The Livy Method Podcast - Menopause and Weight Loss with Dr. Jennifer Zelovitzky - Winter 2025

Episode Date: February 10, 2025

In this Guest Expert episode, Gina is joined by Dr. Jennifer Zelovitzky—Medical Doctor, Certified Menopause Practitioner, and host of the Medsplaining Podcast—who breaks down the stages of menopause, the real impact of hormonal changes on both men and women, and why lifestyle is 80% of the equation. They get into the classic symptoms like hot flashes, sleep issues, anxiety, and weight gain, plus the role of resistance training and shifting the mindset from “skinny” to “strong.” They also get into the facts (and myths) about Menopause Hormone Therapy/Hormone Replacement Therapy and why it’s never too late to take action for your health, longevity, and quality of life.Find Dr. Jennifer:Podcast: MedsplainingInstagram: @medsplainingwww.medcan.com/menopause-and-perimenopauseYou can find the full video hosted at: https://www.facebook.com/groups/livymethodwinter2025 Hosted on Acast. See acast.com/privacy for more information.

I'm Gina Livi and welcome to the Livi Method Podcast. This is where you'll have access to all of the live streams from my 91 Day Weight Loss program. With a combination of daily lives, guest expert interviews, and member stories, there is something new almost every day. Miss the Morning Live? Want to relisten to one of our amazing guest experts? Well, this is the place.

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This is an opportunity to become curious to learn some things How do we help you feel less overwhelmed so you can continue on your journey keep believing yourself and keep trusting the process Just be patient. Hello, good morning, hi. Hi, Tina. Nice to see you. Nice to see you. I was just reading the comments

and of course we get quite a few men doing the program and I love that Dave is here and he's like, I'm here, interested, but not sure I can add much to the conversation. I think this is a relevant conversation in the, for the fact for men that menopause is a huge conversation right now. I don't know how you're living in the world and not catching wind of parts of it, or perhaps your spouse is going through menopause and it might give you insight maybe into what's going on with them and how they're feeling. Well, and not to give a spoiler here,

but you know, estrogen is only part of the story. A lot of what I'm going to be talking about today is relevant. It might be happening in a little bit more of an accelerated fashion for women during this time of their life, but it is happening to men and women both. So there is going to be a lot of good information. And I often tell my patients, get your husband to start doing what we're going to talk about as well. Because it was in this this andropause.

This is sort of like what's happening to women is happening to men, but a much slower rate. So it doesn't seem to it. Can I say it doesn't seem to affect them as much or just doesn't affect them in the same way? Oh, it's not. It's not in the same way. It's not as early. It's not as early and it's not as abrupt for a few reasons we'll get into.

So with women, most of their effects are coming from their decrease in estrogen, especially as they stop producing eggs. With men, what is that with men? Is it a drop in testosterone? What is happening with men? Well, men can have a drop in testosterone that happens later, but no, testosterone, what is happening with men? Well, men can have a drop in testosterone that happens later, but no, most of what affects our weight gain or our slow weight loss at this point in life is more to do with the downstream effects of lifestyle changes or for women it is downstream effects of estrogen to a large extent. But you know, a big part of this is loss of muscle mass that starts for everybody after age 35. And we're not aware of it. We're

thinking about so many other things. Okay. So this is a big takeaway and I'm sure I'm going to ask you what you've learned really about this is this conversation is kind of blown up. But I know there's so many here who want to talk HRT. What can I do thinking the HRT is the answer for your weight? And that's not necessarily the case. No, I often tell women, so although, although we're jumping ahead a little bit, because we'll get to the root cause of what happens when we lose the estrogen, right, or when it declines. I wish, I wish more than anything

that just giving the estrogen back would reverse the whole process. It doesn't, what I always tell my patients is, estrogen replacement, if you need it for symptom management, and if that is really impacting your quality of life, can take the parking break off, but you have to drive the car. You have to drive the car forward.

It won't just move. I can give you estrogen. And if you're not gonna change anything else about your lifestyle and attack the other components of what's driving the weight gain, nothing's gonna happen. Yeah. So we're talking loss of muscle mass, which happens naturally as you start to age, you become more sedentary in your life. Also, if you've ever done any crash diets,

there's a big difference between weight loss and fat loss, weight loss, you're eating less, exercising more, you're losing a lot of muscle mass along with that. Then there's your stress levels going through the roof, there's your sleep being affected for whatever reason, you know, lack of movements and exercise in general. So I just want to put everyone's mind at ease right now, because all the things that you're doing on following the Libby method are really laying the foundation for all of that you're already doing so much at this point, to

address these issues. Okay, so let's get into then menopause. Should we start with what is it? What's the first question that we ask? Let's define the terms because that's really, really important. And then we can delve into what's happening in our body during this time in our lives, right?

