Transcript 

What Every Woman Needs to Know about Perimenopause with Kristin and Maria of Wise and Well

 

Michelle Shapiro [00:00:00]:

I am so excited to have my friends Kristen and Maria back on the podcast, two of the most brilliant woman in the world and so needed in our space. So I'm so happy to have you both here. Hello and welcome.

Kristen [00:04:54]:
Thank you. Hi. It's good to see you again.

Michelle Shapiro [00:04:57]:
In our first episode, we talked about menopause and you are my go to references for all things menopause. You are now also my go to references for all things perimenopause, which seems coincidental because I have seen the word perimenopause on just about every single part of my Instagram feed for the past couple of months. Why is perimenopause getting its time in the spotlight? I like it, by the way, but do you have any feelings about why that is?

 

Why is perimenopause becoming such a popular topic?

Kristen [00:05:27]:
I mean, I would start with saying, and I don't mean to sound cynical, but opportunity to be perfectly blunt, you know, menopause has been having its moment. Part of that has included not just more awareness and more people sort of putting themselves in the space. A lot of self titling of expert status and different things that Marie and I take a little bit of issue with. But primarily we've seen this huge influx of supplements products, you know, different coaching kind of opportunities, things like that. And honestly, I think, you know, perimenopause is really no different. I would say realistically, the 30 to 40 year old generation is a little bit more vocal than probably us 50, 60 plus year olds. And that's just societal norms. We didn't grow up with social media even in our twenties, the way these guys did.

Kristen [00:06:17]:
And so they see an opportunity to leverage a platform to get a discussion going to address their concerns. Nothing wrong with that. I think our problem is that it's really obscuring the bigger issue, which is perimenopausal. Menopausal, which, as we covered before, is just one day or postmenopausal anywhere on that spectrum. The imperatives are the same. So we're a little bit kind of frustrated with this whole, suddenly we're going to act as though it's a whole separate thing. It's technically really not. It's all the same.

Michelle Shapiro [00:06:50]:
What are those imperatives? Tell us, like, what do we need to know to start this conversation? Do we need to even know? Can you define for us what perimenopause is? Tell us the imperatives, please.

 

What is perimenopause?

Maria [00:07:01]:
Perimenopause is. People think back to geometry. It's just the time around menopause. And I would say that the number one imperative is really to understand what is happening in the body. And, you know, and I say that so, you know, women will often categorize themselves as, like, if, if they have a little bit of awareness around these changes, they're gonna say, I'm perimenopausal. And, you know, I know we'll probably get around, get to this discussion later, but they think, well, I have time to do something. Whether that something is change how they eat, change how they sleep, whether or not to take hormone replacement therapy, whether or not to just really, you know, look at thyroid health, all that stuff. And they think, I have time because I'm not menopausal.

Maria [00:07:49]:
I'm still menstruating. And we know that these changes start in earnest in perimenopause, which can be, you know, it's really an unknown. It's four to maybe eight to some people say ten years prior to that. One day without a period, 365 days without a period, which is menopause. So to me, that's the number one imperative, is really understanding what's going on in the body, the changes.

Kristen [00:08:15]:
Yeah, we could say it's my ovaries are sputtering versus my ovaries have shut down. I mean, like, if we're going to just cut hair, split hairs, that's really the difference. You know, I'm fast losing hormones or I have lost them. Those are really the distinctions between Perry and Menno. And it's kind of a false distinction, to be perfectly frank, because regardless of where you are on the spectrum of hormonal decline, you need to pay attention to some things.

Michelle Shapiro [00:08:43]:
It's also weird to view these things as very finite or definitive until menopause. But when you're in the process of perimenopause, you're in the process of menopause. So it's like saying, almost like, if you're a. If we think of the reference of like a slide, it's like you are on the slide. So you're in the cycle of it.

Kristen [00:09:04]:
Correct.

