it's very difficult to find their degrees If you look, you know, even sometimes on the websites you have to go. Sometimes they don't even ever say, and they call themselves a doctor. Well, sure, a chiropractor is a doctor, but the breadth of treatment you can get from a chiropractor for menopause is very different than what you're going to get from someone who's actually a prescriber.
Speaker 1:And sure, not everyone wants to do hormones, but the evidence base says that menopausal hormone therapy is number one for treating the symptoms of menopause. So sure, you know, if you see a registered dietician and they suggest not over consuming sugar or, you know, cut back on the alcohol quite a bit to really improve your sleep and your hot flashes, that's great, like that is evidence based and that makes a lot of sense. But if you're going to see a, you know, there's one particular chiropractor out there who calls herself a menopause specialist, who advocates fasting, and I'll tell you that if you again look at the statistics, we see a bump in the number of disordered eating issues in teens and young 20s and we see another one in the 40s and 50s. So I really it gets my hackles up when I see people selling these programs which basically advocate for very restrictive diets and starving yourself to. You know, try to get into your genes from eighth grade.
Speaker 2:Yeah, I totally know exactly who you're talking about and I definitely, because I will follow people who debunk, which is my favorite thing, and I see her videos so often and I'm I just I'm also so surprised because I'm like this, like this is the one that you're like yes, she sounds great, because also anybody that's like the longer you can go without food, the better. Like Like really, and in what?
Speaker 1:way is that better? Well, and what you brought up about the programs is they get you at the front end. One of my patients shared with me about this physical or personal trainer who was selling this program, which is similarly priced to the chiropractor it's about $1,500. They get that money up front and what she showed me that she got for that and she got all the way into this without realizing that it would not also include recommendations or prescriptions for hormones, which you know I had someone on threads comment like oh well, buyer, beware, she should have looked harder. But I'll tell you, I looked all through that information and I couldn't find anywhere about her education and OK, yeah, that's a red flag.
Speaker 1:But I do think that people go into these, you know, looking for assistance because they're struggling and they're suffering and they see someone who looks like they really care, they look like they have the answer, and then they get your $1,500 up front and you basically get what is a very general meal plan that, literally, the patient probably could have written herself just by. You know, following a Mediterranean food pyramid and doing all the things we know we should do Increase fiber, decrease alcohol, you know, try as much as possible to eat a whole foods diet.
Speaker 2:Well, I'm glad you brought up the bump in eating disorders during menopause, because I absolutely, you know, obviously I'm in eating disorder recovery myself and I see you know exactly how that happens, because bodies change and the very common narrative is like not if you work hard enough, it won't change. And what like conversations do you end up having around body changes and menopause? Because there absolutely are people you know that I can distinctly think of who say like you shouldn't be, that means that you're doing something wrong. You're just eating too much is basically what they say.
Speaker 1:Yeah, there's that. And then there's also the people who promise that their hormone program will help you lose weight. And there's a couple things that the research does tell us about midlife body composition changes is that with the loss of estrogen, your body does try to kind of help you out by adding adipose tissue in the trunk and the mid section, hips, butts, thighs, abdomen and sometimes even the back and the chest area. That adipose tissue and this is new since I graduated, again, why you have to keep up with the research that adipose tissue actually acts as an endocrine organ and produces estrogen. And so you know we are a species that you know would go way back evolutionarily. We are set up to reproduce, you know, as far as long as we can, and so when those estrogen levels start to drop off, our body tries to, you know, maybe eke out, you know, a couple more ovulatory cycles by getting that estrogen level up with this extra fat tissue, and with that can sometimes come extra weight. And we do see that happening in the research, even though, again, there are some people who look at the research and say there's no increased weight gain associated with menopause. You know, maybe in some scientific studies where you're looking for statistical significance, you're not going to find that most people do, but I definitely see people who they're like you know. Two years ago I started to, you know, I couldn't fit in my pants anymore, and then one year ago my menstrual cycle started changing and that's like okay, well, that sounds like perimenopause to me. So, you know, sometimes you do have to put that together. The good news is is that sometimes you know the weight change that is typically. I do see people outside of this or people who don't gain weight at all, but it's typically about five to 10 pounds and it, you know again, it is in that midsection.
