Advice for managing menopause has been mostly useless for the past several decades. Things like grab a glass of wine, avoid Hormone Replacement Therapy (HRT), or just “wait and see” have caused far more harm than good, because they are all flat out BAD advice.
In 2023, we have amazing evidence and science for how hormonal support, lifestyle changes, and even breathwork can help during this phase of life. Implementing these interventions can reduce the risk of urinary tract infections, cancer, osteoporosis and even musculoskeletal issues like rotator cuff tendonosis.
Therefore, we think it’s time that we start providing the care that 51% of the population needs to have a better quality of life. Fortunately some bigger names in the world are bringing light to the importance of caring for women during this phase of their lives. Thank you FIFA, Ophra, Selma Hayek, and Michelle Obama to just name a few. With more and more people talking about this, we believe the revolution is already underway.
Take some time to listen/watch this interview and utilize the resources listed below to make sure you get the most of your life during menopause and beyond.
Michelle Lyons has over 25 years experience as a physio, and she is multi passionate about women’s health. She has expanded her toolbox over the years to include teacher training in yoga, pilates & mindfulness as a therapeutic intervention. She has a postgraduate certification in health coaching & nutrition, and is embarking on a PhD journey. As well as consulting for FIFA, she teaches & presents at conferences nationally, internationally & online.
0:00 Dr. Ginger Garner: Hi, everyone, and welcome back. I am here with a very special guest from across the way a little bit in Ireland, Michelle Lyons, and I cannot wait to talk to you. We have some hot topics to introduce today. Welcome, Michelle.
0:21 Michelle Lyons: It’s a pleasure to be here, Ginger. Thanks so much for having me.
0:23 Dr. Ginger Garner: I have been looking forward to talking to you for a long time. I think we saw each other at the CSM, which is the American Physical Therapy Association meeting for like two seconds at the Pelvic Health Academy party.
0:39 Michelle Lyons: They were two great seconds though.
0:41 Dr. Ginger Garner: Yeah. And then I think before that, I saw you at International Pelvic Pain Society meeting like 10 years prior. Yeah. It has been a while.
0:50 Michelle Lyons: It’s been a while, but we’ve, we’ve been in conversation though, I think, you know, over the years back and forth, just, we need to do more in real life.
0:57 Dr. Ginger Garner: Yeah, exactly. We’ll solve that problem. Before we hit record, we were talking about ways to solve that problem. And I think bringing this information to you about pelvic health and what we’re going to talk about with perimenopause and menopause is a way that you can simplify and improve your quality of life, that you can be informed, that you don’t have to be fearful moving through seasons and phases of life. So I hope that you’ll leave this podcast today kind of armed with knowledge of being an informed healthcare consumer.
Because there’s a lot of medical gaslighting out there and we are here to help you avoid that. So before we jump in, I want to brag on Michelle a lot, not just a little. She has over 25 years of experience as a physio, so we are contemporaries. Let’s see, when was your first year as a PT?
1:54 Michelle Lyons: I graduated in 94.
1:57 Dr. Ginger Garner: 94. Okay. I was right behind you in 98. As a result of that quarter century work, she’s passionate about women’s health. She has such a massive toolbox to include things that she’s been trained in like yoga, pilates and mindfulness. She has a post-grad certification and health coaching and nutrition, which is super helpful since we are truly what we eat. And I didn’t know this, but you’re embarking on, moving towards, your PhD journey.
2:29 Michelle Lyons: I know. I can’t decide if I’m excited or terrified.
3:34 Dr. Ginger Garner: But that’s why I stumbled over my words..like, am I? Am I? I’m excited. I wish I could do that. It’s too expensive in the United States.
2:43 Michelle Lyons: We’ve been quite lucky here in Europe. There’s been a lot of funding made available for, you know, fully funded Ph.D. opportunities with living stipends and things like that. So it’s a good time to be investigating that. So maybe you should come over to Europe and think about doing your PhD over here.
3:03 Dr. Ginger Garner: I would love to do that. I love to learn. And that passion doesn’t end for me. So Michelle also consults with FIFA and teaches and presents at conferences everywhere, which is where we tend to run into each other. Exactly. Right. So welcome, Michelle.
03:26 Michelle Lyons: Thank you. I’m really, really looking forward to our conversation. I’ve enjoyed the podcast. I’ve been listening along and yeah, I feel really honored to be here. So thank you again.