Michelle Shapiro [00:09:04]:
There's, like, not these definitive until there is a definitive for menopause, of course, but there's a little bit more cyclical and process and journey when you're talking about perimenopause. So, you know, it's interesting, Maria, because when you said, like, I am perimenopausal, something like triggered me a little bit when you said that, because what I am seeing a lot of, and is a lot of people defining themselves by being a condition. Right. Like, the condition. And both of you would have experienced perimenopause completely differently, I'm sure. Right. Where there are some key features and experiences that people share. It's not like your body goes into a state of it and it's a medical condition.

Michelle Shapiro [00:09:49]:
It's a part of life cycle. I want to hear your guys feedback on that, because there was a part of me that struck because a lot of my clients now, because it's so popular, have been coming to me and being like, oh, this is perimenopause. And I'm like, wait, I got to see what else is going on, too. I can't just cluster everything and just say, oh, now every medical condition and symptom you have is because you're in this part of life. I still need to know what's going on with your hormones to make a determination about where your symptoms are coming from. We don't just cluster conditions into symptoms. We still have to see the condition of the body. So tell me how you guys feel about that and what you've been seeing too.

Kristen [00:10:25]:
Yeah, I mean, I like that you made the distinction. And I get a little frustrated because it isn't. We can't capture it into one name. It's in a way, I guess I could. I'm trying to think of an analogy, but like irritable bowel syndrome, right. Everyone who has IB's experiences it very differently. And so to kind of raise this flag of I'm perimenopausal, that tells me nothing. All it tells me is that you're a woman who's getting older.

Kristen [00:10:51]:
Welcome to the club. Right? Literally, that's all it is because elite club, a very special extra club. Yes, but Marie and I didn't have hot flashes. My next door neighbor has horrific hot flashes. We're all went through perimenopause and menopausal. It doesn't tell us anything. And using these labels, it's kind of this, I don't know, this identity crisis that we just go, ladies, we're just getting older. Hormones are changing.

Kristen [00:11:20]:
That's all that's happening. Slapping a label on it kind of obscures what your personal experience is. And I think some women do reject that label and the labeling simply because they're like, I'm not you, you're not me, you know? And so I think we need to kind of dispense with that. It's a transitional time. It has an unbelievable variability in how it presents. No different than hormone therapy, unbelievable variability in what that actually entails. And so that's where I think Marie and I get frustrated is because of all these labels and designations and stamps that we want to put on things. It's just, it's noisy and it's not moving the needle for these women.

Kristen [00:12:04]:
It's not going to help them because if we see it as one distinct thing and somebody says, oh, you need to take, I don't know, probiotics for your perimenopausal gut microbiome. It's like, okay, but not everyone does, right? And so then women who find themselves perimenopausal because maybe they found a doctor Google list of low hormone signs or something, they suddenly will be like, I guess I need those probiotics. Well, newsflash, you might note, you know, and so that's, that, I think is our frustration.

Michelle Shapiro [00:12:37]:
But Maria, I feel the same frustration as you, though. And it's funny because you and I, like the three of us, didn't talk about that. We always talk about like everything. But we didn't talk about this specific thing that I'm seeing. You know, in eastern medicine, there are no diagnoses. It's actually learning about the environment and the condition of the body and then working with where the body is. Right. Whether it's like doshas, whether it's like your constitution, that's how the body is looked at.

 

Walk us though the process and transitional timeline of what's happening in the body during perimenopause

Michelle Shapiro [00:13:04]:
And in western medicine, we have the tendency to put diagnoses and labels on conditions. Perimenopause in society is being viewed as a medical condition, actually, instead of a part of the life cycle, which is, it's just so important to differentiate between those two things. So thank you for that added insight to Kristin, Maria or Kristin, walk us through what is the biological process? What is this transitional time? What does it look like for us? What's happening in the body during perimenopause?

Maria [00:13:32]:
Well, it's funny. Before you mentioned perimenopause or the transition was a slide. We're on that slide.

Kristen [00:13:39]:
Right.