So you kind of made a funny joke, like the day of menopause, right? It is a day. Menopause is a moment in time. It's pretty meaningless in the context of symptoms, right? And how it affects our life. But it is technically one year after your final menstrual period. So you've had no, no vaginal bleeding for one full year. This is important for two main reasons. One, risk of pregnancy pretty much goes to zero at this point in time. It's not quite zero up until then, but it's pretty close. And number two, it's useful in terms of if you have any bleeding, vaginal bleeding after that point, you'd

want to bring it to your doctor's attention because we treat it differently. Okay. Period at a time is the time leading up to, it can be up to 10 years, but for most women, it's four to eight years leading up to that final period. And one or two years after the final period at which the hormones are still fluctuating and declining and then at the one to two year mark they get pretty stable again and a lot for a lot of women the symptoms go away but not for everybody. And how early does perimenopause start?

Oh that's yeah that's that's another great question. Highly variable. So we never know when that last period is going to be. But we know the average age range is 45 to 55. So for some women, symptoms can start in your mid 30s. For others, it's not until your 40s. Some women never have symptoms, right? So you never want to discount symptoms that are happening, especially if it's in your late 30s. And then of course, there are some women who have early menopause, which happens between 40 and 45. And their symptoms might start long before that. Yeah, let's talk about symptoms because, you know, I had an interesting question the other day where someone's like, okay, this is great.

I'm, I'm, I'm losing weight. I'm feeling great, but I also feel like I'm entering, uh, menopause at the same time. Is this going to affect my weight? And I'm like, well, you're already doing a lot of the things that you need to do. So that's great. Also, you can look into, um, therapy or whatever, but I've, I've been a weight loss expert. I pretty much maintained my weight for over 30 years, been helping women and menopause lose weight.

The last couple years, I had a lot of stress. And I wasn't as active as I normally was. But my weight, it seemed like I gained like 20 pounds overnight, I had heartburn, heart palpitations, I thought I was gonna have a heart attack. That's really where I went to because I was so stressed. Vertigo, frozen shoulder. Night sweats happened early. I never had hot flashes, but I had like night sweats where I attributed to wine.

So I just thought those nights, that's where, it's because I'm drinking wine and my body's detoxing. My heart palpitations, all of that was because I'm drinking wine and my body's detoxing, my heart palpitations, all of that was because I was stressed. My shoulder was because I wasn't strengthening my rhomboids. So, you know, I blew a lot of these symptoms off and it wasn't really until I started really taking my stress seriously and my, you know, really just my sleep seriously with obviously our guest expert. I remember going to my healthcare provider at the time and she was great.

And she was like, ran me through a bunch of questions. And at the time my children's father had passed away. So she's like, this is a lot of stress. And let's give me, let me give you an antidepressant and see how that works out. So there wasn't really, even though I was in the age group and I was saying all these symptoms, we just didn't really put it together with menopause. Fast forward two years later and I have another conversation with her and she's like, oh my goodness, how are you doing? Let's talk about this. I have so many treatments and things available. And this is because the reality is our doctors

aren't necessarily trained in this. And the information really wasn't there for our doctors to really understand what was going on. So can you talk a little bit about symptoms and why people may have gone to their doctor and they're not having these conversations. I know that's a lot, but I just wanted to use- How much time do you have?

Let's go ahead to toe, right? So I mean, a lot of the really classic symptoms are pop flashes or night sweats, which are the same thing. It's temperature dysregulation. Your brain is misinterpreting small temperature changes, whether that be internal or external, as massive temperature changes. And this causes the small blood vessels in our skin to constrict inappropriately and then dilate inappropriately. So a lot of women feel very, very hot and then very, very cold.

They're kicking the blankets off all night or they're stripping down at work. They're needing a fan. If you're having to stop what you're doing, that's a severe hot flash. If you are kind of sweating but can carry on, that's moderate. And if you're feeling hot, not sweating, that's mild.

