Perimenopause Isn’t All in Your Head: Empowering You with the Knowledge to Take Control

Summary

In this episode of the Hot Flash Diaries podcast, Kristen Parise and Jessica Caceres dive deep into women's health, focusing on perimenopause and menopause. They discuss common symptoms, the importance of hormone optimization, and the benefits of vaginal estrogen. The conversation also highlights the upcoming Empower Transitions masterclass, aimed at educating women on these topics.

Keywords

perimenopause, menopause, hormone optimization, vaginal estrogen, women's health

Takeaways

• Listen to the end for an exciting announcement.
• Perimenopause and menopause symptoms are common but manageable.
• Hormone optimization can improve quality of life.
• Vaginal estrogen is beneficial for pelvic health.
• Education is key to understanding women's health issues.
• Empower Transitions masterclass launches in November.
• Collaboration in healthcare improves patient outcomes.
• Understanding your body helps in advocating for your health.
• Hormone replacement therapy is safe when done correctly.
• Joint pain can be a symptom of menopause.

Title Options

• Empower Your Transition: Mastering Menopause
• Unlocking the Secrets of Perimenopause
• Vaginal Estrogen: A Game Changer
• Hormone Optimization for a Better Life
• Navigating Midlife with Confidence
• The Hot Flash Diaries: Episode 2
• Women's Health Unveiled
• Masterclass on Menopause: Join Us
• From Symptoms to Solutions: Women's Health
• The Power of Education in Women's Health

Sound bites

• Listen to the end for an announcement.
• Perimenopause symptoms are common.
• Hormone optimization improves life.
• Vaginal estrogen benefits pelvic health.
• Education is key to health.
• Masterclass launches in November.
• Collaboration improves outcomes.
• Understand your body, advocate health.
• Hormone therapy is safe.
• Joint pain is a menopause symptom.

Chapters

• 00:00:01 Introduction and Welcome
• 00:00:11 Diving into Perimenopause
• 00:00:34 The Importance of Hormone Optimization
• 00:01:04 Vaginal Estrogen Benefits
• 00:01:44 Empower Transitions Masterclass Announcement
• 00:02:30 Collaboration in Healthcare
• 00:03:17 Understanding Symptoms and Advocacy
• 00:04:51 Conclusion and Final Thoughts

Jessica’s Links For You:

Website: https://www.bonitamedicalaesthetics.com/podcast
Instagram: @thehotflash.diaries & @youare.bonita
• Facebook  •  Tiktok  •   
Youtube: @thehotflashdiariespodcast

Transcript

SPEAKER_00 0:09

Welcome to the Hot Flash Diaries, the podcast where no topic in women's health is off limits. I'm your host, Jessica Casaris, a board-certified nurse practitioner with expertise in hormone and sexual health. This is your safe space for candid conversations about perimenopause, menopause, intimacy, and so much more. If you're tired of being dismissed or want to feel like yourself again, you have found your community. Let's break the silence, tackle tough topics, and help you reclaim your wellness. It's time to feel empowered in your own skin. Welcome back to the Hot Flash Diaries Podcast. I'm so excited that you're here with me today because I get to have my near dear friend, Kristen Parisi, who also happens to be an incredible pelvic floor physio and colleague of mine, the owner of Blueberry Therapy, Pelvic Health and Pediatrics. She is also the host of the whole shebang podcast. And we are so happy to have you again, Kristen, to chat about all things women's health and in particular midlife and pain points that us women go through during this phase of life. Thank you so much for being here with me today. Thank you.

SPEAKER_01 1:20

Honestly, I'm so excited to be here. I mean, this is something that I talk about every day at the clinic. I talk about in my podcast, and I and to your listener, I'm living this. Like this is my life. The Hot Flash Diaries could be like the subtitle to my life right now.

SPEAKER_00 1:35

Well, you and me both, and I love it because we both get it. And every time that we're together, I feel like we have this energy about us that we could just take over the world and educate all these people and help them just have an amazing life, right? So I love that every time that we get together, we're like, we have all these ideas and things to do. So that in mind, I want you guys to listen right until the end of the episode because Kristen and I have an exciting announcement about something that is fabulous that's coming up that I bet if you're listening to this episode, you're going to want to partake in. So take a listen.

SPEAKER_01 2:04

Absolutely. Yeah, I think for all our listeners, you know, education can really be power. And we have a lot to talk about today, but we have a lot more beyond that, which I think is the cool part. And I, you know, I truly value you as a friend, as a practitioner too, Jessica, because as a public health physiotherapist, there are many things that we can do to help people. And having a collaboration with someone who, you know, understands a different set of symptoms or a different set of treatment opportunities can be super, super helpful. So, you know, thinking about symptoms, I mean, what are the things that you're seeing that most people, uh, most women are coming to you with at this point?