Speaker 1:The good news is is that if you decide to use hormones like estrogen, that if you give estrogen from the outside, sometimes it's a signal to your body like you don't need to help me anymore. I can, you know, handle giving you some estrogen through this patch from the outside, and so then your body gets that signal and due to the you know, good nutrition you have and the activity that you had prior to perimenopause, you oftentimes can get back to that, but not all 100%. And then you have to think also of the other symptoms that go along with menopause, that do have to do with the hormones, but they don't seem specifically hormonally related. When you lose estrogen and testosterone in particular, you can be really tired and unmotivated and kind of like meh about everything. Like you used to maybe be really motivated to wake up and go to that 5.30 exercise class and now you are waking up at 3 am and not getting back to sleep and you don't feel like getting up and going to that exercise program and so and then poor sleep.
Speaker 1:We know that poor sleep can really impact your weight and body composition again. The mood changes that can happen with anxiety and depression. Sometimes it gets you just don't really feel like you know working out because you're depressed and you know that is one of the symptoms is of depression, is feeling like you. You know, maybe let some of your self-care things go because of that symptom. So there are ways that the hormones can impact weight through these other channels that might not be very evident at first.
Speaker 2:And that's I definitely that's where I see a lot of predatory pieces whether it is, you know, hormones, pellets or a diet to be able to kind of like get back and I think that's one thing like when I discuss with my clients it just might not be a get back that your body has changed and you know what would that look like if we were more accepting of that and trying to find some peace around. Like my body changed at puberty, my body changed after having kids. My body's changing now, Because I think that is certainly a narrative that isn't supported in a lot of places.
Speaker 1:Yeah, another post that I did was from a patient who ended up spending. Well, she spent $400 for the initial appointment and then she was offered testosterone injections for $100 a week. And when she told me the name of the clinic, I won't say the whole thing, but basically ageless was in the title Hormones and perimenopausal health postmenopausal health. It has nothing to do with agelessness.
Speaker 1:We are not vampires Like we are not ageless, like aging is going to happen and if we look at perimenopause as a time to reset our focus on the healthiest we can be at our given age, that is where the importance come from, and I know, heather, that you are really an advocate, too, for health at every size. I like, maybe put a little spin on that health at every age, like we're not going to have the skin that we did at 20. I'm sorry, and I know that a lot of people, if you're listening here and you live in Scottsdale, you see all the plastics that people do to their face. They don't look like they're 20. They look like they're 70 with a lot of plastics. You know so it's. You know, maybe that is what you want to look like, that you know.
Speaker 1:Again, not body shaming people, but if we're going to be the healthiest psychologically and physically that we can, it is not by trying to be ageless or having these, you know, ideal body weight or ideal figures. That you know. We don't even know what these people on Instagram are doing to look like that. I can tell you that I hear a lot of people. You know, after their last kid they're getting their breasts lifted and they're getting, you know mommy makeovers and having liposuction and tummy tucks and things like that, and they're not talking about that on Instagram, right? So you know everything with a grain of salt. But there are predatory clinics out there that are promising hormones to you know cause weight loss. It's not how it works, unfortunately cause weight loss.
Speaker 2:It's not how it works, unfortunately. Do you feel like the do-it-yourself approach to improving your healthy habits does nothing except feel overwhelming, guilt-inducing and defeating? You don't need more rules, influencers or structured programs. Let me help you discover what you want, what works for you and how to maintain healthy habits during the ever-changing circumstances of your life. If you're ready to create systems that stick head to heathersayerslaymancom backslash health dash coaching and click, let's do it it.
