TRANSCRIPT

TNN Ep 58 | The Nuance of Menopause & Menopausal Hormone Therapy, Hormone Replacement Therapy (MHT, HRT, MHRT)

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[00:00:00] Karinda: okay, so we're recording.

[00:00:01] Julie: Yeah, yeah. No, always singing Mission Impossible.

[00:00:07] Karinda: Oh, I'm, it really wasn't our theme song?

[00:00:09] Julie: Mission Impossible?

[00:00:12] Karinda: No, I thought, no, I really, I thought you were starting to do our Nuanced Naturopaths theme song.

[00:00:17] Julie: I was, but you know, in the, in the same way that you, you try and do an accent and, and you, you know, try and do a Scottish accent and it comes out stand sounding Indian.

[00:00:27] Karinda: Ah,

[00:00:28] Julie: I was singing our theme song, but it was starting to sound like mission

[00:00:30] Karinda: impossible. So, so you, you pulled the plug,

[00:00:34] Julie: Pulled the plug.

[00:00:35] Karinda: But I thought you were just like coy about doing our theme song. That's alright. We'll let the, we'll,

[00:00:43] Julie: I can't remember it as well as I would like to

[00:00:47] Karinda: We'll let the theme song, do its magic on its own this time. And in fact, if you're listening to this, the theme song will start to fade out now, and I'll, I'll edit it as such.

[00:00:58] Julie: Future KariKarinda.

[00:00:59] Karinda: [00:01:00] Future KariKarinda as per usual, up to her antics.

[00:01:04] Julie: Mm-hmm.

[00:01:05] Karinda: What.

[00:01:05] Julie: Hello?

[00:01:06] Karinda: Is on. Oh yeah. Geez. Hello. Oh my God. Look, it's so rude of me. I'm trying to, I'm getting, getting straight to the point without even welcoming anyone.

[00:01:13] Hello. Welcome. Thank you for clicking or tapping on us today.

[00:01:18] Julie: Yes. Thank you very much.

[00:01:19] Karinda: We're

[00:01:20] Julie: Nice to be in your ears.

[00:01:21] Karinda: Nice to be in your ears. We are the nuanced naturopaths. I am KariKarinda.

[00:01:25] Julie: And I am Julie.

[00:01:26] Karinda: and we talk about complicated health stuff and we try to pull apart the nuance and we try to debunk myths. And we are naturopaths and we love natural medicine and holistic health, but rarely are the answers black and white. And so here we are uncovering all the gray and leaving you no clearer than we need.

[00:01:56] No,

[00:01:56] Julie: more questions than you came in,

[00:01:59] Karinda: yes.[00:02:00]

[00:02:00] Julie: but I hope that some people who are listening who maybe have had some strongly held beliefs, are open to some different ideas, some expanded ideas. I

[00:02:18] Karinda: mm

[00:02:18] Julie: that would be a good thing.

[00:02:19] Karinda: mm-hmm.

[00:02:22] Julie: Um, and I, I think the discussion that we have, uh, sometimes to clarify a subject where there is a lot of, a lot of, uh, variables and a lot of nuance.

[00:02:38] Karinda: Yep.

[00:02:40] Julie: hopefully that's what we are doing.

[00:02:41] Karinda: today is no exception to the rule. Hey,

[00:02:46] Julie: Absolutely. And by special request,

[00:02:49] Karinda: and by special request, we put poll.

[00:02:51] Julie: by poll

[00:02:52] Karinda: By poll. Um, yes. So if you don't follow us on Instagram, we are on Instagram, um, [00:03:00] @the.nuanced.naturopaths, and we just, we really like responding to what you want us to talk about. So we looked at our never ending list of episode ideas and put it out as a poll of like, okay, what do you wanna hear about next?

[00:03:13] And every option got voted for, but this was just the one that got voted for the most. So we thought, let's cover this first. And this episode is the nuance of menopause and hormone replacement therapy in a nutshell.

[00:03:33] Julie: And the changing attitudes and discussion around menopause,

[00:03:37] Karinda: Yes.

[00:03:38] Julie: Which is really reaching a peak, I think at the moment

[00:03:42] Karinda: yes,

[00:03:43] Julie: which is really nice.

[00:03:45] Karinda: yes. Yep. It's the dialogue. The conversation is just becoming more nuanced on its own. More people are talking about it. There's louder voices in the menopause and perimenopausal space. There's more information. [00:04:00] I think also many women are just kind of sick of not having been heard for however long, and people are like, nah, actually this needs to be paid attention to.

[00:04:14] Julie: Yeah. Yeah. And the stigma, um, that I think partly because it wasn't discussed, and so there was a lot of a misunderstanding around even what menopause is and when it starts and what the symptoms are and what it means. You know, and it's a normal natural transition in life, like puberty.

[00:04:41] Karinda: It's inevitable. Yes. It's gonna happen. And it's, it's crazy how much time we spend ignoring it or warding it off or being encouraged to like, or, you know, or not wanting to face it. In a way it's become its own kind of taboo and let the record show that my, the [00:05:00] biggest challenge that I will have with this conversation today is, kind of encapsulated by what you said, Julie, that like, menopause is natural and inevitable.

[00:05:10] And so what I struggle with is the line between pathologizing menopause as something that needs to be treated. The line between that and offering women going through this transition safe, evidence based support, that can drastically improve their quality of life. And that's where the HRT, so we'll be saying HRT, referring to hormone replacement therapy.

[00:05:42] And I've also seen, is it also being referred to as MHRT for menopausal hormone replacement therapy?

[00:05:51] Julie: There's, there's been a couple of changes in the, in the way that it's, referenced, and distinguishing it from other forms of hormone replacement therapy.[00:06:00]

[00:06:00] Karinda: Yep.

[00:06:00] Julie: Sometimes it's referred to as menopausal hormone replacement therapy. And sometimes, um, what was the other one? MHT I think was just menopause. Menopause hormone

[00:06:15] Karinda: Therapy.

[00:06:16] Julie: As in, it's not replacing, like

[00:06:19] Karinda: Ah.