SPEAKER_00 2:47

Honestly, when I'm seeing, well, I have two sort of groups of women that I see, as you know. So we have the women that we see in clinical practice who are having some physical challenges that require a pelvic floor assessment. But then I have my virtual clinic where I'm seeing women all across Ontario. And I would say that a lot of the symptoms, of course, will overlap. But with my women that I'm seeing virtually, the majority of the complaints are I'm gaining weight. I feel like I can't, I don't have like that word-finding capacity that I once had. You know, I'm frustrated. I go to the grocery store and I run into somebody and I know that I know them, but I can't think of their name. I'm not sleeping well. My libido's in my boots, and I feel like life is just really, really hard. You know, though that's sort of the overarching complaints and things that I hear from all the women that I see. At least one or more of those symptoms are brought up. So every single day I chat with women about these and I realize that, you know, there's so many gaps in the information that's out there as far as what are the underlying causes of these symptoms, you know. So people are sort of left to think, oh my gosh, is it me? Is it, is am I doing something weird? Like, you know, why do I feel this way? And yet we're all like really, if you're in your possibly late 30s, right up until your 50s, you know, there's so many symptoms there that contribute to or that are part of that perimetapausal menopausal phase that women just don't know that there is so much we can do. So that is totally, those are the symptoms that people complain about. It's like the same topics over and over again.

SPEAKER_01 4:18

And you know, from my perspective, yes, I hear those, and I hear this like heaviness in the pelvis, like this sensation like something is kind of coming out they can't describe or figure out, urinary incontinence, pain with intercourse, you know, just not feeling like themselves. And it's actually it's so funny when you say, like, you know, a lot of people are coming to you and and they're not sure if this is a perimenopause symptom. You know, there's just so many symptoms. And and I had the experience the other day, my 15-year-old son by mistake picked up my phone and it happened to be up to my Instagram feed. And he was like scrolling along, and he's like, Oh my goodness, mom, everything. Like I knew right away it wasn't mine because it was all about like like very menopause and hot flashes and vagical dryness. He's like, What do what do you listen to? So it's funny when I when I talk to people and they aren't as aware of things because I feel like I hear it, I live it, I look it up, and then obviously like my social media knows that, so it sends it all to me. So it's quite funny, isn't it?

SPEAKER_00 5:28

Well, it is, and it again, we sometimes sometimes take it for granted because I this is what we eat, breathe, and sleep, you know, however many hours in the day that we're, you know, awake, some of us more than more than others because we lack sleep with perimetopause. But the reality is, is like we sometimes forget because even other clinicians out there, I'm sure there's pelvic floor physios and or maybe not pelvic floor physios, I feel like they would be pretty aware of changes, I would hope anyway. But physios and in my world, doctors, nurse practitioners, nurses that really don't understand at all how to A identify or B treat a woman who's in midlife. And that becomes so it's every day it's more apparent. In fact, I saw a uh patient this weekend for follow-up, and some of the stuff that her GP was mentioning, you know, almost like fear mongering, was so infuriating. And I thought all of this information that was provided to you is a misinformation and B, now you're fearful for absolutely no reason. And so they stopped their treatment and then felt like absolute garbage and then came back and said, Oh, actually, I think that you were onto something. So again, it's just another opportunity to just educate a bit further and really dive into, you know, sort of the pathophysiology and why these treatments are entirely safe and why you can feel so much better. So it's really um again, it's something that we forget about because we talk about it all the time, but there is such a gap. And I do recognize that, you know, every single day. I see it in some way, shape, or form.

SPEAKER_01 6:55

Yeah, and and that's why I value working with you because I know you've done the training, you understand. And, you know, like even when it comes to pelvic organ prolapse, I have clients that have established pelvic organ prolapse, are seeing potentially a medical provider who might be doing surgery, and they'll come back to me and they'll say, you know, actually there wasn't a physical exam done. And I think like that doesn't that doesn't make sense to me. Now I can't speak for the other provider, but to me, they're they gear up for it, you know, they know that this is a potential, and and having an internal exam can be vulnerable. And what I would say to those patients is I'd ask for it. Like I would say, this is the issue I want you to evaluate. It's my pelvis, and I know it's you know, intimacy, but it's necessary too. And and and you know, I say to my clients, you know, if you have a problem with your tooth, you go to your dentist and you're your dentist is gonna look in there, right? So it's just a different part of your body, right?

SPEAKER_00 7:58

Well, it is, and what's so funny about that is that, you know, there are, I think there's some expectation that women know their own anatomy. And so in there's been physicians that I've, you know, sort of worked with in the past, and you know, you read their notes and you think, okay, so a physical exam wasn't done, but they take the patient's word for what's happening, which I believe strongly for all physical symptoms and emotional symptoms. Like that's the the patient's experience for sure. But physically, you know, there are so many women and men who don't know their anatomy, you know, they don't know where their vagina is or where, like what hole do they pee out of, you know, they don't know that that's like their urethra and not their vagina. And so, and it shocks me, again, this is thankfully not on a daily basis, but you know, there's some women who are in their 70s and 80s. I'm sure you have had this experience as well, who they don't actually know where their vagina is. So to tell then a physician or a nurse practitioner that this is where I'm feeling a bulge or I'm feeling, you know, a certain symptom in this area without actually looking, you don't know. And I am so, so grateful to you and your team because honestly, I mean, I feel like I knew quite a bit before you and I met and connected, and really I fell in love with you. But but prior to like prior to that, I didn't really feel like I had a full understanding of being able to determine what type of prolapse I was looking at. I knew I was looking at a prolapse, I knew that it was likely A or B. You know, I could sort of delineate one, one or two of the three possibilities. But you've really helped me, you know, flourish in that area of my practice. And I'm eternally grateful because that has translated into better patient care and women getting, you know, the exact treatment that they need to overcome their symptoms, you know, because again, incontinence, that pelvic floor heaviness, that low back pain, pain with sex, like all of those things are again major topics that we talk about on the daily with the women that I see. And, you know, if I'm seeing somebody virtually and they're expressing these symptoms, if they're low, like relatively local or wish willing to travel to either you, Dundas, or to St. Jacob's to see you or your team there, I will tell them to do that. But if they're in other areas, I try to find a pelvic floor physio that I could say, go and see this person. I don't know them, I don't know what the experience is going to be like, but it's going to be better than doing nothing, you know? So again, thank you. It's just been awesome.