3:36 Dr. Ginger Garner: Thank you. Thanks for taking the time. So I want to start off with a couple of stats, because that always does a couple of things. It can make my blood boil. And it also motivates me to go, oh, we need to talk about this. We need to bust myths. We need to help women avoid being gaslit when they go into their office, the physician’s office, or anyone’s office, and say, I have this symptom and then someone either says, oh, it’s not a big deal, or you should expect that because of your age, or they just dismiss it as not being even related to perimenopause or menopause.
So the first stat is related to American women. And then the second stat was actually done in London in a small study. But the first stat is about American women. It’s estimated that $1.8 billion are lost in working time each year, according to a Mayo Clinic study published this year. And then a recent smaller study in England, they reported that nine in 10 women were not educated about menopause. So here we go.
4:47 Michelle Lyons: On that note. It’s so bonkers because I think you know sometimes we live in a silo and we live in a world Ginger, you and I, where basically that’s what we talk about all day every day matters pertaining to women’s health. But apparently the rest of the world is not like that. Like literally this afternoon, I was teaching a class to a group of NHS nurses in the UK about brain health, menopause. And, you know, we were talking, we talked about lifestyle, about nutrition, about, you know, neuro nutrition and hydration and the right types of exercise and sleep and why alcohol might not be a great choice at midlife.
And we talked about all the things and the conversation moved, as it often does, then to, well, what about hormone therapy? And what I’m hearing from women that I’m talking to all over the world is that there are two extremes. Either everything is blamed on menopause. And that’s normal. And what do you expect? And you just have to grin and bear it for the next few years and it’ll pass or the medical community are still working off outdated information from the WHI 20 years ago that has been largely disproven.
There was one particular nurse and she’s, you know, she’s 47, having all the classical signs of menopause, has been to her GP three times and they keep saying, maybe it’s your thyroid, let’s run another thyroid panel. We’ve done your blood work. We don’t think you’re in menopause. Now blood work at perimenopause, once you’re over the age of 45, is honestly less than useless. It really doesn’t give us any good information. And the nice guidelines are that if you’re over 45, a three month trial of hormone therapy, and it can be an absolute game changer.
And it’s just to give women these basic facts that they can go back in as informed advocates for themselves. And I’m a big proponent of hormone therapy, if it’s right for you and lifestyle. Because you can’t just do the hormones without looking at the lifestyle as well. But it’s really to give women the knowledge and the confidence to say, no, I don’t accept that. Here is what the evidence says.
And also to remind them that they are not the only ones. Because especially if we’re talking about brain fog or sometimes the feelings of anxiety or depression or despair, I mean, if you’re not sleeping well at night, everything looks grim. And to be able to say, you know what, that’s actually really common at perimenopause. You’re not going crazy. You probably don’t have early dementia, but it might be this, this or this. And here’s what we need to find out to decide what’s really going on with you. And just to see that level of stress literally fall off their shoulders.
Because what can happen sometimes then is then they can get a little angry. It’s like, well, why has nobody told me this before? Why am I only hearing about this now? I don’t know. You know, we need to do better. We need to do better as health care professionals. But I think we also need to do better as women telling each other the truth about what’s really going on, whether that’s through the perinatal stage or reproductive health, but most definitely at menopause.
08:19 Dr. Ginger Garner: Yeah. Yeah. One of the things that we were talking about, I know before we hit record, um, which is something that I talked to my patients about. I have an active practice, um, here in Greensboro, North Carolina, and they, 100% of women come in misinformed with old information that was based on that one study that we all know about that then demonized HRT, hormone replacement therapy, that was deeply flawed from the beginning.
And they’re coming in with that information, oh, no, no, I can’t do HRT, I’ve got a history of this, history of breast cancer, my family, that kind of thing, which we now know has been refuted and is not correct. So if you have a history of breast cancer in your family, that does not mean that HRT is not appropriate for you. That being said, we’ll lay that one down, we’ll come back to that one in a minute, but that means that most information that women are getting in clinical practice when you go to see your provider is actually outdated.
Let’s talk about that for a second. Let’s start with symptoms that are beyond the norm that women come in with that they’ve been, frankly, medically gaslit over or dismissed. You know, what are some of those symptoms?
09:50 Michelle Lyons: I’m just going to take a deep breath before I start here, so the rage doesn’t bubble over too much. You know, if you ask most, and I’m going to say lay people here, you know, who are not in health care, but actually probably most people in health care as well. They’re probably going to go with hot flushes and night sweats, but there are 35 recognized signs and symptoms of menopause and one of the most common, well a couple of the most common, but the most distressing ones that I hear about are the tiredness and fatigue due to not getting a good night’s sleep. Which I think is the big driver for the brain fog that we hear about.