But they can all disrupt sleep. Even if it's not arriving to the level of sweating or even being aware of why you're waking up. So many women are waking up at two, three in the morning. They fall asleep easily because we're exhausted because we're sleep deprived. But we wake up in the middle of the night and can't get back to sleep. And sometimes we get anxiety, often for no reason at all. A fun fact is many women stop driving or stop driving on the highway in their 50s, and this is an undiagnosed symptom of menopause. And we've just accepted this for decades. Like, oh yeah,

you know, some women just don't want to drive anymore when they hit 50. And yet no men do this. Very odd. But so the sleep deprivation is whether you're having hot flashes that wake you up or not, the architecture of your sleep is changing. We're not getting as much deep sleep. We need about 25% or 20% of our sleep somewhere in there. It's 23 is the exact number. Deep sleep. And we need seven hours of sleep statistically to combat some of the downstream effects. So then what does that lead to? Mood dysfunction.

We're irritable, we're depressed, we're tired all the time. And what does that lead to? We expend less energy. We're less able to fight cravings. We have less variation in our hormone levels that normally that kind of natural up and down in the month where half of the month you're one way and half of the month you're the other,

that helps to regulate our appetite. So we've lost that. On top of it, other symptoms, right? Brain fog. Again, this is partly due to the lack of sleep, but also changes in the brain. We're prioritizing different skill sets than we needed when we were gearing up to say,

start our reproductive life, whether we had children or not, our brain underwent changes at that point in puberty that are different from the changes it undergoes at the opposite end of life than puberty. And let's not forget, women traditionally years ago didn't live much beyond the menopause. We're now living 30 years beyond menopause. So we're just learning about all of the other things, which are arthritis, joint pain, especially in the hands and feet, I hear that very often, it's the small joints that can be affected, hair shedding, skin changes, bone density loss, accelerated muscle loss. So it's happening in men

too. But it's an accelerated process in women across the menopause transition for reasons I'm sure we'll get into. And, you know, of course, bloating, digestive changes, which you've already alluded to, that happen for specific reasons. Alcohol intolerance for specific reasons that we can talk about. Changes in our metabolism, but it's not just a random slowing down of our metabolism. There are things that are happening in our microbiome and in our ability to metabolize nutrients that are not in our imagination. They're really happening. And the good news is the more we know, the more we can do to combat this. Yeah, let's all just take a deep breath in right now. I love that the more

we know, the more we can address this. Okay, so this is where I really want. I really want to take a minute and show compassion for ourselves and understanding for ourselves in trying to lose weight. And if you're feeling overwhelmed, and like, my God, I'm never going to lose weight. Yes, you will. Because you, if you are here in week five, you are already doing the things to address all of this. It's how everything works together. So let me go through this. You're trying to lose weight and you're dealing with lack of sleep, which is going to affect your mood, which is going to make you less energetic, which is is gonna have you not only craving more, but more susceptible to giving into those cravings.

You're gonna have brain fog, which is gonna affect the choices that you're making. There's actual changes happening in your brain. There is muscle loss that you're dealing with, digestive changes, especially when it comes to your microbiome, which we're gonna talk about with Dr. Paul tomorrow, more intolerance to alcohol,

which we need because of all this shit. People, maybe we can find a replacement for the reasons why you're relying on alcohol, you know, you just haven't had any other options, but maybe you're gonna have them now. So when when we talk is this theme is this week, one, how can you obviously lose weight in menopause or whatever stage of menopause that you're in, but two, why is your weight sometimes slower to move? And for some people, this might give you a perspective on that.

And so right now you're giving your body what it needs. You are trying to manage your stress, get a handle on that lower cortisol levels. You're working on trying to get better, deeper sleep. You are trying to move your body doing some resistance training plus a whole host of other things. So there's a lot that you are already doing to address. But what is the next level to these things? What if what if you're I'm doing all of that and I still can't lose weight.

So here's the missing the missing piece, the estrogen, right? So okay, we get our estrogen throughout our life from the eggs in our ovaries. And we start our life, we're born with about 500,000 estrogen producing eggs in our ovaries. And throughout our life with each cycle, we don't just lose one egg, we lose many eggs. It's like a little American Idol competition in there, right? So every month, a group of eggs in one of the ovaries grows and one is kind of selected as the ovary of the month, right? That egg is given off and it either gets fertilized and you have a happy little baby, or it doesn't and you have a period. But you lose many eggs in each cycle. So by the time we hit perimenopause, we're down to 10,000 or so eggs. And by the time we're in menopause, we have a thousand or less

eggs. And the result of this is dramatically reduced estrogen levels, right? So they're quite chaotic, but overall the trend is they're declining. And our body sort of needs a new source of estrogen. And the main source of estrogen after menopause is visceral fat tissue. Now, I wish we could say we have this fabulous study that they've done in human women where they see the exact cause

