Please note: Transcripts not 100% accurate.
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Menopause can last up to 10 years. So for most women it’s sort of around four to five, but this can be up to 10 years. So a lot of women are starting to get perimenopausal symptoms in their late 30s.
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This is Dr. Meenal and welcome to Uncover Your Eyes, where we uncover reality. As a mom and eye doctor, I wanna know it all. Women’s healthcare has really come to the forefront. Healthy aging, healthy living, and healthier wellbeing. We have come to a time where we are done with stigmas and done with closed doors.
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around women’s health issues. Today I have with us Dr. Amy Louis-Bayliss, who is a menopause specialist and the co-founder of Loom Women’s Health in Toronto. She’s an educator and an advocate for women’s healthy aging. Her interest stems from years of frustration in treating illness in the ER once it was already too late.
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Her website sums it up perfectly. Welcome to a new era in women’s healthcare where we get to rewrite the rules for life as we age. Welcome Dr. Louis Bayliss. Thank you so much, Amy, for being on today. Really appreciate your time. I’m thrilled to be here. So, you know, tell me, I know you were an ER doctor and there’s this story about like ER to Loom Health. Tell me how.
01:43
Why? Yeah. I get asked this all the time and it is a big pivot, so I understand. But actually, when you hear my story, I think you can understand how I ended up from A to B. So my background, you’re right, is in emergency medicine. I did a specialty. So I did five years of residency in emergency medicine. And during that time, I actually had a really big focus on medical education. And I think this is important because education has always been…
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my passion and has really been actually what I loved most about my job. And a lot of women will say to me, you had an opportunity to educate in the emergency department, but I actually think it’s one of the best places to provide education. Women, men, like kids, elderly, they come.
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because they’re worried, right? They’ve Googled something, you know, they’re scared for their health, they don’t know what’s life threatening or not, and there’s an amazing opportunity to provide education around symptoms, what do you need to look for? And I saw lots and lots of women over my career with gynecologic issues. So for example, women coming in with heavy menstrual bleeding around perimenopause, and having the opportunity to educate over what’s the emergency, what’s not the emergency, what do you need to do about it?
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As time has gone on, I’ve come to realize that the education that I received 20 years ago, I went to medical school 20 years ago, really didn’t provide the education that I needed to treat perimenopausal and menopausal women. Simply it was a lecture once that said, menopause is the end of your periods and you can’t get pregnant and then I really had no education after that. And as I started…
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entering my own 40s. My friends are talking about perimenopause. I started thinking a lot about, why do I not know anything about this? What can I be doing in my 40s to prevent the heart attacks that I’m seeing all the time? The osteoporosis, the dementia, the caregiver burnout, the frailty, and I started learning about menopause. I actually saw a lecture by a gynecologist, Natalie Gamache, and…
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I was blown away. I could not believe that this was not part of our curriculum. I was a faculty lead at U of T. This was not any kind of curriculum that was part of even the modern, for the modern day medical student. And I really saw an education opportunity for myself. And I started talking and educating about healthy aging. And I really saw that there was an unmet need for menopause care.
04:19
You know, right now women are waiting two years to be seen in menopause clinics. And so I applied to the college to retrain. I was actually approved to do it. I’ve had great mentorship under Dr. Wendy Wolfman, Alison Shea, Dr. Alison Shea. And now I actually provide menopause care. And one of the big parts of the care I provide is around healthy aging and disease prevention, which I think really aligns with having spent a career seeing.
04:48
disease once it’s kind of too late. You’ve had the heart attack, you’ve broken your hip. So why, I mean, it’s a simple question, but loaded, but why are hormones so important in women? Like why is it that these are shifting so much that it’s so important? Yeah. So I wish I could share a graph, but really what’s happening in your body between regular ovulation and your regular reproductive years and menopause?
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is a change in your right from a regular ovulatory cycle. So where you’re ovulating every single month. And most of us have had at least a period of time in which we’ve had regular periods that are very predictable, you know, every kind of 28 days. And what happens is this is a transition between ovulating regularly, a regular reproductive cycle to never ovulating again. So menopause is actually the day when you have not had a period for 12 months.
