Balancing the Change: A Holistic Guide to Perimenopause with Dr. Ashley Chauvin ND MSCP

Sabrina talks with naturopathic doctor and Menopause Society Certified Practitioner, Ashley Chauvin about what perimenopause really is, why symptoms can hit long before menopause, and why “normal” lab results don’t always match how you feel. We share practical ways to advocate for yourself, support mood and sleep, and build a sustainable plan that fits real life. 
• defining menopause vs perimenopause and why timing varies 
• common perimenopause symptoms including temperature dysregulation, sleep changes, mood shifts, vaginal and urinary changes, body composition changes 
• why hormone testing can be unreliable during perimenopause and what matters more than a single snapshot 
• rule-outs that can mimic symptoms, especially thyroid dysfunction and nutrient deficiencies 
• mood support through iron, B12, vitamin D, nutrition, sleep and realistic movement 
• when hormone therapy or other medications can help support lifestyle changes 
• prevention mindset for cholesterol, blood pressure and long-term health 
• making a plan sustainable through travel, stress and real-world routines 
• building a circle of care with therapists and medical specialists 
• how to spot medical misinformation especially in social media and push for better conversations 

Transcript

Sabrina Duong (00:44)
Hi, welcome to What Would Sabrina Say? I'm your host Sabrina Duong. And today we have with us Ashley Chauvin, a naturopathic doctor out in Ontario, Canada. Thanks so much, Ashley, for joining us today.

Ashley Chauvin (00:56)
I'm so happy to be here, Sabrina.

Sabrina Duong (00:58)
Ashley, if you wanted to talk a bit about yourself, area of specialties, what you practice in. It's such an important topic today, discussing about women and hormones, perimenopause, and signs to look for and how to have conversations with doctors about symptoms.

Ashley Chauvin (01:16)
So I'm a naturopathic doctor and I'm also a Menopause Society certified practitioner. I've been a naturopathic doctor for over a decade now. And I also have experience working and supporting patients who have a history of cancer. That's actually how I got into hormone health, menopause care. A lot of my patients are breast cancer survivors and breast cancer survivors are essentially put into medical menopause because of their treatments. And I really love supporting these patients. They're my favorite patients. So I began having a more interest in menopause. And we often think that perimenopause and menopause just affect our periods, but they affect so much more. They affect bone health, cardiovascular health, mental health, sexual health. So...

The most holistic thing I can really do to support women is support women through these hormonal changes. ⁓

Sabrina Duong (02:18)
I was wondering if you can touch on the difference between a naturopathic doctor versus going to a primary care physician.

Ashley Chauvin (02:24)
To primary care? So depending on where you practice naturopathic medicine, and this might be the same for psychotherapy, we have different regulations and different scopes of practice. So in Ontario, where I practice, my scope of practice can be somewhat limited into what I can do and what I can't do. There are some hormones that I can actually prescribe and these hormones can be obtained like at commercial pharmacies. So, you know, the same as what your obstetrician, gynecologist or family doctor could prescribe. There are other things that I cannot do though, like other hormones like testosterone that I can't prescribe. So I will sometimes work in conjunction with either a medical doctor or a nurse practitioner to get that well-rounded approach if needed.

As a naturopathic doctor though, I'm also looking at other aspects of care. So one of the biggest advantages that I have with my patients that maybe medical doctors don't is time. So my first visit with patients is up to an hour where I'm talking to them not just about their hormones, but about other aspects of their health. We're talking about nutrition, we're talking about diet, we're talking about supplements that they're taking, we're talking about blood work and not just blood work saying like, you're good or you're good enough, we're talking about optimal values. So the main differences that I have between a medical doctor and myself is the luxury of time and also what I can support with patients and what I can't support patients with.

Sabrina Duong (04:04)
Right, and I think when you talk about luxury time, you can discuss that nutrition piece, the supplement piece, which you can't always in the primary care world, of sort of Western medicine, healthcare. And that's what I enjoyed about seeing a naturopathic doctor is to sit there and talk about my day-to-day routine and lifestyle and...

