Menopause: What to Expect & How to Prepare

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Katie: Hello and welcome to the “Valence Mama” podcast. I’m from And I’m here today with Dr. Leela Black Gumbs, a 22-year-old clinical training and certified family medicine doctor with Cleveland Clinic’s work medicine and urgent care experience. The practice is to focus on listening to your patient’s needs first, then keep them involved in every decision. As a mother of three and a yogi, she enjoys traveling in her spare time. She is accepting a limited number of patients nationwide through Std MD where she is a personal online concierge doctor. You can learn more about it in the show notes at And in this case we deal with peri-regal, hormones, menopausal. If you are in this phase of life, how to live with the least amount of discomfort possible, what do you need to know about hormone replacement, How does everything else come into play? That time of life so if you are in this stage or close to this stage, stay in touch. This episode is going to be a great one for you.

Dr. Leela, welcome. And thanks for being here.

Dr. Leila: Katie, thank you very much for having me. I’m glad to be here

Katie: I’m glad to have you here because you’re a subject matter expert that I get a lot of questions about that I don’t know the answer to, which is the cause of preemopause and menopause and what The best way is to navigate. Possible route with the least inconvenience. And I know this is something that you specialize in a lot. So, to get you started, can you explain exactly what Pyramid Nippos are and why women come of age?

Dr. Leela: All right. This is an interesting concept because we talk about menopause, as it really is a long period in life, when in fact it may take longer for the perimenopause. A woman can become a paralytic, which means around the time of Rajon, the sooner you know, by the mid-40s. And it can continue, depending on how long she stays on her period for 12 months, which is the definition of menopause. She can go up to 52, 53, 54. So it may take a long time to really fall into that category. And it really depends on the woman and a whole host of factors. Like she started her menstrual period? How many pregnancies, if any, did she experience? How long did she breastfeed?

And so this is a very exciting time and the symptoms are confusing. I am sure that the height of the symptoms, where we will enter a little, although this itself may last a few years. But women will start to see some changes in their periods, mostly early on as they move into their mid-40s. So this wide range of ages is leading a lot of women … I’ve even heard women in the late 30’s describe themselves as if they were in the premenopausal era. Sometimes with hormone testing we can tell where people are, but most often it is based on the clinical type of diagnostic symptoms that people cause.

Katie: Got it, so when Perry wants to be technologically admired, it’s not like it’s age or even the hormone test to explain it, but it’s based on the symbol. Is that it, I understand? So how can anyone know that maybe they will be in parampos and they need to keep an eye on these things or pay attention to those things?

Dr. Leela: Yes, of course this is a really good question, because explaining the pathogen is a little easier. This is the definition of menopause is not a cycle for a whole year. If you do not have a period of 12 months, you do not care what FSH is, which is a folic stimulation hormone. However, as with regression, it is true that there is really no lab test that can diagnose it and there is no specific age. As I mentioned earlier, you may start to have some periods, you may have tenderness of the breast, as you start to enter the periodontal period you start to lose weight and make some changes in mood. Can do. You may also have a slight warmth because this is the period when estrogen levels fluctuate from high to low. But progesterone is often quite low. Progesterone begins to drop below estrogen levels, probably about 10 years ago. It may be that in the early 40’s, progesterone levels started to go down. Therefore, such pneumococcal symptoms are known to begin.

Katie: That makes sense. So I’m curious, as I want to understand biochemicals about hormones and physiological what’s happening during the perimenopause? As a whole I guess the body is preparing to stop menstruation and undergo menopause, but which hormones are changing and tend to go up or down?

Dr. Leela: So in the beginning, like I said, you will be slower in progesterone preparation. Progesterone is produced primarily by what we call ovarian corpus luteum. And this happens every month after ovulation. When you become peri-menopausal, you have more cycles where you are not actually ovarian and thus you do not hide as much progesterone as you did in the past. So you will start to see a steady decrease in progesterone. Your estrogen levels can be very good and they can continue at pretty high altitudes until you finish the period. And that creates a problem called estrogen dominance, and we’ll be sure of that during this podcast. So you are seeing a decrease in progesterone, stable or normal estrogen. As you get closer and closer to menopause, you will also see a sharp decrease in the onset of progesterone.

In addition, you will start to see testosterone levels go down. And it also plays a role in symptomatic diseases, especially libido problems and energy issues. But we will not talk about testosterone today at all, but we do know that it is one of the three major hormones that are affecting or bringing about some of the symptoms we face.

Katie: That makes sense. And I would only guess based on my understanding of hormones from me, pregnancy and just the menstrual cycle, it seems like they are so interdependent. As one goes up or down, it can especially affect others in some ways. Is that true in Perry Menopause too?

Dr. Leela: Yes, that’s true. And, you know, other things like body weight can affect the severity of symptoms during the menopausal and menopausal period because remember, fat cells will build up estrogen in the body. And so, you know, one of the ways that you try to maintain your estrogen levels a little bit and avoid estrogen dominance is to try to maintain your body weight.

Katie: That’s good to know. And I know that applies to hormones, too, for people with PCOS or other hormone-related issues that can be really beneficial. Turning around to what you said at the beginning, with just an intensity of your curiosity, you said that like pregnancy and nursing and how many babies and how long it could potentially impact. The age at which one begins to enter this period. So I’m just curious to find out how it works, and whether you’re likely to go through it at a young age, for my own benefit. Because I have six children and I start babies to be pretty young, I am only interested in myself.

Dr. Leela: Yes. So the number of pregnancies and how long you need to nurture because remember we were born with a certain number of plaques in our ovaries. And while you are pregnant, of course, you do not have much ovulat and menstrual cycle during pregnancy. In most cases, you know, in 99% of cases you are not ovulation or having a period during pregnancy. And then for most of the time where at least if you are nursing enough, you know, that window is a place where if you are less than a few minutes a day nursing, you don’t even have to sit. This is why women do not get their periods immediately. And they can often go up to one year without any period. Lucky people, if they are nursing properly, they can go for a year without any period.

So these two things, pregnancy and nursing, help reduce the amount of actual periods you have, the amount of time you are actually ovulating. You can then go on for longer periods of time in your life if there is a fixed period of time left over. So if you have never had a pregnancy then obviously you did not have a nurse. If you have never had an abortion and you have started your period relatively early, you may have had to enter the menopause a while ago. It doesn’t always follow this rule book, right? But these are just the most common and thus affect both of those things when a person enters the perimenopause and can cause menopause. Does that make sense?

