Puberty in Reverse: The Truth About Perimenopause and Hormone Therapy with Dr. Amy Day

In this episode, Mary sits down with Dr. Amy Day, a leading naturopathic doctor specializing in perimenopausal and menopausal health. Dr. Day shares her journey into the field, her passion for empowering women with education, and her commitment to providing holistic, individualized care.

Key Topics Discussed

• Understanding Perimenopause: Dr. Day explains the often-overlooked transition of perimenopause, highlighting the lack of education and awareness that many women face. She emphasizes the importance of recognizing hormonal changes and seeking support early.
• Bioidentical Hormone Therapy (BHRT): The conversation covers what BHRT is, its history, and how it can be safely and effectively used as part of a broader approach to women’s health. Dr. Day addresses common misconceptions and the need for individualized treatment plans.
• Holistic and Lifestyle Approaches: Beyond hormones, Dr. Day discusses the critical role of stress resilience, adrenal health, nutrition, and lifestyle adjustments. She advocates for self-care and viewing this life stage as an opportunity for growth and well-being.
• Virtual Care and Community: Dr. Day describes her virtual practice, licensed in California, and the resources available through her online community at womensvitalitycenter.com.

Connect:

•  Dr. Amy Day’s  Perimenopause 101 mini-course, clinic and online community website:  womensvitalitycenter.com

Resources:

• Article: Medicalization of Menopause, Emme Elle Coaching 

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Transcript

I would like to joke like my mom and her generation, and put menopause on the map.

There was an awareness like, oh, there's hot flashes happening, or there's like certain things happening and we kind of know to think of menopause. But perimenopause, the whole transition leading up to was blindsiding. like I had no idea. No one ever told them. I never was educated that this was gonna happen in my forties so that's been a big part of my mission, is to bring that education to the forefront. I think that, a lot of people will resonate with the idea that we get puberty education as children, usually in middle school or something like that, where we're like being taught like, Hey, your body's gonna be changing. Here's some of the things that can happen and here's some resources if you need help with it.

 is very normalized in society for teenagers to be educated. But we women go through a second big hormone shift in our life and there was not education.

 Welcome back. My listeners. I often thought, should I put a DR in front of my name to really enhance my credibility in the space of women's health and wellness? If I were to do that and pursue a doctorate, I think I would wanna follow in the footsteps of Dr.

Amy Day, a licensed naturopathic doctor based in California and has been prescribing bioidentical hormone therapy long before the days of the Woman's Health Initiative in 2002. Well, not her personally, but her profession. But you know what? Let's not get ahead of ourselves. I'm not going back to school right now.

I kind of like the role I play in women's health as a woman's coaching specialist and a menopause doula, which is all about putting women in touch of the professionals who can give you the resources, the help I'm here to facilitate. I'm here to educate. And Dr. Amy Day is certainly one individual who's not only educating, but empowering with some real common sense knowledge.

This was such an educational episode, and Dr. Amy Day shares her personal and professional journey into women's health. Her passion for holistic care was ignited by her own health crisis. I mean, she had been in the field of naturopathic medicine, but what really led her into women's health was her. A diagnosis of stage four endometriosis that led to an emergency surgery and this life altering event pushed her to deeply understand and advocate for women suffering in silence, especially when it comes to pain.

Pain that has been long, normalized, and we'll get into that. Dr. Day highlights the dangers of brushing off menstrual pains and urges women to challenge the suck it up culture. She explains what endometriosis is as an inflammatory, estrogen driven condition where the endometrium.

Tissue grows outside the uterus and why dismissing symptoms like this leads to delayed diagnosis and unnecessary suffering. Dr. Day will introduce her signature framework, designed to put women back in control of their health.

And her approach is all about education, informed choices and self-advocacy. Women deserve to know what's happening in their bodies and what options they have beyond the one size fits all medical route. Dr. Day beautifully reframes perimenopause as. A time when the body starts talking in new ways and rather than seeing this phase as a decline, she encourages us to see it as a time of redirection, new opportunity.

We're no longer in the procreative phase of life. We're stepping into exploration, creativity, and as I always say, wisdom. She will point out that only recently has the term perimenopause even entered mainstream public health conversations and much more awareness is still needed around it. Many turn to testing and while lab tests can help, we must understand that menopause isn't something that needs to be diagnosed like a disease.

It's a natural transition that benefits from understanding and support. We will also talk about Dr. Day's three pillars for her client approach, and discuss how community there it is again. Community is such a vital, undervalued, underappreciated role in women's overall health and wellbeing from the physical, mental, emotional, and spiritual whole person that we are.

As Dr. Day emphasizes, we need to have an integrated, empowered model that blends science with self knowledge. Before we begin, I'll, here's something you need to know about Dr. Amy Day. Dr. Day hails from Berkeley, California.

And she's a woman's health and hormone expert who has been at the forefront of the Natural Woman's Health Movement since 2004 when she received the fourth naturopathic doctor license in the state of California. She's sought after speaker and is the founder and clinic director of the Women's Vitality Center, a concierge style virtual practice based out of Oakland, California, using a unique approach called the Vital Method.

And her team offers compassionate care that combines lifestyle counseling, functional lab testing, nutritional supplements,

and bioidentical hormones to help women feel great in and about their bodies. throughout all stages of life. You can find her at women's vitality center.com. It's in the show notes.

Dr. Amy Day. Welcome to the Menopause Disruptive Podcast. Pleased to have you here.