05:44
And the transition from regularly ovulating to never ovulating again is called perimenopause. And during that period of time, your hormones are actually all over the place because some months your body’s actually still trying to ovulate. Sometimes it double ovulates. And when that happens, you actually have high estrogen, which is the early part of perimenopause. And this is experienced by most women with breast tenderness, moodiness.
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really, really heavy periods. Heavy periods are a really significant part of perimenopause. And then eventually, you’re no longer really, the ovulation starts to really stretch out. And that’s when we’re really starting to see the periods starting to skip. They’re starting to space out. And without that development of an ovule, we’re not getting estrogen. And without having estrogen, we actually start to experience very low estrogen. And this is when we start to have the hot flashes, the night sweats.
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more irritability, there’s mood symptoms, there is insomnia, you may start to feel vaginal dryness, skin dryness, some people have tinnitus. And the reason why this is important or why your hormones are so important is we actually have estrogen receptors all over our body. This is not just a reproductive organ. There’s estrogen receptors on our skin, in our ears.
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actually around our eyes, when we get some women get dry eyes in our mouth, in our brain, in our blood vessels, in our muscle, around the vagina, the bladder, the bones. And so what happens is when we transition into a period of regular estrogen production to no estrogen production, our body starts to go like, what the heck is happening? And we start to see signs.
07:32
of low estrogen state. And that’s really what makes us symptomatic and provides the classic symptoms that women have. And because we have estrogen receptors all over our body, it can cause a multitude of symptoms. And that’s where I think there’s so much misinformation or misdiagnosis out there is a lot of clinicians aren’t taught about the myriad of symptoms. There’s actually up to 30, 40 symptoms that have been identified as part of menopause. But also these low estrogen states
08:02
have an impact on key disease processes that women are at risk for. So for example, osteoporosis. Low estrogen has a direct impact on osteoporosis. In fact, most women lose up to 10 to 12% of their bone mass just going through the menopause transition. Estrogen has a direct impact on our blood vessels. So they become a lot more stiff. And so our risk for hypertension goes up.
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estrogen has an impact on our muscles. So how well does our muscle utilize insulin? And so it really puts us at risk for insulin resistance and has an impact on our blood sugar and our cholesterol. So that’s why understanding your hormones and just really being educated about what the heck is happening to your body is really important. So correct me if I’m wrong. So what we’re saying is during this perimenopause to menopause shift,
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this hormonal change actually can put you at higher risk of diabetes? Yeah, it’s actually true. So what it does is it increases your risk of insulin resistance and with increased insulin resistance, that’s the precursor to type 2 diabetes. In fact, for some women and not all women, hormone therapy may be a reason to consider hormone therapy for…
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diabetes prevention. Women that are on hormone therapy actually do have an improvement in their blood sugars. Wow. So typically, I mean, is that age shifting? You know, when we think about menopause, we think 40 plus. Is that age shifting to younger? Like when are women expected to have these types of symptoms? When is the general age range? So the age of menopause itself hasn’t changed. So the average age in Canada, it’s been pretty stable for I would say the last 10-20
09:48
So that is the average age that a woman will go 12 months, like I said, without a period. That day is menopause, and then from then on you’re in post-menopause, which for most women can be up to 40% of their lives. But what has garnered attention, and I think rightfully so, is that perimenopause can be just as much of a problem for women in terms of their experiences, in terms of heavy periods and hot flashes as the menopause itself.
10:17
menopause can last up to 10 years. So for most women it’s sort of around four to five, but this can be up to 10 years. So a lot of women are starting to get perimenopausal symptoms in their late 30s. And so I think there hasn’t been a shift to a lower age. I think there’s been a shift to attention about menopause in younger women that hasn’t been there before. So are women suffering with these perimenopausal symptoms for those 10 years until they reach that menopausal stage?
10:47
Well, they can be if they’re offered proper treatment. So the good news is, is there’s actually great treatment options for this. It’s hard navigating care in Canada. I can’t I can’t deny that. But you’re some women can have symptoms for a very long time. In fact, black women are actually and Hispanic women tend to have worse menopausal symptoms and longer menopausal symptoms than their white or Caucasian or Asian counterparts. Wow. So.