Sabrina Duong (04:31)
how I could manage things like PCOS, right? With supplements or diet and seeing how, know, just feeling more in control about the situation as well too holistically.

Ashley Chauvin (04:44)
Absolutely. And with that time, patients and I can have the discussions about medical misinformation and advocacy. So there's a lot of information in the wellness space out there that is just predatory, to be quite frank, ⁓ and harmful and not true. then patients, but it comes from a good place when patients are looking for that information. So the people who are distributing it , there's a special place in the afterlife for them as far as I'm concerned. However, the patients are really doing this out of advocacy because they're usually dismissed or feel that their care is incomplete. So we can go through the information that they have in such a way that's like that part's true, that part's not quite true, or guess you've heard about this, how can I help advocate to your medical doctor to maybe get that examination or... that blood test that you think you really want is actually not gonna change what's going to happen next. So we can have that collaborative approach together to like more empower the patient versus just say, this is what I'm going to do. And there's a lot of medical doctors that, you know, don't have a paternalistic approach. I've worked with medical doctors who are absolutely great, but on the whole, patients are coming to me because they'll say, my family doctor doesn't really know a lot about perimenopause or my family doctor says, it's probably only perimenopause and I can't do anything for you about it because you're too young and you haven't hit menopause yet. So we have the option to do a little bit more.

Sabrina Duong (06:23)
That's great. So what are the symptoms of perimenopause and at what age? Because like you said, sometimes, there's myths you're too young, no, it's not. Or like I shared my journey saying like, that's just what it is. We're not going to look at anything else just because of my age. So yeah, what are some signs and symptoms and what are some questions that people should be asking?

Ashley Chauvin (06:43)
Sure, so the first thing I'll say is that it's important to define what menopause is. So menopause is really just one day in your life where you haven't had your period for 12 months. Perimenopause is the years leading up to that. And that is approximately seven years. It can be a little bit longer or a little bit shorter. And during the perimenopause time, your ovulation, so your your hormones, especially estrogen and progesterone become less predictable, not necessarily less active. So we often think sometimes that perimenopause just means it's like so low decline, but sometimes your estrogen is really, really high. Sometimes it's really, really low. Progesterone also changes a little bit. Sometimes you're ovulating, sometimes you're not. Sometimes you're getting your period. Sometimes you're not. Sometimes you're still getting regular periods.

And because of these fluctuations in hormones, certain symptoms can arise and these symptoms can look like temperature dysregulation. So we often say the words hot flashes and night sweats, although that brings up this like extreme idea that you have to be sweating. It's really temperature dysregulation. We also see fluctuations in mood. We see fluctuations in body composition. We see fluctuations in urination, in vaginal changes. We also see sleep changes are a big one as well. So when people come to me and they say like, have all of these problems, and I'm not sure what's going on, we ask a couple of questions first. The best way to define if someone is in perimenopause is by a good, we call it like a medical intake. So asking the questions. So first, we're looking at age.

Over the age of 35, we can't rule out that it's menopause, that's perimenopause happening. Most of the time, perimenopause starts in like the 40s. However, not for some people, it's a little bit later. For some people, it's a little bit earlier. Most people will finish about 50 % of women will finish having their periods by the age of 51 and about 90%.

by the time they're 55. So we can kind of do the math backwards there. And when patients tell me that they're having these symptoms, so I'll kind of go through the checklist of symptoms, I also don't jump to perimenopause right away. We also want to look at other things. So I'm often asking people the question, I'm often talking to people about is it perimenopause or is it perimenopause and? So often during this period of life, we can have changes in blood sugar, we can have, maybe we're not getting the proper nutrition because the nutrition that we got before isn't serving us as much. We may also have certain vitamin and nutrient deficiencies that can really exacerbate these current symptoms. So when we're looking at perimenopause, we have to look at that. When it comes to testing or lab testing,

It's actually not very accurate in perimenopause because as I mentioned a little bit earlier, our hormones are up and down. And when we take a lab test, it's only one snapshot in time, almost like a selfie. And like a selfie, if you take like a few of them, you're probably going to get something different. So therefore, lab tests alone are not enough to define perimenopause. And often when patients do get lab tests of their estrogen, progesterone, FSH, LH, they'll come to me and they'll say, well, I thought there was something wrong and I know there's something wrong. I know in my bones, I'm not right, but their labs are normal.