Katie: Yeah. By that, it makes perfect sense. And yes, it’s good to know that those factors can really affect it. You mentioned estrogen dominance a minute ago, and I know it’s a word I know for example in the context of PCOS. So I’m curious, can you, for someone you don’t know technically, explain what estrogen is and how it affects women in the premenopausal menstrual period and so on? Is?

Dr. Leela: Well, I said earlier that progesterone levels start to go down and estrogen remains very high. And in some women, their estrogen levels may be higher than normal. So there are some scenarios that can lead to estrogen dominance. One of them is that you are not producing enough progesterone, but you have got normal amounts of estrogen. When you look at this ratio, though your estrogen levels look modest because the progesterone is low, it throws out the ratio and so you have a lot of estrogen. Another scenario is that when you have high estrogen and either normal or low progesterone, then this will lead to a picture of estrogen dominance. And then the third scenario is that even if you live nearby or in the midst of you, say that your period has not been over nine months and your estrogen has already decreased, Estrogen can prevail with low estrogen because you have low progesterone. It can also be almost non-detectable because you do not have corpus luteum preparations. And so you are still going to be estrogen dominant.

And this is interesting because the more I study about it now, the more patients I’ve seen in this period of their lives, the more I find out that this is the picture we see. Are estrogen dominated women. And the symptoms you are seeing are, you know, those tender senses, fiber cystic senses, they are menstrual periods. , The mood changes. You can see a lot of mood swings as the estrogen levels swirl rapidly. We call them basal motor symptoms. These are your hot flashes and hot flushes, weight gain, especially around the stomach. Sometimes the hips can also be included. And also that we can see an increase in uterine fibers. As estrogen levels go down they usually improve a bit because of their lack of a better word by estrogen. So these are all signs and there are more, but these are the main symptoms that people will come across. Sometimes low albedo. During this time, many women complain of brain fog.

Katie: Okay. So if I’m assuming that estrogen dominance is really about ratio. It’s not like men can just take tests and put estrogen numbers in a vacuum and the doctor says, “Well, you have the estrogen dominance.” It is in relation to progesterone.

Dr. Leila: That’s right. So you can get the level of estrogen as well as the level of progesterone produced. And you know, there’s a debate over whether sputum, blood levels or serum levels are the best. I usually use blood levels. You know, I send somebody to the lab and I get estradiol levels and I get progesterone levels and I can do the math to figure it out. And it’s easy to know if a woman … especially if you see her progesterone is really, really low. For example, you want a ratio of one hundred to 200. And I will tell you the truth, most women who come into this period usually do not have a ratio of 100 to 200, and they are usually very symptomatic. When they see me So maybe that’s why we’re watching it.

Katie: Gutta So if it’s about proportion, is it as simple as raising a progesterone or more complicated?

Dr. Leela: Well, that’s a good question. And I think you’ve hit the nail on the head. And there are many ways we can do that. This does not automatically mean giving progesterone to anyone, but in many cases this is what we do. There are other things you can do to reduce estrogen dominance. You can give oral micronized progesterone. Usually we use, studies have shown about 200 milligrams per day. In women who are still menstruating, you can give it in the last half of your cycle. So usually it’s 12 or 14 days until they start menstruating. And for women who are not menstruating, we can give it all the time. We can give it daily. But some other things before going on progesterone, especially in women who are worried about taking any hormones, are definitely biodental hormones. However and this is the correct form of progesterone. This is not the same progesterone you get in oral contraception. But some women still want to try other things.

So one of the biggest things I want to encourage is diet changes. Things like increasing your fiber intake because fiber helps to remove some of the excess estrogen that gets in the way of your intestines. If you have a very low amount of fiber, what will happen most often is that you will rehydrate some estrogen that would otherwise pass through your stool. Therefore, the increase in fiber will help to bind and perform some of these estrogen molecules. One to two servings a day, most vegetables, I recommend. And one of the reasons is that they contain nutrients. خاص طور پر ایک ، جسے انڈول -3-کاربنول کہا جاتا ہے ، ایسٹروجن کو سم ربائی کرنے میں مدد کرتا ہے۔ اور اس طرح ، خاص طور پر ان خواتین کے لئے جنھیں ہم ICOM T اتپریورتن کہتے ہیں ، یہ ایک ایسی جینیاتی تغیر ہے جو کچھ خواتین کے پاس ہوتی ہے جس کی وجہ سے ان کے لئے ایسٹروجن کو آٹوماکسیٹ کرنا زیادہ مشکل ہوسکتا ہے۔

اور ہم ایسٹروجن کی ان تمام شکلوں میں نہیں جائیں گے جو زہریلے کے مقابلے میں غیر زہریلے ہیں ، لیکن کرسٹیفورس سبزیاں اور کچھ سپلیمنٹس جیسے DIM ، Diindolylmethane ایسٹروجن کو سم ربائی میں مدد ملے گی اور اس کو اس پاخانے میں سے گزرنے کی بھی اجازت دے گی۔ نیز ، ورزش اور تناؤ میں کمی۔ میں تناؤ میں کمی کی اہمیت کے بارے میں زیادہ مضبوطی سے بات نہیں کرسکتا۔ یوگا اور مراقبہ اور سانس کے کام جیسے کام۔ یہ سب ضرورت سے زیادہ ایسٹروجن کو کم کرنے یا ختم کرنے میں مددگار ثابت ہوسکتے ہیں اور جسے ہم پروگینولون اسٹیل کہتے ہیں ، جو آپ کو ایسے پروجسٹرون بنانے کی ضرورت ہے جہاں تناؤ کی وجہ سے ہوتا ہے ، کورٹسول بنانے کے لئے ایک طرح سے شٹلڈ کیا جاتا ہے پروجیسٹرون بنانا اور اس کے نتیجے میں آپ کے گردش کرنے والے پروجیسٹرون کی سطح میں کمی واقع ہوتی ہے۔