SPEAKER_01 10:26

Yeah, and I, you know, I and I think the same. And I think it just reinforces the value of a team and that team approach because I mean, when I'm seeing people and I think, ee, I think maybe their hormones are playing into this, or maybe their thyroid is low, but that is not my scope. And so you having a really good thorough intake that, you know, establishes where all of those things are and have the value of, you know, maybe jumping into some kind of menopause hormone therapy, or, you know, all the myriad of things that you can prescribe is such a bonus for the client. Um, and that can be incredibly helpful. And then the other thing, and I'm not sure if we're gonna get to this later, but I have had a number of people who have had vulvar lichen sclerosis, and either it's been missed andor not treated with an optimal treatment. And having having those conversations with you and seeing how these people have done with the with the most efficacious treatment, you know, that can be life-changing. And and that, you know, it's just it, it's it expedites the care for the patient when our scopes of practice, you know, they overlap, but they but they dive into different areas. And that's been really, really helpful for me.

SPEAKER_00 11:49

Oh, it's been amazing. Like just that seamless care, right? From the time that I can identify, okay, now I can help with the whether it be estrogen or the DHEA vaginal prescription or the topical steroid or what have you for to treat their lichen or treat their vaginal symptoms related to their genital urinary syndrome of menopause or what have you. So dryness, itchiness, all that stuff. But oh my goodness, this lady has, you know, a very tight pelvic floor or she has a prolapse. Okay, off to Kristen, see her or her team because that is out of my scope. And I know that they're going to be in the best hands possible. So it's really, we've we really have a great program. I'm so excited and so proud of it, to be honest. We I get such good feedback on the daily. In fact, a client you saw last week emailed me over the weekend, which I forgot to share, um, with you, and she was just so impressed with the care. And my thought always when I see it is I'm not surprised. You know, that's the that's that to us is like the standard of care, which is so exciting. And what's even better is like the timelines, right? Of being able to get people in in a very short period of time. Like some people are waiting years to get into an OBGYN for a pessary fitting to help their, you know, pelvic organ prolapse and or or even just have an assessment. And yet you can see them within max, what, like four weeks. Sometimes, if you're lucky, even sooner, you know, for organized. At my office, it's a little harder because you're not there as much. I wish we could just like divide you up and have you there all the time. But it's so, it's so beautiful. And I'm so proud of the work that we're doing, truly. It's it's making a dent in the community as far as the misinformation and really that healthcare disconnect and the gaps, because I feel that, you know, so strongly that we have such a large gap still in the community as far as educating women about what's normal, what's not normal. And yes, while aging can happen, you know, and we see it all the time. Again, at Bonita, we focus on, you know, anti-aging treatments for face, neck, chest, all the things body. But again, wellness is a big part of what we do. And so we talk to women about this stuff all the time. But when it comes to specifically the hormonal shifts and things that we can do, there's not there it, there's so many women that just don't understand and don't know because they've never been taught, right?

SPEAKER_01 14:07

Yeah, for sure. And and just thinking about that, like for the listener out there that is maybe, you know, over 35, over 40, that is starting to notice changes, is there a timeline, honestly, Jess, that people should be doing testing, should be monitoring symptoms? Like, what is often your first thing that you might do with somebody that thinks that there's something shifting in their hormones?