So great to be here. Thank you so much, Mary.

All right, let's unpack BHRT Bio tenal Hormone replacement therapy, and. Also the holistic approaches in maintaining health and wellness. So Dr. Day, let's get into your story. You have been, I would say, a pioneer of natural health movement since 2004.

What initially inspired you to pursue this path?

Yes, it, it has been a path for sure. And, um, let's see. I was first interested in this holistic and natural medicine out of a personal interest. I just always questioned the normal way of doing things and wanted to know if there were other options and. I was not raised, you know, particularly naturopathic or anything like that, but it was just of interest to me, like, oh, the way you eat can affect how you feel.

Or learning about different herbs, like that was new to me. I was in college and learned about echinacea as something that could help when you have a cold. And I had, I just did never know those things before. So. That idea of expanding what it means to take care of ourselves and the idea of healing and what that really means.

It's not just the conventional medicine, like you have X disease, you do y treatment, but more of the, the concept of healing as a whole person. Um, when I was in. undergrad, I was getting a business degree because I had no idea what I wanted to do, and my mom actually sent me an article that was in like Women's Health Magazine, like she had it like ripped out of the magazine in an envelope, actually mailed to me on paper and it was the first time I had ever heard of naturopathic medicine and it, just opened up this idea.

I lo I was very logical and, and I liked science and math and like knowing how things work. But I had just never found anything that really, sparked my interest in curiosity the way that naturopathic medicine did Once I learned about it.

So then your journey, take us into naturopath medicine to eventually open up your practice set. Very interesting. It combines lifestyle counseling with lab testing and natural supplements, bioidentical hormones. So how do you come to package this all together to better support women and women's health today?

 one thing was the fo the decision to focus into women's health particularly.

Okay.

was in naturopathic medical school and I decided to get off the birth control pill, which had been. Given to me when I was younger 'cause that's what everybody is given for, any kind of women's health conditions pretty much.

Mm-hmm.

I decided I wanted to do the natural way I wanted to be, get off the pill. And it turned out that cycle after cycle after cycle of getting worse and worse and worse pain, I realized and ended up being diagnosed with endometriosis. So I had had that kind of masked earlier on in my life, but, uh, had an emergency surgery at one point and because I had been, ignoring my pain and just trying to push through and suffer through. Like we are also very pro to do. And, and so like emergency surgery, landed me with a diagnosis of endometriosis, stage four, and coming out of that really. had me look more carefully about like, okay, what's, what do I really wanna be focusing on?

And so my personal journey of wanting to really learn how to help myself really turned into then wanting to help so many other, um, women eventually in my practice as well. Because the experience that I had as a patient was not what I would've wanted. And I really wanted to create a practice that was empowering and really supported women on the journey.

 give you options of different, ways to go about things and really build, you know, diet and lifestyle and herbs and nutrients, and then. additional treatments on top of that when that's appropriate too. So it was really my experience as a patient that made me, that really formed my idea of like, I wanna do this better do something that'll really be a different experience for the women that we work with.

And we hear it time and again. Often it is our own personal experience that is the motivator, the fuel. For which we pursue a purpose, a career path, and, and your pursuit, sparked by unfortunately, a diagnosis of endometriosis. Tell our listeners, and we've heard this often, but sometimes it can be confused or misdiagnose.

So tell our listeners exactly what it is and how to rule out whether the she has it or not.

 so Endo for short, because endometriosis is such a mouthful to, to repeat. So endo is a, uh, women's health condition where the tissue that is very similar to the inner lining of the uterus, which is called the endometrium. There's tissue that's very similar to that, but instead of growing inside of the uterus, it's growing somewhere outside of the uterus. So it's in the pelvic cavity. It might be on the organs, on the bladder wall, on the intestines, on the outside of the ovaries. It might be on the, of inner abdominal walls. Um, it can be in other places in the body too, but that those are the most common areas. And these tissues respond to hormones the same way the inside. Lining of the uterus does where it builds up every month and then bleeds every month. But instead of being able to shed through the opening through the vagina, like the uterine lining sheds, this is just bleeding internally in, in the abdominal pelvic cavity. So it can create a lot of pain, is really the hallmark symptom. and that can be pain with the periods. It can be pain, other times it can be pain with exercise, with sex, with bowel movements, with urination, depending on what's going on. It creates a lot of inflammation in the pelvis. And, can be connected to difficulties getting pregnant. About one third of women with Endo have struggles with fertility, and some women with unexplained infertility actually have endometriosis even without pain. So it is possible to have endo but not have pain. so that's maybe that in a nutshell, but maybe a whole other hour long conversation.

I would say for certain, definitely, and, it's worth exploring just a little bit, and I would say right now is that if a any woman feels that she might have this, get it checked out 

Yeah. Yeah. That's the thing. We're ver we really tend to normalize pain, right? and normalize suffering. And the fact that a period is painful, we can just feel like we need to tough it out. While it can be yes, normal to feel some symptoms, like your body is going through a shift when you're having a period and when you're bleeding, and when your hormones are shifting at the ti at that time in the cycle every month. But if you're having so much pain that it's really impacting your life and you're having a hard time function and functioning that day, those days. getting in the way of your work or your school, or your relationships or anything like that. Yes. Ask for help and get evaluated,

Mm-hmm.

that you go to doesn't seem like they know much about it, go to a different doctor. 

Absolutely. Yes. If we're getting ignored, dismissed is a.