and effect of all of this, right? We have animal models that we can draw on. And those show that as we're losing muscle mass, that muscle's being converted to visceral fat. And in women, it's a much stronger and faster process. It's an exaggerated process compared to our male counterparts because that visceral fat can produce a little bit of estrogen for us. So we do have studies that show that older women who are overweight or obese had fewer hot flashes than women who are quite thin when they're older. And that's very interesting, right? Because it just lends more evidence to this idea, this whole concept that, well,

our body's trying to give us as much visceral fat as possible. So it's breaking down that muscle in a more rapid fashion than it is for men and they tend to maintain their muscle mass longer. And then we get this gain in visceral fat around our abdomen and in our organs and you might be told you have fatty liver disease and that's that visceral fat inside your liver. But it's trying to do, it's like the original bio hack, right? It's trying to give us some estrogen. Yeah. It's trying to protect you. Exactly. It's trying to protect you. And that type of visceral fat, that midsection fat. Thanks, buddy. It's a lot of things like store extra fat trying to protect us as well. That visceral fat is not the kind of fat that you can just

diet off, eat less, exercise more. Well, really one of the main essentials, it's really non-negotiable, is we have to get back that muscle mass. Yeah. If we don't, we're not really doing anything to stop the train. And it's so counterintuitive for women to be strength training.

For a lot of us, I'm really, really trying to preach every day of my life, we have to get stronger, strong over skinny. And I don't mean that you can't have both. You can have both, one, but one, believe it or not, leads to the other. So every ounce of muscle you have on your body increases your basal metabolic rate, which you know is how many calories are you burning doing nothing? And so you want to have as much muscle as you can, not only to increase your metabolic rate, but to help dissolve that visceral fat as much as possible and to provide a really

strong scaffolding for your bones because what good is it to be super thin and be in a nursing home because you fell and broke your hip? Yeah. Well, this comes down to the conversation. I don't, you know, if y'all remember from our sleep series, this is where you got to keep up with our guest segments. Our sleep series talks about when you're not getting sleep,

the way your body converts foods is different. You become more sensitive, sorry, less sensitive to insulin. And so when you eat your foods, your body breaks them down into glycogen, stores that in your liver, it stores it in your muscle, and then stores it in your fat. So if you don't have the muscle, it will store it in your fat,

and that's what's happening here, right? I want to address this comment that someone made. This is depressing. So I, look at me, y'all. I do not feel depressed. I feel better than I have in like, I can't tell you how long. This, if you are going through menopause

and your ass feels broken down and you just feel like it is time for you to focus on you, chances are you got this way because of one, all the crappy shitty diets, because you prioritized everything and everybody above your own needs, because your stress levels are through the roof. It's time to take a look at what you got going on

in your life. You probably gave it all to your children as well, right? Like you would just left very little for you. And this is time for you to take a look at your life and say, how am I living? And how is that serving me? And how am I feeling? And how do I want to feel?

And how do I want to live? Menopause is no different than going, is the hormones that we deal with when we move into those teenage years, those hormones that we deal with after we do have children. This is another transition. This is like cleansing our body and our mind to move into the next phase and stage.

What is coming, I hear is amazing. You feel confident and self-assured and you feel calm in your life. This is why older women just don't give a fuck. They're just like, yeah, whatever, you know? So where you are going is amazing, but you wanna feel your best to get to that place.

And this program gives you all the tools that you need to address the things you need to do, not just for weight loss, but to truly live your best life. Come on now. How many of y'all are just trying to survive on wine every day? Frickin tired, dragging your ass everywhere, right? Like this is an opportunity to make change. So this is, this shouldn't be depressing. This should be exciting.

I'm carrying menopausal too. I'm about to turn 51. I gained a lot of weight during COVID. I was kind of studying, studying for my menopause exam. And as I learned more and as they delved more into the lifestyle components of menopause, I was pleasantly surprised because the message I actually want to impart, we're discussing the reasons why,

but if you break all of this down, there's a solution that's completely free of cost and within your own hands to combat all of these things. Because 80% of this is the lifestyle component. 20% is maybe medication, hormone therapy, supplements, things that may support you if your symptoms are affecting your quality of life to a really detrimental extent. But what did I do? I'm not a big fan of strength training, But when I started seeing it as a as a

prescription as a non negotiable, it's amazing how suddenly I could find 15 minutes a day to do something to make myself stronger. Because this isn't just weight loss. This is longevity of life. This is like being active in mobile when you study those blue zones, you know, people are outside, they're being active, they're not sedentary at desk. Like this is beyond just weight loss.