Maria [00:13:39]:
We can't pinpoint exactly where we are. And I was like, that is really good. I was like, I don't know if she realizes how good that is because we don't. Maybe little kids, like, you know, when you're younger, you would get at the bottom of the slide and you would climb up, but you get on the slide and you're going down. And so that's essentially what hormones are doing, even if they are temporarily up. And they will be temporarily up, or probably just estrogen will be temporarily up. And then women will think that they're estrogen dominant, and they think it's like, it's a problem and it needs to be dealt with. And it really is not a problem at all.

Maria [00:14:16]:
It's the default state of this time of life. So it is still, like, on its way down. Progesterone is on its way down. Dhea, which almost no one talks about, is also dhea sulfate on its way down.

Kristen [00:14:32]:
Growth hormone on its way down. Yeah.

Maria [00:14:35]:
Yeah.

Michelle Shapiro [00:14:35]:
And what does that look like? Because we'll kind of differentiate between being on the slide and when you're off the slide. During this transitional period, what could someone experience? And now every single person's different. Again, it's not matching up a diagnosis with a symptom. This is a phase and a stage. It is not a diagnosis. Right. Maybe on a medical chart it could be a diagnosis, but it's a period of time and things that might happen during that period of time. What could people experience in perimenopause that they may not experience before or during menopause.

Michelle Shapiro [00:15:07]:
What is that? What could the experience be like?

Kristen [00:15:09]:
Can I just make a quick distinction? Because I think this is something really important for Maria, and I could kind of dissect for everyone. There's things that can be very variable. Usually those are symptoms, and then there's things that are universal. Okay, so there are two. There's experiences that are occurring. Some are variable, some are universal. So, Maria, do you want to take, like, the symptom variability kind of thing?

Maria [00:15:30]:
Symptom variability? I would be, again, Kristin mentioned it, hot flashes, vaginal dryness can absolutely show up. Sleep issues. And one of the things I really like to talk about a lot because I don't think it gets a lot of attention, is our mood issues. Anxiety, depression, maybe, but whatever exists, like, in not exactly those terms, but maybe something less well defined, like flatness, desire to isolate blunt affect. And that really is because perimenopause is incredibly, very much a neurological transition.

Michelle Shapiro [00:16:06]:
So when you say it's a neurological transition, what do you mean by that?

 

What is happening in the brain during perimenopause?

Maria [00:16:10]:
The brain. The brain is uncoupling from the ovaries. The finely tuned kind of dance of the hormones on that 28 day cycle is just being decoupled. And there are impacts that are felt from a neurological, brain kind of mood, mental health type perspective. Of course, there are other physical symptoms in the body as well.

Michelle Shapiro [00:16:30]:
So funny, because I think people usually think about hormones. They think about like, oh, I have a thyroid issue. I got to take thyroid hormone, which, by the way, yeah, that's extremely valid and true in many cases. But in addition to that, I think of Hashimoto's as a brain condition as much as it's a gut condition, as much as it's a thyroid condition. So when we're talking about changing over from having your body operating in one way your entire life in some level of cyclical nature, unless people are on birth control and don't experience cycles. But there's still some cyclical nature of the body in women's lives, right, to having your body operating in a way where there's not that consistency. And again, like hormones, which are this brain ovary or brain thyroid, brain other organization, connection, like you're saying the communication is changing. Do you notice, and have you noticed in clients or in yourselves that during perimenopause, there was like a different, like, identity of self that you were also becoming aware of because the nature of your, like life was different and ways of seasonal and ways of cyclical?

 

Kristen [00:17:35]:
Yeah, I mean, I think a lot of women, you know, whether we want to call it a midlife crisis or not. I mean, there's a reason why that term exists, but we do start to suddenly question what we thought we were so certain about with respect to our lives, our likes, our dislikes, our abilities, our faculties. All of that stuff starts to change, and it can be incredibly unsettling for women. And for me personally, I always consider myself a very high performing person. I had practiced corporate law for a long time. I had my three kids during that time. I was managing ador work weeks and raising kids and doing hockey parenting. And I was also competing at a national level of rowing.