The musculoskeletal health implications of this, because tendons and muscles love estrogen. I’m going to try and say estrogen for the rest of our conversation here, but bear with me. They absolutely love estrogen and they get really unhappy and cranky when it’s taken away. So we have phenomena like “we call it the 50-year-old shoulder. That’s how it’s referred to in the literature. We see this increase in rotator cuff issues in 50-year-old women.”
One in four women in their 50s develop gluteal tendinopathy, which is often mistaken for hip arthritis. We have issues with posterior tibial tendinopathies, which are often mistaken as plantar fasciitis. And women are told, oh, it’s wear and tear. It’s a part of getting older. You just have to grin and bear it. Or here’s a steroid injection. And then the other issue is the change and the new onset for many pelvic health issues.
Because, you know, estrogen has about 300 different functions in the female body. Your bladder loves estrogen. And when it’s taken away or when it starts to decline, the bladder shrinks. And the lining gets a little bit thinner, so we might have some more frequency urgency. The vaginal microbiome changes. So we might be a little bit more prone to UTIs or yeast infections. We lose some sphincteric or closure control, both of the bladder and of the anal opening as well. So continence can become an issue. And then, of course, the connective tissue loves estrogen dearly, too. So we might start to have some prolapse issues.
And those are the ones that people don’t necessarily think of straight away when it comes to menopause. But those are the ones that are actually distressing women more and are more of a barrier to performing well at work. We have research showing that pelvic health issues are a barrier for one in two women participating in exercise. And we know that exercise, it’s huge. Exercise is the closest thing we have to a magic bullet when it comes to cardiovascular disease, dementia, and cancer prevention.
But if someone’s afraid they’re going to leak, you know, they’re not going to exercise. And so it’s by getting information like this, I think this is why conversations like this are so valuable. By telling women that yes, these are really common at menopause and we have grade A evidence that we can help you. We have the technology, we can rebuild you, you know, and we can show you how to do it for yourself more importantly. and give you that education and empower you to really regain that quality of life.
Because, you know, we’re recording this in October and it’s Breast Cancer Awareness Month and we all know how much treatment for breast cancer has improved. You know, we’re now regarding it almost as a chronic disease that people are living much longer with it. But our job, I think, is to really make sure that as well as the quantity of life, that we are restoring good quality of life. And it’s by just normalizing the conversation about women’s health. I mean, that’s really what it’s about. We just want to help people live well.
13:51 Dr. Ginger Garner: Yeah. One of the things that you mentioned in talking about the kind of lesser understood symptoms of perimenopause and menopause is, classically, it’s why I wanted to have this conversation today because they are kind of the classic presentation of someone that comes in to see me on a regular basis. And here’s what it sounds like. They come in usually of their own volition because they haven’t been referred. It started out with gaslighting as in, Oh, you have a prolapse. What a patient says. Uh, what do I do about that? Caregiver goes, nothing. We’ll just watch it.
14:36 Michelle Lyons: And when it’s bad enough, we’ll operate right.
14:38 Dr. Ginger Garner: Nothing. We’ll just watch it. Patient goes, huh? They know enough to say that doesn’t, that doesn’t sound right. That’s inadequate. That’s BS. By the way, we can swear on the podcast.
14:51 Michelle Lyons: Excellent. Good to know.
14:52 Dr. Ginger Garner: We might need to do that. So this person comes in and says, and this is actually, this is a classic case, but it is actually, you know, a real one. She came in because she was told that. She was told that she had a prolapse. She had gone through menopause. They didn’t want to do anything about it unless it was going to be something that they could, let’s just say, cash in on because they’re not considering anything else. So once they need surgery, of course, that’s what they’re going to do. They’re not going to recommend anything else.
And that’s a common problem in the United States because our system is malaligned with what the values of health care provision should be. We should be providing health care in a way that is going to, like you mentioned, maximize quality of life, minimize cost, and it actually be evidence-based. And we know to the contrary, surgery is a first line for prolapse without referring to pelvic health is not evidence-based at all.
So this person said, that sounds a little off. So she self-referred and came in. Now she also had musculoskeletal issues, poor sleep, a base level systemic inflammation that we can measure because we have access to measuring those things. When her labs came back from looking at, you know, her base hormone levels, which were all not within those parameters. She also had a caregiver tell her because I measured her cortisol as well. And it was flatlined. And here’s what the provider said. Oh, that’s normal. You’re menopausal.
