[00:00:00] Kris Hormones are all the rage, and sometimes they're literally raging. I mean, everybody's talking about them these days, and it's about time. But where do we start? What tests should we get? How do we support them? Is HRT right for you? So many questions. Well, my guest today is Doctor Aviva Rahm, a Yale trained, board certified family physician who specializes in women's health and obstetrics. She's also a New York Times bestselling author, an herbalist, a midwife. And she is here to talk about hormone intelligence. So whether you're in perimenopause like me, menopause, or you just want to understand your hormones better, this episode could be your turning point.
INTRO:
Welcome to Made to Thrive. I'm your host, New York Times bestselling author Kris Carr, and it's my mission to help you feel better, live bolder, and create a more meaningful life. Let's get started, my friend.
Kris First and foremost, Aviva, welcome to me to thrive, my friend. I want to start by thanking you, because my listeners know that I've had a recent health scare and I've been on a hormone journey, and a hormone chaos journey, rather. And you were the first person I called when I was scared and a little overwhelmed, and you walked me through so many of the things that I was really clueless about. So I want to just start by saying thank you for being my friend. Thank you for being there for me, and thank you for the work that you do in the world.
[00:01:46] Aviva You know, this is like Jerry Maguire where the guy makes the guy cry.
[00:01:50] Kris You're not going to.
[00:01:51] Aviva Make me cry
[00:01:52] Kris Like, oh.
[00:01:53] Aviva Thank you, Kris and I, I really it's an honor to be someone that you feel like you can call. And I want to honor your transparency with your online community because not everyone does that. And it can leave people who are following the work of someone like yourself or me feeling like we've got it all together and we're in perfect, shining health all the time, and what are they doing wrong? So I do really deeply believe that when we share our real lives, it helps a lot of people in pretty profound ways. So thank you, beautiful sister.
[00:02:28] Kris I want to second what you said, and I think that that's is a perfect way to sort of segue into my first question, because it seems as though menopause and perimenopause and all things hormones. Are having a moment.
[00:02:46] Aviva Oh, yeah.
[00:02:47] Kris And it is so long overdue. And I. You've been at the forefront for so many years. Why is it having a moment now?
[00:02:57] Aviva So what's really interesting is it's like a population groundswell, like we're even seeing it in the election right now. Right? Like the face of this moment is a menopausal woman. And it's because half of the female population in the United States is approaching it or past menopause. So we have literally created a sea. We're creating a sea change based on population numbers. It's astonishing. And I think that the women who are also entering perimenopause and menopause right now, along with the women who are in menopause, so they're like the women in their late 50s, 60s, etc., were just at that age and generation where we don't necessarily give too many F's about what people think about us compared to owning what we want to see happen in our culture and communities politically. So it's like we've got this swell of women who are reaching a certain age or have reached a certain age, who have been empowered and educated from, like our previous generation of mothers and grandmothers, who were those like the second wave feminists who use our voices. And then the other thing that's really interesting is by the time a woman reaches her late, late 40s to early 60s, she's often at a time in her life where she has achieved at least a little bit more of a modicum of financial resources. Not everyone. But even when you have fewer financial resources, even if you've been raising kids, they're kind of getting more on their own a little bit now until you can dedicate a little bit more time and resources to getting that book or joining that program or trying that supplement or making that change. So it's a really cool, kind of perfect storm of wonderful things happening.
[00:04:51] Kris It's so interesting because I feel like this conversation is is growing for all the reasons that you just, talked about. I think it's so long overdue because so many of us come to this stage of our life and we don't have a lot of the tools because it's not part of the conversations that we have been having either. The mainstream conversations, the conversations we're having our around our own kitchen tables, even with our mothers, certainly not with our doctors. Oftentimes, so many of the symptoms or the experiences that you go through are dismissed. And then you go down this rabbit hole of, well, maybe it's this and maybe it's that, maybe it's this and that. And you go through all of the various testing when we if we had a little to your point, beautiful book, which is now my Bible, we had a little more hormone intelligence. And we, we would have more, resources and more, agency. Can you talk a little bit about what hormone intelligence means to you?