To request the help that she deserves in her healthcare system, which unfortunately still seems to be in a very patriarchal

Patriarchal.

 structure. Um, very, yeah, volume driven of course, and very little time, but.

sure. So in contrast that you're asking how we package things. So my practice now is a, concierge style. Uh, we have a virtual practice here in California. We're down in in California, in the us and we, have an annual membership where we work with patients over time and we really know you and we know what's going on.

And you have. who's your main doctor, and then you have a health coach available to support you too. And we collaborate as a team, to support patients. And, it's a really different kind of experience where you're being supported in a different way. So that's been part of what I really wanted to put together so that women would have that kind of experience in their healthcare.

So, reading in your bio, and of course on the website. This is the vital method, tell us a little bit more about what some of the core principles behind this approach to healthcare are in your clinic as opposed to traditional women's health.

Yeah, so we're my clinic's called the Women's Vitality Center, so we're all about vitality and being vital. And so of course we had to come up with something that had the initials of V-I-T-A-L. So the vital method is to start with V is validate and really. one, when you go seeking help, you should be believed, you should be listened to and heard and witnessed, and what's going on with you?

 I, I still to this day, it saddens me so many stories that we hear from people of their doctor blowing them off and telling them it's not real. And, that can definitely happen with things like Endo, all sorts of. Issues when we're in our twenties, thirties, but it's so common with perimenopause and menopause as well.

 which I know we're gonna be getting into, but just being told, oh, that's normal, or we don't do that. Or just being blown off like that in gaslit. So we start with validate right from the get-go. number two. The second is, I is for investigate. So the importance of getting more information, of course, taking a really detailed history, so we're understanding your history and your family history and like that.

And also labs, which we can touch on a little later too, but getting that investigated, like what's going on here. because that's, you'd need to know what's going on in order to know what to focus on and what to do about it. which takes us to t of the vital method. T is target and track. So the idea of having a targeted treatment plan, that that's based on the information that we know so far.

And then tracking so that you're monitoring and seeing and noticing what happens from that and how do you do with that. And which brings us to the a is adjust. And I think this is unfortunately a piece that's often missing in conventional medicine is like, oh, you have this thing, here's this treatment.

 and that's kind of the end of the conversation where that ongoing relationship to be able to adjust. To make sure that it's working well for you. That if you're having any side effects that's being dealt with, if you, if it's not working and we need to try something different, that, that's being monitored and adjusted over time. And then l is for live it up.

Uh.

I think it's so important that we recognize that health is not only for the sake of health, it's because of how the health supports you in your life. And we love working with women who are difference makers, you're contributing to your family and your community, your career, or whatever it is that you're doing.

Like you, you want to have your health and your energy and your vitality really supporting you to do the things that you're doing in your life so that it doesn't become, I'm just like managing my health constantly. It's that you have your health supporting you to do your thing, to do your purpose.

Absolutely. I love that. So let's talk about the specifics when it comes to treating women in their menopausal years, addressing their symptoms, and then addressing it from both a bioidentical hormone perspective and holistic living.

Yeah. So, one thing just to segue and, and explain, I shared my endometriosis story, but then there's perimenopause too, so,

We all.

so I, yes, and I really actually started focusing my practice on perimenopause well before I was going through anything personally. Perimenopause and menopause is such a huge thing right now, but I've been at this for like 20 years, um, and I think that supporting this phase of life has been such a missing piece. It was something that I really wanted to focus on, empowering women with education and knowledge and, uh, and options for moving through this phase. when I was 40, which was like 10, 11 years ago, at this point, I super focused on perimenopausal, support in our practice. So that has been our specialty for a long while now, since, Yeah, whenever that was, 20 15, 20 14, so part of my thinking at that time, and it was that there had been some progress in raising awareness around menopause. These last couple of years have done it so much more justice of just raising awareness and putting it on the map and like knowing, I would like to joke like my mom and her generation, put menopause on the map.

 there was an awareness like, oh, there's hot flashes happening, or there's like certain things happening and we kind of know to think of menopause. But perimenopause, the whole transition leading up to was blindsiding people left and right, like I had no idea. No one ever told them. I never was educated that this was gonna happen in my forties so that's been a big part of my mission, is to bring that education to the forefront. I think that, a lot of people will resonate with the idea that we get puberty education as children, usually in middle school or something like that, where we're like being taught like, Hey, your body's gonna be changing. Here's some of the things that can happen and here's some resources if you need help with it.

 is very normalized in society for, teenagers to be educated. But we women go through a second big hormone shift in our life and there was not education. So I have a perimenopause 1 0 1 minicourse on my, in my online community and like we try to do a lot of workshops and education because it is, it's really important that this conversation is happening and that we're talking more about perimenopause and menopause and having an awareness that like, oh, let me connect the dots, like these different things going on, like that might be my hormones and, and to even think to get help or ask about that.

 So women come to you I assume in clinic and work. with the clinic virtually as well.

Uh, yes, throughout all of California. So we're licensed by state. Currently my, the doctors on my team are licensing licensed in California. We're considering expanding to other states, but that is the current is throughout all of California. 'cause we are a virtual practice, so you don't have to be, coming to a certain location in office. but a person doesn't need to be in California to work with us one-on-one. and we also then have an online community and lots of educational resources on our website at women's vitality center.com. there's a lot of resources there too.