SPEAKER_00 14:32

Yeah, so the thing, it's tough to really say when is the best time. I think that educating around the symptoms and the less lesser known symptoms, if you will, of perimenopause and menopause in our 30s is so important because that's the way that women will become A more educated and be able to advocate for themselves as far as it comes to your, as far as their healthcare is concerned with their provider. But I'm a huge advocate of prevention and also optimization, right? So when we look at things, even like vitamin D, vitamin B12, your iron levels, all of that stuff is really important to look at, even before we get into that phase of midlife, if you will, you know. So I don't think that there's a wrong time ever to have a proper set of blood work done with somebody who understands, you know, your body from a functional standpoint, and then can say, okay, here's some areas that we can improve to keep you feeling stronger and healthier. I mean, the reality is if we're menstruating monthly, we're losing a ton of iron monthly. So it's no surprise that a lot of women, huge amounts of women, in fact, you know, probably over 75 women. I don't have an actual stat. I'd have to see in my own practice, I can say comfortably, about 85% of the women that I see are not optimal with their iron. And a good 50% of them are actually deficient and they have no idea. And they come to me with thinning hair, fatigue, just overall just have like sort of like this flat affect and just not enjoying life. And it's because they feel like garbage all the time. And as soon as you optimize their iron, their B12, their vitamin D, and oftentimes their thyroid too, they just feel like a better person. They feel like themselves again. So I think it's really important to look at those things. Now, when we head into more so of like that late 30s, early 40s, it's not uncommon to say at that time, or it's not wrong, I shouldn't say, to say, hey, you might be perimenopausal. You may or may not be. It's hard to know. We don't have sort of that crystal ball. But what we do know physiologically is that 10 years before we head into our last period, um, which that then transitions us into menopause, there's going to be changes. There's going to be changes in all of our hormones. It's not like one day all of a sudden the factory just closes or shuts down, right? So it really is a slow and steady progression that our body really tries to keep our hormones balanced as much as possible and creating these hormones because we know we feel best when we're in that state. But eventually we have that decline. And so getting a good set of blood work with hormone markers and all of that is really important towards like sort of our late 30s, early 40s for sure. Now, I have a lot of women who will say, okay, does my blood work show that I'm in perimenopause? And um I think it's like it's such a cute question, but also like it's it's not a question that just gets me going off on a tangent because I think there is a misconception that a blood test is going to tell us where we are at in this trajectory. And the reality is that that's that doesn't exist. We have a blood test that can tell us how hard your brain is working to tell your ovaries to release eggs to make, you know, to have a to have a period or follicles to have a period, but we don't have a blood test to say you are in stage three of 10 of your perimenopausal, you know, like lifespan, if you will. And so what we can do though is look at your symptoms. And so if you are talking with a provider who is well versed and who understands, you know, what our bodies go through and what hormones go through, and what those hormone deprivation and spikes, how those manifest in our bodies and mind, then we can sort of determine, okay, this is where you're at. So, and then from there, what could we do to replace whichever hormone might be low or high? How do we, how do we sort of balance that a little bit? Because true balancing of hormones, I get a lot of that. Can you balance my hormones? Well, it's kind of a thing that's not possible. You know, our home hormones sort of balance themselves in our bodies, but I am not a magician. I cannot balance your hormones. And really, what does that mean? It's really about optimizing your hormone levels to where we were sort of in our early 30s, maybe late 20s, so that we can feel even keeled. Our brain is feeling like it's firing clearly, and that we can really, you know, carry on with life and enjoy our life as opposed to feeling tired, not like ourselves, irritated, not sleeping, angry at things that never used to make us angry, and you know, deal with a whole spectrum of adulting, you know, responsibilities on top of that, right? So, yeah, so sorry, long, long-winded answer to your question, but optimization of overall health anytime, looking at hormones specifically, great idea to do it in your late 30s, early 40s, but that doesn't include the women who are experiencing things like endometriosis symptoms or PCOS in that case. And those women, I would say anytime. I see some ladies that are in their 20s, early 20s, right up until their 60s, who have had PCOS and you know, have had a whole mirage of symptoms that have been sort of overlooked or or misdiagnosed. So yeah.

SPEAKER_01 19:46

Yeah, that's that's an awesome answer. And I know that that was a like a big question. Um, PCOS, polycystic ovarian syndrome. So I think, you know, bottom line, it's not all in your head. Like I think there are so many things going on at this stage of life that you know you need to know that changes in your memory and brain fog and you know, feeling more anxious or more depressed than normal, among the other physical symptoms are really, really common. And and I think that's something we see all the time with our patients. So, you know, if you were thinking now, you know, periods are getting more irregular and sleep is really disrupted, and somebody thinks, you know, I've heard stuff about menopause hormone replacement therapy, but is it dangerous? What what would you say to that?