It's about longevity. It's about aging, yes, but living a wonderful, beautiful, active life when you are older. And maintaining your social connections, right? Go for a walk with a friend. This is, you know, something we're so busy. We're almost not allowed. We don't have permission to go and live a full healthy life

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And beyond weight loss, this is so much more. So I'm just, people are trying to figure out where they land. So there's perimenopause there when your eggs start to deplete, your estrogen starts to drop. You can usually 45 to 55, but you can feel the effects as early as 35. Then there's the one day where after a year, so you don't have your period for a year, then it's the one day that's technically menopause, which just makes the whole conversation so confusing. And then there's the one day that's technically menopause, which just makes the whole conversation so confusing. And then there's post menopause. Is a conversation

in terms of weight different for someone in perimenopause versus someone in post menopause? Well, post menopause, although the things do start to stabilize a little bit for most women because that the curve is steeper in terms of the loss of muscle mass and the gain in visceral fat during the perimenopause Okay, so for that four to eight years Quite a quite a lot of muscle mass loss and quite a lot of visceral fat gain For someone who's not doing anything to combat it. Yeah Once you reach post menopause, so I'm talking one to two

years after that final period, the levels are sort of flatlined again. And for many women, it remains a little more stable. They sort of feel like the train, it's not a runaway train anymore. They sort of feel like they have that control back. And I wanted to say something, hormone therapy is very, very, very safe for the vast majority of women, can safely be started up to 10 years from your final menstrual period, or age 60 if you're not sure when that final period was. Okay. And that's important because I do not want to discount that as a tool at all.

What most women tell me when I start them on hormone therapy is they feel like it gives them the keys to the car back. That's not to say it's going to benefit every woman. We know it mostly benefits women who are symptomatic, right? Who are sleepless, who are having hot flashes, who are having significant mood disorders. But I think an argument could be made that a lot more women could benefit from it than are actually accessing it at this point in time.

And so often people say, okay, I sort of feel like the train is no longer off the tracks. I feel like I have control back, but more so I'm sleeping better. I have more energy, I have more motivation. I feel like I'm more optimistic and more in control of my body. And therefore, I'm making the changes and slowly starting to see control come back. So I want to get into the HRT. I do recognize that for some people, for some reasons reasons they aren't able to take in which we're going

to be talking about non hormonal options in the next couple of weeks as well. But let's talk about so 80% is really things that you can control on your own and address on your own your stress and your sleep start building your muscle mass what you are eating all of that. Let me just be very clear. Is HRT going to help someone lose weight if they just take HRT? No. Okay. Not on its own. Not without the lifestyle components. But it can really help because... Well what it does is it allows you to sleep. Well, for some women, they don't have control over their sleep. They're having hot flashes all night long and no amount of sleep hygiene, no amount of giving up

alcohol, no amount of anything else is going to help them sleep. The only thing that's going to help them sleep is we have to solve these nights left, whether that's through hormones or non hormonal options. Okay. So it will not in and of itself reverse things, but it might just put the brakes on your body's drive to create more visceral fat. If it has a source of estrogen now, your brain has a source of estrogen now. Your brain has a source of estrogen now. Okay, I got that. The difference between anti-depressants... It's not a GLP-1 agonist. It's not something that by itself is going to induce weight loss. Well, I was just thinking about that because I was trying to find like the correlation between the two words, JLP ones can calm your minds and help you get a, and, and address your hunger hormones and help you get a handle on this so that you can make the choices that

you need to make. So not really the same. No, because estrogen is a separate hormone, right? There's many hormones that are all responsible for weight gain, not just estrogen. That's like an extra component that women have. But it's not always the main character there in the weight gain issue. OK, because if taking HRT is a help addressing giving the body more estrogen so that it doesn't feel the need to store it viscerally

That can help Yes, in fact Women who took who took a GLP one agonist in conjunction with HRT Lost 30% more weight than women who just took a GLP agonist on its own Because there's what was going on. There's an interplay there. Estrogen is in every cell in our body. Therefore, replacing estrogen for women

has a positive impact on so many cells in our body. Yeah, lots of questions coming in about HRT. What is it? Is it a pill? Is it a whatever? Can you actually, you can take it when you're older now because there is a lot of misinformation out there. What happened long ago was a study came out,

said that it was bad. That's not necessarily at all what's going on. Now we're coming to realize that hormone replacement therapy can actually just, it can be so beneficial for a variety of reasons. So how do you know, what does HRT stand for? What do you, how do you know when you need it? How do we go about getting it?