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Would you consider women who are experiencing this in their late 30s or early 40s, premature menopause, perimenopause or earlier menopre perimenopause? So would there be reasons for that? Like they’re not eating healthy or certain reasons for what would be those reasons for premature perimenopause, I guess.
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So premature perimenopause to me is a little bit different than premature menopause. And the reason is once you kind of hit menopause, that’s when we know your estrogen has dropped to zero. And in perimenopause, you can have a lot of fluctuations where you actually have high estrogen. And so that risk of disease isn’t really there. You’re having the heavy periods. And so there’s a risk of potentially anemia, but that risk of bone and heart and brain health really doesn’t happen until you’re no longer ovulating
12:09
dropped very, very low. So any woman under the age of 45, if they’re starting to skip periods or their periods have stopped altogether, I do think we’re a little bit more of a workup. The most common cause of a period in your 30s, sorry, of menopause in your 30s is actually iatrogenic, which means we do not have a great explanation for it. We can’t find it out. It’s usually diagnosed by blood. So…
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symptoms, you’re no longer getting periods, and by blood test, a blood test called FSH or follicle stimulating hormone. After that, the next most common cause of menopause in your 30s is actually induced menopause. So, women who have had chemotherapy or radiation for maybe uterine cancer, ovary cancer, bladder cancer, or any kind of chemotherapy for any cancer regimen.
13:01
A lot of women with breast cancer are put on medications if they have hormonally mediated breast cancer. And these medications actually induce menopause. We’re actually, they’re trying to suppress the ovaries. And so they’re in chemically or medically induced menopause. There are some endocrine disorders, really abnormal thyroid, adrenal gland causes that can cause early menopause. And then there’s some genetic factors.
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that can contribute to menopause as well in a much earlier age. But most of those women tend to not even really develop periods in the first place with the genetic diseases. So I know you listed like so many symptoms. What would you say are the most common three or four that you see every day coming in of perimenopause? Just for the women out there to know, but also…
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as healthcare providers, right? We see patients that are women all the time, but we’re not always so receptive to their symptoms being symptoms of perimenopause, but being able to direct those patients to the right providers like yourself. So what would those kind of warning signs or most common symptoms be, would you say, if you had to sum it up? So, I mean, hot flashes and night sweats are major players. They’re very, very common symptoms of menopause. I do wonder if…
14:23
One of the reasons why I see so many hot flashes and night sweats is because doctors refer to me and they recognize that very classically as being a menopausal symptom. I would say the other three that I see the most, one would be mood. So 60% of women who go through menopause actually develop new onset mood symptoms. And so this can be depression-like symptoms, anxiety-like symptoms.
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If you’ve had depression before, anxiety before, it could be a reemergence of it. Irritability is a big piece. Actually, there was a study that came out a few months ago, and one of the really common symptoms of perimenopause is this kind of, it’s that you can’t really define what I’m feeling. It’s a feeling of, I just don’t feel like myself. And I’ll see a lot of women where they’re like, I’m having hot flashes, they’re not that bad, but I just don’t feel like myself.
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And that can be a really common symptom. And then the fourth one, the two others that I see quite a bit are vaginal dryness. And I think it’s worth discussing because vaginal dryness is an incredible part of the perimenopause and menopause transition that impacts so many women, their relationships. It ends up with women having a lot of painful sex or not having sex at all.
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And this is progressive. You don’t kind of transition through it. You’ll continue to have vaginal dryness for the rest of your life if you don’t do something about it. And we have great treatment options. And then the fourth one, which is very, very common is the weight gain. And so the average amount of weight gain through menopause is about five pounds. And also there’s a redistribution of fat from our thighs and our bum to our belly area. And so a lot of complaints around weight gain in my practice for sure.
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And what would you say, like I know you mentioned, there’s a lot of treatment options for, there’s hormone replacement therapy, there’s for vaginal dryness, things like that. What are the most common sort of treatments that you’re putting a lot of your patients are on? Are you using a lot of hormone replacement therapies? What are the most common?