SPEAKER_00 20:36

Oh, yeah, that's that's a great question. So it's it's not if it's done correctly and the proper um hormones are used. I go through, I explain sort of when when somebody shares their symptoms, I like to go through why these symptoms are happening and what's happening with their hormones, right? In terms of estrogen and progesterone and testosterone as well. And then we talk about how we can replace them and how we can replace them safely. Um, there are hormones out there which I use exclusively in my practice, which are considered bioidentical, which bioidentical is kind of it's a buzzword, it's really a marketing term. It's just the type of estradiol or estrogen and the type of progesterone that we're using to replace, which is identical to that of what your body has made your entire life. And so I talk about there's risks with everything, right? And we talk about all of that in great detail. Now, the risks that were identified in some of these big studies, like the Women's Health Initiative and so forth, the issues that came from those studies, in particular, you know, the heart attack, stroke risk, and the breast cancer have all been debunked, right? At this point. And they weren't using the estrogen that you've made your whole life, that I've made my whole life, and the progesterone that you and I've both made our whole lives as well. They were using a different form, so almost like a birth control form versus what we've made. So you cannot compare apples to apples here. It's a completely different. Study. And so all of that has been debunked over and over again. But the problem is that people can't unhear the word cancer. Everyone's petrified of cancer, right? Nobody wants that. Although cardiovascular or death from heart attack and stroke is the leading, you know, cause of death for women and for men as well. We still always worry about cancer, which is completely, and I get that. I mean, it's an awful thing to even consider. But I walk through, you know, what these medications do, what we're trying to do in terms of relieving symptoms, and oftentimes are extremely successful. In some cases, we need to tweak things to get feeling better. But generally, people have a wonderful response to them and how they're safe and why they're safe. So it's really an individual conversation, you know, and we take things into consideration like family history, lifestyle factors, like do they smoke or not smoke? You know, do they have a clotting history in terms of their family or themselves that they've had a clot at one point or another? But there's there's a lot to be to be discussed, and that's why it's so important to have this wonderful one-on-one, you know, conversation and assessment with somebody who understands things, right? So as opposed to just providing fear and saying, well, this is why I don't prescribe things because it causes A, B, and C with not really understanding what that means and then scaring patients. So it's again, our program is wonderful. It's being virtual, I help women all across Ontario. But what we do is we check over 150 biomarkers and really go through all their symptoms, like from top to bottom, and discuss them at length. So our visits are an hour long. Like, think of how long you're sitting with your family doctor, right? They don't have time to delve into the women's health initiative and why this was incorrect and that was incorrect, and also pull out the good things that came from the study because there were several things that were awesome. But the reality is what it did was cause, you know, this high degree of stress and fear amongst women, and which has led to, you know, two decades of women being neglected. So we're not we're not standing for that anymore.

SPEAKER_01 24:08

Yeah, and I think that that is kind of the point is you don't have to suffer. Like there are resources, you should be getting stuff checked, you should talk to whomever provider that you're with, and you should get resources and or script back. And you know, I follow um Kim Volpini, the the vagina coach online, and she actually did this little where she showed what she's taking every day. So I, like her, have my estrogen gel that I rub on. I take my progesterone so I can sleep. I do a testosterone shot, I do a vaginal estrogen pill. Like I'm like, bring it on. If this makes me feel better, this keeps my lean mass, it reduces my joint pain, it helps me to sleep, it helps control some hot flashes, then you know, I'm all into it. And, you know, I have loved the conversations we've had in the past about vaginal estrogen. And and do you want to just dive a little bit for our listener into how vaginal estrogen saves lives, Jess?

SPEAKER_00 25:10

Oh my goodness. Well, first, why don't you tell us about what vaginal estrogen or the lack of estrogen does, estrogen and testosterone does to our pelvic floor. Tell us about that and I'll tell you why it's life-changing.

SPEAKER_01 25:22

Yeah, for sure. I mean, what we see, it's interesting. We see this through the lifespan. So, you know, if you're listening right now and you know, every time the week before your period, you feel maybe a little more incontinence, a little more heaviness, all of that kind of stuff. That is the impact of lower estrogen on your pelvic floor. So even in people who are cycling, we can see what lower estrogen does. We see it also in the postpartum period. And then, as we're talking about now, we see it in perimenopause and menopause. So lower estrogen contributes to a pelvic floor that doesn't respond quite the same way. So it may have less ability to contract well. So we may find that people who have managed really well now are starting to see a little bit of urinary incontinence. We also see that people who have been, you know, pretty good, they space out their bathroom visits really well, all of a sudden now feel like they have to go to the bathroom more and they're responding to their bladder and they're going more, and then they feel like they have to go more, and now they're getting up at night to go more. So, this overact of bladder, we see that happen with lower estrogen and in this particular time period. And then we see that people have pain with intercourse, so that you know, they feel, you know, there might have some a burning sensation. Some people say that it feels like a tearing sensation, even some people will say that they have a little bit of spotting after intercourse or the sensation of cramping. And we know that estrogen impacts all of those things. So, as a public floor physiotherapist, you know, one of the things if you hear nothing else on this podcast today, muscle, you can increase your muscle at any point in your life. So we can work on improving muscle, both tone, bulk, function, control, all of those kind of things. But sometimes we need to also improve tissue health and improve the hormones around that muscle in order for it really to be optimized. And I think that optimization is a really good word. So enter vaginal estrogen.