ایکیوپنکچر مددگار بھی ہے اور خواتین کی بے بنیاد موٹر علامات کی بہت سی مدد کرسکتا ہے۔ جس کا میں نے ذکر نہیں کیا وہ سب سے بڑی شکایت ہے جس کی وجہ سے خواتین آتی ہیں لیکن ضروری نہیں کہ وہ رجونورتی کا سب سے خطرناک پہلو ہوں۔ اور ، آپ جانتے ہو ، وہ قلبی ہوں گے ، ہڈیوں کے گرنے کا خطرہ۔ اور میں اسے صرف یہیں چھوڑ دوں گا۔ ہڈیوں کے ضیاع اور قلبی خطرہ کے عوامل۔ نیز ، کولیسٹرول پروفائل میں تبدیلیاں اور تغیرات۔ ہم دیکھیں گے کہ ایسٹروجن کی سطح میں کمی کے ساتھ ایسا ہوتا ہے۔

کیٹی: مجھے پسند ہے کہ آپ نے کھانے پر مبنی کچھ طریقوں پر توجہ دی کیونکہ یہ میرا پس منظر غذائیت کا ہے اور ایسا ہی ہے جیسے ہم سب کو سبزیاں کھانے کے ل even اور بھی وجوہات کی ضرورت ہو۔ لیکن وہ بہت سارے طریقوں سے فائدہ مند ہیں۔ اور میں نے یہ بھی پڑھا ہے کہ سبز سبزیاں میگنیشیم کی مقدار میں زیادہ ہوتی ہیں ، جو میں نے ذاتی طور پر پایا ہے اور مجھے لگتا ہے کہ بہت سی خواتین پائی جانے والی علامتوں کو کم کرنے میں مدد دیتی ہیں جیسے پی ایم ایس یا میرے لئے درد بھی۔ اور اس طرح میں یہ اندازہ کروں گا کہ شاید وہاں بھی فائدہ مند اثر ہو۔ اور میں یہ بھی پسند کرتا ہوں کہ آپ نے کارڈیو اور ہڈی لیز سائیڈ کو پالا ہے کیوں کہ آپ ٹھیک ہیں ، میرے خیال میں گرم چمک وہی ہے جو ہم دقیانوسی لحاظ سے رجونورتی کے ساتھ وابستہ ہیں۔ لیکن جو کچھ میں نے پڑھا ہے اس سے ، رجونورتی کے وقت ، خواتین میں دل کی بیماری کا خطرہ مردوں کی شرح تک بڑھ جاتا ہے۔ اور میں تھوڑا سا دریافت کرنا چاہوں گا کہ ایسا کیوں ہے اور اگر ایسا ہی ہے تو وہاں پہلو بھی ایسا ہی ہے کیونکہ خواتین ہر مہینے خون بہنے سے لوہا کھو رہی ہیں۔ کیا اس میں اور بھی عوامل شامل ہیں اور ہم اس کا مقابلہ کیسے کرسکتے ہیں؟ کیونکہ ظاہر ہے کہ یہ ہمارے معاشرے کا ایک بہت بڑا مسئلہ ہے اور یہ عروج پر ہے۔ تو عورتیں یہ جان کر کیا کر سکتی ہیں کہ اس میں جانے سے اپنے آپ کو اپنے تحفظ میں مدد ملے گی؟

ڈاکٹر لیلا: ٹھیک ہے۔ ٹھیک ہے ، ہم جانتے ہیں کہ قلبی مرض امریکہ میں نمبر ایک کا قاتل ہے اور یہ پوری دنیا میں تیزی سے ایک نمبر کا قاتل بنتا جا رہا ہے۔ جب ہم اپنی کھانے کی عادات اور فاسٹ فوڈ چینز کو دنیا کے دوسرے حصوں میں ڈھونڈتے ہیں تو ، ہم صرف ہر ایک کو اپنے ساتھ لیتے ہوئے دیکھ رہے ہیں۔ ایسا کہا جا رہا ہے ، ایسٹروجن خواتین کے لئے حفاظتی ہے۔ اور اسی طرح پری مینوپاسل خواتین مردوں کی نسبت دل کی بیماری کی ترقی کا بہت کم خطرہ رکھتے ہیں۔ اور اس طرح جو کچھ ختم ہوتا ہے وہ اس وقت ہوتا ہے جب ہمارے خون میں وہ حفاظتی عنصر نہیں رہتا جس کی سطح ہمارے پاس عصبی خواتین کی حیثیت سے ہوتی تھی ، پھر ہم مردوں کی طرح کچھ حد تک نظر آنے لگے کیونکہ اس کا تعلق ہمارے کولیسٹرول پروفائل اور اس کی نسبت سے ہے۔ دل کی بیماری کی ترقی.

اس کے بارے میں دلچسپ بات یہ ہے کہ ایسٹروجن ، جو ہمیں ویمنز ہیلتھ انیشی ایٹو میں ملا ، جو 2000 کی دہائی کے اوائل میں ایک مطالعہ تھا ، میرا یقین ہے ، 2001 جب شائع ہوا تھا ، اس نے طبی معاشرے میں خوف و ہراس پھیلادیا تھا کیونکہ ، آپ جانتے ہیں ، اس وقت ، تقریبا ہر مردودی عورت کو ہارمون کی تبدیلی کی کسی نہ کسی شکل میں ڈال دیا گیا تھا۔ وہ مصنوعی ہارمون تھے۔ ٹھیک ہے ، مجھے اس طرح سے ڈالنے دو۔ ایسٹروجن جزو پریمرین تھا جو گھوڑی کے پیشاب ، گھوڑوں کے پیشاب ، حاملہ گھوڑوں کا پیشاب اور مصنوعی پروجسٹین سے ماخوذ ہے۔ اس مطالعے سے جو بات ظاہر ہوئی وہ یہ تھی کہ جس چیز کو ہم VTE کہتے ہیں اس کے لئے خواتین کا خطرہ ہوتا ہے یا وینوس تھرومبوسس واقعات اس طرح بڑھتا جاتا ہے جیسا کہ ان کے دل کے واقعات ہوتے ہیں۔ اور اس طرح اس نے ان چیزوں سے ان کی حفاظت نہیں کی جس کے بارے میں ہمارا خیال تھا کہ ان کو ان اجزاء دے کر ان سے حفاظت کی جانی چاہئے۔ تاہم ، اور اس مطالعے اور اس اعداد و شمار کی ترجمانی کے لئے یہ ایک بہت بڑی بات ہے ، اس گروہ میں بہت سی خواتین تھیں جو رجونج کی وجہ سے 10 سال سے زیادہ تھیں۔ اس طرح ان کی عمر 60 سال سے زیادہ تھی۔