16:29
Yeah, so hormone therapy is the gold standard of care for hot flashes and night sweats that are bothersome to women. So I do prescribe quite a bit of hormone therapy. I use the term menopause hormone therapy as kind of the new term because we’re giving back estrogen to try and dampen the symptoms, but we’re not completely replacing the estrogen in the same way we would maybe if you went into menopause in your 30s and 40s.
16:57
And so for menopause hormone therapy, I would definitely say I’m prescribing that for hot flashes and night sweats. I do think it’s worth a trial of hormone therapy for women with mood symptoms, especially if they have other symptoms like hot flashes and night sweats. Also, if they’ve had symptoms related to mood changes around low hormonal states in the past. So for example, when you’re postpartum, your estrogen is also very, very low, which is why most women have
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dry vaginas, dry skin, and they are at risk for postpartum depression and postpartum mood changes. Your estrogen drops right before your period. So women that have PMDD or PMS type symptoms, mood symptoms around their periods, are also going to be hormonally sensitive to the menopause transition. So women that have had those changes, I’m definitely more likely to talk about hormone therapy as a treatment option for sure. Hormone therapy does not help with weight gain.
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If you are having lots of hot flashes and night sweats, it will 100% help you feel better. But hormone therapy for isolated weight gain, it’s not going to be helpful. So at that point, I talk quite a little bit more about lifestyle changes and some of the changes that you may need to make compared to what you did previously. Hormone therapy is very, very effective for vaginal dryness as well. It’s a local vaginal estrogen. Almost anyone can have it. A 90-year-old can have vaginal estrogen and it’s very, very effective.
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There are women that can’t have hormone therapy. So if you’ve had a history of hormonally sensitive cancer, if you have had a heart attack or you have significant heart disease, you have liver disease, you would not be a candidate for hormone therapy. And for those women, and actually some women don’t even like hormone therapy. They take it and they feel rotten on it. So it’s not for everyone. And for those women, there’s non-hormonal options as well.
18:45
So we use medication, some of them are from the antidepressant group. So even though we’re not using it to treat necessarily depression, if it’s for hot flashes, it does work quite well. There’s a new medication that’s hopefully coming to Canada next spring. It’s called a Thasolinotin, and it actually acts right on the brain. So we know that hot flashes are a neurologic phenomenon. And I think this will be a great medication. You can take it if you have a cancer history and is already being used in the United States.
19:13
Amazing. So are there risks involved? I know a lot of women are kind of nervous about taking hormone hormone therapy. Are there risks involved or do you feel like they should, you know, you want to give them advice to not make them so scared or shy away from hormone replacement therapy? Yeah, this is a great, great question and want to get asked every single time I’m at work. So a couple of things is one, we have now come to understand that there is a window of opportunity
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where the benefits of hormone therapy far outweigh the risks. And that window of opportunity is really in a woman who’s under the age of 60 or who has been less than 10 years since menopause. And the reason is, is we believe, we don’t know 100% for sure, but we believe that if your estrogen kind of goes very, very low and we give a little bit back close to when your estrogen was still dwindling, there really aren’t really that many, there’s not really that many risks.
20:11
to taking the medication. I’ll talk about the risks in the second. However, if you’ve gone 10, 15, 20, 25 years without your body seeing any estrogen and you give it back, once you’re in your 60s, 70s, and 80s, your risk of disease is already there. Like over time, your risk of heart disease has already established itself. We think the combination of giving estrogen back with the development of the risk factors, it may actually worsen your risk for heart disease. And so…
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we really use this window of opportunity where the benefits outweigh the risk to really make a decision. When I give hormone therapy, the biggest risks are the side effects associated with hormone therapy, to be honest. So some women get some breast tenderness. Some women find that they’re quite moody from taking estrogen. Some women find that they’re quite bloated and permetrium, which is the progesterone that goes with estrogen.