Speaker 2:I think it's such an opportunity to like redefine health. I mean, health means something different to everyone and it should. But it seems like um, taking the lens off of weight gives you an opportunity to say like okay, so what? What do I want health to look like? Because, um and I certainly run across, like so many women that are like I'm done with this, I don't want to count anything anymore, like I'm sick of, like never eating this food or never eating this food, and they're just trying to find some kind of comfort and balance. And I think you know my focus is also that we don't have to overdo. I mean, I talk all the time about healthy habits without obsession and exhaustion, but we are able to still pursue health, but then we also get to kind of decide what flavor that will be, especially if you've been pursuing weight loss for a really long time, because I assume you see a lot of people that really have that focus and like, how do you help them kind of widen their viewpoint of what health means?
Speaker 1:Well, I really do, and it might sound a little cold but I really do lean in Facts are facts right? So you know, I did just do a presentation for a community group about metabolism and menopause and say, for example, with the push for semaglutide injections and a lot of people come to me wanting that but don't meet the criteria, and what I will share with them are some of the facts about the research that's out there that don't necessarily get shared. For example, the research that has been done on semaglutide for weight loss and for improvement and reversal of diabetes and that such thing. First off, the people who are in those studies, their BMI which I know BMI is imperfect, but the BMIs where people have to meet these criteria to even get in the studies, they're 47 to 52 BMI, and I'm not saying I don't see people of that size, but the majority of women that I see actually have a normal BMI. And again, they're just looking at that weight distribution that has changed because of the hormonal changes. So that's one thing. So when you look at 15 to 20% weight loss, that's not in someone with a BMI of 27. That's in someone with a BMI of 50. So that looks very different.
Speaker 1:And so when you look at it, like that person might be losing 50 pounds in the study, but our you know kind of typical gal who might have a BMI of 27 or 28, she might lose like 7 to 10 pounds, spending $1,000 a month to get that Ozempic injection. And you know, for some people 7 to 10 pounds really, you know, does mean a lot to them with their scale, but it doesn't change health. And again, looking at the people who are really who Ozempic is made for and Wagobe is made for, those are people who are going to be on lifelong medications anyway because of their blood sugar and diabetes issues. They were also probably looking at bariatric surgery or already had bariatric surgery, so that's in addition to those medications. So that, I think, is, you know, part of that that comes out when I talked to that community group again, this is just the people who happen to be, who happened to show up for it but they were like, you know, when I kind of when I asked like, well, seven to 10 pounds, is that worth $1,000 a month?
Speaker 1:And then, when you stop it, to have two thirds of the weight gained back within six months, no, they were like that. No, that's not worth it. But you don't see that from Red Mountain or these clinics that are pumping out, you know, the compounded semaglutide for a very large price margin for themselves large price margin for themselves.
Speaker 2:Yeah, that is really interesting because it also to me, because I've certainly heard a lot of conversations of I'm going to do this for three months, because I think also those clinics are packaging things of like, yeah, you come in, you'll do it three months or six months or whatever, and then, as long as you've got your healthy habits in place, like, you'll be fine, which is wildly interesting to even say, because if you go off of the medication and you're hungrier, like you can have all of the healthy habits you want, but at some point your body is speaking and you're going to have to listen, like I always just think that is such a.
Speaker 2:I mean, I just think it just sounds so weird that like, oh, okay, I've got my healthy habits in place, because also in pursuing health for the better part of my adulthood, that changes constantly because like, oh, now I hurt my back, so I guess I can't, you know, really work out and do this. Or, um, you know, affordability of food, like all of these different things. So I think it's just the weirdest thing to be like, yeah, this is, you know, in the short term, like this will help and it just it has that same quick fix mentality that you know. You and I've heard a bazillion different things that are going to help. It's just a short term thing and then you're going to be good to go.