So Dr. Day and I, we came into each other's, presence or contact through a what's called menopause brain trust group of women who are working in different facets of the field in menopause and perimenopause through either education. Products and helping drive that conversation, to the forefront. And oftentimes, and me as a menopause doula, menopause coach.

I'm not in the business of subscribing or even diagnosing or counseling. I put people in contact such as you, Dr. Day. But I have found that the conversation still is geared towards, well, if I can just get my doctor to prescribe some. Hormone therapy. If I can just go see an OB, GYN, that's going to help me get bioidentical hormones.

Let's unpack that. It tends to be a topic of great interest, certainly for my listeners, and I think it's really important too, we understand that the role it plays and what it doesn't play in women's health. So that we can have a real educated conversation and really solid information around this, even as a yardstick is moving fast and furious, with the menopause Society, putting out its position statements.

Uh, we are just seeing, like you'd mentioned, we are seeing leaps and bounds in the last, even 5, 6 years let's unpack the role of BHRT.

BHRT Bioidentical Hormone. Replacement therapy, replace, people can argue about whether the word replacement should be in that. but yes, you mentioned five, six years, I'd say even in the last year, there has been a huge leap in interest and awareness and, podcasts like yourselves and lots of book coming out and movies, the M factor came out, all those things.

So, the one thing I just wanna share is that as naturopathic doctors, we've been using and have been trained on bioidentical hormone therapy all along. So even before the women's health initiative study that came out in 2002 that concerned everybody about possible concerns with hormone therapy, even before that, we were prescribing bioidentical hormones. Certainly in the wake of that when people were more fearful about hormone therapy, especially the kinds of hormones that were used in that study that had a little bit of concern about them, which got way blown out of proportion. And there are totally ways to work around that, to make HRT safe for most people. but in the wake of that study, we have been, turning to bioidenticals as the form of hormone therapy as a safe way to, get the support that hormones can offer, which is not everything, but let's talk a little bit about the hormones and then let's talk about other things, because it's not only the hormones just for definition, just in case there's anybody new here to the term bioidentical, which refers to the concept that the molecular structure of the hormone, like the chemical, actual structure of the hormone, is exactly identical to your own biology. So bioidentical. Meaning the chemical structure is exactly what the ovary produces when the ovary is producing its own hormones. So that means that as that, Hormone is floating around in the bloodstream, your body is responding to it in exactly the same way that it would respond to hormones that your own ovaries had produced, which means it binds to receptor sites and it works the same way throughout the body, and it also can be detoxed and processed and broken down in the exact same way that your body has been processing hormones all along as well. so that's the definition for bioidentical.

 And then, you know, it's interesting because, There's still a lot of questions that come up about, well, should I be taking oral estrogen? And of course I wanna unpack that a little bit more too. 'cause still to this day, because of the lack of information and because we see on the internet, there's just so much sensationalism.

There's social media, Posts and influencers that are just throwing out information all the time, and it can get very confusing for women. Confusing in terms of method of administration, confusing in terms of when can I start and should I be stopping within a certain timeframe. And we're even seeing that the, the statement as I mentioned earlier from the Menopause Society is making clear about the safety and efficacy and risk versus benefits.

I think this is a great intersection or a great time to really explain this 

Okay. so let's start with, what are the forms of hormones that we're talking about, the hormone itself, and then we'll talk about the delivery method. So the hormones themselves, so there's estrogen, right? There's actually no one hormone that is estrogen. Estrogen is a family of hormones. There's, no actual chemical structure that's called estrogen. It's a family. E2, the number two, is the most common estrogen, and it's the one that is in the patch. If people are familiar with the estrogen patch for menopausal hormone therapy. It's called estradiol. It has the DI for estradiol E2. There is another form of estrogen called estriol is E3 that has TRI or tri in the name of it. Estriol is E3. There is also an E1, which is estrone has the word one in it, just for easy reference. So estrone, estradiol, estriol are the three kind of main estrogens. Those each get broken down in different ways and create other estrogenic metabolites that can have different effects in the body So it's this whole family of estrogenic compounds that refer to as estrogen. But generally speaking, when we just say estrogen, we mean estradiol. and it within the realm of bioidentical.

So there, the other version of estrogen that some people may be familiar with that is not used very much anymore is Premarin, which is named for pregnant mares urine. And that is the,  form of estrogen that was used in the WHI study that does have some concerns associated with it. Again, the concerns that were there were blown way out of proportion, but that, you know, it's a totally different type of estrogen than what we're mostly using now today, or what naturopathic doctors had always been using anyway. So kind of the story on estrogens. There's also progesterone, the word progesterone does refer to a specific one chemical molecule that is progesterone. There is also progestins.  There are a bunch of different kinds and they are synthetic versions of molecules that act kind of like progesterone but they are not exactly the same as the progesterone that your own ovaries produce. As a category.

these are all referred to as progestogen. That might be the bioidentical progesterone or might be one of the synthetic progestins. But just in case that terminology is helpful just to mention and go over. A lot of times in research, they're just put together and they just say progesterone, even though they're actually referring to one of the synthetic forms.

So you have to really look carefully at what you're reading and what you're seeing, to know what form of the hormone they're talking about. So those are kind of the two big categories, the estrogens and the progestogen. and then we have testosterone, which I will not want us to miss mentioning, which is part of the androgenic family of hormones including DHEA and testosterone, which can also play very important roles in supporting, female bodied people in, perimenopause and menopause when they need that additional support. I don't know if that was the whole first question, but I felt like we should start with those definitions.