Kristen [00:18:16]:
I mean, I had a lot going on, and it all became difficult to keep together. And I was like, what is happening to me? And you kind of. Some women can be vulnerable. And I will admit to being this. Of settling into kind of this almost like depression over the losses that you're experiencing. And, you know, ironically, I had kids at such an age that when I was hitting this time of hormonal decline, I was also seeing my kids go off to college. And that's a loss. Right.

Kristen [00:18:47]:
And husband was kind of transitioning to a different phase of his career. And I felt a little left out of, you know, kind of everyone's new steps in life and everything. And. And so women can start to kind of question, like, what am I doing? You know, what is happening with my life? And it's sad because I think that's partly a brain influence and not actually a reality. Right. And if I had stepped back and had a little bit more of my faculties and a little bit more hormonal sufficiency, I would see that, like, life is still good. I'm still capable of these things. I'm not being left behind.

Kristen [00:19:19]:
There's no reason to isolate, et cetera. But it's so unsettling that women start to, as Maria said, they self isolate. But also, who wants to talk about that stuff with your friends? In a way, we have the term gray divorce. This is when marriages start to really see some of their biggest challenges. And that's not coincidental, right. That's because one or both partners are at a phase of life. And for women, it's frequently hormonally driven, where we start to wonder about all of it. And it's really hard, you know, on women.

Kristen [00:19:49]:
So I get why the perimenopausal crowd is suddenly like, whoa, what about us? You know, totally.

Michelle Shapiro [00:19:57]:
But if it's four to eight years, we can't forget about people for four to eight years. Exactly. Over ten years. Exactly. They're humans.

Kristen [00:20:02]:
Exactly. But maybe just take a breath, take a breath. And as Marie was saying, you've got this symptom variability. The hard thing with relying on symptoms, not just the fact that they're variable, but not everyone's going to face it, is that women might say, well, I don't have vaginal dryness, I don't have a hot flash. I must not be in perimenopause yet. The reason why that's dangerous, as far as Maria and I are concerned, is because you have some universal things that are happening, regardless of whether or not you identify as perimenopausal or not, because your friend has x, y and z going on. And that is, we know specifically with cardiovascular disease, there are drastic changes occurring in the arterial, arterial walls, arterial lining, its flexibility turns rigid, etcetera. We know that's happening.

Kristen [00:20:52]:
We know that women become more vulnerable to plaque deposition. That is happening. We know that women are having a lower tau protein clearance from the brain. That is happening. We know that bones are becoming a little bit more vulnerable. That is happening. So there are these universal things, regardless of where you are on the spectrum of perimenopausal to post menopausal, that are going to happen to all of us, every single one of you, no matter how much you think you fast, an orange theory fitness your way into a healthy state, it's happening. And then we have those symptom things.

Kristen [00:21:26]:
So this is where we want to shift that discussion around each woman's feelings about it and say, okay, why are those things happening? Because most women can't answer that question. And that's because this hormonal decline is way more than your menstrual cycle and your fertility, right? This hormonal decline is the fact that, newsflash, ladies, all those hormones that we either hated or loved when we were growing up were catalysts for all these physiologic processes. That's the universality. Every single woman who has ovaries, every single woman had a dependency on those hormones. Wherever you are on that slide, right, going down or at the bottom, you're losing those things, and with that, you're losing those catalysts. So we're all going to lose the health without the hormones.

Michelle Shapiro [00:22:13]:
I like that you use the word dependency a lot. And I'll ask you this question, either one of you, of course, how much of who we are and our personality do you. This is. This is a subjective question. How much of our personality do you attribute to our hormones? Like, how much of our identity and personality do you attribute to our hormones?

 

How much of our personality can be attributed to our hormones?

Maria [00:22:31]:
That's a really good question. I think personality is probably somewhat genetic, somewhat kind of lived, learned experience genetic as you're, as you're growing up. And it's a really good question about hormones. I would say that what Kristen said about the changes that she was feeling in perimenopause and it being was mostly related around, you know, mood and kind of mental acuity.