21:01
can cause bloating, it can cause somnolence and make you sleepy. Some women like that, some women feel terrible on it. There can be actually more moodiness instead of less moodiness. So the side effect profile is actually, it can also cause vaginal spotting. So the side effect profile is actually what I say we need to manage the most. And then there’s like the big risk factors that we need to talk about. And for the most part, the-
21:24
biggest risk of hormone therapy is the development of a blood clot. And this is way, way less than the risk associated with being on the birth control pill. In fact, we think it’s somewhere between three and five of every 10,000 women. And we think that risk is almost completely mitigated if we use a transdermal or so like an estrogen gel or a patch. The risk of breast cancer is the one that comes up probably the most. And the risk of breast cancer has been completely overblown.
21:54
For a woman who has had a hormonally mediated breast cancer, we would not want to give them hormones back. But even if you’ve had a family history, the risk of breast cancer from taking this small amount of hormones that come with hormone therapy, the most that we have ever seen in a study, in studies, is an increased risk of seven per every 10,000. So it’s still a very small risk. And we actually have medications now that we can use or hormone therapy.
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combinations that we actually believe decrease your risk for breast cancer. And so for a woman that might have a family history or may have high risk family cancer in their family, for a woman who’s very, very nervous, we actually have options that we think decrease the risk of breast cancer that we can use. Wow. That’s really interesting. So with these therapies like HRTs, what like is this going to, are these therapies going to help women?
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with their risk of that cardiovascular disease, that diabetes, like is that one of the benefits of using hormone replacement therapy? Another great question. So what we know is the big three diseases that impact women that we think are impacted by the menopause transition are dementia, heart disease, and osteoporosis.
23:11
So we do obviously have risk for cancer as we get older, but we don’t believe that the menopause transition has a big impact on our cancer risk. It’s really age, just getting older, that increases our risk for cancer. And so we do know that hormone therapy can help prevent osteoporosis. In fact, it’s FDA approved for prevention of osteoporosis. So one of the pieces that I talk to my patients about, especially as they come up to the age of 50, you need to be 50 for a diagnosis of osteoporosis.
23:40
is do you have risk factors that would make me more nervous about you developing osteoporosis? So for example, do you have a family history of osteoporosis? Has your mother fallen and broken her hip? Have you had a history of a wrist fracture? Even a wrist fracture or foot fracture puts you at risk for osteoporosis. Did you take certain medications like steroids? Maybe you had asthma, maybe you have an autoimmune disease that would increase your risk. Alcohol increases your risk.
24:09
There’s something called a FRAX tool, F-R-A-X. You can go to Osteoporosis Canada and you fill in your age, your weight, your family history, some personal history, and it tells you what your risk is, your tenure risk of osteoporosis is. And so for women that are actually at very high risk, the use of hormone therapy to prevent osteoporosis can be very, very helpful. 30% reduction in hip fractures. So we know that hormone therapy works for those women.
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despite what you may hear in media, we do not have robust evidence to say that putting all women on hormone therapy is going to help prevent women from developing heart disease or dementia. And this is because we’re really giving a small amount of estrogen back. We’re not giving the quantity of estrogen that you had when you were in your reproductive age. And so we do not believe that the estrogen that we’re giving back is enough to really mitigate the risk of heart disease and dementia.
25:06
We don’t think it makes it worse. And in some studies, it actually shows that it made it better. But those women were also having hot flashes, night sweats. They showed that they were very hormonally sensitive. And so for everyone as a panacea, as a wonder drug, hormone therapy in terms of preventing dementia or heart disease were not there yet. So what are the sort of lifestyle, I guess, modifications that women should be making when they feel they’re in those age groups?
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or having those symptoms versus taking medication that might help mitigate that risk of cardiovascular disease and dementia. So I would challenge that it would more, it’s beyond might help. We think that 80%, 80%, eight, zero percent of heart disease is actually from modifiable risk factors. Wow. You can have an unbelievable contribution to whether or not you develop heart disease.
26:03
We think 20% is genetic and the rest is really modifiable risk factors. Now, some of those risk factors you need to modify with your family doctor. So hypertension and high cholesterol are both modifiable risk factors, meaning that with proper treatment, they can be controlled. But those are those are things that you would be that would be managed with the family doctor. You can modify your blood pressure and have an impact on your blood pressure by, you know, having a healthy weight.