[00:06:01] Aviva I can, and I want to just jump back to your previous question because, as you said, we're having this conversation on the podcast today. And probably one of the biggest factors that I didn't mention is the fact that we have the internet and we have podcasts. And so we are actually, as women, really broadly able to amplify our voices, but also not sort of be in the dark, and alone. Right. We're talking about it more because we're hearing other women talking about it, and we can share information in this sort of epic way. And I would love to just, this is the first time I think I'm announcing this, but I just signed a book contract for an actual menopause book, and it's called A Force of Nature. And I'm really excited about it, but yes. So hormone intelligence to me means two things. It is this innate blueprint that we in female bodies have had since the beginning of time. It really hasn't changed that much. And then there's a lot of evolution that happens over eons. But the fact that we menstruate, the fact that we can bear children, and the fact that we can breastfeed biologically, even if individually we do or don't or are or aren't able to do any of those things, the fact that we go through menopause and live X, y, z years or decades after this really has not changed. So when we look back historically, women have not always experienced the intensity, frequency and volume, and constellation of hormonal and other things that come along with that, like autoimmune, chronic conditions that women are experiencing now. So when I think of hormone intelligence, I think of that really deep innate blueprint. And what is. That has allowed that blueprint to work for millennia. And what is it in our modern way of living in our modern environment that is creating noise or static, so that that hormone intelligence messaging is not translating into happy, healthy hormones, right? Whether it's PMS or period problems or endometriosis or fertility challenges or menopause or endometrial cancer or anything like that. And then the other way I think of hormone intelligence is the enabled, empowered, actualized agency to be intelligent and know that there are things we can do to realign with that innate blueprint. So that's kind of a big answer, but that's really at the core of how I think of it. And so with my patients, for example, or even the material I provide online or in my book, it really is like, here's what the blueprint in its ideal looks like. Here's what it looks like when you're traveling or under stress, or the little things that come up in life. And then here are the big disruptors that may be causing all of the above kind of things that I've mentioned and more.
[00:08:54] Kris You provide such a clear roadmap for us, and I think especially when we're going through difficult times, it's such a comfort. I wish that I didn't always reach for new knowledge because I was in the middle of a storm. Yeah, but sometimes that's what happens, you know? I love also that you called it static because it it can be so scary when something changes and you don't quite know why or what's going on. And, and just to look at it that way, like, oh, there's just some disruption in the conversation in your body. Yeah. You know, allows you to get back, get out of that fight or flight and back into Rest Digest. Let me approach this with a level head and, you know, I'm okay. We got this, which is a lot of what your text thread said, by the way. Like, I know this is.
[00:09:51] Aviva Going to look up for the big scary things right? Like that. Sometimes I think my unique kind of space that I hold is that I have all this experience as a midwife, herbalist, home birth, you know, like hippie mama doing the back to the land living. And then there's part of me that's also that's Yale trained. And then I'm.
[00:10:14] Kris Like, well, we.
[00:10:15] Aviva Can't just assume that. It's a little bit of static, like, let's make sure there's not a lot of noise happening. And then once we know that, then we can just sort of like, you know, you think about a radio like or like fine tuning until you get a clear, clear signal and then what's the fine tuning we need to do.
[00:10:33] Kris So we're going to talk about that fine tuning. And we're going to talk about some symptoms that that women could be looking out for. And and we'll get into some of your a holistic recommendations. But I want to actually start with the positive because we are we'll go into the medical right. We'll go into what we can do. And and some of that could be triggering. So if we were to take a big step back and just start with the upside of these changes, because Lord knows we focus on the downside a lot. What's the upside of perimenopause. And then entering you know your menopausal years.
[00:11:14] Aviva Yeah I mean for me I love the I can wear white jeans any day that I want to and never think twice about it. It's like, oh, when I'm 58, when I first stop getting my my cycle, I was, 52 and I mourned. Actually, I was like, not I mean, I didn't have a big mourning time, but I was like, I felt grief. I felt like, oh, I'm actually letting go of a certain whole phase of my life that was meaningful in so many ways. And the idea of fertility and all that culturally connotes. Right. And for me, you know, speaking to my own experience, the upside is there's a lot of freedom. It's not just the freedom to wear white pants. And if you're already doing that, great for me, I will. I like typically to not wear white pants on my own. I'm like, well, I save that for another day. But there is a certain freedom of just not being as, cyclically driven. There's an evenness that comes. There's not as many ups and downs of your menstrual cycle. You do lose that fertility time, but you get kind of this like, nice hum that starts to happen if it's going smoothly. And, and even for me, it's not always a hum. Right? Because your hormones are still finding their ups and downs. Your estrogen is going a bit. But wait, wait, wait, don't leave without me. Your progesterone is going. But wait, what about me and your test? Your testosterone is like, well, I'm out of here for a little while, you guys, you know, so you can go through a lot of changes. But I think the biggest upside is just that if we embrace this new kind of like. Grown woman, adult place of power and confidence. And think about new freedoms. Kind of the way you think about the white pants. It's like, okay, I have the freedom to now. And it's not that you didn't before, but I will say something just shifts inside. And I think that there's a reckoning that I see a lot of women, especially in kind of more mid and late, menopause, like, not just like at the very beginning, but in their 50s, early, middle, late 50s. So I go, what do I really want? Like, what do I want? I've done all this nurturing, I've done all this giving, I did all this career building, I've done all this working, I've done all this tending. And often you're still tending. You might have teenage or college age kids or young kids. If you've had babies in your 40s, you might have parents that need your help. But if you can find that kind of stillness within and really ask yourself, what do I need? It can help you start to really reframe your priorities, your boundaries, your value system, and own a sense of a right to take care of yourself in a whole new way from a physiologic perspective, like what's happening hormonally, I think we're still learning more what the benefits are and what the advantages are, because there's been a lot of focus on the negative. Like you lose estrogen and it affects your brain negatively. It affects your heart negatively, affects your bones negatively. But I don't think that that's the full story. And I think we're really still learning what that full story is like. What is the role of menopause from an evolutionary perspective. So like if you continued to be exposed to high levels of estrogen your whole life, that's very proliferative. It could actually lead to overgrowth of tissue and, you know, endometrial cancer, breast cancer and things like that. So I, I truly believe nature is sort of saying, okay, you've been bathed in this for a really long time. We're going to kind of give you a break from that chronic constant exposure. And what that fully means is still sort of TBD. It's interesting. There's only one other animal species that lives for decades past menopause, and that's some whales. And we know that for whales, like they're not going through cognitive decline, bone loss, all the things. Right. But what they what we do know is that they take on a new role in their pods. They become the hunter says, so that the younger generation of females can take care of the babies. They become the protectors. So it's really interesting when we can look outside of ourselves and go, what is really happening? But I think we're still there are still more questions than we have answers, because until recently, nobody's been talking about it and barely been researching it. So we're looking at like the work of my friend Lisa mosconi, who's a neuroscientist, who's doing a lot of work on estrogen in the brain. And she has identified that the brain goes through various actual physical, structural changes at different inflection points in our life, like pregnancy and menopause. In pregnancy, I think we have a better idea of what those changes do. They make us more connected. They give us certain awarenesses of others that allow us, as moms, to be kind of aware of the needs of the baby and protecting of the baby. We don't fully know in menopause yet, and it's kind of exciting that I find that it.