Speaker 1:Which, if you look at and you probably have heard of this term, you know with the research you've done on disordered eating there is a process called metabolic adaptation or compensation, where, if you are so, say, for people who are, you know, kind of over exercising, doing more than they need for health or strength or balance like the things that we really need going into our 50s and 60s so that we don't fall and break a hip they, they will just like, naturally crave more calories because your body, if you're working out that much and you're literally starving yourself. So some of these weight loss clinics like to do it used to be very fashionable and I just saw someone come in who was doing it with the HCG, the HCG diet or the human growth hormone diet. The same thing. Give these injections of this medication or substance I guess you might call it, and they limit you to a 500 calorie a day diet. Sure, you're going to lose weight for doing that. For again, like you said, these are always time limited for a month, six weeks, 90 days but then they push you out the door and they don't expect to see you. But when you leave, you're not getting that injection but you're also eating more than 500 calories a day. They also don't let you exercise.
Speaker 1:So, again, your body kind of, you know, if you're starving it, it actually does have a mechanism whereby it will hold on to body weight. It'll hold on to fat in particular, and let muscle go because it's worried that you're not going to feed it. Again, you know our bodies are set up for like the cold, dark, winter or, you know, the harvest failing or something like that. And so if we're not consuming enough calories, that can actually backfire on you to also not lose weight. And so we see that again with over exercisers or people, or even people who are exercising, say, for a half marathon or a marathon. That's your goal, or something like that.
Speaker 1:Again, if you're not consuming enough calories to support that, you'll see people who are running a lot or cycling a lot, stuff like that. They'll gain weight when they're doing that because they're not eating enough. And your body just is holding on for dear life, just in case you get sick or in case you can't find food. Well, we don't have a problem with that in this society, but we do still have that evolutionary mechanism, is still holding on and can sometimes again in some people. We're not all the same, but in some people, when you really restrict your calories down, you might not see it the first week, you might not see it the sixth week, but you will see it, this rebound of weight gain, even if you're you know I talk to people all the time they say they barely eat and they don't lose weight. That's, your body is not going to let those calories go.
Speaker 2:That's always really interesting because I think there is like a prize or trophy, like all kinds of things out there of like you know, I'm eating the least amount possible and it's like it's. It's not the flex that you think it is, because your body is not a big fan of this.
Speaker 1:Yeah, yeah, and of course it can't. It can't, then it loses then the nutrients that are the building blocks for neurotransmitters, the building blocks to make energy or ATP in our body. Our brain is fat like. We need those fatty acids to do that. And then, like I alluded to just generally, is the muscle loss that goes along with that.
Speaker 1:Well, perimenopausal women, who oftentimes are, you know, have undetectable testosterone levels, are already losing muscle. So then you add that onto it and that actually can really turn around and bite you, because the less muscle you have, kind of like the less your basal metabolic rate is, or just the less calories you burn throughout the day. So you know you're, you're doing these things at the expense of very important parts of your body that, like, again, we need our muscles there so that we don't trip, fall and become weak and break a hip. So you know, again, we just we do that to our detriment. It might not be in the short term, but down like future, you will be annoyed that you really limited your calories and maybe you even have brittle bones because you weren't eating enough calories. You know, even despite the lack of estrogen that we have to deal with, that also can cause bone loss in the 50s. So a lot of these things can compound on each other.
Speaker 2:We want to switch gears a little bit into mental health, because you mentioned this before we got started about some research that's coming out, or recently came out, about mental health and perimenopause. Can you talk a little bit about that?