[00:06:19] Julie: it is normal and natural to have a change in the hormones, in the balance of the hormones and in the, the amounts of the hormones in the body. This is what is meant to happen.

[00:06:33] Karinda: Yeah,

[00:06:34] Julie: replacing it is not really accurate.

[00:06:37] Karinda: that's a really great, wow, that's a great layer of nuance to cover like straight off the top, I, I hadn't even, I, I had seen the new acronyms coming out and I thought, okay, there's gotta be some reason behind it. And I just realized that the newer acronyms also help me feel better about it. That it's like, no, no, we're not out to replace what's being lost 'cause that's what our, what's in our [00:07:00] DNA to happen.

[00:07:01] We are supporting the woman via hormones,

[00:07:04] Julie: yeah.

[00:07:05] Karinda: to improve quality of life.

[00:07:07] Julie: Mm

[00:07:07] Karinda: and there's more to it. Do we start with what is menopause? What is perimenopause? Is that too broad? Is is that too easy for our listeners?

[00:07:20] Julie: No, no. I think that's a really good place to start. So perimenopause is the time before one year after your last menstrual period. So there, there is that, that time period, which is a bit of a gray area. The time before menopause is two to 10 years. So can be as early as in your, your forties. And then around about to 50, 51 to 53, I think is the average in Australia, uh, where women will transition into [00:08:00] menopause. So, uh, they have their last menstrual period, 12 months goes by, 12 months, and one day, yay, you've graduated and

[00:08:07] Karinda: You are officially menopausal.

[00:08:10] Julie: You are officially menopausal, post-menopausal

[00:08:13] Karinda: Okay. Technically. Yeah, because the menopause is that, I guess marked as like 12 months after the last period. So anything after that is post.

[00:08:25] Julie: yeah.

[00:08:25] Karinda: Cool.

[00:08:25] Julie: But of course, that gray area is,

[00:08:28] Karinda: Mm-hmm.

[00:08:29] Julie: where a woman will go. And I think pretty much every woman I've spoken to, every woman I treat says I got to 11 months.

[00:08:39] Karinda: Yeah. Yeah.

[00:08:41] Julie: And then I had one, then I had one in, in the next month.

[00:08:45] Karinda: Mm-hmm.

[00:08:45] Julie: what's going on.

[00:08:46] Karinda: Yeah.

[00:08:47] Julie: And

[00:08:47] Karinda: Very common.

[00:08:48] Julie: the last sputtering of, of the, the transition.

[00:08:52] And

[00:08:52] Karinda: Yeah.

[00:08:53] Julie: and then you go into menopause. The, the perimenopausal period is when most women [00:09:00] experience the most number and the strongest symptoms. And particularly in the last stage, there's kind of three stages of perimenopause. And as you transition into that last stage, that's when things really peak.

[00:09:14] And that mostly that's because you get these really high surges of estrogen then a drop and you get this, slow, kind of drop off of progesterone. So what it can mean is the relationship between those two hormones can be really vast from one day to the next. So that can really, cause some really strong symptoms, but it's, it's only a short period of time

[00:09:41] Mm-hmm.

[00:09:42] and it gets better.

[00:09:45] Karinda: And on that note, there will be factors that determine an individual's experience of perimenopause, right? Like they'll, I mean, I can only imagine there's so much. Well, I, well, not only [00:10:00] imagine, I do treat women going through severe perimenopausal symptoms. Um, but there are so many factors, right? That will make, you know, someone might go through that period a breeze and they don't even notice anything until their periods stop.

[00:10:16] Um, and then others it's like, what? That, you know, they might even be, I've, I've heard of people in their late thirties being like, what the hell is going on? And it's, it's the start of perimenopause.

[00:10:27] Julie: Yeah. Yeah. And there are a lot of symptoms I, that I think are very easy to attribute to other health conditions, because it, it can affect every part of the body in,

[00:10:40] Karinda: Mm.

[00:10:41] Julie: way or another. It doesn't mean that every woman is gonna experience all of those symptoms. I think on average, women tend to experience, you know, between three and five of the collective group of symptoms that they could experience.

[00:10:54] Karinda: Yep.

[00:10:54] Julie: So it might be, it might be joint pain, it might be headaches,

[00:10:57] Karinda: Mm.

[00:10:58] Julie: be, it might be [00:11:00] mood swings, it might be, night sweats or insomnia. It can affect any part of the body. And so I think sometimes it's easy to. Uh, you know, not even notice these things as being perimenopausal symptoms.

[00:11:18] Karinda: Yeah. And it's a good reminder that your, your sex hormones that govern your reproductive cycles, the estrogen, progesterone, testosterone, pretty much have a role in every tissue in your body. And so you could be experiencing symptoms and you're like," no, but that's not related to like the pelvic region or my ovaries or any bleeding that I'm having or my vagina.

[00:11:40] So like, is it, can it be, you know, menopause related?" And the answer is most likely yes, because if the hormones are changing, any tissue in your body could be changing and that including brain tissue. And I feel like that's the biggest one in terms of women noticing that they're thinking differently, they're perceiving things differently.

[00:11:59] I don't [00:12:00] know the statistic. You might have more information than me, but I wouldn't be surprised to learn that a significant amount of women maybe get diagnosed with certain mental health conditions sometime during perimenopause. Whether that's anxiety or depression. Um, or, or other things.

[00:12:17] Just 'cause there's so much changing in the brain.

[00:12:20] Julie: Hmm. I, I dunno what the statistics are either, but, because there's, there's another layer to this that we haven't mentioned, and that is the, the emotional side of things. You know, the, the emotional health of a woman who may be at the peak of her career, with teenage children, which can have, changing dynamics in the relationships with, with family members. They may also be looking after aging parents. And so the responsibilities and the, the activity level. Increases. And you then you are also [00:13:00] confronted with this apparent aging of the body because I mean, menopause and aging are two separate things. It just happens to happen at a period of time when you're getting older, but still two separate events, you know. And there's a lot of, there's a lot of anxiety about, beauty and desirability and women afraid to lose side of themselves. So that can add to the, um, and the, and, and depression as well sometimes

[00:13:39] Karinda: Yeah,

[00:13:40] Julie: along with, with changing hormone levels, which can make you more susceptible.