26:31
by exercising, but you may require medications. Most women don’t feel high blood pressure. So part of this is actually making sure you follow up with your doctor and you get assessed. High cholesterol, same thing. You don’t feel high cholesterol. I will say the majority of women that I see through the menopause transition have borderline cholesterol. So this is something that’s really worth keeping an eye on. With my patients, we calculate your risk for disease. We get right on the computer and check it. And then we make a really…
27:00
We make an informed choice over whether a statin or a cholesterol medication is the right medication for you. Same with using the FRAX tool to decide whether or not getting on top of the osteoporosis is there. When it comes to things that you can be doing at home, there really is no bigger or better intervention than exercise. And I really, really believe this. And in terms of exercise, what I really try and encourage women to introduce into their regimen,
27:28
you know, one that most women do not do is strength training. And 95 of us do not strength train. And the reason why strength training is so important is twofold. One is it helps preserve bone mass. So strength training actually has an impact on our bone mass. It can help prevent osteoporosis. The second piece is muscle mass is something that we lose after the age of 30. So most women lose.
27:54
know, about 1%, but 1% a year. By the time their women are 80, they’ve lost like over 50% of their muscle mass. And sarcopenia impacts us in multiple ways. One, it increases our risk for metabolic disease. We really can use our muscles to help with insulin resistance, to help with our metabolism, to help with a healthy weight. But also muscles help with stability, help prevent you from falling. They’ll help with recovery if you do fall.
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We also know that strength training has a significant impact on the brain. So it helps impact your risk of dementia. It impacts your mood and decreases your risk of depression. It helps you sleep better. Sleep is very important in terms of a lifestyle factor that impacts disease.
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It helps with, what else does it help with? Your blood pressure, it helps with your cholesterol, it helps with your blood sugar. So it really is a wonder drug, muscle, and it’s something we should be really working hard to preserve. Now, I imagine most women that are listening to this may not be strength training. So how do you get started? And I think what’s important here is you can start small. So 15 minutes twice a week is actually enough to get some muscle benefit. There’s YouTube videos.
29:11
Peloton has getting started videos. With myself and my girlfriends, we split the cost of a personal trainer. And 10 of us go, we split the cost, and we really work on lifting weights in a safe environment. Nutrition is important. And the two pieces that I’ll say with nutrition, because most women know what they should be eating and shouldn’t be eating, is one, alcohol really needs to be considered.
29:39
if you’re drinking every day or drinking more than a couple of times a week. We know that alcohol has a significant impact on dementia risk and a significant impact on bone risk and heart disease. So alcohol is something as women I think we should be thinking a lot more about. Protein is a macronutrient that most women don’t meet their daily nutrition goals. And if you’re going to be weightlifting, you really want to get the benefit of
30:06
having the protein to go with it. Sleep is important, of course, and does increase your risk for disease. And really a lot of women are at increased risk for sleep apnea as they get older. And we do know that estrogen, lack of estrogen does affect our ability to sleep, like have a deep sleep. So a lot of women wake up at two, three in the morning. And so there’s a couple of things that can be really helpful for that. One is cognitive behavioral therapy for insomnia. You can actually even do some online.
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that are available and developing great sleep habits. The last piece I would say is being socially connected, having social interactions and managing your stress are very, very helpful for, and we know actually are modifiable risk factors for dementia prevention and stress can definitely impact your heart. That was so great. Are there certain…
30:59
vitamins. Sorry, I know this is like a complete sidebar, but I was just thinking about it because I take magnesium, right? And I know that it helps with calming me down and there’s the sleep benefits. Are there certain vitamins? I’m not saying they’re going to be right for everybody, but that you generally are telling patients to take or women in that age group. Yeah. So the supplement industry is, I think it’s like a $3 billion industry in North America.
31:27
And I would say the majority of women that I see, they’re health literate, right? They’re going out and they’re looking for menopause support and then they get referred to me. And most of them are on three, four, five supplements. I would say for the most part, you are better off taking your money and investing in someone to help you with strength training, especially if you have osteoporosis or you have injury. Trainer could really help at least get you started on a program where…
31:55
you’re not at increased risk for injury. The other one, may I add, is using machines at the gym. So they are also really helpful for injury prevention. There are, however, a few supplements that I do think are well validated and worth considering for every woman. So the first is vitamin D. In North America, most women are vitamin D deficient. I will check a vitamin D level on most of my patients once just to see where they stand. And I would say at least 90% of these women are vitamin D deficient.