SPEAKER_00 27:40

Well, I tell you, vaginal estrogen is again, over the last five years, I've learned so much more. Prior to five years ago, I thought this is just use some lubricant, right? I've learned so much more. There's differences between lubricant and vulvar moisturizing, just like you know, you wouldn't use a moisturizer as lubricant, you know, it there's just so much there that we've that I've learned, and I'm just so excited about it. But specifically when it comes to vaginal hormones, and there's so many receptors there, right? Like they're covered in receptors, our vagina, our vulvar vestibule, which is just outside, which is was really cool actually listening to Rachel Rubin, who is a huge influencer, influencer slash. I don't like using the word influencer because I feel like there's a lot of misconceptions from influencers, but she is a huge presence, I'll say, in the perimenopausal and midlife phase and talking a lot about hormones and and uh debunking a lot of things. She is a uh urologist out in the US. And she really helped me understand, in addition to what you've helped me with, Kristen, understanding the vulvar vestibule, exactly that external sort of area and what, how many receptors are there? And it's no wonder that when we stop making estrogen, stop making testosterone, that this entire area feels different. It feels like tissue paper. It hurts when we have intimacy or intercourse, even external stimulation is painful at times. The itchiness, the discomfort. You know, how many women have told me it, they say it feels like I'm sitting on a cactus? I mean, how appealing does that sound, right? It doesn't matter how big the cactus, I can't even imagine. It's awful. And so it makes sense because all of these receptors are sort of sitting there and there's no hormone to innervate them. And what's actually kind of cool about our bodies is that we start to create more and more receptors because our body senses, oh my gosh, like why is, you know, Fran over here not grabbing onto any estrogen progesterone? So we'll just make more babies and try and grab onto anything we can find. And there's nothing there because it's gone, right? So when we replace it, all of a sudden it's like happy tissue. The tissue all of a sudden is like plumper. It's, it's, I hate to use this word, but juicier because that's the reality. The inside of our vaginas feel like the inside of our mouth, which is what it should feel like, as opposed to feeling just dry and and uncomfortable. And the external part, all of a sudden, too, things like our labia start to feel a little bit thicker and not as dry, and everything just sort of reverts back. It's like all of a sudden you're turning the clock back, and all of a sudden you're more lubricated and intimacy feels better, and all of those things. It's so wonderful and like the easiest thing in the world to A prescribe, B access, and C administer. It is so, so easy. And before we only had just estrogen, and now we have a product that is actually DHEA, which is a precursor to both testosterone and estrogen, and it's administered the same way. So it's a little ovule that you put inside the vagina every single night, and it sort of melts with your body heat because it's it's made in like this little oil capsule, and it goes where it needs to go and feeds all of these receptors, the both testosterone and estrogen that's required. And in doing so, things feel better, intimacy is better, all of these things. So that's like the sort of the pathophysiology, physiology aspect of it. But why and how that saves lives is so incredible. So when we think of urinary tract infections, you think, well, what does the vagina have to do with the urinary tract infections? I mean, although a lot of people don't think that way because they don't understand where P comes from and where your vagina is. So that's a whole, like we talked about before, a whole other topic that gets me, you know, feeling like I have to talk about this all day long. But so what happens is that when the tissue becomes so thin, the pH balance of that tissue becomes very, very, very different than what our body is normally. And normally we have a whole crew of little soldiers, as I call them, our little microbiome that live both externally and internally, and they protect our bodies, right? Like they really protect us from foreign bacteria and so forth. And so when you're having intimacy or any sort of intercourse, and again, whether it's external or internal, we're we're introducing potentially another person's bacteria into our bodies as well. And so if our body doesn't detect that, oh, that's foreign or that's healthy or not, and take care of said foreign bacteria, then that can lead to an infection because it grabs onto the wall of the vagina, sort of climbs up, eventually makes its way into our bladder. It can also externally, you know, get to the opening of our urethra, which is our where we really where we empty our bladder, and it can go up the urethra and into our bladder and cause an infection because the environment is suitable to bad bacteria. Bad bacteria like that sort of environment, whereas good bacteria does not. So when we replenish the vagina with both testosterone and estrogen, or just estrogen alone, estrogen does a fantastic job, even just on its own. The pH replenishes back to or reverts back to where it should be. And all of a sudden we have a full army ready to, you know, take on any sort of foreign bacteria that could lead to an infection. And so there really is such a preventative measure when it comes to vaginal estrogen. I have seen women go from having a urinary tract infection, oh my gosh, like one a month, you know. I think you and I actually saw a mutual patient who was one a month. So if you can imagine as a woman being on antibiotics once a month, we know all the side effects of antibiotics, stomach upset, diarrhea, your um yeast infections, like it just goes on and on. Once a month having to experience that and your gut really never, you know, recovering from that amount of antibiotic. Now to all of a sudden having one maybe every six months, maybe not at all anymore, right? It's so exciting because now it's like the tissue is so so much healthier and the pH is is balanced again, where the bad bacteria doesn't stand a chance. So it really is so life-changing, especially in our women who are sort of post-menopausal, who are already prone to UTIs. But it's also great for women who have already been prone to UTIs in their 30s, 40s, and 50s, especially like how many times have you heard, oh, I get a UTI every time I have sex, right? And instead of educating about proper lubricants that are pH balanced, proper, you know, vaginal or cleanliness, or not cleanliness, what's the word I'm looking for? Hygiene, where like we're not using, you know, soaps, we're just using water, you know, the vagina's a self-cleaning oven, people. So stop using soap up there. And really talking about that, getting on a great probiotic, all of these things, we're just giving women prescriptions for antibiotics so that right after they have sex, they can take a probiotic or sorry, a um antibiotic, which is just crazy to me. Like I think, oh my gosh, and especially if you have a super active sex life, like how many antibiotics are you going to be taking in a month, right? Like you're just wrecking your gut and all the things in between. So again, I can't say enough things about vaginal estrogen and vaginal DHEA. They're amazing. I've, you know, I really have sourced a lot of inexpensive options because there are women who don't have coverage, of course. And so I want this to be accessible for women as much as possible. And um, it's just been life-changing. And I love that you can identify when you see your patients if they need it, and maybe their GP or NP is not open or willing or understands. And so then you tell them to come see me and I get them hooked up and then their vagina and they are happy. It's wonderful.