[00:16:13] Kris I love the way you talk about that because it feels exciting. It feels the way you're framing it, that, you know, there is a chapter where we may be very hyper vigilant and focused on building our lives, our businesses, our families, and caring and nurturing and and that doesn't necessarily completely turn off.
[00:16:31] Aviva No, it hasn't for me.
[00:16:33] Kris No. But it what turns on is, oh, wow, now I'm in this chapter, I'm really going to build me, you know, more, more authentically, more deeply, more in more deeper alignment, connection to self and what I actually want. And I think that's very exciting. And and we have to hold on to those positive frames because again, I think we see so much of it, portrayed negatively either in, you know, online or in our media or whatnot. We don't even see a lot of women of a certain age represented in the media, let alone women from diverse backgrounds or whatnot. So that's why I wanted to start with that, that frame of how positive this chapter can be.
[00:17:15] Aviva Yeah. There's another really interesting phenomenon that's happening that I don't feel like has been explored really fully yet either, which is that we're actually expending a lot less biological energy, especially for women who have been ovulating year after year after year. They're still cycling year after year after year. We think about blood loss and we, you know, in our periods, right? We don't tend to think of the energy expenditure of ovulation. And so there's a less there's less reproductive energy required. And so I think okay. Well then we're. Can we put that energy elsewhere? Else? Where? In our lives or back toward ourselves? And it's interesting. I find myself asking a question and I think we're closest. I'm a few years older than you, I think.
[00:18:04] Kris Yeah, I'm 53, 73.
[00:18:06] Aviva Something like.
[00:18:06] Kris That.
[00:18:07] Aviva Yeah, yeah. And there's been a little shift for me, I would say, especially in this past year, where rather than sort of thinking so much like, what do I need to achieve? I find myself thinking, what's enough? What's enough? Like, what's enough to achieve or to acquire? And there's something about it that I can tell. It's not just the way I'm sort of spiritually or psychologically evolving. There's actually something happening within my internal chemical, hormonal ecosystem that's asking me to ask a different question in my life right now. And it's very fascinating and powerful and kind of, in a way liberating, too.
[00:18:54] Kris I can't wait for us to have our lunch because I'm asking the exact same questions and it's different. And yet I feel that same sense of excitement and I feel a little, off balance by it, too, because, yes, it's just a very new chapter, one that I'm very excited about. But but again, I don't have a lot of experience asking that question because of the pressures that I have felt. You know, as with life, with business as a patient and and so on. So, yeah, we will pick that up at tea time. And I want to.
[00:19:36] Aviva Say, like, I know we're talking about the positive. And I think it's really important for us. Not all women have significant menopausal symptoms. Like, if you go on the internet right now, you'd think it's just like hell on wheels all the time. Not all women have significant menopause symptoms, and not all women in all cultures have. We are known in the US, in the West to have some of the worst menopause symptoms, and there is some thought that it's a combination of environmental factors, stress, but also the way we believe menopause is, which is kind of interesting. But also I have been since I've been a midwife and an herbalist for 40 years. I've been a doctor for 16 years and working with women the whole time. I started teaching my first classes on natural approaches to menopause in my 20s as an herbalist. Women were asking me to teach this, so, you know, I. Fancy myself as as knowing a thing or two about menopause, and I've helped a lot of women. But until you're in it, it's hard to fully explain the power of it. I think if you've for me at least, I have not had a lot of physical symptoms. But I've definitely had sleep changes, psycho emotional symptoms, changes in, my bandwidth and capacity for, like, how many moving parts I can have going on in my work at one time without feeling overwhelmed. And I think that some of these neuro cog like, we hear a lot about hot flashes, we hear a lot vaginal dryness, etc., etc. and honestly, those are actually things that are, I think, easier to address weather naturally with herbs and so forth and hormones and lifestyle. But some of these neurocognitive changes are for me. It's been actually really intense, and given how much I thought I knew or do know, it's really gotten me focusing deeply on those aspects and what women are going through, like the acceptance of the transition into being in a different phase of our life. And we're not crones yet. We're not old women, but we're also not young, fertile women anymore. Right? We're in a different phase. And what does that mean? The impact of sleep changes, the impact of. Being more raw in your hormones. I mean, in your emotions. It's a lot, actually. I think it's been a lot for me to integrate and understand.