وہ اس پورے وقت کے لئے ایسٹروجن کے لئے بولے تھے۔ ان میں سے بہت سے ، یا ان میں سے بیشتر ، 10 سال یا اس سے زیادہ عرصہ گذرنے کے دوران کسی ایسٹروجن پر نہیں آئے تھے۔ اور اس کا تیسرا ٹکڑا یہ تھا کہ یہ وہی قسم کی مصنوع نہیں تھیں جن کی ہم اب گھوڑوں کے پیشاب سے تعل .ق شدہ ایسٹروجینز کی مخالفت کے طور پر ایسٹراڈیول کا استعمال کرتے ہوئے اس معاملے میں کشش لے رہے ہیں۔ اور پروجسٹنز جن کا میں نے تذکرہ کیا وہ زبانی مائکرونائزڈ پروجیسٹرون سے مختلف تھے جو ہم اب استعمال کرتے ہیں جو زیادہ جیو جیسی ہے۔ اور اس مطالعے کی تشریح نے واقعتا people بہت سے لوگوں کو استعمال کرنے سے خوفزدہ کیا اگر آپ اسے ہارمون ریپلیسمنٹ تھراپی یا رجونورتی ہارمون کا علاج قرار دے سکتے ہیں کیونکہ وہ نتائج کی مناسب ترجمانی کررہے تھے ، لیکن وہ مریض جو کلینیکل ٹرائلز میں تھے وہ مریض نہیں تھے۔ کہ ہم ابھی نشانہ بنانے کی کوشش کر رہے ہیں جو سب سے زیادہ علامتی علامت ہیں اور وہ رجونورتی شروع ہونے یا گذرنے کے 10 سال کے اندر ہیں۔

لہذا میں یہ واضح کرسکتا ہوں کہ اگر آپ کے پاس کچھ مخصوص سوالات ہیں تو ، لیکن صرف اتنا جان لیں کہ وہ… یہ بہت کیچڑ میں مبتلا ہوسکتا ہے ، ہے نا؟ کیونکہ ہم یہ کہہ رہے ہیں کہ ، “ٹھیک ہے ، آپ کسی کے ایسٹروجن کی جگہ لے کر قلبی خطرہ کا علاج کر رہے ہیں ، لیکن ایک منٹ انتظار کریں ایسٹروجن اور پروجیسٹرون یا پروجیسٹن زیادہ دل کے دورے اور جمنے کے واقعات کا سبب بنے۔ منقطع کہاں ہے؟ “یہی منقطع ہے۔ ہم اب ان مصنوعات کی مختلف شکلیں استعمال کررہے ہیں اور ہم خواتین کو پہلے شروع کرنے کی کوشش کر رہے ہیں۔

کیٹی: سمجھ گیا یہ سمجھ میں آتا ہے۔ ٹھیک ہے. لہذا میں ہارمون ریپلیسمنٹ تھراپی پر گہری بات کرنا پسند کروں گا کیونکہ مجھے معلوم ہے کہ متعدد قسمیں ہیں۔ آپ نے ان میں سے ایک جوڑے کا تذکرہ کیا ہے۔ اور یہ ایک آپشن ہے جو اکثر اس عمر میں خواتین کے سامنے پیش کیا جاتا ہے۔ اور میں جانتا ہوں کہ دواؤں کے عملی فعل کے نقطہ نظر سے بھی تھوڑا سا فرق ہوتا ہے جیسے سیدھے روایتی دوائی نقطہ نظر سے۔ لہذا میں متجسس ہوں جب کوئی مریض آپ کے پاس آجائے جو اس مرحلے میں ہے ، جس کے پاس کچھ علامات ہیں کہ اس کے پاس کون سے آپشن دستیاب ہیں اور آپ اس بات کا اندازہ کیسے کریں گے کہ کون سا بہتر ہے؟

ڈاکٹر لیلا: ابتداء میں میں یہ کہنا چاہتا ہوں کہ ، آپ جانتے ہیں ، خواتین ، ہم سب فرد ہیں۔ اور اس کے ساتھ اچھی بات یہ ہے کہ آپ واقعی بیٹھ کر کسی عورت سے بات کرسکتے ہیں اور معلوم کرسکتے ہیں کہ آپ کو کیا پریشانی لاحق ہے ، آپ کی علامات کیا ہیں؟ اور واقعتا میں یہی ہے کہ میں اپنے سلوک کو کم کرنے کی کوشش کرتا ہوں یہی ہے جو آپ کے معیار زندگی کے ساتھ مداخلت کررہا ہے۔ اور پھر زیادہ تر معاملات میں ، جیسا کہ ہم نے پہلے بھی بات کی تھی ، اس میں بیسال موٹر علامات ، گرمی کی چمک ، رات کا پسینہ وغیرہ بہت زیادہ ہوتا ہے۔ لہذا اس طرح کے کسی فرد کے ل we ، ہم جانتے ہیں کہ جب تک عورت اندر ہے اس کے رجونورتی کے پہلے 10 سال اور وہ 60 سال سے کم عمر ہیں ، خطرہ سے فائدہ اٹھانے والا تناسب ایسٹروجن کی تبدیلی کی کچھ شکلیں اس کے حق میں ہوگا۔ اس کے علاوہ ، یہ بھی یاد رکھیں کہ اگر آپ کے پاس بچہ دانی (بچہ دانی) برقرار ہے تو ، دوسرے الفاظ میں ، آپ کو کسی بھی وجہ سے ہسٹریکٹومی نہیں ہوا ہے ، پھر اگر آپ ایسٹروجن لے رہے ہیں تو آپ کو لازمی پروجسٹرون لینا ضروری ہے۔