16:33 Michelle Lyons: The cursing will be beginning shortly, just to give you a heads up.
16:38 Dr. Ginger Garner: So how much misinformation did she just get? Plus she had hip pain and back pain. They weren’t correlating those either. Like, oh, that has nothing to do with menopause. Your cortisol level is okay if it’s flatlined. Yeah, you don’t have any hormones whatsoever in your system because we measured those, but that doesn’t have anything to do with your urgency frequency.
17:00 Michelle Lyons: I’m laughing so I don’t cry.
17:05 Dr. Ginger Garner: And then the prolapse, yeah, we’ll just watch that until, you know, we need to do something surgically.
17:10 Michelle Lyons: Then we’ll do a hysterectomy.
17:11 Dr. Ginger Garner: Right. If this is the person that comes in my door, and not just my door, right? it’s a lot of people’s clinician stores, then I would love for us to just address, because I think those are the major things. And no one had talked to her about sleep. No one had talked to her about nutritional triggers or any of the lifestyle medicine that really matters that makes our care holistic and integrative. So if we just break that down, so women can leave, you know, this podcast with the empowerment of, if I hear a practitioner, tell me any of the things that Ginger just said.
17:48 Michelle Lyons: Red flag.
17:49 Dr. Ginger Garner: That’s right. Big red flag as whatever color this is, my shirt, you know, and you quiet quit. You don’t have to get into a confrontation with your provider.
17:58 Michelle Lyons: But you can.
18:00 Dr. Ginger Garner: You can if you would like. Because I have, and then I haven’t. It’s like, where’s my battle line today? Where’s my line in the sand? So I’ll leave that up to the listener to decide how you want to approach it. But you can also spread that information by word of mouth. Maybe friends need to know that, you know, that practitioner is not practicing in an evidence-based way to save someone’s quality of life. It is worth speaking up about. So let’s talk about that.
18:27 Michelle Lyons: It really gets my goat, Ginger, that we regard menopause as a specialist or niche topic. This is a situation that will affect 51% of the people on this planet. It’s not a specialist topic. So it’s really unacceptable in this day and age for certainly a gynecologist, a urogyn, and I would say also a primary care to not be well educated on current best practice, because Lord knows there are plenty of educational opportunities available.
You can go to the North American Menopause Society. They have lots of continuing education available there. You can become menopause certified. It’s not overly complex, but it just takes a certain level of commitment and understanding to really just get to grips with, as I said, the physiology and the anatomical implications of that physiology on over half the people on the planet.
And particularly if you’re a gynecologist or a urogyn, 100% of your patient population who are, let’s face it, they’re either pre, peri or postmenopausal, all of them. And I just think it’s outrageous in this day and age that women are still being dismissed or, as you said, gaslit or being given bad information. You know, whether that’s about systemic hormone therapy, whether that’s about vaginal estrogen, which, you know, is an absolute game changer when you combine it with pelvic rehab. [Mm hmm.]
And I just think it’s really, I hear what you’re saying. Quiet quitting and like monitoring your own stress levels and not letting yourself get upset. But honestly, I really do think there needs to be some sort of revolution about this, because I see it happening. I see it happening. Conversations are being had. Podcasts like this are happening. And I think there is a general swelling of feeling that, you know, to quote that film, we’re mad as hell and we’re not going to take it anymore. And because honestly, it’s just it can be so powerful, just to wee work being impacted, relationships, just your ability to function as a human being with some baseline of joy in the world. Yeah. That’s not asking too much, is it?
21:10 Dr. Ginger Garner: Absolutely not. And speaking of the awareness that has been increasing, the celebrity discussions around menopause worldwide, but people like Michelle Obama, Salma Hayek, Naomi Watts, Gwyneth Paltrow, Angelina Jolie, Oprah. [Yeah]. You know, if Oprah’s going to her physician, who I’m sure must be pretty good, right? [One would think.]
One would think. And initially, not understanding, you know, what those symptoms are because none of us have been educated about menopause. Unless you are specializing in this discussion of lifestyle medicine to treat these things integratively, you’re not going to have had that discussion or training. And so we have to think about, you know, celebrities are bringing awareness to this with unlimited funds to seek out absolutely the best care, then I don’t want anyone else to be shaming themselves like, oh, I should have known that.
22:10 Michelle Lyons: No. How could you know if nobody ever told you?
22:14 Dr. Ginger Garner: Right. So I just want to make sure too that, you know, our listener and women are not shaming themselves as in, oh, I can just, I should know which provider to go to, or, you know, it really is not your fault.