SPEAKER_01 35:28

Exactly. And the other thing, I mean, I can identify, but the other thing I think if we're talking about people being better self-advocates, self-advocates, I ask them to look. So, and you know, if you're listening to this podcast and you are in your 20s or 30s, I want you to start looking then because you want to look at the color, the plumpness, the size of your labia menorah and labia majora. I mean, and there's a big variety among different people, but you will know your body best. So when something changes, and now you're seeing that there's paleness, that you're starting to lose your labia menorah a little bit, that you know, it just doesn't look quite the same, or you're noticing a small bulge at the front wall or something that like that of your vagina, then you're going to chat with your nurse practitioner, your pelvic floor physio, your family doc, your gynecologist, whomever is out there that you know you trust. And but you can have those really good conversations because people can pick this up and and it again is your body. So, so you know, you want to look, you want to see. And and that sometimes for people is like, what? Where do you want me to look? I'm like, it's you. We're just looking at you.

SPEAKER_00 36:41

Yeah, exactly. It's it's the parts you've had your whole life, and we're gonna get, you know, intimate with them, if you will, right? Let's this is what this is, this is what that is. And that's why I love our models that we have in office. You know, it's funny, it's so the first time people see them, they're kind of a little creeped out by them, but then they get used to them, you know? And and even my staff, I remember they're like, oh my gosh, you got what? I'm like, it's a clitoris, look. And you know, we'd go through all the parts and they just sort of shake their head. But it's hilarious because now when somebody comes in, they're like, oh, you need to see Jess, and like this is the model, and this is what happens. And and I love it because it's although not trained specifically in that area, it's like the word is getting out and people are becoming more educated and it's less of a stigma or taboo to talk about our parts, you know. Like, my goodness, 50% of the population own a vagina. Let's get over it and start saying the word, you know.

SPEAKER_01 37:35

You know what? And yeah, and for our listener too, I mean, I saw Jess's clitorit model, and it is a glorious model. I have posted it on my Instagram, blueberry therapy, pelvic health, and I just absolutely love it. So then I had to go and buy my own. Like I it wasn't enough that Jess had one. I had to get one too.

SPEAKER_00 37:53

Well, you know what's funny, Kristen? Really quick story is I I traded my vehicle in, got a new vehicle, and in that I had my daughter sort of empty everything out of my old car before I got the new one. And so John um was going through this bucket of things that, of course, as a teenager, she just threw everything in, had no care, or just whatever. And he's like, I think I should go through that. And I come down this one morning and I see I just have to reach for it and grab it. My glow in the dark clitoris ornament. Oh yes, ornament. I love it. Yeah, that I purchased when I got my clitorit model. And I bought one for everybody on my team, you included. And so John had, I guess it was all dusty from being in the bin, and he washed it and it was hanging on the um the spout of the uh the faucet in the kitchen. And I walked down and I looked at it. He goes, I found your clit and I washed it for you. And then I it just sort of sat there all night. And then when I turned the light off to go to bed, it was glowing in the dark. It was hilarious. Anyway, the things that happen in our house that, you know, most people don't experience, but I'm happy with it.

SPEAKER_01 39:01

No, I think it's fabulous. And it's demystifying something that we need to demystify. Like it's our bodies and we need to know how they work so that we can make sure that they work better or work optimally. You know, when you're working with your women either online or in person, what are the things that you're noticing right away is changing when you know they're on the right regime? What are the things that they tell you?

SPEAKER_00 39:24

Oh my goodness, their sleep and their energy level is improved almost immediately. Almost immediately, which then transcends into their their mood, right? And overall just feeling of feeling lighter, you know, which then makes them feel more energized. You want to go for those walks, you want to be outside, you want to do good things for your body because you don't feel like this weight on you all the time. That is generally the first symptoms. And also then vaginal symptoms. If we're starting vaginal products like the vaginal estrogen or DHEA, there is an immediate change, which is so rewarding. So there's, you know, other symptoms as we go down the line that take a bit longer, but generally it's that. And also for women who are menopausal, if they're having hot flashes and night sweats, almost immediately that's improved, which is just amazing.

SPEAKER_01 40:15

Yeah. And I would say, like, when I went on the hormone replacement, those are the things that really helped. I my sleep was pretty disrupted. It's much better now. And yeah, and and it's the hot stuff. For me, my first big symptom was joint pain. Like I'm uh I exercise all the time and I would be sore for like two, three days after. And that was that really impacted how I felt about diving into another exercise class or what have you. And so that's helped as well. So that's been good. And I see, like, from my perspective, as soon as people understand how their pelvic floor works, understand how their bladder works, understand maybe that they're a bit constipated and they didn't even realize that was maybe impacting how their bladder functions and can connect with their pelvic floor. If somebody is have uh has all kinds of pelvic floor tension and they're having vaginal dryness and they're having pain with intercourse, that addition of the vaginal estrogen or DHEA, and then doing some pelvic floor lengthening, they they find, oh, now sex isn't painful, or now, you know, I can go a little longer because I don't have to go to the bathroom all the time. Those are the things that I'm finding like are really impactful. And then, like you said, they're feeling more energized. Maybe now because they're not leaking urine, they're diving back into their exercise and they're feeling comfortable with that.