I agree because it can be confusing and the more a woman knows, the more information she can advocate. She can go in with the information and have that good discussion with her doctor if she's not able to see someone like yourself who's well educated in this field. Because we still seeing a really a big gap in the medical field when it comes to menopause and also when it comes to prescribing and diagnosing.

So, with this background, it gives a lot of women more armor, I would say, to go in. and state her case. Let's talk about the women who do come to your clinic and they are just beside themselves. They're experiencing a variety of symptoms and every, everyone will show up uniquely, just like snowflakes.

Talk us through how they will be first treated, obviously using the vital method and where the role of lab testing comes in. Is it necessary for lab testing and is it necessary to go on BRhT. And I was gonna say, and then we can even take it one step further, the role of holistic lifestyle choices.

yeah, and something else that you had mentioned, I just remembered in your previous question, so just to touch on it, is that these hormones can be delivered to the body in various formats. You can take things orally. You can apply it as a cream to your skin, like on your inner arms or inner thighs.

There are ones that are available in a patch. There are ones that are delivered vaginally, either with like a ring or a cream or a suppository. sometimes we do really concentrated creams that get applied to the vulva externally. so there are different. Options. And that's one of the things about trying to work with a hormone specialist if you can find one near you because really catering to you as an individual.

Oh, there's also pellets. We don't do pellets in our practice here. but there are options and there are pros and cons to the different options and really working with you as an individual. So I don't love it when a doctor only knows one way to do it, and they just give that same version to everybody. It's, different people respond to different things and being able to have some flexibility and understanding about how to individualize, the delivery method as well as the dose. And how much of each of these hormones and what kind of combinations. so I don't mean to make it sound overly complicated because I want people to feel like they can go to their doctor and get some help. but if you're going that path and you're not getting the help that you need, it doesn't mean that Hormones are bad or hormones are bad for you, or anything like that. Like it might mean that you need, that, you need an adjustment of some kind, that would help it to work better, either to work better for symptom management.

And then also you were touching on this a little bit, just safety profiles. Like we know that generally speaking, estrogen, it's better to take in a topical form at topical or vaginal and not oral. there are some instances where someone needs to take it orally for some reason or another, and then that needs to be weighed with the pros and cons of the risks and it's a nuanced conversation.

We can have guidelines and an understanding of generally what's best, but then we need to work with the individual patient. 

I'm glad you made that point. The individualized approach, and this is where the point I made earlier, we see so much do this, don't do that. This is good, this is bad. But every woman's situation is unique and so that adjusting and monitoring piece. So that she can get her quality of life, have her vitality, just the way she needs.

And so hearing these blanket statements can be very daunting for women. I heard this and Oh, I heard that. And, this is what confuses the space around menopause. We're seeing the yardstick or the, the pendulum swing, if you will, but in that process there is so much gray area and so it's.

 There really is, and we need to have structure of a guideline to start with and all of that. I'll touch just because we're talking about the guidelines, the, the concept of timing of starting, hormones or possibly ending hormones. that I, I will say there's, a quite an understanding of this guideline of you if you're gonna be on hormone therapy, you wanna start it before age 60. Or within 10 years of your menopause, which everyone comes first and that's 'cause you, it's not as optimal to start hormones after you've been, not without hormones for such a long time. so there are a lot of people who are over 60 who stopped taking their hormones because of the Women's Health Initiative study.

Yeah.

never started them because of all the fear that has been in place for the last 20 plus years. And, I think it's a lot more nuanced than saying oh, sorry, you're over 60. this isn't available to you, I think. But we need to look at like, well, what risks are higher starting at that point in general?

And then how can we look at you as an individual and actually evaluate those risks more closely? There might be a higher risk of. Clotting. Well, how can, there are ways to evaluate your clot risk and help you understand where your personal risk is as opposed to what that kind of global guideline is.

Perfect. Very important.

Yeah. And then you make empowered, informed choices.

yes, you speak my language or I speak your language 'cause you're the professional. This is really.

we're talking, we're talking the same language.

We're talking same language, and this is really key. When I went through my menopause doula training, it was all about meet them where they're at. You're a compassionate listener, first and foremost. Then you help facilitate, curate the information, and if necessary, you go to bat, you advocate, you support them, and help them advocate their case because it really comes down to a shared decision making model with their healthcare team, their healthcare professional.

That is excellent. But the education comes first. So.

I love it.

The evaluation piece, the lab tests, I often hear this like, I just wanna get a lab test on this. whether it's bone density or hormone levels, uh, FSH and LH levels, which you can speak to as well. My thought is it's great, but know this, you're gonna have perimenopause and you will go through menopause.

 some of those numbers will be misleading, It's work with your team, but don't hang everything on, lab tests to just know my personal situation, but correct me if I'm wrong.

Uh, yes, and I agree and I am, I'm all for empowering with information, with the understanding of how you're. Be interpreting that information.

Ah.

Um, so yeah, but I will say I think there's an important aspect of what you're maybe touching on there and see if we're talking the same language here, which is I think we're in a phase where we are at risk of over medicalizing menopause. And this is really a natural transition.

 It kind of feels like it's all new 'cause we're all talking about it in the recent years. But I you, perimenopause and menopause have been happening for a very, very long time and all cultures all around the world in all different ways, and there's not much new about this. And this is a natural transition. And we don't need to overly, I use the term medicalize it like that it needs to be diagnosed or that it has to be treated even. it's an interesting with what's happening with the menopause having its moment right now, as I'm super excited about the awareness and the conversations and the empowerment of that. And I'm a little concerned about how much emphasis there is on needing treatment.