[00:13:45] Karinda: Yeah. Yep. It's a lot to navigate.

[00:13:50] Julie: Mm mm, It is.

[00:13:52] Karinda: So it was probably a couple of months ago that I [00:14:00] sent you a post on Instagram, and I actually, truth be told, I didn't even know. What we are, what we're gonna talk about more in depth today was what I had sent you, but I remembered recently I was like, I sent you a post, and the post was something along, along the lines of the FDA has removed the black box warning for certain hormonal therapies.

[00:14:22] And I guess, and I didn't even read into it that much, I just thought this, whatever this is, could be a great topic of conversation for the podcast. And then I guess more conversation around it recently resurfaced and it was put onto your radar as well. And, and here we are. So this is what we're gonna be diving into is how hormonal therapies have been used as insofar as, women, menopausally, seeking help for their symptoms from their [00:15:00] doctor or their gyno, I imagine, would be able to prescribe, and how the use of those therapies has changed and how the views on those therapies has changed from like past to now, given that there's just been this significant change in, there were warnings on these therapies and now they've just been removed.

[00:15:18] And there were studies on those therapies, where there was risk in, you know, um, implicated. And so lots has changed. So we're gonna unpack it a bit. And yeah, the warning is that there is gonna be lots of nuance there. There's gonna be lots of opinions as well as facts. And let's see where we land.

[00:15:37] Julie: Yeah. Yep. I, I, and perhaps we'll just reiterate, woman's experience of menopause is as different as every woman's experience of menstruation, of childbirth.

[00:15:51] Karinda: Yep.

[00:15:51] Julie: So the treatment, the symptoms and the outcomes of those things is gonna be different for every woman. [00:16:00] So

[00:16:00] Karinda: Yep.

[00:16:00] Julie: keep that in mind

[00:16:02] Karinda: Yes, yes, yes, yes.

[00:16:04] Julie: it.

[00:16:04] Karinda: No one size fits all, no blanketed approaches. Uh, this is also anything we say or share in this podcast. You can read the show notes below is not intended to be medical advice. It's not intended to diagnose, cure, or treat or prevent any disease or symptom. Please consult your healthcare professional.

[00:16:22] Julie: Absolutely. Also, we don't prescribe pharmaceuticals and,

[00:16:25] Karinda: Yes,

[00:16:26] Julie: replacement therapy is a, is a pharmaceutical medicine. You will need to speak to your doctor about whether it's appropriate for you.

[00:16:33] So hormone replacement therapy was happily being prescribed to many women until the, a couple of studies came out. One of them was the Women's Health Initiative, which was the largest health research project in the US time, which is 2002. And, the, it was, [00:17:00] it was a, a study of 161,000 women, broken into two groups. They were given Premarin, which is the synthetic conjugated equine estrogen, and the other group was giving, given the medroxyprogesterone. Now, both of those are, I don't like using the word synthetic because technically any medicine is synthetic.

[00:17:26] If it's produced in a laboratory, it's synthetic. But these are NOT bio-identical hormones. So the, the equine conjugated, estrogen is taken from mares urine. It's similar to human estrogen, but it's not the same.

[00:17:46] Karinda: Mm-hmm.

[00:17:47] Julie: And the medroxyprogesterone is a progestin. So that is a, uh, a molecule that is actually more alike testosterone [00:18:00] than, um, than progesterone that, that a woman makes.

[00:18:07] Karinda: And even then it's, it's not mimicking any of the, the sex hormones in our body exactly.

[00:18:14] Julie: yeah. Yeah. So. It was a very large study. It was actually stopped three years before the end of it because there were incidents of, a perceived increased risk of breast cancer, and there was some increased in heart disease and stroke. I should just say though, that the, the risk of breast cancer in that study reported by the media as being a 26% risk, increased risk, but in fact, that's eight out of every 10,000 women, is not statistically significant compared to the general [00:19:00] population.

[00:19:00] So it's not an increased risk.

[00:19:04] Karinda: Right. I see.

[00:19:07] Julie: The other thing is, there was another continued on part of that study. It's a bit confusing because the world, the Women's Health Initiative is a group and they performed a couple of studies, but then there was also the Million Women Study. And combined these studies, um, triggered an immediate response from, from experts who, um, withdrew hormone replacement therapy for women in menopause. And the summary of it is that the Women's Health Initiative looked at only one dose and one type of HRT or, or estrogen only HRT. The dose was more appropriate for younger women, [00:20:00] though most of the women in the study were, uh, over 60 and even over 70.

[00:20:07] Karinda: Yeah, the, the range was 50 to 79. Yeah.

[00:20:11] Julie: Yeah. And many of those women being, being older, that the dosage that they were given was more appropriate for a, for a younger woman. So it was inappropriate for them. it, because it was done in America, the profile of the American women in the study was quite different from, the million women study. And they tended, so they tended to be older. Because they were older, there was a, a higher absolute risk of stroke, heart disease and breast cancer, because it increases with age. So that wasn't really factored in. Majority of the women were overweight. And so that has an increased risk of heart disease, certain cancers of breast cancer. there was a [00:21:00] substantial number of dropouts then that wasn't explained well in the study. And we always like to see why they were dropping out. The methodology's been criticized because it wasn't a randomized control trial where you can actually say, intervention X equals this outcome. So that wasn't measured against say, a placebo?

[00:21:23] Karinda: Oh,

[00:21:24] Julie: Um, mm.

[00:21:25] Oh, sorry. This is the million women study.

[00:21:27] Karinda: Pardon me.

[00:21:29] So these were, these were at around, were these around the same time? The Women's Health Initiative and the, okay. Yep.

[00:21:38] Julie: Yeah. It was around, around about, I think it was 2005.

[00:21:42] Karinda: Okay.

[00:21:43] Julie: In the million women study, they, they recruited women who were already having a mammogram, which may mean that they were at higher risk of breast cancer because they're, you know, perhaps going into investigate a lump.