Michelle Shapiro [00:22:53]:
Right.

Maria [00:22:54]:
I mean, I felt the same exact thing as well, and I felt some mood slip. Yeah.

Michelle Shapiro [00:23:01]:
I can't imagine either of you being 1% less of your personalities because you're two of the most, like, clear and defined personality people, which is so interesting. And I think that it brings me to that mood question. Right. I have clients who, the first time that they're pregnant, there's such profound experiences they have in ways of how they're feeling, and they are really similar to other women's experience while they're pregnant, but it's like, not in their. What they feel like is their baseline nature. So I think that scares a lot of people in pregnancy or perimenopause. And that's, I guess this is, again, that's totally subjective. Question like, these mood changes, I'm sure they're going to vary from person to person, of course, but everyone is vulnerable, I'm sure, to systemic changes that are huge, altering our mood and things like that.

Michelle Shapiro [00:23:46]:
So I'm going to pitch the same question to you, Kristen. What do you think? How much of our personality or our mood is built in? And are certain people more vulnerable to changes than others when it comes to the decline in hormones?

Kristen [00:23:58]:
Yeah, no, I think it's a great, great question, and I think you, you know, kind of highlighted that without knowing it, is that we have personality and we have mood, or I would say personality outlook. Right. You have your personality and then you have your disposition. Like, I'm a type a personality with or without my hormones. That's just what it is. But in terms of my disposition, right. In terms of my level of chill or not chill, in terms of my ability to let things roll off my shoulders, my ability to frame things that I'm experiencing a particular way, I think all of those are highly dependent upon the hormones. And I doubt she's listening, but I have a sister who is four years older than me, and we were very different hormonally.

Kristen [00:24:35]:
And the only reason I say that is because she had more curvy hips and more voluptuous breasts, which, you know, news flash, lady curvature and fullness of your breasts is dependent upon your estrogen. So, you know, she had a different physique compared to me, and it was really tough because we looked a lot alike and we still somewhat do. And yet she was kind of the bigger girl, right. Even though we were only within about a half inch of each other, she was the bigger girl, and she was much more vulnerable to fluctuations and her outlook in life and things like that. So it, in retrospect, and now based on some things that we know about our health, she definitely had probably a very different hormonal presentation than I did. And I think that's where we can kind of look at those things and say, yes, they do influence those things. And whether we call it personality or disposition, I don't know if that matters. But are they being factored because of our hormones? Yeah, I think they are.

Kristen [00:25:31]:
We know people who are really hormonally deficient. And Marie and I can, without even looking at labs, we can hop on a call with a woman. I hate to admit this, we're not judging any of you when you work with us, but we will literally hop off the call and say, I want to hug her. I feel so bad because she's so flat. She's just so not there, and it's almost like she's failing to experience life. So why is that? This is not personality. This is usually because of hormones. I think is really important for women to understand that.

Kristen [00:26:03]:
You start to feel yourself changing. That might just be the only sign you need. Right. Your identity of yourself as that changes. That's probably hormonally driven in the beginning of the slide, right?

Michelle Shapiro [00:26:17]:
Exactly.

Maria [00:26:17]:
Woohoo. The slide, yeah.

Michelle Shapiro [00:26:18]:
It's not a woohoo kind of slide for sure, but I think that's so profound. And again, that could be something where you don't have to diagnose based on symptoms kind of thing, but you can have a shared experience, and it's something to just, like, bring your awareness to in the work you're doing with clients. Are you looking at diagnostic features for perimenopause? Are you like, oh, I see this pattern is about to happen. I see kind of where you are in the slide, or do you just bring awareness to, these are the changes. So now we have to work with the symptoms. And of course, the hormone replacement therapy aspect is hugely important as well. What is the goal in working with someone who's in perimenopause? Is it to deal with the changes that are happening as a result, or is it to slow the changes? Is it to make people aware? What's your goal in working with clients in this stage?

 

What is the goal in working with someone who's in perimenopause?