[00:22:16] Kris Well, I want to talk about some of the symptoms, especially because for so many of us, we may attribute it to something else. Yeah. And for me, it started you like years ago. And I don't think I realized what was happening because I was also going through a really difficult time in my life. Right. So I had. My dad was diagnosed with pancreatic cancer. I was on your beautiful podcast. You know, the book that I wrote, about grief and loss. And so that was a full four plus year journey and then writing the book and whatnot. And so when you're going through a time of elevated stress, the for me, the symptoms of fatigue, brain fog, etc., so beautifully like inability to hold as much as I used to be able to hold or a impatience with multitasking. And I just felt less resilient. And I was like, well, this is grief, you know? But actually then cut to when I called you, and all of a sudden, I'm not making any progesterone. I think it the changes, that I had, the cognitive changes that I was experiencing was sure exacerbated by grief. But I was going through a hormonal change and some hormone, probably chaos, long before I understood it. So what are some of the other symptoms that somebody out there listening to might be experiencing and they don't know why?
[00:24:00] Aviva Yeah. And isn't it just the way of humans. But I think especially women, humans that we tend to look at all of the reasons, like I'm stressed, I'm overworked, I'm grieving and forget that there can sometimes actually be a biological reason. There's a really funny Instagram meme of a woman in, like, kind of white pants and a colored shirt, and she's, kind of dancing up a path, right? It's just kind of funny and goofy. And then it says that moment when you realize your totally shitty mood was just that you were the day before your period. And like, how often does that happen? Right? You're like, or we feel really tired and we're like, what am I doing wrong? Maybe I'm not exercising enough. And then the next day you get the flu or, you know, something like that and you're like, oh, and I feel like for perimenopause and menopause, so let's just say what they are. First of all, great. So menopause by definition is it starts one year after your last menstrual period. So if you have a menstrual period September of 2024 and you don't have another period at all, one year later, September of 2025, that would be the official start of menopause. So one year after your last period, that's menopause. Perimenopause. Perry just means around and perimenopause can last 8 to 10 years. It can be this slow lead up. And the average age of menopause internationally for women is 51. So you for your average age. But that range can be like 42 to 56. So if you're someone who's going to go into menopause at like let's say 44, you don't know that when you're 38, but you can be having symptoms like your periods are getting a little more irregular, or your periods are further, apart than they used to be. And then you have three months of periods that are further apart, and then two months of periods where you get like 2 in 1 month and then you don't see it again for three months. Like this irregularity. And there are patterns to that irregularity. And that can also include some episodes of heavy bleeding, like remember when you're in high and you know, middle school and you're afraid you're going to just bleed through your pad right into your pants, like that can happen to it in, perimenopause and early menopause because it's well, but in that like one year transition before you've stopped, and it can kind of catch you by surprise. So changes in your cycle, if you're having those changes in your cycle before you're 42, it is a good idea just to get your hormones check to make sure you're not going into what's called, sort of colloquially premature menopause, but make sure there's no primary ovarian insufficiency or things just aren't working as well as they might be for other reasons like low ovarian reserve. And of course, many women are waiting until late 30s, early 40s to have babies. So you definitely want to check for fertility as part of your plan at that point. But changes in your cycle and changes in your flow are a really big one to look out for in those early years. Changes in your mood. It can be you're just raging for no reason, you're crying for no reason. Or maybe there is a reason like your partner is the reason. But the rage is bigger than you might have and faster than you might have expressed it previously. Or things just trigger you that or like, you know, your partner's chewing or breathing or whatever. Like take that as a sign you're not necessarily just annoyed by them. You could be too. But those amplified emotions, vaginal dryness is certainly. One. Lower libido, such as lower sex drive. And those can go hand-in-hand because if it's a little dry and it hurts when you have penetrative sex, that can make you want to do it less too. But then also those hormone shifts can make you want to do it less, too. Often women are experiencing they're receptive, Lee stimulated, but they're they're, not the ones initiating things like if you're if you have a partner and they get things going, you may be responsive to that, but you're less likely to say, hey, let's let's get things going. Hot flushes and night sweats. Those are very, very common. As many as 80% of women are going to experience those. There are some really odd symptoms. So there's something called musculoskeletal symptom syndrome of menopause. So I've never had muscle or joint pain in my life. And then about five years before I actually thought I had I live in the country in western Massachusetts. Like do I have Lyme or something like this shoulder's hurting now. Now that knee is hurting and I, I checked, I did not have Lyme and it took care