[00:21:58] So you've got a higher proportion of women [00:22:00] predisposed for breast cancer and then giving them the HRT. And follow up was done by reports from national cancer registries, not by subsequent questionnaires. So changes in HRT use after initial registration were not recorded. So, and the list goes on.

[00:22:22] I, I've heard a number of different, uh, summaries of how these studies were done. Generally, the methodology was not representative of the women of the dosage. The results were skewed and then misrepresented. And again, going back to the type of intervention, they were not bioidentical hormones.

[00:22:50] And we know now that these estin are proliferative to uterine [00:23:00] and, and breast tissues. And so they can potentially contribute to cancers, whereas the body identical hormones, uh, have a more protective effect on them.

[00:23:13] Karinda: Yep.

[00:23:14] Julie: So. The upshot is that this was then not prescribed to women who may well benefit from the use of identical, hormone therapy.

[00:23:28] Karinda: So again, we are finding that issue of misuse and misunderstanding of pharmacological language when we're the, the distinction wasn't clear enough between these body identical hormones and these progestins and,

[00:23:47] and it just, it, it, it baffles me that, you know, there's lots of factors when it comes to this issue, but it baffles me that it is possible that a lot of this comes down to language [00:24:00] and like, misunderstanding of,

[00:24:01] Julie: Mm-hmm.

[00:24:02] Karinda: Mechanism of actions of, of two different therapies that have just been classed under the same kind of therapy.

[00:24:08] Right? Like you could be getting two totally different outcomes, putting a woman on progestins versus, body identical progesterone. It's just really baffling to me.

[00:24:19] Julie: Hmm. And it's, it's, it's actually not just in these studies, but in subsequent studies using progestins,

[00:24:27] Karinda: Yeah.

[00:24:28] Julie: they are often referred to as progesterone. So this, this terminology confusion has

[00:24:34] Karinda: Oh yeah.

[00:24:36] Julie: and so it means that unless you are deliberately looking trying to, you know, tease apart what the studies used what the outcomes were, it's very easy for practitioners to not be clear on what they're prescribing.

[00:24:53] Karinda: Yeah, absolutely. And I remember if, if anyone is wanting like a bit more specific context or a deeper dive into that, [00:25:00] one of our, I'm, I'm sure it's episode four of the podcast, but um, I'll, I'll link it below. We did a little rabbit hole of like progestins vs progesterone, because I had found some research that, that included exactly what Julie just described, where they were just interchanging the two words.

[00:25:16] Like it was nothing. And I was recommending, wild yam based creams that had body identical progesterone in them. And these products were coming from the US and the, these products had that warning label of like, you are using a product that has been shown to increase the risk of uterine cancers.

[00:25:38] I think it was uterine cancer and breast cancer, you know. So, but when, you know, those findings are based on a, a, a entirely different substance. While we're at this point, I do also wanna say that when Julie and I were discussing this the other day, one of the first things that came to my head as she was sort of like, unpicking these [00:26:00] details and these analyses for me was that like, it's interesting that it's taken menopause for this conversation to come up because the basis of a lot of birth control pills and treatments for like PCOS or endometriosis are progestin based or include progestins.

[00:26:21] And

[00:26:22] Julie: Hmm.

[00:26:22] Karinda: It's, it's just interesting that, I don't know, has the risk been overstated for menopausal women, and then kind of dismissed for this broader category of, hormonal contraceptives, you know, that, that target younger women? And I, I don't even know what the conclusion is there, but it's just interesting that this is how it's come about.

[00:26:47] And I, I wanna just make sure that we are not just fully separating, like this stuff's for menopausal women and that stuff's for non menopausal women, you know, on just on birth control. Like, no, these are, these are interchangeable substances. Now, [00:27:00] yes, the dosage may vary, but it's the same thing.

[00:27:06] Julie: Yeah. And, you know, what are the implications for a therapy that has a proliferative effect on the cell, the, the endometrial cells in somebody with endometriosis?

[00:27:23] Karinda: Yeah. Yeah. Gosh, I wonder if that's been studied.

[00:27:26] Julie: mean, yeah, I'm sure somebody's studying it.

[00:27:30] Karinda: Yeah.

[00:27:31] Julie: No, and I think, I think you're right. The subject does need to be discussed broadly.

[00:27:38] Karinda: Yeah. Broadly and in, in distinct detail. No, no. Interchanging hormones with pharmaceuticals. Mm.

[00:27:48] Julie: Yeah.

[00:27:49] Karinda: Okay.

[00:27:49] Julie: So they were the flaws and, and so now, I think it was November, um, in the US it

[00:27:58] Karinda: Mm.

[00:27:59] Julie: that [00:28:00] the black box warning label

[00:28:03] Karinda: Mm-hmm.

[00:28:03] Julie: that was on HRT products, has now been removed. And they've acknowledged that maybe, that was a mistake to have that on there.

[00:28:16] Karinda: Hmm.

[00:28:16] Julie: maybe it is actually safe for most women to be using menopausal hormone therapy.

[00:28:27] Karinda: Interesting. Yep.

[00:28:29] Julie: Interesting. Yeah, we haven't had an announcement here in Australia as far as I know, but then we have a different regulatory body.

[00:28:40] Karinda: So what, and and 'cause I know we were talking about the percentage the other day, and I forget the exact percentage, but in terms of the impact of the black box warning was put on after these studies came out in the early two thousands and now they've just been reducted and it's like, what was the impact of that?

[00:28:57] 'cause I think at least in America, it did [00:29:00] significantly change prescribing behavior by doctors. Right. I think I, I feel like, look, it was a news article, but they quoted like something like 70% reduction in, in prescription, that women were just being dissuaded from, from using these products.

[00:29:17] Julie: Oh, I've got a note here saying 46% decline in HRT, but I

[00:29:23] Karinda: Oh,

[00:29:23] Julie: to 70 or 80%.

[00:29:25] Karinda: yeah. So mixed stats. So either way we can acknowledge there was a, this, the outcome of these studies and the media reporting on them changed, consumer behavior and prescribing behavior by practitioners.