32:24
So vitamin D is mostly absorbed to the sun and because we live in the Northern hemisphere, we just don’t get that absorption and most of us use sunscreen. So vitamin D supplementation, you’re looking for anywhere between 600 international units and 1000 international units a day. If you are overweight, you may require actually more. So somewhere between one and 2000 units a day. The other supplement that I recommend is calcium. If you are not getting calcium from your diet alone, calcium from your diet is
32:53
better than calcium in a supplement. And the way you know whether or not you’re meeting your calcium goals is you can go once again to that Osteoporosis Canada website. You can put in your daily kind of food diary and they’ll let you know whether or not you should add a calcium supplement. My first recommendation would be see if you can add it in nutritionally, but if not, we’re really aiming for up to 1200 milligrams of calcium a day.
33:16
Magnesium has mixed evidence. I wouldn’t say it’s a slam dunk in terms of taking it. Some women swear by it for sleep, especially magnesium by glycinate at 200 milligrams. I would say try it, and if it helps you with your sleep, take it. There is some evidence that it also helps you with better vitamin D absorption, but I wouldn’t say it’s- The most important. Yeah, I wouldn’t say it’s robust evidence.
33:40
The two other supplements that I talk to women a lot about are iron. So a lot of women with those heavy periods during perimenopause require some kind of iron supplementation. But once again, it would be based on what your iron level is. I don’t think it’s for everyone. And then the last one, which I’m really excited about and is getting a lot of attention is actually creatine. So creatine monohydrate. And so the caveat being that the studies have shown the…
34:06
best results in women who are strength training or exercising regularly. The benefits haven’t been there as much in women who are not. And it is showing incredible benefits for muscle mass. So maintaining muscle mass, preserving bone mass. So actually impacting risk of osteoporosis. And there’s two recent studies that have come, just come out in the last six months. One’s looking at cognitive performance. So may help with brain fog and cognitive performance as you age. And the second is actually sleep.
34:35
it helping with sleep. So the average dose that’s being used is about five grams. It can cause bloating. And so for women that I find it causes bloating for, you can divide it like two and a half grams in the morning, two and a half grams at night. You could work your way up to five grams. Darren Candow is the like leading expert researcher on this and he’s actually Canadian.
34:58
And so you can also follow Darren Candow, C-A-N-D-O-W, if you want to find out more about it. But I think we’re gonna see creatine being used a lot more and more as time goes on. That’s so interesting. Okay, that’s great. So tell me, like, I mean, you must have a lot of women coming in or even healthcare providers like myself, that kind of have these myths, right? Like, what are the most common myths that you wanna bust today, right? Where…
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women listening to this podcast or healthcare providers can help educate their patients better? Another great question. So some of the myths that are out there, I would say number one, my most passionate is just that disease and aging is inevitable. I do think that we have the ability to impact what our health looks like 10, 20, 30 years from now. And the diseases that we see are diseases that have occurred over a long period of time.
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heart disease doesn’t really happen overnight. It’s been 10, 20, 30 years to get you there. And so being motivated to make an effort on your health now will benefit you now, but it’ll also benefit you as you age. So I think really not being passive about what aging looks like to you, I think is a big one. I have a lot of women tell me that their doctors or healthcare providers have kind of said,
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You know, oh, this is just a stage of life menopause is just a stage of life And you just kind of have to like get used to it by some extra fans and I would challenge that I think we’ve got great great treatment options both hormonal and non hormonal options and I think if you’re struggling if you’re having bothersome symptoms like it’s worth seeing if medication works for you Accessing a doctor can be hard, but we’re
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really trying our best to be healthcare advocates and try and arm women with the information that they need. One of the great resources that I think is available to Canadian women is something called the MQ-6. It’s a quiz that was developed by Susan Goldstein, who’s a family doctor in Toronto. And this really allows you to sort of do a quiz to see whether or not your symptoms align with menopause, but it also gives you kind of a treatment algorithm that you can take to your family doctor.