Speaker 1:Yeah, there is. First off, I would like to say, a resource that I think is really great for anyone who is a provider or also anyone who's just interested in mental health and women's health, is the Massachusetts General Hospital has a Center for Women's Health and they put out a weekly email that shares a lot of the research that has come out, regardless of which stage of life you're in. It could be for PMS or perimenstrual mood disorders or perinatal mood disorders or perimenopause, and they write their abstracts of the study in a way that anyone can understand. So that's very nice. You can kind of keep up with women's health, mental health research, in that way as well. But what we really see and this is again something that I don't think is oftentimes understood is that if you've had mental health issues or psychological symptoms at puberty, with PMS, with perinatal mental health issues, all of these things can predict kind of the next stage of having mental health issues. So we know that women who have mental health issues at any time of her life prior could potentially, or is at an increased risk for perimenopausal mental health issues. The second thing that we really know is it's not how high or low your estrogen progesterone is. It is the fluctuations that are happening, and we know that these hormones fluctuate naturally during our menstrual cycle and in pregnancy and postpartum, and then again in perimenopause that fluctuation becomes pure chaos. So it's kind of like this, and so some women are just exquisitely sensitive to those changes from high to low, and that can really set women up for having anxiety and depression, in particular sleep problems.
Speaker 1:I kind of lump together with mental health issues as well and so with a lot of these again, if we can kind of reflect back to people who are promising these programs or you know, menopausal hormone fix, quick fixes and stuff like that, they'll oftentimes sell these hormone tests, and hormone tests are not helpful for any of these mental health issues in perimenopause or even earlier on, because what they do is they take a snapshot of how you looked on a specific day, whether it's through blood or urine or saliva. It is not helpful because what would happen is you could look perfectly normal during that time where they checked your hormones, but you could still be reeling from the mental health symptoms that go along with just the changeability of the hormones during this phase. And if they were to check your hormones six weeks later which I don't recommend because we'd have to be at a specific time. Six weeks later it could look totally flip-flopped and it would show that your hormones are in the toilet. That is just the reality of what happens during perimenopause.
Speaker 1:So you can work with these providers who might sell these Dutch tests or saliva that's dried urine.
Speaker 1:Hormone tests is what Dutch stands for and then the saliva tests for, you know, $200, $400, $600, and they're not going to tell you anything, they're not going to inform the provider how they should treat you either. Like I said, if we, a lot of the treatment that I do is based on retrospective symptoms. So if someone tells me you know, a year ago they started having problems sleeping, they got really irritable with their partner and their kids, or they just don't feel like themselves anymore and you know their period has changed a bit, it doesn't have to completely stop for it to be a perimenopausal or menopausal hormone issue, but just the changeability maybe it's gotten lighter, maybe the cycles have gotten longer, like that basically closes the case and we know that this is perimenopausal psychological symptoms, even, you know, in a woman who's still having her period, even in a woman who's not having hot flashes like you do not need to have those things and, like I said, despite normal hormones, we can still use hormones to treat these symptoms.
Speaker 2:That's a huge piece of what I have found so comforting about your approach, because you know it's also dealing with the.
Speaker 2:You know entire other side of you, know my thyroid and things like that with other doctors, because your whole approach is tell me how you feel and then I'm going to believe you and then we'll actually create a treatment plan based on what you just said, which in the other side of medicine that I deal with luckily I have a good endocrinologist now like that doesn't exist.
Speaker 2:They're like well, you know, and it gets dismissed. But I think that it also feels like it really makes sense because, like you can't measure, like I remember having that irritability piece and I remember being like like this is, um, this is not rational for what is happening. I could, I could totally like see like well, this, you are more upset than what is being called for. Um, and like there there isn't a test, like, like should I have to go to my doctor and say like, so he said this and I got this mad. Like oh, sounds normal to me, but you know the fact that you're like oh, okay, well, you're saying that you feel irritable, let's treat that like shouldn't be groundbreaking, but it kind of is.
Speaker 1:Well, and you know, another resource that I really like is the International Association of Perimenstrual Disorders. That's a kind of a mouthful but it's IAPMDorg Very easy, and they have some great trackers on there and I'll oftentimes ask women who are in their 30s or 40s to use those if they're still menstruating, because the mental health symptoms they might not be always just pre-menstrual, they could also be periovulation or maybe even when your period it stops and maybe those are only the good days that you have. But we can kind of track that the hormones are changing again in the buildup to ovulation. So you'll meet women in perimenopause which PMS can worsen and get longer for people who had PMS previously, to the point where they have one good week a month and that too, as they track that out, it can tell me sometimes you don't need to do a tracker. I, you know again, believe the woman.