22:29 Michelle Lyons: Absolutely not. Not your fault. Absolutely. You know, the support network just has not been there. The drive to educate within health care has not been there, I would say, really the past two or three years. But to give you an example about the menopausal revolution that I think is happening, FIFA over the past year has been developing a female athlete health project.
And I came on as a consultant to talk about menopausal health for female athletes. Now, FIFA is a substantially wealthy organization that has really been, you know, obviously the world drivers of football/soccer globally. And they have seen the again, the huge interest that’s been happening in women’s soccer over the past couple of years. And what they’re looking at doing now is keeping women in the game and developing women’s football as distinct from the men’s game, because they are recognizing, again, that women are not small men.
So when you see organizations like FIFA, not just looking at, you know, young female athletes or the elite professional athletes, but they’re also looking at, you know, what can we do to get girls and women in the game at a young age, but keep them there through perimenopause, menopause and beyond. Whether that’s as referees or coaches or, you know, playing on on master’s level teams.
That to me is a real glimmer of hope, you know, in the darkness, because, you know, we all got together. We had a meeting of all the different consultants, you know, whether it was for adolescent athletes or, you know, pregnancy and postnatal and then the menopausal cohort, multidisciplinary, we all got together in Sydney. And we produced this document looking at what we need to do better to support women in sport at every age. And to see menopause there front and center for me, it just it makes me really happy because, you know, there is life after menopause.
And hopefully there’s plenty of it. Yes. And we wanted to be joyous. And I think, you know, really acknowledging that. When we start getting support from organizations like that, I think that it’s uplifting and it helps us get the message out to girls and women worldwide. Because I don’t know about you, but I remember, you know, obviously it was back in the last century when I was in school, before I went to college to become a physio, but like in high school. And I remember learning about the reproductive cycle and the menstrual cycle, menopause was never mentioned.
If we ever heard about the menopause was like, oh, she’s going through the change. Euphemisms abounding and don’t make direct eye contact. She’s going through the change. You know, and I just feel like now we’re really starting to have a lot more openness about these conversations. And I think that that can only be for the good of humanity.
25:44 Dr. Ginger Garner: Yeah, absolutely. So to go back, I want to visit the stress point of this for for women in discussing it. And I’m so glad that big voices like FIFA, like people who have the exposure. The Oprah’s of the world, if you will, are actually speaking up because it does take some of the pressure off women who are, even like myself, you know, I’m on the other side of the thing, right? I’m on the other side of that and have been able to thrive through that and want to share that experience with other women.
But let’s just take, you know, a woman who might be going through while you’ve got, we were just talking about this, I’ve got a senior, you know, I’ve got a 16 year old right behind him, I’ve got a 12 year old, three kids in school, I’m running a practice, I’m doing this podcast and you know, teaching and all that stuff.
Lots of other women have those same stories. They are, they’ve got all the balls in the air, you know, and they’re trying to navigate a thing, menopause, that they weren’t taught about, right, on top of all their other regular day-to-day life. So I also want to encourage, you know, women that in finding hope in listening to things like this and seeking out the help that you need that you don’t have to be the one to like whistle blow on your local practitioner if you don’t want to because you’re feeling so kind of beaten down by the situation. There are big voices that are speaking, there are big voices that are changing the conversation on it. There are more articles about it every single day. There’s more articles about medical gaslighting. And so you can feel a lot of hope to, you know, you can feel a lot of hope that things are shifting and changing and that we want to support moms who have the energy to have the big voice, but also support the moms and women that are going through this and they’re like, this is all I can do. Just give you to a practitioner that can just help me, you know.
27:50 Michelle Lyons: And Ginger, I think though, it also behooves us to mention that, you know, here we are, two cis, het, white, educated, fairly privileged women. If you don’t have the socioeconomic prowess or the financial capability to go doctor shopping, to have access to all this information. And we know the stats about menopause in women of color. We know that women of color are more likely to have early onset dementia, are more likely to have strokes, are less likely to access good healthcare.
You know, and we’ve seen that over the past couple of years, particularly in postnatal health. But I think we’re starting to see, you know, data emerging that the same holds true for menopause. And that’s why I think it’s so important that those of us who have a voice use it to do some shouting for the people who just do not have the wherewithal at this time. We do point out like there is an intersectional issue at play here.