Okay, so you can have normal labs, but experience symptoms still. And is there other testing or other ways that you as a naturopath doctor can navigate and investigate further?

So if someone is younger than 35 and their periods are stopping, I will look at those hormones and some other ones just to make sure that there's not any major issues. We'll also look at thyroid because thyroid dysfunction can definitely cause disruptions in periods, temperature regulation, body composition, those types of things as well. But

From the Menopause Society standards, so the gold standard is that we're not using tests or hormone tests to define perimenopause. I will say that there are practitioners out there that do use different functional tests. I am not one of the practitioners who does that because I generally am going by the Menopause Society standards, but other tests do exist.

They're not very, to be honest, accurate.

Sabrina Duong (11:47)
Okay, that's good

what are some ways that women can cope with mood and some of these changes during perimenopause?

Ashley Chauvin (11:57)
Yeah, so the first thing is, knowing what else is impacted by mood. So I'm often looking at iron. Iron deficiency gets missed quite a bit in menstruators. And even when we stop menstruating, you can still have iron deficiency up to 18 months later. So people will say, I had iron deficiency before but now I don't get my period as much or people's periods become heavier in perimenopause. So they're losing more iron and iron deficiency and mood definitely linked. So our other things like B12 and vitamin D and as I mentioned before, thyroid. So we're looking at those as well. We're also looking at nutrition in perimenopause. People's body composition often changes. So they lose muscle, gain a little more fat, and to cope with that or an attempt to correct with that will have less nutrient intake. And often they're under fueling. So therefore we're kind of in this cycle where people are intermittent fasting or over exercising, but they're not getting enough nutrients, but they're also not losing the weight. And that's going to affect mood.

We also see too that things like sleep, which commonly ends up going off the rails in perimenopause, affects mood significantly. I'm sure anybody who gets a bad sleep can tell you that their mood's going to be affected. So we're looking at those kinds of aspects and trying to correct that. There's also certain supplements that we can give patients to support mood and it depends what the cause of the mood is. So we also, it's also really important when we're talking to patients to try to figure out and we will use the help of a psychologist, psychotherapist, other practitioners as well. Is this perimenopause related mood or is this a diagnosis of ADHD or is this an anxiety diagnosis or is this a diagnosis of depression?

Although I'm a naturopathic doctor and I don't have access or scope of practice to mood medications, many of my patients are on mood stabilizing medications and I'm definitely an advocate of that. And sometimes patients can really benefit from that too. So people may need that support or even permission from a naturopathic doctor that going to get some help for their mood is not a personal loss, essentially.

Sabrina Duong (14:37)
Right, when you're using a holistic approach and when you're exploring symptoms, you're supporting whatever works for a person. And if it is helpful, natural or sometimes medication synthetically, it's all about quality of life and what will help with your other goals. If someone needs to take medication for a mood and that helps with your goals together with sleep, exercise, motivation,

diet, then it's all about why not do what's helpful and beneficial.

Ashley Chauvin (15:10)
Absolutely. And I think one of the biggest challenges in perimenopause is that people often come to me and say, but Ashley, before I didn't need that, right? before I didn't need to look at what I was eating or before I could survive on six hours sleep or before my libido was better or like my, there was no changes to my vulva and almost like why should I have to do it now? Like I've been doing all those things. And I compare it to like, well, before I never need to wear glasses. And now I do. And I'm really glad I do because I'd be walking around with very, very blurry vision. So just because things are changing, we need to adapt as humans with these changes because we can't change perimenopause, we can't change this ovulation. Even all of the herbs, the supplements, and frankly even, unless we put somebody in medical menopause, we can't walk it back with medications. So we just have to be mindful that we have to also play the cards that were dealt, and we can play them really, really well if we're well-resourced and we have the tools.