[00:29:38] Julie: Real fear around it. I, my, my own mother who had been on HRT since she, uh, went into menopause, so she's been on it quite a long period of time.

[00:29:51] Karinda: Hmm.

[00:29:52] Julie: Her doctors just spontaneously took her off it, and that really distressed her. [00:30:00] And they, she tried other doctors that would prescribe it and because she was in a regional area, they few doctors and they were just not happy.

[00:30:11] Karinda: But now this is recently, right?

[00:30:14] Julie: Well, it's a couple of years ago. Yeah. But it's,

[00:30:17] Karinda: It, well, isn't it interesting that the, the, all the hubbub was early two thousands, maybe let's even say mid 2000 and tens by the time, you know, everything was reported and places caught up. So it's interesting that it had been that long, and it's almost like she was taken off it closer to this redaction coming out.

[00:30:38] Although further, and, and like, I, I will, I will do a little bit of, um, devil's, um, advocating because the question is like, I'm, I'm familiar with, with your mum's age.

[00:30:50] But the question is, do we have the long term studies to [00:31:00] show, like how long is it safe for? At what dosage are these even bioidentical hormone therapies, what dosages are they safe at? And for what period of time? And the word that came up the other day in our conversation was bridging; where's the bridge and where's the, and where's the limit?

[00:31:21] And, okay. Okay. Gonna get a little bit more exploratory here.

[00:31:26] We often vouch for patients to come off pharmaceutical products when we can see that the side effects are outweighing the benefits, when it's it's disturbing their quality of life or when we believe there has been a, sometimes really, unfortunately, just totally overlooked prescribing and, and a little bit negligent at some times.

[00:31:45] And we never tell people to come off their prescribed medications flat out. It's always,

[00:31:50] Julie: That's not our job.

[00:31:51] Karinda: Not our job. It's always, "please go back to your prescribing doctor. Please see your pharmacist and at least ask them about it." So we are often in [00:32:00] that role, but with, with these kind of therapies, they are akin to our natural sex hormones.

[00:32:12] So there's the aspect of natural, but then we've also acknowledged that menopause is a natural transition. So at what point, at what point are we really advocating for that prescribing versus advocating for not relying on these exogenous hormones. And at what point are we potentially, and this is probably happening on a more mainstream level compared to the patients that we see, but at what point are we neglecting fouKarindational health practices?

[00:32:49] Because you can just get rid of those symptoms with this, if you have vaginal dryness, well, yeah, we'll just give you estro gel, you know? If you are having hot flushes, [00:33:00] we'll just, you know, here's the patch or here's the cream. Or you can take it orally like. When maybe there's a huge diet thing or a huge metabolic shift going on that could be really well supported with a simple change in the movement regimen of that person.

[00:33:16] Julie: Yeah.

[00:33:16] Karinda: Increasing fiber or protein, you know, stress reduction practices. So I'm really trying to hold that line of I'm a naturopath and I want, and, and I think this is where it's slippery slope- I want women to have the care that they deserve.

[00:33:34] Julie: yeah.

[00:33:35] Karinda: I also am a strong advocate for women being really in touch with their innate cycles, menopause being included in that.

[00:33:45] And I don't just like, I don't want people to avoid their periods. I don't want people to avoid menopause and

[00:33:52] Julie: Oh,

[00:33:53] Karinda: I'm trying to toe that line. And I, I, I know, I don't have an answer by the way, like I'm just sharing my sort of raw, [00:34:00] progressing, opinion, but.

[00:34:02] Julie: yeah. Uh, look, I, I agree with you entirely. I really do because, the first question you've gotta ask is why do you feel you need support

[00:34:15] Karinda: Yep.

[00:34:16] Julie: hormones?

[00:34:17] Karinda: Yep.

[00:34:17] Julie: Because if it's, if it's something, I mean, given that once, once you, are in menopause, the symptoms that you experienced during perimenopause drop off.

[00:34:32] Karinda: Yeah.

[00:34:32] Julie: So you, you don't necessarily have those, those same really strong symptoms. So it tends to be when you get to that sort of last stage of perimenopause that women are really looking for support.

[00:34:46] Karinda: Yeah.

[00:34:47] Julie: They might go on MHRT, um, do you like how I'm switching the terminology all around. They might go on hormonal support [00:35:00] and then stay on it, they will naturally lose many of those symptoms. If it's something like vaginal dryness and, and it's causing, uh, you know, problems during sex or even, you know, some women find that just walking can cause irritation, and discomfort.

[00:35:25] Karinda: Hmm.

[00:35:26] Julie: You can also use some other really good natural treatments for the short period of time that that's an issue.

[00:35:34] Karinda: Yeah.

[00:35:35] Julie: Or, or maybe, maybe you need to have some more soy isoflavones. Maybe you

[00:35:43] Karinda: Yeah.

[00:35:43] Julie: flaxseed in your diet or some nice organic soy products

[00:35:48] Karinda: Yeah.

[00:35:50] Julie: It can be that simple for some women.

[00:35:52] Karinda: It can. And, and, and this is again where I'm really, um, hesitant about blanket approaches. And usually when things, when pharmac, [00:36:00] you know, dare I say pharmaceutical, pharmaceuticals being prescribed at kind of like set doses with not heaps of tailoring is a little bit of a blanket approach. Like so many different women, when you think about it. And like you point out that the time that they're probably most desperate to seek answers and to seek health help and support is when they're actually,

[00:36:22] they can't see it yet 'cause you can't know, but they're actually so close to those symptoms dropping off. And I think, and please like, let me know if you've had positive experiences with your doctor prescribing these hormone therapies in terms of a conversation being had about duration and a way to measure when,

[00:36:45] when it will no longer be necessary or suitable for you to be on those hormone therapies. I, I, I,

[00:36:52] Julie: Hmm.

[00:36:53] Karinda: not sure, I haven't sat in a doctor's office as a menopausal woman being prescribed, uh, MHT, so I don't [00:37:00] have the answer, but I can't imagine that there's a lot of those conversations happening. 'cause clinically I just don't see it reflected.