تو جو ہم عام طور پر کریں گے وہی پیش کش ہے جسے ہم ٹرانسڈرمل ایسٹروجن کہتے ہیں۔ اور وہ ایک پیچ ہے۔ اور ، آپ جانتے ہیں ، تاریخی طور پر ، آپ جانتے ہیں ، ہمارے پاس عرصہ دراز سے پیچ آتے ہیں ، لیکن اب جو ٹکنالوجی ہمارے آس پاس موجود ہے وہ ہمیں جلد کے ذریعے جذب ہونے والی مناسب مقدار میں ایسٹروجن مہیا کرنے کی اجازت دیتی ہے۔ اسے جگر سے نہیں گذرنا پڑتا ، اسے زیادہ محفوظ شکل اور ایک بہت ہی موثر شکل بنا دیتا ہے۔ وہ ان گرم چشموں کے ل the سب سے موثر ثابت ہوگا۔ اور پھر پروجیسٹرون عام طور پر ایک گولی یا کیپسول میں پہنچایا جاتا تھا۔ دوسرے اختیارات کریم کی شکل میں اندام نہانی ایسٹروجن ہیں۔ اندام نہانی کے نسبتا میں کچھ خشک ہونے اور پتلی ہونے کے ل That یہ بہت اچھا ثابت ہوگا ، لیکن گرم چمک کے ساتھ یہ اتنی مدد نہیں کرسکتا۔ گرم چشموں میں مدد کے ل You آپ کو تھوڑا سا مزید نظامی چیز کی ضرورت ہے۔

ایسی خواتین کے لئے جن کا ایسٹروجن تھراپی سے کوئی برعکس اشارہ ہے ، ان میں سے کچھ چیزوں کے ساتھ دوبارہ شروعات ہوگی۔ غذا کے ساتھ ، آپ جانتے ہو ، فائبر میں اضافہ ، بڑھتی ہوئی سلیفیرس سبزیاں ، ایکیوپنکچر ، کسی کو DIM پر شروع کرنا بھی بہت مددگار تھا ، بعض اوقات ان علامات میں مدد مل سکتی ہے۔ اگر کسی عورت کو ابھی تک شدید گرم چمک نہیں ہورہی ہے ، لیکن اسے شاید بہت زیادہ خون بہہ رہا ہے ، بے قابو خون بہہ رہا ہے جس کی وجہ سے کچھ خواتین کو ہوسکتا ہے ، شاید اس سے پہلے پیری مینوپاسل پیریڈ میں ، بعض اوقات ہم چیست بیری جیسے کام کرسکتے ہیں جو آپ ہر روز لیتے ہیں . یہ اس کا دوسرا نام ہے Vitex ، V- I-T-E-X۔ بعض اوقات یہ خواتین میں ادوار کو منظم کرنے میں مدد دیتا ہے ، انھیں زیادہ قابل اعتماد بنانے میں مدد کرتا ہے۔ آپ جانتے ہو ، وہ شاید تھوڑا بہت زیادہ آتے ہیں اور ہوسکتا ہے کہ ان کا وزن تھوڑا کم ہو۔ اس سے پہلے کہ آپ کو کسی اور قسم کا ہارمون شروع کرنے کی ضرورت ہو اس سے تھوڑا سا وقت آپ کو خریدتا ہے۔

ایک بار پھر ، وزن میں کمی اہم ہے کیونکہ ایسٹروجن کی پیداوار جو چربی کے خلیوں میں ہوتی ہے ان جھولوں میں حصہ ڈال سکتی ہے۔ اور دوسری چیزیں جیسے شام کے پرائمروز کا تیل استعمال کیا گیا ہے۔ اگنس کاسٹس ، یہ ایک اور جڑی بوٹی ہے جسے کچھ لوگ استعمال کرتے ہیں۔ تو ہمارے آرمیمنٹریوم میں بہت کچھ ہے اور واقعی ہم میں سے بیشتر جو کچھ کرنے والے ہیں وہ یہ ہے کہ ہمارے سامنے بیٹھی خاص عورت کو دیکھیں اور ہم کہیں گے ، “ٹھیک ہے ، آپ کی علامات کیا ہیں؟ آپ کو سب سے زیادہ پریشان کن کیا ہے؟ ”اور اس وقت ہمارا سلوک کرنے کی کوشش کریں۔ اس کا مطلب یہ ہوسکتا ہے کہ ہم پانچ سے 10 سال کی مدت میں متعدد مختلف چیزیں کرنے والے ہیں۔ لہذا تھراپی جب وہ اپنے 40s کے وسط میں ہوسکتی ہے یا 40 کی دہائی کے آخر میں اس وقت سے تبدیل ہوسکتی ہے جب وہ 50 کی دہائی کے اوائل میں تھی۔ کچھ دوسری چیزیں جو مددگار ثابت ہوسکتی ہیں ہم یہ بھی کرتے ہیں کہ آپ کیفین کی مقدار میں شراب کی مقدار کو کم کرتے یا کم کرتے ہیں جس کی وجہ سے آپ شراب پیتے ہیں کیونکہ ہم جانتے ہیں کہ ایسٹراڈیول کی سطح میں اضافہ ہوسکتا ہے اور پروجیسٹرون کی سطح میں بھی کمی واقع ہوسکتی ہے۔ اور اس طرح کسی بھی ایسٹروجن غلبہ کو بڑھاوا دینے والا ہے جسے ہم پہلے ہی बेस لائن پر دیکھ رہے ہیں۔

اور آخر میں ، میں یہ کہوں گا کہ پلاسٹک اور اس طرح کے دوسرے Xenoestrogens سے گریز کریں۔ ہر ایک نے بسمفونیٹ A کے بارے میں سنا ہے جو بی پی اے ہے۔ لہذا جب بھی آپ پلاسٹک کے استعمال سے گریز کریں ، نہ صرف ، آپ جانتے ہو ، انہیں مائکروویو میں استعمال کرتے ہو لیکن پلاسٹک میں کھانا ذخیرہ نہ کرنے کی کوشش کرتے ہو اور اپنا پانی سٹینلیس سٹیل کے کنٹینر اور اس طرح کی چیزوں سے پینے کی کوشش کرتے ہو۔ اپنے کاسمیٹکس اور کسی بھی زینوسٹروجن کو دیکھتے ہو جو ان میں موجود ہو ، کیڑے مار ادویات کے ساتھ کھانے سے پرہیز کریں ، لہذا نامیاتی اور غیر GMO کھانے پینے سے یہ ساری چیزیں کسی کو پروجیسٹرون اور یا ایسٹروجن دینے سے پہلے ان علامات کا علاج کرنے میں مدد کرسکتی ہیں۔