of itself just with more exercise. But that is a really common phenomenon because estrogen lubricates the joints. And as estrogen starts to go down, you have less joint lubrication, you get more inflammation. So if you're suddenly having like joint aches, pains, just kind of general muscle aches and pains, it could be that weight gain, especially around the middle 5 pounds, 7 pounds, 10 pounds, 15 pounds. That can be a sign that your hormones are shifting and it's typically around the waist. There are so many. There's like 40 or something symptoms. And then the neurocognitive, you know, changes that we talked about. I remember for me, I was working on the adrenal Thyroid Revolution book and the way that I came up with the whole because it was pretty early on talking about hitting the reset button was actually, I had so many tabs open on my computer that my computer went into that spin, and the only way I could get out of that spin was to restart. And like, I had to totally shut everything down and reboot. And I remember that feeling kind of like almost a metaphor for the fact that I did not enjoy the feeling of having so many tabs open at once that I have things I was juggling. And that kind of comes also to brain fog. Lowered stress tolerance and sleep problems. And sleep problems can be typically trouble falling asleep. But more commonly, what I hear is women are waking up in the middle of the night two, three, four in the morning, and it's like the lights are on in their head and they just can't turn it off and go back to sleep. Those are a lot of the big ones. But you can have like changes in your body odor, changes in your vaginal odor. New onset of bacterial vaginosis. Like, I know it sounds so glorious and wonderful, but these are just a range of the kinds of things that come up.
[00:30:45] Kris Yeah. And it's important to understand this range or just to be familiar a little bit with it because it's, you know, it's it may happen. And so we want to just again understand the basics. I recorded a podcast recently and it's multi series. It's about becoming the CEO of your health. And one of the things I talk about is if it's been a while since you've had a wellness check, since you've looked under the hood, just get a baseline to get your blood work.
[00:31:12] Aviva Figure out where your cholesterol is.
[00:31:14] Kris Yeah. So to let that episode or let this conversation be an invitation. And I think the same is true when it comes to women's health. And I'm wondering, what a wellness check would look like in your eyes and what are the types of things that we should be asking for when we go to our doctors?
[00:31:37] Aviva Yeah, I mean, this is such a great time in life to do that peek under the hood. And actually, I just did this for myself. Last September, I got to the core set of labs to see where I was at because like, yes, I live this really healthy lifestyle and I've been really fortunate to do it since I was a teenager. So, but like, there's that's no guarantee of anything. I'm like, let me just see. So I'll even share what what I got done. And it's a really it's an opportunity because when we think about perimenopause being in our late 30s to potentially, you know, mid 40s and then menopause being potentially early mid 40s to our mid 50s, hopefully you have 30 or 40 more years of life beyond the 50s. And if you're in your 30s, 40s like 50 more years. Right. So what a great time. It's I think of it as like preconception care. Like is ideal to be doing the things before you try to get pregnant for optimizing fertility and pregnancy. This is a great time to be doing the. Things to optimize for those you know. What is it Jane Fonda calls it like the fourth and the fifth fifth act. Right? Yeah. And so the big things that I really encourage women to think about are inflammation, cardiovascular health, nutritional status. And when you talk about things like cholesterol, that kind of fits into nutritional status and cardiovascular health and inflammation kind of across the board. So let's just get granular and then we can maybe even give a list of these that women can go in and may not be exhaustive. There might be a thing or two that I just don't think of as I'm talking. But basically you want to get a complete blood count that's going to include your iron status. It's going to include your white blood cells. It'll give you just a good sense of where you're at from. Are you getting enough iron? This iron is really important for cognitive function for immunity and other factors. So just going to go like everything's kind of okay. And then something called a complete metabolic profile. These are standard labs like any lab will do them. Any doctor will do them any nurse practitioner etc.. And the complete metabolic metabolic profile just looks at things like your liver function. It's sort of a core panel of basic tests. In addition to those, I really encourage women to get a homocysteine level. Highly sensitive CRP, something called an ESR which is a set rate. There was a study done. Now it's got to be about 20 years called the MacArthur Study on Aging. And what this study did was a very large study that looked at what are sort of the, measurable parameters of people who age. Well, and when we talk about aging, well, we're not talking about like, not having crow's feet. We're talking about, being independent into your senior, senior years. Right. You're still able to function at a high level without significant chronic disease, disability, or risk. And they found that, inflammatory markers were really big factor. And so the ones that I've mentioned, homocysteine, ESR and HSP, those are really good indications of your inflammatory status. I recommend getting something called a hemoglobin A1, C or just an A1 c. That's a three month measure of blood glucose. It'll