28:51 Dr. Ginger Garner: Yeah, yeah, totally. You know, the symptoms can be so wide ranging. And I think that we’ve kind of pulled those in, so that you understand that if you’re having urgency frequency, where you’re going a lot, you’re going often, that can be related, that can be an estrogen, you know, driven issue and hormonally driven issue that is related to menopause, joint pain, absolutely related to menopause. So I think that we have highlighted some of the things that, you know, listeners may not, you may not think is related to menopause, but it absolutely is. It is a reason to seek out, um, the help that you need.
And there are resources, there are low cost resources, um, that we will put some of these in the show notes for you so that you will have access to them. We definitely aren’t having a, um, conversation that only applies to people who can afford it, live in big areas, you know.
29:50 Michelle Lyons: It’s really important that we do have these conversations because this is where the role of lifestyle really comes into play. Literally this morning, I was reading a research article showing that women who eat more ultra processed foods are more likely to develop depression. And we know that depression does rise around menopause as well, perimenopause in particular. But we also have to acknowledge them. Well, what if you live in a food desert? What if you don’t have access to fresh fruit and vegetables? You know, if all that’s available to you in terms of availability or price point is ultra high processed foods, you know. How can we how can we make small steps to start giving her back some power again. And so, yes, there’s the micro and there’s the macro that we have to look at as well.
And it’s not just about availability of hormonal therapy, you know, the right hormone at the right time. But it is, you know, we’ve got to look at lifestyle. You’ve seen the research, I’m sure you know that physical activity is as effective as medication or talk therapy for depression. But if you’re not sleeping and if you’re wondering, you know, how you’re going to balance your budget each week, you know, how motivated are you going to be really if the doctor says, well, look, here’s some antidepressants instead? [Right].
Because that’s so many women at menopause they’re told that they’re either given anti-anxiety medication or antidepressant medication, or, and I know this is probably a particular favorite of yours as well, go home and have a glass of wine and relax.
31:24 Dr. Ginger Garner: Yeah. Oh, cover the ears. Yes. And so if you are living in a food desert, um, then I want to encourage, and this is stuff that, you know, food prices are ridiculously, they have ridiculously increased and also, uh, corporate profits have ridiculously increased. So a lot of corporations just to be, um, just a whistleblower here are using the excuse of inflation to increase their prices even more to cut down on the amount that you’re getting. And they’re making record profits off of this. So that is just freaking wrong on all levels. But if you live in a food desert, some of the things that I’m thinking about, I have three teenage boys, they eat massive quantities of food. There’s no way that I could go out and buy fresh fruit. Apples because they’re local to the mountains and they’re abundant and they’re very inexpensive. So I have to think seasonally, I have to think locally. If they needed raspberries, all of the exotic fruits and things that you think that are so good for you and packed with antioxidants and are the opposite of that, you know, ultra processed. If you’ve not read the book, Ultra Processed People, that’s another one that you could pick up (for everybody listening), but I will turn to frozen fruit. So think about things like that.
32:58 Michelle Lyons: Yes. And you know, as good if not better than fresh because they’re flash frozen, you know, and again, certain certain canned foods again. But just I honestly wish that at a high school level, less time was spent on trigonometry and more time was spent on knife skills and budgeting and food shopping and prep.
33:14 Dr. Ginger Garner: Yes and how your body works. [Yes, yes] Yeah, a little discussion on on basic anatomy and physiology.
33:22 Michelle Lyons: Because when was the last time Pythagoras came up in a conversation for you? I mean really.
33:28 Dr. Ginger Garner: I talk to my boys about this all the time about the practicality of what they’re learning and there’s a lot of gap filling that has to happen. So things like for, you know, for food deserts, because that education is not going to shift, particularly in the United States, I have to teach them that now. And so I talked to my kids about, okay, we’ll do a granola parfait, granola can be inexpensive, you can make it yourself. I go to Costco and get a giant container of, you know, plain whole fat yogurt and I mix it myself. And then a big bag of frozen fruit and say, hey guys, this is what we’re doing. We do have a budget. Um, we want to make sure that all of you are well fed and you’re not just you’re not eating processed food at all.
Which fortunately they can appreciate but I just want to encourage people that You can do it. You can do it on a budget and if you’re confused about it, you know, like reach out reach out We are happy to answer those questions. We’re happy to point you to people in your area. To help you solve the problems because we don’t want this just to be a you know, uh some kind of conversation about privileged care because you can afford to have it.
34:34 Michelle Lyons: It’s really important. Really, really important.
34:38 Dr. Ginger Garner: Oh, and the other thing about food that we should mention, because, gosh, we could talk about this all day, is there are, if you can’t, because so many women can’t, they don’t even have access to HRT and to hormone replacement, and they can’t afford it if they could, and their insurance company is, oh, I don’t even want to talk about that in the United States, not covering virtually so much that women need.