کیٹی: ہاں ، مجھے اس سے بہت پیار ہے اور میں سمجھتا ہوں کہ یہ اس قدر اہم ہے کہ آپ نے جسم کے پورے حص approachے کو لینے اور عورت کے سامنے بیٹھے ہوئے کو دیکھنے کے بارے میں کیا کہا تھا۔ اور میں عملی دوائیوں کے ل for بہت خوش ہوں اور اس کے لئے اس طرح کے عروج اور عملی دوائی کے بارے میں سمجھنا۔ کیونکہ مجھے لگتا ہے کہ جب آپ زندگی کی کسی تبدیلی یا صحت کی صورتحال کے بارے میں بات کر رہے ہیں تو ، ڈاکٹر کے ساتھ کام کرنا بہت زیادہ مؤثر ہے جو ہر چیز کو دھیان میں لے رہا ہے اور اسی طرح ہارمونز کو ، آپ کو معلوم ہے کہ وہ سب ایک دوسرے کو متاثر کرتے ہیں اور اگر ایک ہوجاتا ہے۔ اوپر یا نیچے یہ دوسروں کو متاثر کرسکتا ہے۔ کم از کم میرے اپنے تجربے سے ، ایسی چیزیں بھی ہیں جیسے تھائیرائڈ فنکشن اور یہ کہ کس طرح پیریمونوپوز یا کسی ہارمون پہلو کو متاثر کرسکتا ہے یا اگر وہاں گٹ چیزیں چل رہی ہیں۔ آپ جانتے ہیں ، اگر لوگوں کے خالی جگہ میں ایسٹروجن کو دیکھنے کی بجائے اور بھی شرائط ہیں اور کیا یہ بہت زیادہ ہے یا بہت کم ہے ، تو یہ جسم کے پورے نقطہ نظر کو لے رہا ہے اور ان تمام چیزوں کی جانچ کر رہا ہے اور پھر مریض کے ساتھ مل کر کام کرنے کا اندازہ لگاتا ہے کہ کیا آپ اس شخص کی حیثیت سے جہاں آپ ابھی ہیں ، اپنی طرز زندگی ، اپنی غذا تبدیل کرسکتے ہیں اور کیا ہارمون متبادل کی طرح چیزوں کی ضرورت ہے تاکہ یہ پوری طرح سے جسمانی نقطہ نظر ہو۔

اور یہ صرف ، میں نے پایا تھا کہ یہ میرے لئے تائرایڈ کی بیماری اور اس کے ساتھ ساتھ اور بھی بہت سی بیماری ہے۔ آپ اسٹڈی ایم ڈی کے ساتھ کام کرتے ہیں ، جو ایک کمپنی ہے جس سے مجھے پیار ہے اور میرا ڈاکٹر بھی اسٹڈی ایم ڈی ہے۔ لہذا میں صرف یہ بتانا چاہتا تھا کہ کسی بھی شخص کے ل approach جو عملی دوا کے بارے میں تلاش کرتے ہیں جس کے پاس مقامی ڈاکٹر ہوسکتا ہے یا نہیں ہوسکتا ہے یہ ایک عمدہ طریقہ ہے کہ لوگ آپ جیسے ڈاکٹروں سے رابطہ کرسکتے ہیں اور ان سب چیزوں کے ذریعہ کام کرسکتے ہیں ، نہ صرف۔ کسی خلا میں علامت کی حیثیت سے دیکھا جانا۔ مجھے یہ بھی پسند ہے کہ آپ پلاسٹک کی پرورش کرتے ہیں کیونکہ یہی ان عنوانات میں سے ایک ہے جن کے بارے میں لکھنا اور تعلیم دینا مجھے پسند ہے اور میرے خیال میں یہ بہت اہم ہے۔ میں اس کے بارے میں خاص طور پر بچوں کے نقطہ نظر سے لکھتا ہوں اور جب وہ جوان ہوتے ہیں اور وہ اب بھی مستقل رہتے ہیں ، ابھی تک وہ بلوغت میں بھی نہیں گزرے ہیں ، پلاسٹک کو کم سے کم کرنا کتنا ضروری ہے ، لیکن آپ بالکل ٹھیک کہتے ہیں۔ میرے خیال میں ہمیں بھی اپنے لئے خاص طور پر سوچنا ہوگا اور خاص کر جب ہم کسی بھی ہارمونل دور سے گزر رہے ہوں۔ یہ اتنا اہم ہے۔ اور میرا خیال ہے کہ لوگ اکثر کتنا ضروری ہوسکتے ہیں۔

جب میں ہارمون کی تبدیلیوں کی بات کرتا ہوں تو میں اپنے لئے جانتا ہوں ، اور پھر بھی ، میں پیریمونوپوز سے نہیں گذرا تھا ، لیکن میں نے اپنے ہی ہارمونز کو متوازن کرنے پر کام کیا ہے ، مجھے یہ بھی پتہ چلا ہے کہ نیند جیسی چیزیں سخت ہیں۔ اگر مجھے کافی نیند نہیں آتی ہے تو ، میرے ہارمونز دور ہوجائیں گے۔ اور میرے لئے بھی ، سورج کی روشنی۔ And I’m curious if this is something that you found as well, but if I get up and go outside in the morning and drink tea or water or just be outside early in the morning, I find that it not only gives me more energy and helps my sleep at night, but that over time my hormones including cortisol, but also estrogen and progesterone have all seemed to get into better ranges. And I’ve done other things as well. But I’m curious if that’s something that you look at with your patients as well.

Dr. Lyla: Oh, absolutely. And thank you for bringing up just the intertwined nature of our organ systems and our hormones because you’re right that all of these hormones are important to understand your thyroid. You know, you can’t do this in a vacuum. You can’t treat someone in menopause and ignore what’s going on with their thyroid. It doesn’t always mean that something’s wrong with their thyroid, but we really need to rule that out as a contributing factor. As it relates to the last thing that you said surrounding the importance of sunlight and sleep, absolutely. So you know that not getting enough sleep causes in and of itself just that alone can cause stressors on the body, which are gonna increase cortisol. And remember I mentioned earlier in the podcast that when the need for cortisol production goes up because of chronic stress, including sleep deprivation, that you’re gonna be pulling away from the hormone cascade that makes progesterone. And so that’s gonna cause a problem right there.