give you a good sense of, your your status, you know, are you pre-diabetic? Do you need to do something about that? Are you totally fine? You know, it's a really measurable way to look at an average of blood glucose. I do encourage people to get thyroid labs. At least a TSH is a great one, or a TSH and thyroid antibodies, but you can get a whole panel, TSH free T3, free T4, and thyroid antibodies. And the reason for that, particularly for women and as we're in this phase of our life, is we think about things like brain fog. Brain fog can be a function of your estrogen going down. It can be a function of not sleeping as well of the emotional changes that we're going through. But it can also be a function of, hypothyroidism. And this is something that often gets dismissed or missed in women in this age range and, and even in, women in their 60s and beyond. And it can it can be a huge factor in cognitive dysfunction. It can also be a huge factor in how well your heart is pumping. And so I really encourage women to just have a look at your thyroid, see what's going on there. And then the other thing I encourage women to do is get an A and A. So a an A that's anti-nuclear antibodies with reflex your care provider or lab will know what that is. And and looks at whether you have, an elevated marker that could suggest the possibility that you have an autoimmune disorder and having a positive or elevated and a doesn't necessarily mean anything. But if you get that A and A and the reflexes if it's positive, they'll ordered this reflex. And that'll then tell you, is there any, autoimmune condition that's being missed. Now, I don't necessarily encourage all women to get that last test routinely, but if you are having brain fog, if you are having aches and pains, if you are having lower mood depression, particularly, those can be actual signs of an autoimmune condition that are also often missed. Fatigue is a really big one that gets talked up to like, oh well, you're not sleeping as well actually. And then a basic nutritional panel to include vitamin D and B12, vitamin D is really important for blood sugar, health and immunity, cognitive functioning, healthy aging, and vitamin B12 is really important for healthy balance. And particularly as we get older, if our balance gets off and we fall, hip fractures are actually one of the bigger risk factors for women in in our 60s and beyond. So making sure you get that taken care of now is great. Really. Interestingly, there isn't a whole lot of value to getting your hormones checked. This is something that isn't controversial at all. This is like established evidence, but there are a lot of lab companies out there, and a lot of companies that are selling supplements and hormones that are pushing hormone labs. If you're having perimenopausal symptoms and you're kind of young to be having them, then getting your labs checked is appropriate because then you can see, well, is this perimenopause or is this some or early menopause or is this something else? But once you're, you know, if you're in your late 40s, as as I like to say, if it walks like a duck and it quacks like a duck, it's probably a duck. So if you're having skip periods, you're having some hot flashes, you're having some night sweats, you're having mood changes. They're you don't have to get tested to confirm that you're in menopause. And getting tested isn't really going to make a difference. So you can. But I actually don't routinely do it unless there's some concern. Like in your case, it's like we're like, okay, this would be a time because this is an. Outlier symptom. You're not having the other symptoms necessarily. And like let's just make sure there's nothing that we need to figure out hormonally.
[00:39:04] Kris I mean that that's an incredible list everybody. We're going to have to create a transcript of this interview.
[00:39:11] Aviva I can write the list out for you.
[00:39:13] Kris It's really it's so important and so helpful. And I appreciate you sharing all that. And to your point. I had never had my hormones tested. I did my regular mammograms and pap smears and, you know, stayed up on the things that I knew I was supposed to stay up on.
[00:39:28] Aviva Yes. And those are important. And I forgot to say cholesterol, I apologize. So a cholesterol panel, we had talked about it, so I didn't restate it. Yeah, yeah. Sorry.
[00:39:37] Kris But it wasn't until there was an outlier. And for me it was, you know, for two months it would be about 23 days, 24 days of very heavy bleeding. And then we had to rule out, you know, the things that we hoped it was, which was, oh, this is a hormonal change or oh, this is potentially precancerous or oh, this is another, as I call a big casino, this is endometrial cancer. And so, you know, it was because it was so outside of the norm for me that I got my hormones tested. And I'm so glad that you said that, because what I didn't know is whether or not I would have to continue to get them tested regularly. And I'm not completely done with that because we did. What I found out, as you now is and as I mentioned earlier, I wasn't making any progesterone. So I did a two week course of progesterone. And now we're kind of saying, okay, has that reset, Kris. Obviously, I have to go deeper than just taking two weeks of a medication. But I also felt as though that medication was really helpful because, again, it got me to stop bleeding. Which.
[00:40:49] Aviva Is a big.
[00:40:50] Kris Thing. Yeah, it was huge. But now, you know, going on this, this new, exciting health journey, I could like, oh, what are the some of the things that I can do to support my body naturally. And so let's shift into that. What are some of the things that we can do nutritionally through our diet, through maybe our lifestyle that supports our hormone health?