SPEAKER_00 41:37

So yeah, exactly.

SPEAKER_01 41:39

It can be quick. It can be quick because a lot of what we do, I think, is education-based.

SPEAKER_00 41:44

Oh, a hundred percent. And it's interesting that you mentioned the joint pain because that is a lesser-known symptom. Joint pain, frozen shoulder, shoulder pain, all of that is has been in the media as of late, but we it was something that we never talked about before. But it makes sense. Hormones are anti-inflammatory. You have this deprivation of hormones, you're going to start feeling aches and pains in places that you never did before. So it's interesting that that was your first, your first symptom.

SPEAKER_01 42:11

And I think, I think that is something you're right. I see in the media now as the musculoskeletal syndrome of menopause. So frozen shoulder, hippocitis, pelvic floor stuff, and plantar fasciitis are things, and we see that in the clinic. Somebody's around, we used to call it like the 50-year-old shoulder. Now we say musculoskeletal syndrome of menopause. And, you know, I think it is worthwhile to yes, see a physio, but probably see someone like yourself to see if hormones, in addition to doing some of the physical stuff, could could help clear up those things as well.

SPEAKER_00 42:46

For sure. The trouble with that is that they're not indicated yet or health candidate approved just for that soul treatment. But the the key to that is that the majority of women, if you're already experiencing some joint aches, you are, I would bet a large sum of money that you were experiencing a handful of other symptoms that you just didn't know were related. And so that's how we're able to then treat to help women feel better. And it's it's really a full-body experience, right? Which is amazing.

SPEAKER_01 43:15

So yeah, I mean, we've covered so much great stuff today. What I'm most excited about, and this is we we kind of chatted about this at the very beginning, is that we're diving in, we're doing a masterclass.

SPEAKER_00 43:26

Yes, we are. I'm so excited.

SPEAKER_01 43:29

Yes, Empowered Transitions is a masterclass that we are going to be launching in November. And I'll um include all the information in the show notes and make sure you follow Jessica as well as myself on Instagram and wherever you get your social media because this is what we want to be able to do is to help people to really demystify. And, you know, today we've we've gone over a number of things in the last, you know, less than an hour, but we've got 90 minutes through that masterclass. To really dive deeper.

SPEAKER_00 44:01

Yeah, I'm excited really to touch upon the pain points, right? These common things that we see in women and really, really dive into them and chat about it. It's it's gonna be a lot of fun. I love this. I love chatting with you. And I feel like there's so much value and so many, you know, women will learn so much from what we have to say that I'm pumped. And I'm really excited that we're including a question and answer period as well, right? So we can ask some very or answer some very specific questions. So I'm I'm excited. It's gonna be an intimate group and it's gonna be fun.

SPEAKER_01 44:32

Yeah, I think so too. And that's the value of doing it live. I mean, people can get the recording, but if you show up live, then you can get on there and ask your questions and get them answered in real time, which I think, you know, that that's the added value of attending the Empowered Transitions masterclass.

SPEAKER_00 44:50

Exactly. And we're also including a resource guide, aren't we? A PDF download with some symptom trackers and hormone timelines, some things that you can say to help advocate for yourself with your providers. So it's gonna be quite a quite a good little document to have on hand to support you through your journey.

SPEAKER_01 45:08

Yes, absolutely. And that's it. I mean, the education from both attending and getting that PDF, you know, hopefully we're gonna impact some people and send them on a journey where they have had some issues related to perimenopause or menopause, right?

SPEAKER_00 45:25

100%. Yeah, I'm so, so pumped for it. So, Kristen, I always love chatting with you. I feel like we could sit and chat for, well, we do sometimes for hours, but it could be like a week of just constant conversation and we would have so much ground covered, but still so much more to cover because it you're just the best. I thank you so, so much for coming back onto the Hot Flash Diaries podcast to chat about all things that we've talked about today and share your expertise. I mean, I really, really appreciate you. You know that you're one of my most favorite humans in the world, and I am so excited we're doing this masterclass together on November 13th. It's going to be in the evening. I think we still need to sort out the time exactly, but all of the information will be in the show notes. So I urge all of our listeners to definitely join because it's going to be a good time and you're going to learn so much. So thank you again, Kristen, and I hope you have the best day.

SPEAKER_01 46:15

Thank you so much. Jess has been lots of fun. And I enjoy speaking with you just as much, which you're right. We do spend a lot of time going back and forth. So thanks for having me on your podcast. I enjoyed every minute.

SPEAKER_00 46:28

Oh, always, and I'm sure I'll have you back on again very soon. Thanks, Kristen.

SPEAKER_01 46:33

Thank you.

SPEAKER_00 46:34

Have a good day, everybody. Thank you for tuning in to the Hot Flash Diaries podcast. I hope that today's episode left you feeling more informed and empowered. This is your safe space for honest conversation. So be sure to subscribe, share, and join again for more insights on reclaiming your health and wellness. Take good care of yourself and we'll see you next time.