Maria [00:27:06]:
So I would say that's a really great question. First part of your question about diagnostic, or just looking at symptoms is, I would say the one kind of diagnostic criteria that we do look at is the level of FSH, follicle stimulating hormone, because that really can, we need more than one reading. But we do know that once that reading starts to edge up around 20 to 25, like, she's kind of late stage perimenopausal. If it's 25, she's probably not too far from that menopause kind of timeline. And so, of course, we look at symptoms as well, because perimenopause is largely diagnosed on symptoms and the goal is to obviously always make women comfortable. I mean, nobody, like, we shouldn't be so unconcerned about symptoms that we don't address those. Like, this is life, this is how we kind of live in our body on a day to day basis. So we are concerned with those, but we are, I would say, at heart, educators, and we really want women to understand we get the symptoms and we're going to work with you on those, but we want you to know what is really, really going on in the body so that we can go beyond just symptom management for longevity.

Maria [00:28:24]:
Healthy longevity.

Kristen [00:28:26]:
Yeah, I think it's really important because we do start to beat ourselves up during this time of life. We really hold ourselves to sometimes impossible standards or expectations that might have been realistic when we were maybe less encumbered and a little bit more footloose during our twenties and thirties. And so if we can build awareness in women, maybe they can kind of get off their own backs a little bit. And I think that's something that's really important for me and Maria and our education, awareness with these ladies is to be like, this isn't for lack of willpower, this isn't for lack of, oh, you just don't care enough, right? Or, you know, someone will be like, my husband, just, he can't understand what's happening, I don't know what to tell him. And we're like, this isn't you. As you know, you, right, this is just this shifting kind of landscape and it's impacting you in this way. And when women can kind of see that, like, oh, it wasn't a failure of mine, it wasn't something that I did to get here, and that maybe I just need to change my outlook on life. That's not to say lower the bars or do anything like that.

Kristen [00:29:31]:
We're just saying, understand that you are different now than you were before. And fun fact, you were different in your thirties than you were in your twenties, too. Like, this isn't some life sentence that we all have to be like, oh, my God, it's happening.

Michelle Shapiro [00:29:44]:
You're not even at the bottom of the slide yet. I mean, come on, you're not even at the bottom of the slide. And then you have 50 more years when you're at the bottom of the slide anyway. So, I mean, it's like, we got a lot of living to do.

Kristen [00:29:54]:
That's a perfect point because I think there's so much resistance to, like, I am not in perimenopause because that means I'm going to hit that finish line or that, you know, cross that line of menopause. Marina are like, girlfriend, it is a blast once you get past that line. Like, this is the hard part right afterwards. There's so much to kind of embrace and just love about your life. So I think sometimes for us, it's just trying to teach this is happening. You're a female with ovaries. It's going to happen. Whether you're at the top of the slide, the middle of the slide, or the bottom slide doesn't really matter.

Kristen [00:30:27]:
And if women can kind of buy off on that and realize they're not going to be strong enough to stop it, they're not going to be some miracle worker that's going to be able to avoid it. It's coming for you. It's going to happen. But if you understand what is happening, why it's happening, and the tools, you know, build out a new toolbox in order to deal with it, it's going to be a great time.

Michelle Shapiro [00:30:48]:
I love that we are going to talk about the toolbox. And just what you're saying also made me reflective about something, too. Again, I'm asking these very subjective questions, these deeply scientific, like, brilliant women. I'm asking you these really just no answer questions. Thank you for rolling with me. Is there a sense of, when I'm even hearing it, I feel like there's a sense of this kind of isn't fair. There's why also just there's a lot of not fair about being a woman anyway, but there's a sense of that, right? Because it's like, so now I, for the next, whatever, 40 years of my life are going to have to be on hormone replacement and I have to do another thing. How do you have your clients or yourself grapple with that kind of feeling, and it could be just like, don't be in the victim mentality, and it is what it is or something else.

Michelle Shapiro [00:31:33]:
But I feel like there's probably a sense of, hey, maybe this kind of is unfair, which is why people are saying, I'm not perimenopausal. It ain't happening, because I don't want that. Essentially.