So we used to call it HRT, right? Hormone replacement therapy, but that led to sort of an idea that everybody needs it because there's something missing. And we know for some women, you actually don't have symptoms and your estrogen receptors are not adjusting badly to the loss in estrogen. They're very adaptive, congratulations.

You're in the minority who were able to do that. But we now call it menopause hormone therapy. So you might see those two MHT or HRT used interchangeably, but they mean the same thing. What this is is estrogen and usually progesterone. Now if you've had a hysterectomy, so your uterus has been removed, you don't need progesterone. You can just use estrogen. And if you still have your uterus, you do need progesterone with your estrogen. If you take estrogen by itself, the uterine lining gets thicker and thicker and thicker over time and can develop uterine cancer.

We do not want that. So we need to have the two together to balance that off. Now, although we say 10 years past your final period is optimal, if you are having hot flashes, if it is affecting your quality of life and you are more than 10 years from your final period, you still want to see your doctor because, first of all, if you're otherwise in good health, if you don't have cardiovascular risk factors, you may still be a candidate for hormone therapy. But there are also things like SSRIs, SNRIs, the antidepressants, which at low doses can be quite effective for hot flashes and night sweats and the mood dysregulation that comes with it can also help a little bit with

sleep. There's also a medication called gabapentin, which is safe for virtually everybody. At low doses, it can be very helpful for both sleep and night sweats. And it's non hormonal. And we now are about to get, and I'm trying to find out when the pharmacies will have this in stock, but we've had approval for a medication called Vioza or Fezolinotant, which is the first non-hormonal medication that works directly on the what's called the thermoregulatory center in the brain, so the heat sensor in the brain to reduce hot flashes. And so these are very exciting developments because the last ones, the SSRIs, the SNRIs, the VOZA and the Gabapentin are all very,

very safe even in women who have had breast cancer or who are currently being treated for breast cancer or uterine cancer. I love that because the comments are being flooded with, I can't take HRT because of this, I can't take it because of that, I can't. So. Myth bust there though,

because a lot of women have been told they can't take it for reasons that are absolutely not true. So the number one reason I hear a family history of breast cancer. I'm sure you have comments. I have a family history of breast cancer, right? Yeah. But not true. This has never ever been true. Now, the one caveat to that is if your mother, sister, anyone else was diagnosed with early breast cancer and they tested positive for the BRCA cancer gene, then you do want to get tested for that gene. Because if you carry that gene, it's recommended that you have your prophylactic surgery, so ovary removal usually,

before you start on hormone therapy. But you can, in fact, it is recommended if you're young and you have your ovaries removed, that you should be on hormone therapy to prevent diseases later in life. Yeah, because they- The number one that I hear hear family history of breast cancer, not true. You can bring a copy of the menopause society hormone therapy statement,

guidelines to your doctor and ask them to show you where it says a family history of breast cancer means that you cannot be considered for HRT. You won't find it. Yeah, it's you know, this is where you really shouldn't be getting your information out there from the internet because what you're getting is click baity pieces, where you want to find the right people who I'm thinking of like your meds planning. Dr. Jennifer Zalawitzki is also the host of a podcast meds planning, which was really designed to really tell people the truth of what's going on.

And really, you shouldn't be getting any information from a two second sound bite. You really need to. There's so much out there, but you got to be able to get into it. What's your advice for people when they're trying to figure this all out? Well, sadly, I was going to say this. They're not even getting this from clickbait. They're getting this from their doctors. Unfortunately, family doctors, family doctors know almost all of them have had zero training, zero training in perimenopause and menopause. Myself included, I went back and I certified as a menopause practitioner on my own. We're all sort of not self-taught, but self-guided through our education in this area. And then we get certified through our examination,

but it was very eye-opening because everything I thought I'd been told was wrong. Now, of course, good resources. I have to plug my own, so medsplaining, which we, not only, if you're not even into long format podcasts, please follow us on Instagram, YouTube, we give quick set of quick bites, I try to update the latest information, myth-bust as much as possible. And you might even see Gina on an episode of our podcast talking about her life. But the Menopause Society is a fantastic resource. This is a website that has an entire

section devoted for patient resources. You will have access to those guidelines, those position statements, a wealth of information, advice about using bioidenticals versus health Canada formulated hormone therapy. And there it's validated, it's easy to follow, and it's really a wonderful resource. Mount Sinai Hospital, they've also put together a very, a great resource. I don't have the exact link, but you can find it by Googling for it. But they have a resource where they've put together fact sheets for patients, not only regarding menopause, but regarding many, many different aspects of gynecology. So even for

younger, for younger women who might be having issues like polycystic ovarian syndrome, endometriosis, they have a really awesome resource there. So I highly recommend getting your resources from a trusted source. Jen Gunter, she's another great one. She's a gynecologist. She's Canadian, but she now lives in the States. Her book, The Menopause Manifesto, The Vagina Bible, and Blood, which is her book all about menstruation. Very, very, very strictly evidence based. So you know, if you're reading it there, it's as strict as strict can be about being evidence based. And one of the reasons why it is important to kind of do your own research in this place is because there's not really a lot of testing that you can do.