[00:37:07] I, I see women being stuck on birth control as well. I, I see women being stuck on birth control or just sort of like feeling, perhaps reliant on, reliant on these therapies for decades and,

[00:37:20] Julie: Hmm.

[00:37:21] Karinda: yeah.

[00:37:22] Julie: Well, there's also the prescribing that is done preventative as

[00:37:29] Karinda: Mm.

[00:37:30] Julie: And, and I, sorry, I do that. I mean, I'm not saying that it can't be preventative.

[00:37:38] Karinda: Mm,

[00:37:39] Julie: I, I, I, I'm like you, I, I always question a medication that is prescribed for, for the rest of your life.

[00:37:47] Karinda: yes. Yeah.

[00:37:48] Julie: I think you always need to ask, that appropriate?

[00:37:51] Karinda: Yep.

[00:37:52] Julie: Um,

[00:37:53] Karinda: And preventative of what?

[00:37:56] Julie: well say the, the, and the premise [00:38:00] is estrogen is supportive of brain tissue. So a, a lot of women are taking it because it makes them look younger.

[00:38:10] Karinda: And there's my beef. We have a fear of an, uh, lack of acceptance of the natural aging process. That was, that's not ingrained in us though. Like this is a product of society.

[00:38:26] Julie: yeah. We're, we're being sold this, this beauty myth, that beauty is only youth.

[00:38:33] Karinda: Yeah.

[00:38:33] Julie: It's only associated with youth. You, why can't beauty be, being recognized for the, for the wrinkles in your skin that you've gained through wisdom and experience? Why can't, why can't it be a body that has carried children and brought them up and nurtured them?

[00:38:54] Karinda: yeah,

[00:38:55] Julie: It's not gonna look the same as a [00:39:00] 20-year-old. It's just not.

[00:39:01] Karinda: And it's not bloody meant to.

[00:39:04] Julie: No,

[00:39:05] Karinda: So this is the thing, like when we, when we use the word, and obviously we would consider ourselves like in a sense, preventative, health practitioners. Do you know what I mean? That that's a lot of what we do. But it it, when it comes to, if the conversation is about preventing a natural transition,

[00:39:23] out of fear or out of, maybe even out of misinformation. Maybe there's a lot of misunderstanding about what menopause is or that it's an, again, the pathologizing of menopause. I think some people, perhaps, potentially even some doctors believe that it's just, it's, it's a pathology that needs treatment.

[00:39:44] Julie: Yeah. Well, I, I think if, if your practice is built around giving one type of intervention, let's say you've only got pills give out. [00:40:00] Then the way that you view your patients is gonna be through the lens of do I give them this pill or this pill? I know that there's more nuance in most doctors practice, but do have, there are limited forms of intervention, generally.

[00:40:20] Karinda: Yep. Yeah.

[00:40:21] And on that note, if I'm being, again, real devil's advocate, and these are, I'm just, I'm being a really lazy journalist at the moment. I'm gonna be doing the thing that news outlets do where they show, uh, like the equivalent of when they show, like someone's Twitter post as like, you know, to show, to show the viewers how the public is reacting to this.

[00:40:44] Um, uh, it's gonna be a little bit better than that. And, uh, my disclosure is, is that I haven't properly looked into this. I invite you to look into it, or maybe I'll look into it before I write up the show notes, if it intrigues you. [00:41:00] But this definitely spoke to a part of me. Now we have a naturopathic forum

[00:41:06] Julie: Mm-hmm.

[00:41:06] Karinda: A conversation came up around MHT.

[00:41:09] And, you know, a naturopath was pretty much just asking o other naturopaths, what do we think about this? Like, have you used it yourself? Like, you know, where do we stand? Like, what's, what's the vibe? And I will say most of the comments, let's see, there are 79 comments, and most of them are talking about how MHT has impacted them so positively, that it's taken away their depression, low energy.

[00:41:34] They didn't understand what was happening. And then they try, HMHT, usually in a topical form, I'm, I'm seeing a lot of, and, they, they're feeling like themselves again, if not like a brand new woman, they're at least feeling like themselves. Again, there were a lot of people saying that, it helps them maintain a sex life into their seventies and eighties.

[00:41:54] And that's, you know, that's a really high value for some people. Here's a comment [00:42:00] that I came across. And this just got me thinking. So let's see where this, whether this takes us to a discussion or not, that's totally fine.

[00:42:08] Julie: And this is a naturopath, right?

[00:42:08] Karinda: Um, and, and this is a naturopath? Yes. "Not so much a comment on the treatment itself, but a comment about the context of why you were seeing the campaigns." The poster mentioned that they were seeing a lot of ads for hormone therapies. "It is the first time in 20 years that there are new pharmaceutical HRT medicines being approved.

[00:42:27] So the marketing machine of pharmaceuticals is in the highlight the need phase beginning the solve the problem phase", which is very, very common, progression in marketing of anything. "Messages such as women deserve more, they have been excluded from studies. Women don't deserve to suffer the symptoms a man wouldn't.

[00:42:46] The Women's Health Initiative has been debunked are all part of the campaign, which can be found by looking at the US press releases for fami or EC 5 0 8 or others. The menopause societies [00:43:00] finally have funding to be more vocal and a quick check of the funding of guidelines slash sponsors are the pharmaceutical companies. Are they good or bad?

[00:43:08] No comment. Are we aware of the origin of the messaging? We should be." And I just think that is important to point out. And now we tell people to come and see us and we tell people all the ways that we can help them. We make money from that. That is how we make a living patients pay us. It's important to remember that

[00:43:31] the medicines that are being prescribed, and even when we prescribe supplements, people pay for those supplements, companies are making money from those purchases. It's important to remember that medicines aren't just, and pharmaceuticals more specifically, they're not just like for free 'cause they help people and we live in such a good world and like we just wanna help people.