[00:41:16] Aviva Yeah. So during this phase of life, I think one of the really important things that all of us can do is just pay attention to how you feel when you eat certain foods that you may have been eating your whole life, but now may not. Work as well for you. This is a great time to really emphasize protein and good quality fats. Those are going to give you a really sustained energy, which also helps our mood better. And then it also means we're not going to be like going for the coffee in the sugar all day long as we're tired and we get better sleep that way too. And we know that that protein is great for supporting muscle. It's like a great building block for healthy tissue and that fat. A study just came out recently that just showed that people who eat good quality fats, plant based fats, olive oil, avocado, etc. actually have better cardiovascular health for much longer. But the fat also does serve as a building block for hormones too, so it's not like we completely start making hormones. We're just making a different kind of estrogen that's not as potent. We're making less progesterone. Once we stop ovulating, we're making much less. We're still making testosterone, so we still need those building blocks. So I emphasize like good quality protein, good quality fats, pretty much every meal. Eating steadily. I think there can be a role for intermittent fasting, but I find that in my practice and in my own personal experience, that keeping kind of a steady energy throughout the day, rather than having long gaps and then, you know, eating two meals seems to be more sustainable for women over the long run. And then tons of veggies and local fresh fruit in-season. And lots of berries. Berries, fresh berries frozen. I really emphasize the importance of getting good fiber at this time in our lives too. A lot of women find their digestion, their elimination changes. Their find themselves more constipated. So getting that fiber. The other thing I think is really crucial is even if you've never been someone who has loved exercise and movement in your life like it is a gift that you can give yourself to start doing something that's cardiovascular every week, whether it's a good brisk walk, a swim, if you can get really into like biking or jumping rope or dance, all the better. But a good walk is is phenomenal. And then doing some kind of weight training and core training. So weight training is really important for keeping our muscles strong as we age, which is important for, look, just being able to function. And I, you know. Get from one end of an airport to another end of an airport, which can be an ordeal these days, right? Or if you have grandkids picking up, your grandkids are working in your garden. That muscle strength is really important for longevity and also function like we don't want to just live a long time. We want to live a long time really well. And then core strength is also incredibly important for just balance again and not falling. And then when you're doing some combination of cardiovascular, and weights, especially if you're doing weight bearing things like walking, and weight lifting and it doesn't be heavy weights you're building bone and healthy bone is crucial for us. So if all you do is like protein, eat good quality fat, eat lots of veggies, get some good quality fruit, keep alcohol to a minimum, and add an exercise. You'll be like, you'll be doing so much for yourself. Look, I know there's so much emphasis on the internet right now on hormone replacement therapy, but a big study just came out showing that, as much as 50% of all dementia, 55 0% of all dementia globally could be prevented. And they give like 14 lifestyle changes eating well, not smoking cigarets, avoiding loneliness. Hormones weren't part of that. It was all these other things. And I really just want to emphasize that.
[00:45:33] Kris That sounds that's so interesting because it seems like we're always looking for the, medication or something that we can do outside of ourselves and outside of lifestyle changes. And it's not to say that HRT isn't really positive for.
[00:45:49] Aviva Yeah, no, it can be really positive a.
[00:45:50] Kris Lot of people, but are we starting with making those lifestyle upgrades and then seeing how we do and kind of going to the root cause of what some of the imbalance might be, and then enhancing it with something like HRT. I think that's a really great thing to just slide across people's radar. Because so often we outsource our well-being to something outside of ourselves.
[00:46:15] Aviva I love that you said that. I agree, and even if you do need to take HRT for hormone symptoms, sleep, whatever it is that you're taking it for, it doesn't negate the need to still do all of those other things.
[00:46:28] Kris You know, I have friends who just are doing their thriving because of it, and I have friends who've tried it and and stopped because they didn't really see a difference. So I think just to bring that back is that every single woman has to go on this journey for herself. And what I love about you as a midwife and an arboles and a medical doctor is you are using the best of everything available to us. That's why you're such a great resource. And speaking of resource, I can't wait for your new book because you'll. Well, maybe I'll get some advanced chapters.
[00:47:01] Aviva Oh, yeah, it's it's in the making. Is it? You know, you know how books are. It's like, you know, you get to, you know, process the hormone intelligence does take women through perimenopause. And the core plan is relevant for a healthy life, for teenagers, all the way well into our senior years or wisdom years. Yeah, I, I feel like HRT can be really valuable. And, you know, my my bottom line is, if you're suffering, why suffer? Right. And I have women who come to me all the time who are struggling with something for a long time, and they've tried all the things and they come to me and I'm like, yes, we can keep trying all the things that you didn't know that I can add on. And at some point, like if those things are working for you, phenomenal. But if they're still not and you're struggling, let's give ourselves permission to tap into the whole set of tools that are available to us. And I think particularly for women kind of in our ecosystems, Kris, where I think a lot of women who come to our worlds are more self-identified with natural and think of using whether it's progesterone or the pill, if they need that, or hormone replacement therapy as if they're betraying some fundamental part of their identity. And I would really love us as like own. Not suffering is a fundamental.
[00:48:24] Kris Thank you.
[00:48:25] Aviva To.