So minimum, ideally of six, ideally more like seven to nine hours of sleep. And what we know is that DNA changes occur after just one night of getting less than six hours of sleep. And these DNA changes lead to an upregulation of your inflammatory what we call cytokines or inflammatory chemicals in your body and downregulation of the anti-inflammatory cytokines. And so what ends up happening is you have an inflammatory picture going on when these genes change. So you’ve gotta get enough sleep first and foremost. And then also the stress piece. We talked about that a little while ago. You really have to keep stress under control. And that means different things to different people. Sometimes it’s meditating. And I recommend all my patients to meditate. We could do a whole podcast on meditation. Sometimes it’s breath work. Sometimes it’s, you know, a walking type meditation, something that’s gonna calm your nervous system. So anything that brings you calm and comfort, you should do that every day for at least 20 minutes.

Sunlight, you brought up. I’m sitting here in front of my light right now because even though it’s still sunny and the weather is still not too bad in Ohio right now, I wanna get ahead of the game in terms of it’s gonna get dark here really soon. It’s gonna start getting dark early. It’s gonna be dark when I wake up. And so trying to get exposure to the sunlight if you can, that would be ideal because if you’re out and you’re walking, you’re getting exercise and you’re getting sunlight. However, for people that live in areas where it’s not as amenable to that type of activity every day, you can get yourself a light that provides at least 10,000 Lux, that’s L-U-X. And use that 20 to 30 minutes sometime shortly upon awakening. If you can get it in within the first four hours upon awakening, that would be great. And that will also help not only your mood, I don’t know that there’s any studies that will prove that lights like this will or sunlight, it in fact helps with hormone levels, but I think you’re onto something when you say that this has helped you because if it helps your mood and it helps your stress levels, then it’s by definition going to help balance your hormones.

Katie: That makes sense. And like you said, if it helps your sleep as well, like sleep is so, so key for, I find that more and more for every aspect of health. And also the stress component you mentioned. That was the one I ignored for a lot of years because I just thought I could power through and as long as I ate really clean and exercise and did all of that, I could just kind of power through the stress and the emotional side of things. And it wasn’t until I really dove in and addressed those things that I really started seeing those internal shifts and then also the physiological shifts that come with them. A few kind of a followup questions related to things we’ve talked about. So, so many of the things you’ve mentioned related to perimenopause sound like things I also hear from women with PCOS and I’m curious if there is any type of connection there and if people who have PCOS are more or less likely to experience symptoms more in perimenopause or to go through menopause earlier.

Dr. Lyla: So women with PCOS have a little bit of a different milled of symptoms. A lot of them, have because of the fact that they have so many it’s called polycystic ovarian syndrome because they have an increase in the number of cysts. They’re producing more testosterone. And so that testosterone is what kind of monkeys up, monkeys with their hormone kind of picture. I don’t know, honestly whether or not women with PCOS tend to have more symptomatic or less symptomatic perimenopausal periods. My gut instinct would tell me that they probably do only because most people with PCOS have spent decades with hormonal aberrations. And so why should it be any different during the perimenopausal and menopausal period of time? They also tend to have problems with blood sugars. And when you have blood sugar issues, that tends to lead to you know, weight discrepancies or having too much weight on board, which as we already talked about, can lead to increased production of estrogen and that estrogen dominance becoming again a problem.

So yes, the symptoms can sound very similar. And, you know, let’s face it, a lot of the symptoms that we’re talking about are sometimes sort of vague symptoms that a lot of us complain about. Fatigue and moodiness and, you know, acne and these kinds of things. So, you know, we’re gonna see them across the board in women with different reproductive type conditions. We can treat them very similarly. People that come in with PCOS though I’m gonna have probably a different mindset as it relates to, “Okay, which hormones do we wanna treat here?” And it’s also gonna depend a lot on their age.

Katie: Gotcha. And then as another followup to that I’m curious about different methods of birth control and how they might impact people and their experience in peri-menopause and just hormonally overall. Because I know there’s a lot of options out there and I get a lot of questions from women about this and I have no idea, and I’m not a doctor, so I don’t answer them. But I’m curious how, if they do come into play, how they come into play?

Dr. Lyla: Well, so the interesting thing is what we often see is that women that enter this period because they’re having these irregular periods, oftentimes very heavy periods because of the high levels of estrogen and the anovulatory cycles that they might experience because of the low progesterone or as a result of low progesterone. We’ll see them get recommended to have, say a Mirena, which is a progesterone eluding IUD placed. Because that will help provides for a local installation of progesterone in the area of the uterus. It can help reduce bleeding and oftentimes just stops periods altogether which can by women a few years before they actually enter menopause. So it can really reduce the amount of bleeding and blood loss that women experience.

Some women are treated with low dose oral contraceptives. Because remember when you’re perimenopausal, you’re still capable of becoming pregnant because you do ovulate sometimes and if you ovulate and you have intercourse, you can become pregnant. So some doctors will use various types of oral contraceptive, usually combination contraception. However, women that are over 40 and or women that smoke may be more at risk for blood clots if they’re on oral contraceptives. So that’s less and less common. We see that less and less commonly nowadays. And that’s certainly nothing that somebody in functional or integrative medicine probably would recommend.

I think it’s definitely worth, especially for the women out there that don’t tend to go to the doctor a lot. If you’re on an oral contraceptive, you may not really see a lot of these changes because you’re gonna be getting a pretty constant dose of estrogen and progesterone throughout, you know, the days that you’re taking your tablets. So you may not get as much of the hot flashes and your periods are gonna be regulated. However, it might be worth for sure a visit at age 48, 49 to start discussing how to manage these symptoms or how long you should continue to be on the oral contraceptive therapy. And I say that because of what I mentioned a minute ago about the risk for blood clots, especially if you have a family history of blood clots. It may be advisable to come off of that and to choose another course of therapy.

You definitely wanna wait until you’ve been off of your oral contraceptives for a period of time, at least four to six weeks before checking hormone levels because clearly if you’re checking them while you’re on those types of hormones, it’s gonna throw off the results. So having an appointment 48, 49, no later than 50 to discuss, “Okay, I’m entering this age range where most likely I’m gonna be entering menopause.” And the average age in the US is 51 for women becoming menopausal. And so while there is a range of typically four to five years on either side of that, I think going to the doctor no later than age 48 would be advisable to see if there are some other ways to manage this period of life in the safest way possible.

Katie: That’s, yeah, great advice.