[00:43:53] It's not charity,

[00:43:55] Julie: that's also true,

[00:43:56] Karinda: although, yeah. Right. Yes. For some, yeah. [00:44:00] Companies, usually big conglomerates, are making large amounts of money and have a lot of money to be able to market better. I mean, this is why you don't really see many ads for natural supplements. I mean, you do, but not as much as you see for Telfast or Panadol or, you know, just a normal pharmaceutical.

[00:44:22] Julie: Yeah, there are some restrictions in the way that you advertise those things.

[00:44:25] Karinda: Yes, yes, yes, yes. Yep.

[00:44:27] Julie: contributes to it. Yeah.

[00:44:29] Karinda: I was a bit surprised to learn that this person said they were getting a lot of an ad campaigns for it, like on social media ads. I thought there would've been some more restrictions there, given that it is a pharmaceutical. But maybe the online world, there's, there's different restrictions than, you know, like we don't, I know in America they have TV ads for prescription only medications, and they just end up with, "talk to your doctor about starting this today."

[00:44:54] Whereas here we see lots of ads for over the counter stuff, but not, not really any [00:45:00] that like is prescription only. And

[00:45:02] Julie: we're not allowed,

[00:45:03] Karinda: we're not, yeah.

[00:45:04] Julie: permit, it's, it's not permitted in Australia.

[00:45:07] Karinda: So I'm just finding it interesting. 'cause this was an Australian, I believe, I believe an Australian naturopath, seeing social media ads for menopause hormone replacement.

[00:45:16] And maybe that's just a, maybe they could be advertising like a prompt to book in with a menopausal clinic perhaps to like, you know, there, there are answers for you. You know, we, there are modern technologies or options, you know, um, yeah, I, I, I,

[00:45:33] Julie: like, like, like the GLP one ads that have now been removed by the TGA, ones that were saying, worried about your health and showing overweight people?

[00:45:45] Karinda: Oh really? Ah, interesting.

[00:45:48] Julie: Now been withdrawn.

[00:45:50] Karinda: Have you on online or anywhere, have you seen ads for menopause hormone replacement?

[00:45:57] Julie: No.

[00:45:58] Karinda: Yeah.

[00:45:58] Julie: Whether this person

[00:45:59] Karinda: [00:46:00] there's some,

[00:46:00] Julie: somehow seeing overseas advertising.

[00:46:04] Karinda: yeah, maybe it's very popular. So yeah, this is in Australia.

[00:46:08] Julie: interesting, interesting.

[00:46:10] Karinda: And the, the only other, the other major concern that, that came up in this discussion was just the, you know, kind of what I already mentioned before, just in terms of the safety profiles based on duration of these therapies, I maybe, I'm not convinced that we have that data.

[00:46:35] Julie: I don't think we've had the bioidentical hormones long enough to have very much data on it.

[00:46:46] Karinda: Yeah.

[00:46:46] Julie: I'm sure that they are being studied, but, how can we know they haven't been around that long.

[00:46:52] Karinda: Yeah, true.

[00:46:54] Julie: There, there's also the, the, the spiritual aspect. The, this is [00:47:00] the, the woo. And you said it before that when taking these hormones, she feels more like herself. But just gone through a transition where yourself is no longer the same. It's,

[00:47:16] Karinda: Great point.

[00:47:17] Julie: Neurological rewiring to prepare you for a stage of life as a non fertile human,

[00:47:24] Karinda: Hmm.

[00:47:24] Julie: who has different priorities and, and different, I mean, even your metabolism changes.

[00:47:31] You don't have the same, requirement for calories that you did previously.

[00:47:40] Karinda: Hmm.

[00:47:41] Julie: Because, in a communal setting, the, the grandmother, this is under the grandmother hypothesis. The grandmother is the knowledge holder who assists the childbearing people in the group to look after the kids, to, [00:48:00] to feed them, to nurture them, to show them the hunting grounds or, you know, particular techniques of finding food. It's a, it's a support role, so who you are is different from who you were then. In the same way that you wouldn't describe a, a prepubescent girl as the same as a post pubescent girl.

[00:48:27] Karinda: Yeah. And we would be concerned if a post pubescent girl was sort of, um, or you know, a woman in her reproductive years, if her goal was to try and feel like her pre pubescent self, you know, like it we

[00:48:41] Julie: Some would argue.

[00:48:41] Karinda: Some would argue.. But you know, we do- you make an excellent point, like we go, I think it's the nature of humans, but you could argue it's a little bit more juicy and flavorful for the nature of being a female, that we have these really [00:49:00] distinct seasons of life and we have past selves and we have future selves, and there's a lot of shedding

[00:49:08] in going through these different, you know, there's shedding in every menstrual cycle, so, my God, when you have your last menstrual cycle and then enter a whole new era, that is a massive shedding. And I think, I don't know if we, if we have much more to say, but perhaps a semi conclusionary, semi conclusionary comment, just making up words here, invitation would be, is it possible whether, are you close to menopause?

[00:49:39] Are you perimenopausal, are you on these hormonal therapies? Are you not, are you contemplating them? Is it possible to consider that menopause may have gifts to offer you that you are not yet aware of? I think that's all I wanna put out there is, is it [00:50:00] possible? And some people might hear that question, they might go, "Nope.

[00:50:03] It's not possible." Just let it be a possibility that there is maybe something that this new phase of life is just so ready and excited to offer you, to show you. But it does require leaning into it and not avoiding, and not shaming yourself for getting older and or not shaming yourself for, you know, feeling your lost fertility.

[00:50:31] Like, you know. That's all looking at it through a lens of your reproductive self when that was biologically your role. If menopausal women weren't needed, it wouldn't be in our DNA, it wouldn't be a capacity in our DNA to experience menopause and then to live this much longer. We would be reproductive until we die.

[00:50:54] Julie: Yeah.

[00:50:54] Karinda: But we are not.

[00:50:56] Julie: And, and we, we longer than men

[00:50:59] Karinda: [00:51:00] Hmm.

[00:51:00] Julie: there's an evolutionary reason why we live longer, and it's because we are needed. We are needed for the community. We've got, we've got gifts that are so valuable that it's worth extending our lives, by taking away the, the burden of being a reproductive human.