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So it almost like takes the guesswork out of the family doctor and kind of helps the family doctor in terms of helping manage and manage your symptoms. Another myth that I think is really, really prevalent is that painful sex is a normal part of aging. And I see so many women who are either continuing to engage in painful sex because it’s important to the relationship or are no longer having sex at all.
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which I would say is even more common than having painful sex, because they are having so much pain, they’re experiencing terrible vaginal dryness, and no one has provided them with the education and the options for them to be having a healthy sex life. And I think this needs to change. So as I kind of mentioned before, the genital urinary syndrome of menopause,
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which really is a fancy word to say the vaginal changes that happen with menopause are progressive. They continue and continue unless you do something about it. And it can cause tearing with intercourse, it can cause bleeding with intercourse and pain with intercourse. And vaginal, there’s multiple options, including vaginal estrogens, there’s a vaginal DHEA, there’s even a pill that you can take that really can mitigate this risk that are extremely safe. You can even take this if you’ve had breast cancer.
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So we don’t think this is systemically absorbed. And so women shouldn’t have to advocate for themselves. They do believe this should be part of a comprehensive assessment with the doctor in which the doctor brings it up, but unfortunately we’re not there yet in Canada. And so advocating for these treatment options I think are really important and I think can be actually life-changing for women. Yeah, you know, one of the things you talked about, like the painful sex and…
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I mean, I see the flip side, right? Where you’re having painful sex and that’s affecting your relationship and then mental health, right? So I want to urge our listeners that hormone replacement therapy, first of all, is not dangerous in some cases or in most cases. And then secondly, there are other options when they come to the right provider and discuss options or other things. So I think a lot of women shy away from seeking help because they just assume.
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the answer is HRT, right? They assume that they’re just gonna need hormone replacement therapy, but I think it’s worth the conversation, seeing a provider like yourself and talking to them about what they want is important and that there are options. Yeah, and I don’t think there’s a woman I’ve seen yet who I haven’t been able to provide some sort of support for. And one of the things I’ll say on our first meeting is, I’m going to come up with a treatment regimen right now that I think will help you.
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but it may not be the right solution. So let’s give it a go and let’s develop a relationship in which you can come back, be transparent with me. And if we need to change around the regimen, we change around the regimen. But trying something and it not working or doesn’t mean you failed treatment options for menopause. There are multiple options to work with and it just may take a little bit of time to get it right. Thank you so much. This was so great. I wanna-
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I want to leave our listeners quickly with something that I got from your website because it inspired me. The words were, no more secrets, no more stigma, no more empty promises. Instead, unwavering support, empowerment, and advanced care every step of the way. I just got goosebumps again every time I read that, right? It’s so true. I think it’s so inspirational what you guys are doing. Tell us where…
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patients people can find you and do they have to be referred through their you know family doctor how can they get to you? So currently like August 2024 where I’m practicing now referral is required I’m practicing in Hamilton and in Oakville. I am opening a clinic in Toronto called Loom Women’s Health with three other incredible partners and you can actually self-refer to that clinic.
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There is some OHIP and non-OHIP funded services through there. I’m actually also in talks with going to a large hospital in Toronto to also contribute towards their menopause waitlist as well. And so a referral to me through there would be possible as well. I do a lot of advocacy work. I really, really, really believe that an informed woman has so much power.
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And so you can find me on It’s Her Time Canada. It’s a platform for women’s health advocacy in Canada. And then if you wanna find out more about our clinic or follow our journey along, our goal is to open this November. You can follow us at Lume Women’s Health, L-U-M-E. Perfect. Thank you so much. Oh, you’re so welcome. Really appreciate your time today. Oh no, thank you so much for having me and trusting me with your audience. Thank you listeners and viewers for tuning in.
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If you want to catch more episodes of Uncover Your Eyes, make sure to follow or subscribe on your favorite podcast platform and on YouTube. To learn more about me, follow me on Instagram @Dr.MeenalAgarwal Until next time, keep those eyes uncovered!