Sabrina Duong (16:27)
So it's accepting what stage of life you're in and it's not going to look like other stages and understanding that there's change in your metabolism, change in your hormones, in your bone density and ways to maximize and improve in terms of prevention for later on.

Ashley Chauvin (16:47)
Absolutely. I do a lot of conversation with patients about prevention because often patients, other patients will come to me and say, Ashley, I was blindsided by this high cholesterol diagnosis or I was blindsided by this diagnosis of high blood pressure or I gained like 20 pounds within a year. And if we're actually going back sometimes and looking at those results, we see that they were probably always in, I'll call it like, the yellow light zone. So there was probably a space where prevention could have been done and it wasn't. So my goal is always to educate people and say, this isn't a concern now, but let's make some modifications so it doesn't become a concern in the future.

Sabrina Duong (17:33)
Right, so you're also helping people understand about where things are at involving their health, accepting that your role or job is not to reverse aging, reverse what's happening naturally and to help heal, improve or prevent things from happening further or problem solving around, again, feeling better energy wise, perhaps sleep wise and addressing some symptoms.

Ashley Chauvin (18:01)
Yeah, absolutely. And when I'm taking a health history, patients often will question me or I'll tell them this is what I'm doing. I'll say, I might be asking you some questions that you don't think are related. So I might be asking you about if you had postpartum mood challenges, or I might be asking you if you've ever had a diagnosis of PCOS. And they're sitting in front of me, maybe their periods have stopped five years ago, and they're thinking this has nothing to do with it.

But often those things that have happened before hormonally give us clues for maybe some of the challenges that people are going to have. So for example, everybody who goes into menopause is at a risk of mood challenges and changes. However, individuals who have experienced incidences of anxiety, depression, whether that be postpartum or different, they tend to have a higher risk of mood challenges than maybe their peers. Individuals who have had a history of PCOS, often we just think of PCOS in terms of fertility or periods, but actually my individuals with PCOS, they tend to have higher challenges with insulin resistance and body composition changes. And I can still use some of the tools that I would use before now, but it's just a matter of putting all those
pieces of the puzzle together for them and saying, okay, this is what it's going to look like for you. So the strategy.

Sabrina Duong (19:32)
Right, definitely. And myself and having PCOS in my journey, having to deal with insulin recently, and accepting I can't eat like a 20 year old anymore. Can't have dessert first, can't have that sugar taken. I was able to reverse being diabetic within months of work, dedication, accepting where things are at increasing my water and hydration, protein, not being a sedentary, but it comes down to, you do need to make those lifestyle changes because when you do have diagnosis later on, those symptoms, our concerns can definitely pop up.

Ashley Chauvin (20:13)
Absolutely. Making lifestyle changes is so important. And I also like to acknowledge with patients too that yes, there's lifestyle changes that we have to make, but sometimes people also need some help so they can make those lifestyle changes. So sometimes what hormone therapy can do, for example, if somebody is having temperature dysregulation, so these night sweats and they're not sleeping, maybe it's really hard for them to wake up early in the morning to do more physical activity. Maybe if people are like iron deficient, they don't have the motivation to go to the gym or they can't because they're so fatigued. So it's really important to also figure out the why for people so that they can be empowered to make those lifestyle changes as well. Because being lazy is not a diagnosis. I've never met a lazy patient in my life. There's not been one patient that has come to me that is actually lazy. They're under resourced. They are deficient in things, but they're not stupid and they're not lazy. All of my patients are highly intelligent and they're motivated, which is why they're in my office, but they do need that support and they just don't have the answers.

Sabrina Duong (21:28)
that's a conversation I had with health care providers too, if the lifestyle change isn't sustainable or not realistic, it was talking about medication and accepting that's what I would need because later on in life, these numbers are going to increase or these concerns are going to still be there. So there's only so much we can do to try, but sometimes we do need help, whether it's medical history, genetics for using medication medical science.