35:01 Michelle Lyons: But Viagra is okay.
35:03 Dr. Ginger Garner: Yes, totally. But Viagra is okay, but they’re not going to do what would prevent osteoporosis and metabolic syndrome and everything like that. There are lovely resources, I can put some of these in the show notes as well, on looking at what you eat to help naturally balance hormones, because that can really shift some of your signs and symptoms. Like maybe alcohol, having that glass of wine not being the best choice, is shifting some of those things so that we’re metabolizing estrogen in a way that is healthy and that we don’t have those, you know, kind of estrogen dominance type symptoms.
35:40 Michelle Lyons: I think that is really important. And obviously, yes, I’m a big fan of of nutrition, of exercise, of sleep. But also, I think it doesn’t have to be either or. And this is sometimes a conversation that I have. It’s like, oh, I want to do my menopause naturally. It’s like, well, OK, but did you drive here? Do you wear shoes? You know, I mean, if honestly, like my back, I went, I did in the University of Arizona, I did like the herbal medicine program there. So I am all about the comfrey poultices and the chamomile tea at the right time.
If I get stabbed, I’m going to go to the emergency room because, you know, it’s it’s not one size fits all. So absolutely. I mean, we know that a primarily plant based, healthy, whole food, Mediterranean style diet has been shown to be the most anti-inflammatory, probably, that we have. We know that strength training, for example, decreases hot flashes by 44% after 12 weeks.
But it doesn’t have to be either or, it can be yes and. And I’m just going to mention that for a lot of women that I’ve talked to in the US, Cost Plus Drugs, Mark Cuban’s organization, very, very cost effective access to vaginal estrogen and systemic. So you can get your prescriptions faxed directly there, but literally $22 versus $240 for the same medication, for vaginal estrogen, a three month supply.
Game changer, you know, because the thing is with systemic, you know, there are some questions about how long we should be on it and, you know, that window of opportunity. But with the pelvic health issues that we see at menopause, the you know, the genital urinary syndrome of menopause, we call it, but basically the bladder, the vaginal and the anal symptoms that we see. People ask, well, how long should I use vaginal estrogen for? And essentially it’s till death do you part, because that’s not going to get better by itself.
Your body will get used in terms of temperature control to the estrogen going up and down and that they last about five to seven years, most menopausal symptoms. But the pelvic health issues are not going to get better by themselves. And so vaginal estrogen is safe, effective, works best when combined with good pelvic rehab, and safe for people who’ve had cancer, you know. And it’s really important that we do some myth busting.
And absolutely, you know, there are great vaginal moisturizers out there. And, you know, the lube conversation is really important to have as well. But neither of those two are actually addressing the problem of the lower estrogen. And so if recurrent UTIs can kill you, it is literally that serious because the pH in around the vagina changes when estrogen goes away. And so it’s really important that again, making the knowledge, but also then making the resources accessible. So I think it’s something that I feel really strongly about.
So, yes, you must pay attention to your nutrition and things like, you know, for some people, caffeine or spicy food can be a big driver of of the vasomotor symptoms like the hot flashes and the night sweats. Alcohol. It’s time to break up with alcohol at midlife. It’s toxic for your brain. It’s usually very dense in calories. It’s estrogenic, but not in a good way. Possibly, you know, people who are worried about the link between hormone therapy and cancer. There’s a stronger link between a daily glass of wine and developing breast cancer than there is between hormone therapy and breast cancer.
So again, it’s but it’s information like that that we have to get out into the world as well. So the hormone therapy that we have available to us now is not the same hormone therapy that was out 20 years ago. It’s evolving. It’s safer. We know so much more about its safety profile. It’s not for everybody and everybody doesn’t have to have it. But we want people to be able to make informed choices. And yes, embrace the broccoli.
40:01 Dr. Ginger Garner: Yeah, it doesn’t have to be a binary conversation. And for some women, we’ve had the conversation that come into the practice. We have the whole conversation about all the lifestyle pieces from sleep, nutrition, physical activity, relational stressors, environmental xenoestrogens. Removing all the fake estrogens from our diet, but also they’re in shampoo, they’re in household cleaners, they’re in everything. So EWG.org is a great organization. They have a list on removing those fake estrogens out of your diet. So we have that conversation. And then we have the hormone replacement conversation.