[00:48:27] Kris I would be remiss if I also didn't share that. I had to check with my oncologist to make sure that I could take anything. And because for me as a cancer patient and I see a lot of times online, is somebody posting about HRT and a lot of support for it, which is great, and I support that too. But then there are cancer patients who are like, what about me? Can I do this? And so if you are a cancer patient, you do want to talk to your oncologist. But also, and this is something that I'm looking for actively and will probably have more resources on, but finding functional or integrative oncologist to who focus and specialize in women's health. Yeah. Because just because your oncologist might say no because he or she might be nervous, to give you hormones and in some cases, rightly so, doesn't mean that you wouldn't be able to benefit from them, that they wouldn't compromise, you know, your well-being. And so again, it all to me, it just comes back to building your medical team, and having different people on that team who have their own specialty and their on their own knowledge. Like I always say, I wouldn't go to a podiatrist to fix an eye problem. Yeah. You know, well, I.
[00:49:50] Aviva Think that the thing with HRT, too, is that there are it's like we're seeing a pendulum swing right now. In the 70s, women were being prescribed estrogen for everything. As if, our estrogen declining meant we were drying up, shriveling up, becoming unsexy and lacking value. And that was actually like kind of the belief system operating at that time. And then in the early 2000s, there was a Women's Health Initiative study, which the early conclusions were very scary about hormone therapy. And so women were going off of hormone therapy left and right, and doctors were afraid to prescribe it. Now, 20 years later, we're seeing another pendulum swing where we're seeing a lot of internet female physicians, particularly OB GYNs, but also others who are just like gung ho that every woman who's in perimenopause or menopause basically should be on HRT. Like it's going to change your life. And the truth is really more somewhere in the middle in that these are still pharmaceuticals and they're still hormones. They're not risk free, they're not candy, they're not benign. They can actually cause things like breast cancer and endometrial cancer and, heavy bleeding just from endometrial overgrowth, from the stimulation, from the estrogen. So we have to not sort of be so open minded that our brains fall out. As a friend of mine used to say, there's also like there are specific indications for which HRT has been unequivocally demonstrated to be effective for and done properly for most women. Of course, as you say, Kris, like knowing what your own personal risk factors are generally safe. Then there are other indications that they're being promoted for now that actually haven't been, proven to be indications for taking HRT, for example. And this may change like the information is evolving. Like until recently it was like once you hit 60, you should basically stop because your risk factors go up. But the kind of the information is evolving, like literally as we speak today, you know, so we know that you can continue it longer if it's benefiting you, but just because you got put on it at 52 doesn't mean you still need it at 58. So if somebody's checking in with you saying, should you still be on this? Or can you reduce your dose and see if you need to come off of it? And then there are things like dementia and heart disease where we know that HRT may have preventative effects if you take it, but it doesn't mean that you're supposed to take it for those things. It just means like if you're taking it for something else, hot flashes or, osteopenia or a little bit of bone loss. You may get those benefits, but it doesn't mean every woman needs it for those benefits, or that if you don't take it, you're going to get those conditions. And that's where the lifestyle comes in, because we know that benefits everyone. So being careful of extremes in either direction when it comes to HRT information, I think is really important right now because also the women, a lot of the women who are promoting it, I mean, they're women in my community, they're women in my circle, they're colleagues, and they're lovely excited to support women in menopause. And maybe there's a little bit of overemphasis on that being the primary solution for everyone.
[00:53:15] Kris I love your balanced approach. I love your pragmatism. I love your down to earth knits. I love the work that you do. And, until we get your our hands on your new. We're going to go with this Bible and that is Hormone Intelligence The Complete Guide to Calming Hormone Chaos, and restoring your body's natural blueprint for well-being. You can see I have lots of bookmarks in here, my friend. I want to thank you so much for coming on Made to Thrive today, and I would love for you to leave us with any last words of inspiration. But also, where can we find you?
[00:53:56] Aviva Okay. Finding me is easier. You can find me at Doctor Aviva. I'm on Instagram, and I try to engage as many and as many comments as I possibly can. And DMs. You can find my work over at my website. If you have a romcom where there will be roll outs of lots of articles that will make their way into the book as we as we do. And I have a podcast too. You can find the information in the links to that over on my website. Words of wisdom, I would say be really, really gentle with yourself and allow yourself to emerge into a totally new space at this time in your life. It's not toddlerhood, it's not puberty, it's not new motherhood. But with each of those changes in a in different life cycles, we have to give ourselves permission to learn. And this is a new learning curve. So embracing it with curiosity and self gentleness as I am also continuing to learn to do, I think it's really powerful. And look to women who inspire you, who are ten years, 20 years older than you. I just love watching Michelle Obama rocket in a peekaboo top. I love watching Helen Mirren talk about not giving ups anymore. You know, I'm just loving Halle Berry. I mean, you know, Jennifer Aniston, all these incredible women who are rocking and older women who are rocking. It can really remind you like, this is just a new phase and a new beginning. And that is very powerful.
[00:55:24] Kris It's beautiful. Thank you, my beautiful friend, I adore you. Thanks for coming on the show and thanks for all your wisdom and everybody. I hope you got the full meal. This was such an incredible installment. Talk about a great podcast to follow up how to become the CEO of Your Health. Until next time. Everybody out there listening. Keep thriving.