Ashley Chauvin (21:56)
Yeah, it's really important whatever plan you choose is going to be a sustainable plan. So I tell my patients that blood work is not studying for a test. I see this a lot with cholesterol. So we know the patients will get a cholesterol number that is undesirable, we'll say, and then they're told, maybe by their family doctor, okay, you probably need medication, but I'm gonna give like three months and then they'll come to me and we'll do some work and then they'll be like, but Ashley, I went on this amazing vacation and then this happened. So I'm just going to wait to do my blood work for another couple of weeks so I can clean it up and like, but in life you have vacations, you have weddings, you have summer. So we want to do is be able to have your plan integrated into your life. And for some people that means doing things 80 % and that's sustainable enough and their numbers are great. But for some people,

That might also mean medication help. And we also have to consider other factors, as you mentioned, genetics. For some people, they could eat like a rabbit and still have high cholesterol because they have that genetic factor and it's actually safer for them to be on some medication as well as do all that diet and lifestyle things. I tell my patients that even if you take a medication, even if you take hormone therapy, it's not going to correct you doom scrolling at night and not going to bed. It's not going to correct the fact that you're not in taking enough vegetables and fiber. It's not going to correct the fact that your partnership is very unhealthy and you need to see the therapist, right? So even some of, even taking hormones or even taking medication is not going to correct everything. There needs to be some kind of work to do.

Sabrina Duong (23:49)
Right, so it's so great, like you said, if you're dealt certain cards as a naturopathic doctor, you can lay out, how you can deal with it, and one step at a time in finding ways to support. And like you said, taking the time to have those conversations, educate, explain, listening to the patient, which is really important. And, you know, having that circle of care, it might require the therapist, psychiatrist, endocrinologist, gynecologist for women, and just working together with what's recommended and what's helpful.

Ashley Chauvin (24:23)
Absolutely. I recommend almost all of my patients see a therapist or have some kind of counseling because perimenopause is the time where stuff comes up. And if they have children, often their children are going through hormonal changes as well, just like based on the age. So it's like this double whammy. Yeah, there's a lot that comes up mentally, emotionally around even just the change of aging, right?

Sabrina Duong (24:50)
Right. And I know we were talking a bit before, started recording for women around, changes in hormones, our cycle, menstrual cycle, and just continuously being dismissed with our concerns when, we're talking about effects of mood or heightened anxiety, if there is a diagnosis of anxiety in OCD, and only now starting to come around to validate,
your body changes in your mood during times of cycle, during different milestones in time in your life. And it's important to, have conversations and see what's helpful to manage mood, anxiety, or stressors during different times.

Ashley Chauvin (25:26)
Absolutely.

Sabrina Duong (25:27)
Thanks so much for your time, Ashley, today and your knowledge and expertise on menopause. think it's so important for women to be able to talk about it. It was taboo before to share. I women just knew that it happens later in life and not really discussed. I only knew that there's hot flashes, ha ha, and that was it. I think you just don't know about anything else other than the stereotypes. And I just appreciate.

you being an advocate and using these platforms and share how you can help.

Ashley Chauvin (26:00)
Thank you, Sabrina. I'm glad that you're an advocate for mental health. Everybody needs mental health support, especially at these like hormone time, hormone changing times. And I do agree, menopause conversations used to be taboo and now they're not. The pendulum has swung the other way. But just like in the mental health space, all conversations are not necessarily great information. So being able to sift through that misinformation so people can get the best care for themselves is so important.

Sabrina Duong (26:35)
Definitely. It's a time where I joke, know, Instagram's like a giant infomercial and you want to be able to know who to talk to, who's credentialed about the menopause society. what's legit help And thank you so much for, being authentic and and sharing the truth out there that some things are just not as helpful.

Ashley Chauvin (26:58)
Thank you, I had a great time today.

Sabrina Duong (27:01)
Well, I hope to have you on another time. Thanks so much.

Ashley Chauvin (27:03)
I'd be happy to come back.