And I have some women who choose not to go that route, you know, of HRT, and then some who want to do the combo. I want to do both. Because there’s some instances where we would need to, let’s for example, if we were going to fit a pessary where that’s a requirement, we need to have 30 days of that replacement in place with a positive response to it before I can really ethically or properly fit someone at that point.
So if you have a prolapse and you’re having those symptoms, that’s something to consider. There is, and you’ve mentioned this too, that window of opportunity where you would need to start them. Time can’t lapse. Not a lot of time can lapse between, um, you know, your last period and when you can are considered to be in menopause versus when you would actually want to start them. So starting them earlier versus later also decreases cancer risk. It doesn’t increase cancer risk. And those are a lot of, again, we’ll kind of come in full circle, that the information that was out there 20 years ago was deeply flawed and incorrect. But it’s still being used. We can decrease our risk of cancers, chronic disease, pain, and pelvic issues if we’re on replacement therapy versus not. And that is a giant conversation. I think we need to have a second conversation.
42:10 Michelle Lyons: Anytime.
42:12 Dr. Ginger Garner: I am, I am actually serious. We probably need to run a part two because, um, I would love to get into the details of, um, you know, talking about, you know, estrogen, progesterone, testosterone balance. There’s so many questions about metabolism, um, estrogen metabolism and, and what some of those symptoms can be driven by, which can frankly create weight management issues also, you know, that
42:35 Michelle Lyons: Hello, insulin and cortisol.
42:37 Dr. Ginger Garner: Yes, that’s right. That are often dismissed. It’s why in my practice, I want to see hormone levels, but also I want to see cortisol, I want to see a 24 hour cortisol panel. If nothing else to make sure that they weren’t told that a flat cortisol line, which should be a nice little somewhat for for those of you who haven’t seen a cortisol panel before, it’s somewhat like a little skewed bell curve, a cute little bell curve.
And if you have something that is above that or flatlined, it’s not normal. And it’s certainly not normal just because you’re going through menopause. And there’s so many things that we can do as pelvic PTs can help to help you manage that starting with stress management, mindfulness. Yeah.
43:23 Michelle Lyons: Breath work. I mean, we have, we have to breathe 20,000 times a day anyway. Why not make some of those just work for you? Um, you know, just even something as simple as the physiological sigh. Andrew Huberman’s group just released a paper on that earlier this year, that that’s actually five minutes of that physiological sighing where you inhale, you sniff it a little bit more, and then you exhale through the mouth. Five minutes of that decreases stress levels, improves sleep quality and quantity, and it’s free and you have all the equipment that you need.
44:02 Dr. Ginger Garner: It is. And it improves heart rate variability. Another part two conversation.
44:06 Michelle Lyons: It is. And then you see what you can do. You can tweak that a little bit then. And then on the exhale, turn that into a, ah, you’re getting a little bit of larynx vagal, you know, tuning up there. There’s so many ways that are relatively easy and cheap to start optimizing your health at any age, but particularly at menopause.
44:29 Dr. Ginger Garner: Absolutely. That is a good finisher. It does not have to be expensive. It’s absolutely accessible. We will be putting some of the links that we mentioned into the show notes, but if you have questions, do not hesitate to reach out because that’s what we’re passionate about.
So Michelle, I want to ask you one question, kind of a rapid fire finisher.What book are you reading right now?
45:03 Michelle Lyons: What book am I reading right now? I have a couple on the go. Yeah, well, maybe. I am reading, well, I can read a cookbook like a novel. So I am reading Jamie Oliver’s Five Ingredient Mediterranean Style. And I’m also reading, I just started The Inflamed Mind. It’s just, it’s looking at the links between inflammation and depression. and what we can do about that. So those are my two favorites and I’m anxiously, anxiously waiting for another Outlander installment.
45:38 Dr. Ginger Garner: Yes, I have been saving the last one, the ninth book, I think it is. Yeah, I’ve been saving it for like a year. Tell the Bees That I’m Gone, I think.
45:49 Michelle Lyons: Yes. And so I’m so good.
45:54 Dr. Ginger Garner: I’m gonna start it. I’m gonna start it.
45:59 Michelle Lyons: Wait, don’t wait anymore, Ginger. Don’t wait. Life is too short. Jump in.
46:00 Dr. Ginger Garner: Oh my gosh. Thank you so much, Michelle, for this time. This has been so illuminating.
46:03 Michelle Lyons: Absolute pleasure. Let’s go change the world.
46:07 Dr. Ginger Garner: Yeah.That’s right. Mad as hell. Not going to stop until it changes.
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