I want people to have access to treatment. I don't want them to feel like they have to treat if they choose not to or don't need it, or are doing just fine without it.   and what do we mean by treat? is it something we'll get into more too, but that's taking hormones or doing other kinds of things to

support yourself? I think about it is really that  this period in our lives where we're going through our second hormone transition, kind of like puberty in reverse,

This is 

a time for us to refocus a little on ourselves.

Mm.

So much of our lifespan is spent on others. And taking care of kids and being a partner or taking care of aging parents and doing your career and advancing that and making sure everyone else is taken care of and everything's done and all of that. And I think this is a period of time where your body starts talking to you and that it's a beautiful opportunity. People don't always think of this as an opportunity, but this is, this time is really a window of opportunity to put some focus on self-care. And that can look like different things for different people.

but that's a big part of it. you gotta take care of yourself. Something for historical perspective, up until the last maybe 150 years or so, average life expectancy for females was around 50. that was kind of like, this was the end in a sense. For a lot of people, on average, of course, we had elders and people that would live longer too, on upper averaging.

But, but now with modern science, it is quite expected that we have decades ahead of us still post menopause and the opportunity to take action. And really get committed to self-care so that your health is there supporting you for everything else that you wanna do in your life. Like we said from the beginning of the call about the L phase of the vital method of live it up. You've got a lot of years and decades ahead of you and this is a really opportunity to set the trajectory of how your health goes for those years.

So well spoken, and yes, 100%. I am speaking your language. I actually did an article, a blog post on over medicalization of menopause, and I'm, I'm heavily on, and I say this often, Ayurvedic philosophy deems that menopause is the time of the great reveal. All those things that we have not been paying attention to, listening to, we shelve away.

We pretend we avoid, we mask. They come to bear because estrogen is no longer playing the protective veil anymore. And it is. It's a great time to tend to those, tend to the garden that has been wrought with weeds for so long and let it flourish. I love all of these paintings.

re really, um, he helps us or encourages us, whatever, to kind of tolerate things because that's in the interest of the future of the species, like for the sake of procreation, we have to kind of put up with stuff in order to, be with the other gender and procreate. So I think that as we move away from that more estrogenic phase of our lives, that we have a real opportunity to be like, Hey, what do I care about? And what am I gonna put up with and what, how am I I this questioning that I think is also, again, very similar to our puberty and reverse analogy is.

Yeah.

like who do I wanna be when I grow up? Who am I? this identity kind of questioning and it's a really exciting time. There's real, it's not just hot flashes and dry vaginas. like can be an empowering, exciting time to step into your second half.

 I love how you put it, estrogenic phase of our life. I love that quote Powerful.

 So you asked about lab testing. So

Yes. Go back.

Again, this idea, this is not something that needs to be diagnosed. It's not like I have a growth and I need to get a image to look and see what it is or take a biopsy and check it stage it's not a disease that needs to be diagnosed in that sense.

Yeah.

we do have a definition of menopause. It's when it's been one year since your last period. The

Right.

that's the definition is because you don't know when it's your last period. 'cause they're, if they're getting spaced out, like you can't. Tell if you're gonna have another one. So you don't know it's your last one until it's been long enough.

You're like, oh, I guess that was the last one. so about a year is the definition for that. This strictness of a definition of one year is really for research purposes. It's so that they can define like who's menopausal and who's not yet, and that kind of thing for breaking up cohorts and subjects.

Yes.

Studies. It's really, it's, it really, the cutoffs and the exact boxes of definitions are not that useful to an individual person on the journey. One question that I get a lot is how do I know if I'm in perimenopause, so someone who's. perimenopause. How do you define that? Because it's easier to define.

The end of perimenopause is when it's been a year since your last period. If you're having periods, that can be great for people with IUDs and hysterectomies and all of that. But generally speaking, we have that definition of the end of perimenopause and that one day of menopause, which I always recommend to throw a party. For that one day when it's

I did,

since

I did.

did too. Yep. And then after that is post menopause. But how do we define the start of perimenopause? So I will reflect back something again. the, theme of puberty in reverse. We most people remember, most female bodied people. Remember when you first got your period, like that's like the st.

A

Oh God.

a puberty kind of time.

Mm-hmm.

your puberty years through your teenage years, your 16, you're 17, you're 18. When does puberty end? at a certain point your periods are more regular. You're finally more into kind of like a stable, not for everyone, but generally speaking, that like stable regular cycles and things are not as topsy-turvy, but it's a loose thing.

There isn't an exact definition. It's like things are a little topsy-turvy and then they get settled. Well in perimenopause, after things have been more settled, things start changing. So it's really anytime that things feel like they're changing and they're different than what your normal had been. And that can be with the periods, or it can be with all the other symptoms. If you're getting brain fog, you're getting, night sweats, you're not sleeping as well, you're having itchy or dryness or. Nerve things or hair changes or skin, like all these different kinds of changes, which we, you've probably covered, in other episodes I don't mean to say that everything that happens when you're in your forties is perimenopause. there could be other things going on too. but perimenopause could definitely be a layer of whatever you're experiencing just because it's a natural shifty changey time in our life.