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Katie: For me personally, I’ve never been on any form of hormonal contraceptives at all, but I track my cycle using several apps actually in NFP and body temperature. I hope I still have quite a bit of time before peri-menopause. But I’m curious for those of us who do track our cycles, you mentioned that like cycles can space out. Are there other changes that we would begin to notice if we were actually like watching for fertile signs? Would like a certain phase of the cycle tend to lengthen? Would it be like the luteal phase or what would we see there?

Dr. Lyla: Yeah, so typically your cycles are gonna get the time between your cycles, say your typical period might be every 28, every 29 days. They tend to get a little bit shorter. And that variation tends to be the luteal phase where that’s actually shortening. And that’s what accounts for the change in the overall cycle length. More often than not, you’re gonna see women that have heavier bleeding maybe more clots. And it can be a little off putting. Women often will come in iron deficient at this point in time because they’re having such heavy periods.

You know, it’s interesting to know that the average woman should typically only lose about 35 MLs of blood per cycle, and that would equate to about 70 spoons of blood. Women that are in the perimenopausal period can lose that in a day or in two days of their cycle or even shorter than that. So you’ll find that maybe you’re going through more tampons or you’re going through more pads, or if you use a menstrual cup, it’s filling up within a few hours as opposed to the 12 hours they say that it’s supposed to last you. Those are indications that you’re probably beginning to have lower progesterone levels and entering perimenopausal time. Another symptom would be of course the hot flashes and sometimes they’ll only happen at night. You might just wake up a little warmer than you typically would. So those are probably the main kind of alerting symptoms that you’re gonna see. So, you know, watching those cycle lengths on your apps can be the first tip off before you’ve even gotten any breast tenderness or anything like that.

Katie: Okay. Awesome. That’s great to know. And as we start to get towards the end, I’m curious, we’ve talked about a lot of these symptoms and what to look for. Is and I know that the understanding is that women think they’re gonna have these symptoms, especially in menopause, are the symptoms avoidable to some degree or completely if women are willing to kind of take this broader functional medicine approach that you talked about and address diet and lifestyle as well as hormones? Have you seen women go through perimenopause and menopause much more easily by doing that?

Dr. Lyla: You know, it’s interesting because you’ve talked to women I’m sure that have said, “You know, I hardly had any hot flashes. I had the easiest menopause known to mankind.” And they’re not always women that are seeing functional medicine doctors. You know, sometimes it just really depends on the person, their family history, their, you know, obviously diet and things like that. I would say this, I would say that in the vast majority of women that are really symptomatic, seeing the right, you know, practitioner can really, really make a difference. Making these dietary changes, losing weight, sometimes it’s putting on weight. If you’re underweight, sometimes putting on weight will help a little bit. Exercise. Can’t stress enough the stress reduction. All of these things can definitely ameliorate the symptoms of menopause.

And when all else fails, you know, we know that estrogen combined with progesterone will help symptoms. And more and more information actually has come out that even progesterone alone, micronized progesterone, like I said, 200 milligrams daily in a postmenopausal woman sometimes is enough. Sometimes they don’t even need to resort to using an estrodiol. It just is gonna be so individual. And so I really urge people to have that conversation with somebody that they trust. Read, read, read. There are all kinds of… Well there’s lots of things out there that you probably don’t wanna read, but there are really good Christiane Northrup’s book ”The Wisdom of Menopause.” It’s an older book, but there’s really a lot of good information in that book. And I think just really getting to know A, your body and B, paying really close attention to when an intervention is tried taking good notes and really being able to document how did that intervention work for you because it’s not always gonna work the same for every individual. And talk to your physician about the results of any interventions that are tried because if it’s not working, working together, the two of you can figure out something that will work. It may take some trial and error and it may take a little bit of time to get it right, but that’s so important. And don’t hesitate if something’s not working to bring it up and just keep plugging away at it because you can get relief.

Katie: Absolutely. And I mentioned SteadyMD kind of in the middle of the episode and there’s gonna be links to both SteadyMD and to you directly on steadyMD in the show notes at So if any of you guys are listening and you are in this phase of life you can definitely find and work with Dr. Lyla or any of the doctors at SteadyMD. But anything you wanna say about SteadyMD or how people can find and work with you.

Dr. Lyla: Well, the great thing about SteadyMD really is, you know, I’ve found in my past 19 years of practice that one of the biggest complaints of people is that they can’t get in when they need to get in. They don’t have the access that they want or that they need. People are busy nowadays and they really need, if they have an issue, they need to be able to get into their doctor. And sometimes two, three, four weeks isn’t fast enough. So with SteadyMD, you have access to somebody that is aligned with your thought process and your philosophy for health and you have access to them and they’re gonna get back to you. The app is great. The video chat is to me as good as being there in person. And so I feel like I can really help improve access. I can see people from all around the country.

Another piece of it is that, you know, if there’s issues with these types of symptoms, I can order labs and you can take them to your local lab. You don’t have to fly to Cleveland, Ohio to see me. And so I really like the convenience of it. The piece about, you know, they typically, when you sign up for SteadyMD, you take this quiz and this quiz will kind of match you with the doctor that has the most similar outlook or philosophy to yours. And so you’re gonna end up with somebody that you didn’t just pick out of a book because they were on your insurance. You’re finding somebody that’s very aligned with the way you look at the world. And I think there’s nothing better than sitting and talking with somebody that thinks the same way you do. You don’t spend a lot of your visit trying to convince the doctor that this is how things should be or this is what you’re experiencing. So that I think it also makes it a very efficient service.

Katie: I agree. And I think a link to find the quiz is So if you guys are listening, it’s really quick, easy quiz and like Dr. Lyla said, it connects you with the doctor who’s gonna agree with you. You’re not gonna have to fight your doctor about nutrition or the fact that you want to take a natural approach. They’re amazing. I love my SteadyMD doctor and I think this was a super, super helpful podcast episode. Like I said, this is an area I don’t have experience with and I love that you jumped in and answered all these questions and provided so much value. So Dr. Lyla, thank you so much for being here today.

Dr. Lyla: Thank you, Katie. I look forward to talking with you again and I hope this has been helpful to your listeners.

Katie: It absolutely has. And thanks as always to all of you for listening and sharing your valuable resource, your time with both of us. We’re so grateful that you did and that you are here today. And I hope that you will join me again on the next episode of the ”Wellness Mama” podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.

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