You can't really test. If you've gone to your doctor's and you're like, test me if I'm in menopause or whatever, you can't really test. It's really about the signs and symptoms that you have, what's going on. You know, if you were aware, if I had been more aware of some of the symptoms of menopause, I would have known exactly what was going on rather than brushing it off on my stress, on my lifestyle, on whatever,

which obviously those things had a massive impact. But the reality was I was also going menopause at the same time. Well, that's refreshing. You actually don't need any tests. You do want to rule out, your doctor will correctly rule out a thyroid disorder because those are also very, very common in women at midlife.

And that can mimic a lot of the symptoms of perimenopause. But the great news is blood test into hormones will tell you one of two things. Are you in menopause yet or are you not? The levels are fluctuating and changing day by day. There's no point in testing if you're still having periods. None at all. I often do a baseline test just to rule anything else out. If I'm, you know, just to make sure we're not looking at anything apart from normal transitions in the menopause cycles. And then if you've stopped getting your periods, if

you fall into the right age range, and you're having those symptoms, that's all we need to know. It's what we call a clinical diagnosis. Don't need the blood. Don't get frustrated. Your doctor doesn't want to do the blood work. That's irrelevant. Tell them your symptoms, tell them you're in the right age range, tell them you've done your homework, you've looked at the position statement and you feel like that you're a good candidate and you'd like to have a trial of estrogen plus or minus progesterone. Well I mean just like talk about the formats by the way so for estrogen progesterone is typically a pill, a pill you take in bed time.

It's very helpful. But estrogen can be a patch. A pill or a gel. Or vaginal estrogen, which can be for absolutely everybody at every age, never too late to start vaginal estrogen. Someone was asking about vaginal estrogen, if you have to take something else to go along with it or you can just take the vaginal estrogen. Someone was asking about vaginal estrogen if you have to take something else to go along with it, or you can just take the... Vaginal estrogen is extremely safe.

They studied it for up to two years and then some in terms of whether it caused the same thickening of the uterine lining, and it does not. So this is a fun fact. You would have to use vaginal estrogen every single day for an entire year to equal the amount of estrogen in one birth control tablet. So it does not increase your blood level of estrogen and it does not cause any thickening of the uterine lining if it's used as prescribed.

Okay. I love this conversation because it's really about like all of our conversations. This is about bringing awareness. This is about our members following along and already doing the things like eating good, nutrient rich foods, trying to manage stress. If you're already doing so much, this is about informing you so you can bring awareness to maybe what you have going on or give you some insight to what you got going on. So then you can have really valuable, productive conversations with your doctors. I know there's a lot of questions that have gone unanswered with being mindful about how specific we can get into. Um, I know there are some of you who you don't want to go the HRT route. You're asking about black coho should whatnot. We're going to talk about

sort of supplements, other things that you can do above and beyond what you're asking about black coho, she went not, we're gonna talk about sort of supplements, other things that you can do above and beyond what you're already doing. I hope this gave you great, some good takeaways today. Dr. Jennifer Zalewicki took part in our menopause add-on as well. Right now we've broken that into a self-guided course. We're gonna start that up again in the next couple of weeks. There's a lot of information.

We got into specific types of treatments. We went down, I hate to say the rabbit hole, but for lack of a better term, went down the rabbit hole of all of it, if you're interested in that. What do I do if my doctor doesn't know much about menopause? I do want to, before we go talk about this, because a lot of the clinics available to women are at an extra cost, But there's a reason for that. Yeah. So Ontario does not have the Ministry of Health does not have a billing code for doctors for menopause. So I cannot as a family physician who specialized in menopause, or even frankly, a gynecologist could not work outside of a hospital

and set up a clinic because the billing codes that we could use are so low that we couldn't afford to run the clinic. So Alberta is the only province that actually has a billing code right now for doctors to use for menopause. I have worked hard with people who know who are higher up than me on trying to lobby the government to change that but that's the fact right now. Now what we're left with then is there is one pretty much one OHIP covered option which is the team of gynecologists at Mount Sinai Hospital. Now they're working on expanding their availability right now unfortunately it's quite a long wait they're working on expanding their availability. Right now, unfortunately, it's quite a long wait. They're booking into 2026 because the demand is obviously so high.