Yes. And we always look back in retrospect saying, oh, that's why 12 years ago I was really edgy or increased fatigue, or recovery from my workouts weren't the same. And my approach has always been, let's go back and look at some of the pillars, whether it's perimenopause. Or not.

Let's go back and look at lifestyle. Are you eating optimally? Are you resting enough? Are you managing stress? And are you moving the body or are you living in a sedate lifestyle? being in a career, maybe sitting at the desk all the time because those factors. Also come into play and they will amplify the symptoms if that those aren't addressed.

So I like to take the approaches you are gonna go through perimenopause and that the age is specifically when it happens, it could be first indicated by the thyroid gland. changes with the sleep habits and the fatigue 'cause a lot, we'll see. It's the fatigue that happens first for first protocol might be giving progesterone, but regardless, again, great golden opportunity for the body to say, Hey, um, we would like some improvement in our nutrition, please.

That microbiome might be saying, Hey, you know, um, is this good bacteria is just not digging those chips for lunch and Coca-Cola. And so it's such a beautiful invitation to really listen in and take control and go, yeah, you know what this muffin top, which has been starting around age 35, maybe it's about time I start to address it.

And in doing so and living out a healthy lifestyle, we are optimizing those perimenopausal years. So that we can enter into it with feeling a little bit more in control.

Yeah, I love that. And so that idea of a lab test to diagnose, is it perimenopause? It's not so much about that. It's more about just acknowledging this phase, having that commitment that you're talking about. I love that. Then the role of labs is often like looking at, well, what is it specifically that's going on and is the thyroid off?

 let's measure that. Or is there a gut microbiome thing that's off? Let's measure that. Is there a, an iron deficiency because you're having heavy periods now and you're exhausted, but if you supplemented your iron, your energy would be better. what is it that's actually going on? That's part of your perimenopausal journey. So it's not really to diagnose perimenopause or not perimenopause. It's more to diagnose and un better understand your individual journey and what's going on in your body so that you can focus your efforts. Right? There can be, too many things on that list of what you could do for self-care. So sometimes labs are having a, better evaluation and understanding of what's going on for you helps you focus on the things that are gonna make the biggest difference for you. I would love to share, I have three pillars of a vital perimenopause protocol

Perfect.

I think it would be great to, to dive into that a little bit with what we're just saying. And the first one is something that we haven't touched on too much yet, but I always wanna make sure to mention is stress, resilience and adrenal health.

Okay.

 we, know that the adrenal glands that are what help us to respond to stress. Can really get into a phase of burnout at this time in life when you've been go, go, go, go, go for such a long time with all the demands on you. And as we move through perimenopause and menopause, we actually want to start being able to rely on the adrenal glands to produce some of our estrogen or progesterone that the ovaries are starting to produce less of.

But if the adrenals are burned out, it's harder for them to step in to do that. so there's oftentimes an adrenal component to whatever is going on during perimenopause and adrenal assessment is one of the biggest missing pieces in conventional medicine, in my opinion. It's, they're never tested.

There's, it's just not looked at as part of what's making us feel unwell. and that's because the true, disease states of the adrenal glands are very extreme on the very high cortisol or very, very low cortisol output. Whereas all the functional differences that can happen in between that, that are more. that are not from a disease state that are more from the day-to-day functioning of the gland,

Okay.

not really considered. You know, worthy of treatment and conventional medicine, there's no drug for that. but it's pillar number one in our protocol for addressing perimenopause, knowing what's going on with your adrenals, having your daily routines and habits supporting adrenal health. Possibly using herbs and supplements that help to bolster adrenal resiliency, to help boost energy and help with motivation and help with winding down and sleep at nighttime depending on what, what exactly is going on with the adrenals. so that's pillar number one, is stress resilience, because we're all gonna experience stress, but we need to be resilient. Yeah. pillar number two is metabolic health. So this is where we wanna take a closer look at things like the thyroid. You mentioned before the digestive health you were touching in on, cardiovascular health. how is your body's engine running and how is that going? And looking at the symptoms that are associated with those things and possibly doing labs.

 if that would help to, better understand what's going on for. You as an individual and your, your body and the things that you're dealing with right now, because those all really factor in and have a, have an important, role to play in your experience of perimenopause. Um, and it's setting the tone for your future.

 if you are having some cardiovascular, signs that are off, like how can we be addressing things now to be preventive and proactive for your future? And blood sugar is in there too. I didn't say that one out loud, but huge, huge importance of knowing your blood sugar and your insulin function.

We prescribed CGMs for patients, the continuous glucose monitor. Sometimes that you, the one that you wear on your arm and it like reads your glucose for two weeks so you can really get that immediate feedback of how your food and exercise and sleep and stress levels and how everything is affecting blood sugar and how you have the power to do something about it, even in the moment to help get it down, the way you combine your foods or if you go for a walk after you eat or those kinds of things. So blood sugar is something that can really, a lot of women get diagnosed with pre-diabetes during this phase of life, and it's very empowering to know that oh, okay, this is going on and it's something you can fix. It's something you can do something about to turn that back.

Fantastic.

Yeah. Yeah. So then the third pillar is hormone balance, and that's usually where people like to start, or are thinking of starting, but I really put it third on purpose because these other factors need to be part of the picture.