Speaker 1:I happen to have a selection bias of a lot of medically savvy women. They've already researched this stuff, you know. They can tell me that you know it's cycle day 10 and they can basically be very mean to anyone that they meet with. You know, for the next 30 weeks and I'm going to believe them and that is definitely hormonally mediated. We do not need a hormone test to corroborate that for us. You know it's just like with. You know we believe women if they say they're changing their tampon pad protection every hour in terms of determining that they're having like basically hemorrhaging with menses. So why wouldn't we believe them when they're, you know, reporting mental health symptoms? Or you know energy issues, like if your energy really drops after ovulation and it doesn't pick up until day two of your menses, that is also, you know, hormonally mediated. There are hormone and then, like I said, because during perimenopause the hormone production can just be all over the place, that we're not going to be able to map out this nice, you know consistent slope that we had when we were 20 years old and the other thing is slope that we had when we were 20 years old and the other thing is we talk a lot about age with these hormonal changes, but you can be perimenopausal at any age.
Speaker 1:I've had women who stop their normal menses in their 20s. So you track back. You can have perimenopausal symptoms for 10 to 15 years before that final menstrual period. That woman could have been in her teens and so things that might have been like oh, you're just. You know, this is just related to puberty. You're not getting your, you're not hitting your stride with your normal menstrual cycle. Well, that woman might never have hit her stride with a normal menstrual cycle because she went from puberty into perimenopause, into her final menstrual period at 28 years old or again. More normally will be the woman who is in her late 30s, early 40s and starts noticing these changes. You know, and I'll just kind of lump them all into quality of life, their, their mood changes, their sleep changes, their energy changes, their libido changes, and these can all be early perimenopausal symptoms. That can go on, even for someone who's going to have their normal or average final menstrual period at 51 or 52. You can be experiencing symptoms in your late 30s, early 40s, totally normal.
Speaker 2:So much. Well, I appreciate you coming on and talking about all of this, because I would I really appreciate your vantage point and the evidence that you always do bring. So tell everybody where they can find you.
Speaker 1:So I'm on Instagram. I'm also on threads. I don't do that quite as or oftentimes I repeat, the stuff I do on Instagram is Dr Lee Lewis and my website is wwwarcadiowomenswellnesscom. It's a big change, or a big pain, I should say, to change your domain name. So, even though I'm working all over Arizona and doing telemed, even with people in other states, that's going to stay. So I mean, I do live and kind of play here in Arcadia. So it matches that, I guess. And that's the best way to find me is, you know, through the contact form.
Speaker 1:Like I said, I try to keep a lot of updated content about menopause on my website. You don't need to see me to, you know, learn about that. And another resource that I want to share is menopauseorg. That's very easy to remember and you can do a provider search or get a lot of up-to-date evidence-based research there. So I mean, you know, heather, I think we were talking before we got online about like the analysis paralysis that happens, where people, just you know, are constantly looking at all these new accounts, all these new influencers. Find a couple that you really trust and again, those are probably people who have had an extra education and certification through the menopause society and just limit yourself to you know the five people that you really like or the people that you can see are not really gimmicky with nutrition, menopause nutrition information and menopause exercise information. If they're, I'll tell you the red flags. If they're asking for hundreds or thousands of dollars for a program, that's a red flag. You should not need to pay that much for rational, practical menopause information.
Speaker 2:Great Well, thank you for all of your information today. It was really nice chatting with you.
Speaker 1:You too, Heather.
Speaker 2:All right, take care, take care. Bye-bye, as always. Please follow the show, or you can leave a five-star review on Apple or Spotify. That would be fun too. See you in the next episode.