[00:51:23] Karinda: Yeah. Yep. Similar to, I learned from, uh, that book that I always mention that Julie purchased on my recommeKarindation and then finished like years before I finished it. But Eve by Cat Hannan, which I am reading 10 pages a day of, on Julie's tip of how to build a reading habit. I learned in that, that populations, you know, back in the day, I can't, don't ask me what century, but back in a century that isn't this century or the last century.

[00:51:54] Populations boomed when there was, wet nursing and where there, when there were [00:52:00] other women around to breastfeed babies who weren't the biological mothers. In the same, in that same fashion, I wonder, if populations boom and thrive when there are more grandmothers, in their menopausal years, healthy and there and available and present, to offer help for growing families.

[00:52:24] I think that is a really important role. And that's just looking at it from like a very biological, you know, "protect the species, procreate" perspective, but I think menopausal women are crucial to our survival and thriving as a species.

[00:52:43] Julie: I agree. And, and that book that you're talking about, actually discusses that

[00:52:48] Karinda: There you go.

[00:52:49] Julie: goes into that. So you haven't, you haven't got to that bit yet. but yes. Yes. And. It's not just, this is, we are not just hypothesizing about [00:53:00] humans. There are other species of animals, the finned whales, uh, so orcas and belugas and finfin whales, uh, they're called find whales. Some species of chimpanzees. The Congolese chimps. They have similar social structures to ours. Their grandmothers have similar behaviors, like they've filmed orcas taking the young killer, young orcas and teaching this particular hunting technique, and it's the grandmothers that do that.

[00:53:39] Karinda: That's really special. And I think I just want people to remember that like if, especially if someone is really experiencing more of that emotional, mental health challenge of this transition, like, you are so needed. Like you are crucial to the human race.

[00:53:56] Because it can be a time I feel when people are really going [00:54:00] through identity crisis and crisis of belonging and what their role is now. And I think the answers are, the answers are within, your body has the answers. There is an innate wisdom, but there's just a lot of noise and fog that can stop us from accessing that answer as quickly or as clearly as we would like.

[00:54:25] That's what I believe.

[00:54:27] Julie: Yeah. Pushing up against it because you are not ready.

[00:54:30] Karinda: Mm-hmm.

[00:54:31] Julie: Is not a very effective way of, of helping yourself. And I think leaning into it, being gentle with yourself, being curious and open-minded about what the change can mean for you and having the discussions with, with your peers, with the women of your age and older, I think is a really, really great way.

[00:54:55] And that's what we do as women really well is, is that we do [00:55:00] support each other. I mean, it's, we don't always support each other, but in our friend groups,

[00:55:05] Karinda: Mm,

[00:55:06] Julie: You know that that's the time when, when you can lean on those people and yeah,

[00:55:12] Karinda: yeah,

[00:55:14] Julie: Find the good in it.

[00:55:15] Karinda: That's it.

[00:55:16] Julie: I could keep talking for another hour, but we probably should let people get back to their.

[00:55:24] Karinda: Their next podcast episode or

[00:55:25] Julie: Back to their lives.

[00:55:26] Karinda: Lives. So I think, yeah, we've said what we wanted to say. Please remember, no one size fits all approaches. If you have questions about your prescribed medications, please go back to your prescribing professional. If you would like our support with holistic, nature based therapies and tools and techniques and strategies to help make this transition a little bit smoother for you.

[00:55:56] I mean, I can only encourage you to please book in a discovery call with [00:56:00] Julie. This is her bread and butter. This is something that she's experienced. She has the, the embodied experience of it, and we are here to help and we can help. And we have so many tools that un unfortunately, you know, by no fault of their own, just isn't taught to a lot of medical professionals.

[00:56:18] So yeah, we can maybe offer some other puzzle pieces that fit into your beautiful thousand piece puzzle that is your life.

[00:56:28] Julie: Yeah. And can I just suggest that some of these natural, you know, and, and it's not just supplements, it's lifestyle, it's dietary changes, it's even some mindset changes as well. There's a whole range of things, but it depends on what, what you are experiencing and what your needs are.

[00:56:52] Karinda: Yeah.

[00:56:53] Julie: Try those first and get your body, as functioning, as optimally as it [00:57:00] can before you turn to the hormonal support.

[00:57:04] Karinda: Mm-hmm.

[00:57:05] Julie: They can certainly be prescribed

[00:57:07] Karinda: Mm-hmm.

[00:57:07] Julie: But that's, that is a really effective way to go. And if you are a younger woman who is maybe just entering perimenopause or even anticipation of it, seeing Karinda is the perfect, Karinda is the perfect person to see she's with menstrual cycles and getting women to a really. place. Getting, getting people in, in touch with what the menstrual cycle means, at a deeper level, and that kind of preparation can potentially make your journey through perimenopause, a smoother one.

[00:57:56] Karinda: And, and yeah, we do know that, you know, if we can optimize your [00:58:00] hormone levels and fluctuations while you are still having your menstrual cycles, it can lead to much better outcomes during that perimenopausal window. And I think even doing the deeper menstrual cycle work, maybe some of the more spiritual elements, I, I think I do believe in my heart of hearts that that can make embracing the menopausal transition, a lot more easier as well.

[00:58:22] Julie: Absolutely. Yeah.

[00:58:24] Karinda: We bridge really well together, don't we, Jules?

[00:58:27] Julie: We do.

[00:58:28] Karinda: I can see someone for a decade and then, and then they go see you.

[00:58:34] Let us know how you felt about this episode. You can comment on Spotify or you can message us on Instagram. If you're listening, let us know that you are listening. If you like, the kind of conversations that we have here at the Nuance Nats please consider subscribing or following wherever you are watching or listening.

[00:58:50] If you are listening to this on the podcast app, our episodes are now also on YouTube if you would like to watch. And let us know what you want us [00:59:00] to gab about next time.

[00:59:03] Julie: Thank you.

[00:59:04] Karinda: Take care. See you guys.

[00:59:06] Thank you for listening to another episode of The Nuanced Naturopaths. Be sure to ask us any questions you have below, engage with the polls and we'll catch you in the next one.