So there is a range of private pay options. So low cost option would be something like Felix, felix.ca, which is a telehealth provider, but the doctors there are certified experts in menopause care. So you can absolutely trust their advice. So that's a good option. All the way up to private clinics, like I work at MedCan. I'm lucky to be able to do that

because at least I can provide services for certain women. You check because many employers do provide a discount to use MedCan services. And one thing I did do to advocate was to make my service, my particular clinic there available to people even if they're not a MedCan client. So we have what's called our standalone service, meaning you do not have to be an existing client of MedCan. You can just sign up to use our service and we run all the testing that's necessary. Make sure you're up to date with your mammogram and all of that. And then I manage your menopause care. Now, if your doctor will not is not being helpful to you. I think we're having some technical issues. Oh yeah, just it timed

up for a second. Sorry. If your doctor does not know, cannot help you, don't be afraid to ask for a referral to someone who does. But the good news is because it is privatized, you don't need a referral. Anyone can access MyService, anyone can access Felix without a referral. OK. Thank you so much for your time today. I know we I gotta say, I know we have way over time,

but here's a comment here. I'm eight years post menopause. My cholesterol has suddenly increased, not genetically high, have a good diet and exercise, weight train regularly. My GP does not believe the increase can be due to menopause as the increase would have taken place earlier. What do you think about that? Oh, it's absolutely, it's absolutely due to menopause.

This is what happens, that visceral fat tissue that we talk about, it carries more cholesterol. So I'm hard pressed to think of any patients I have who are post-menopausal where the LDL cholesterol isn't creeping up or the total cholesterol isn't creeping up. Me too. But mine, mine is going up. Yeah, it happens. I don't think they understand. We're not just small men. We are different.

Our biology is different. Remember, it's about your overall cardiovascular risk. Don't let a doctor start you on a statin medication purely based on your numbers unless your LDL is over five. That's sort of like a cutoff. If your LDL is below five and you're doing all of the right things with your lifestyle, ask for a more comprehensive cardiovascular workout before you start on a statin. There's nothing wrong with a statin, but a lot of doctors are still just prescribing

based on the number. I have an elevated LDL cholesterol, but my cardiovascular risk is less than 1%. Why on earth would I go on a statin to cut my risk to what? Less than 1%? So remember, I'm just giving this as a general principle. You wanna know your risk, not just your numbers.

No, okay. And this is because I've had so many people over the years, women lose weight. And then there is like a bounce back after you lost weight, your cholesterol levels can be a little higher. But as they're doing the program and cholesterol levels are going, I'm like, okay, how old are you? Where are you at? Like, this is a little higher. But as they're doing the program and cholesterol levels are going, I'm like, okay, how old are you?

Where are you at? Like, this is a real thing. We have so many questions. I know, we could literally talk all day. We could talk all day. But the good news is we're gonna talk many, many more times. Many more times.

I did try to get to some of the questions that we had because they're fascinating. Um, save them up. We'll, we'll, we'll talk like I'm sure in the menopause program, we talk about mythbusting and all of that great stuff too. So stay tuned. We're going to, we're going to get into this even more further down the rabbit hole. I love that. Uh, thank you for joining us in the weight loss program.

I'm looking forward to those for anyone who's interested in the menopause add-on, you can sign up at any time. We're gonna start that up week seven of this program. So another couple of weeks, we're gonna get going again. We'll run the six week course. It is a self-driven course at the end of the day. So you can always follow where you can catch up, where you need it and whatnot.

Dr. Jennifer Zalawitzki, the host of her podcast, Med Explaining, check her out on Instagram. From there, you can reach out to her. Can you pull up that other contact where to reach out to Jennifer? medcan.com slash menopause and perimenopause. Thanks everyone for joining us. I hope that you got,

I know you got a lot out of this conversation. Again, this is an awareness conversation like all of our conversations to help empower you at the end of the day. Dr. Jennifer Zalawitzki, I am honored that you took the time to spend with us today. Thank you so much. It's always a pleasure. Thank you, everybody. Thanks, everyone. Let's take a minute to hear from our podcast sponsor today because this new year, why not let Audible expand your life by listening kind of like what you're doing right now. So you can explore audiobooks, podcasts, even exclusive Audible originals that are no doubt

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