Love it.

it's a three-legged stool really, you know, it's like you might need to do all of it or whatever. It's not

Sure.

the order of operations, but it's, that hormone balance of looking at your estrogen, your progesterone, the androgens like testosterone or DHEA. And the balance between them and how your body's processing everything and really getting that. extra layer optimized. but as you can see from that, it's not that The answer is, oh, I just need to go to my ob gyn and get an estrogen patch and a progesterone pill, and then I'm treating my perimenopause and I'm good 

Mm-hmm.

those things would be a helpful layer. I also sometimes teach a pyramid, all these other foundational layers are so important and. Getting your daily routines and self care and your fitness. I know you're a big proponent of heavy lifting and getting that protein in and getting your sleep in and really how you're approaching this whole, phase of life and how you're taking care of yourself during it. Not only does that help you smooth the ride through the transition, it really sets you up for a much healthier future for yourself as well.

Yeah.

to tell people your 80-year-old self will thank you

Yeah.

that you're doing.

 it absolutely, and let's face it, it's those things such as frailty or incontinence and osteoporosis, osteopenia that are such a burden on the healthcare system. And if we had the information and then the right tools at the right time to implement and make significant changes, for ourselves doing great things.

But I think holistically as a community, we can do better if we take those. Yeah.

our healthcare system supported all of that, how great would that be? So we're working on it. One doctor's office at a time. Mm-hmm.

has been fantastic information and Dr. Amy Day. I wish that we could have one of you in every state, every province, every country. your model is fantastic. It's a vital importance. I bet you hear that a lot, Dr. Too.

It's final importance and I'll say if someone will travel to California once we establish, uh, care, so

Yes,

Yeah,

but that aside education, we stress that enough. Education is such a significant factor. They can reap all the benefits of you with your education pieces. So tell the listeners where they can find it, what's available to them. I did check out your little webinar masterclass today, and it was excellent.

great. Excellent. Yeah, so our website, you just go to women's vitality center.com. Um, has the information there. We have a. Free workshop, that is called Navigating Perimenopause. And menopause is HRT right for me. and that will pop up on the website or, uh, in the future if the website has changed.

If someone's listening to this, you just go to women's vitality center.com/workshop and it'll take you to our latest workshop. and we also have an online community that you can join for free and there's tons of resources, there. So other recorded workshops and blog articles and, places to post questions and share with the community and everything too. so check out the blog, check out the online community and check out the work.

I love that you brought up community, joining community because that really is one of those hidden gems or one of those pillars of good health that doesn't get enough attention. But It is vital. Sorry, I had, it really is.

I don't mind you saying that. I love it. 

It's so true. In the episode that launched this week was from another doctor who knew that we needed to do better in wellness, women's wellness, and she purposely left practice to create these communities so we can feel in company of others, share information, feel supported, share our stories.

Because since the dawn of time, women have been gathering in. Circles, so to speak, of some form or another to celebrate, to honor, to raise each other up, and so that is lovely. Yeah. Thank you.

 Yes, yes, yes. I love that. I love all of that. And yeah, you're not alone. You're not alone and your body's not broken. it just might need to be taken care of a little bit differently,

Yeah.

it's, you're not alone in this. And we have so much to learn from each other. As much as I have focused on this for such a long time, I still learn so much from our patients every day and learn, from each other.

Like every experience is something to learn and share. and be really open to other ways of doing things and other possibilities. one thing's gonna work for someone and not for someone else, but if they share what they're doing, it might give someone else the idea. That's something that would be really life changing for them.

So, exactly. Women gathering and supporting one another. That's what's gonna get us through this.

Beautiful. That's a beautiful way to finish this off. It's such a great episode. can't wait to share. And our conversation together has been delightful. 

thank you so much. This has been great and I really appreciate your whole podcast, everything you're doing to make this information and all your guests, available to your listeners and everything you're doing as a menopause doula.

It's so cool. So thank you for your work in the world.

Thank you for yours. I'll get all those links in the show notes Dr. Amy Day. Such a pleasure to have you on the show.

This is such a great conversation because we highlighted the fact that bioidentical hormones, while still very helpful in a woman's symptom management plan, there is such a broader approach to managing symptoms, and Dr. Amy Day really hit the mark when she shared with us that.

Menopause isn't a medical problem to fix. It is a natural transition. I loved how she says that puberty in reverse, emphasizing that this is a time for us to refocus on self-care and listen to what our bodies need, what our bodies are telling us, rather than feeling pressured to seek out treatments that.

We think are right for us, could be right for us. But there's so much more in our bodies to tap into like movements and strength training, which I emphasize a lot in my podcasts, our nutrition, and of course our sleep management practices and our stress reduction. There's anything, sleep would be the panacea if we can get that under control.

We're doing so much for our health and wellbeing, and the statistics are showing that, but one of the biggest themes was the importance of education and awareness. And Dr. D pointed out that many of us never receive any real guidance about what to expect during this phase of life. That's exactly why I became a menopause doula and an educator.

And of course, Dr. Day makes it her mission to fill that gap. Offering resources, workshops, and a supportive online community to help women feel more informed and empowered.

And empowered means we have full autonomy to make the right choices, informed choices about our health and our wellbeing. And just like Dr. Day says, let's take a look at the big picture. It's not just about balancing hormones, it's supporting the whole person that we are supporting our adrenal health, nourishing our bodies properly, staying active, of course, and managing our stress.

And if you're, and if you're interested in learning more about. And if you're interested in learning more or connecting with Dr Day's resources, you can visit Women's Vitality center.com for free workshops and access to her online communi her online community. Truly hope this conversation leaves you feeling encouraged and better equipped to navigate this stage of life with confidence and compassion.