Maria [00:31:45]:
I think Michelle is a really good question. I don't know if you're gonna like.

Michelle Shapiro [00:31:48]:
My answer, but I think I am. Cause I know you, so I think I am gonna like your answer. Go ahead.

Maria [00:31:53]:
So there is for a lot of women. Absolutely. A morning, like, I know there was for me, I know there was. For many people I've spoken to, like, really close friends. It's just sort of like they have to some women, you know, I know we've all been led to believe that our period is a nuisance and we want to get rid of it. There are some women who actually mourn its loss, and so there can be a mourning. And I think, you know, maybe we just have to confront that, like things, you know, I am changing. And this is going to sound so trite, but you just have to kind of roll with it and support yourself as best as possible.

Maria [00:32:41]:
No one's getting out of this life alive. And like Kristen said, if you get to experience a post menopausal life, you're blessed. Not everyone gets to experience that.

Kristen [00:32:53]:
There you go. That's what I was looking for out of it.

Michelle Shapiro [00:32:55]:
She got there. Kristen. Okay?

Kristen [00:32:56]:
She made it to the line.

Maria [00:32:57]:
She got there.

Kristen [00:32:58]:
And I think she brought up a really important point, which is that for women who kind of identify their femininity with their fertility, this is probably the part of life that's hard to accept. Right? Totally get it. You know, some of us, Marie and I started really young, and so we were done pretty early. But that being said, there is still this sort of like, ah, you know, does the world see me differently since I cannot any longer produce this child? No, I don't think. I think there are societal kind of messaging around that. That people like to harper on. But I don't believe that really to be the kind of predominant view of women in this phase of life, at least amongst women, and as personally, that's all that matters. But what I think Maria, what I wanted her to say, which she got to, which was aging is a privilege.

Kristen [00:33:41]:
It's truly a privilege. Like, we are forebearer women did not get to this point of life. We didn't live this long. We didn't get to enjoy grandchildren or traveling with a partner or seeing the world unencumbered. We didn't get those opportunities. So it's sort of a shift in the mindset. But it's not like you're trying to gaslight yourself. You're just trying to say, like, is it really all that bad? Because, like I've said multiple times, I ain't ever going back.

Kristen [00:34:09]:
I'm more than happy to be in this phase of life than the earlier ones. It's much easier. You know, usually you have a little bit more security, both financially and just personally, socially, community wise, etcetera. Lean into those things. You know, recently I was dealing with something, and I said to someone, I said, it's kind of like shifting from the what if to even if mindset, right? That, like, it's just so, like, even if. Even if you're losing your cycle, even if you can't have babies any longer, even if your hair is graying, you need to get it colored every two weeks instead of every four. Raising my hand, you know, even if all of these things are happening, like, how freaking blessed am I to be here, right? And so I think that, again, goes back to this whole, like, why are we beating this stupid drum over? I'm perimenopausal. I'm like, girlfriend, sit down.

Kristen [00:34:56]:
This is a wonderful blessing in your life. It might get a little uncomfortable. You just need to make some shifts. You know, it's like going on a long road trip and you find out that Google Maps didn't tell you the road was closed. Figure out a way around it, right? And you're still going to get to your destination.

Michelle Shapiro [00:35:11]:
I also just. I'm very resistant to the idea as a person of being wrapping up your identity and diagnoses. It's just something that I'm very resistant to, and that is what I'm really seeing on social and what I'm realizing why I'm like, I am perimenopausal. Like, I am in the transitional phase of life that is called perimenopause. You are not a perimenopausal. It's not a noun. It's on a descriptor of you. You're a human being who is also, this is something that's going on biologically for you, for sure.

Michelle Shapiro [00:35:41]:
And it can be really big for people in ways, the symptoms they're experiencing. And then also, again, I really need to just differentiate that the symptoms you're experiencing are maybe the hormones are the root cause of. But you still have to deal with more, like the fallout from it, which is what I want to talk about when we're building that toolbox. So what are your concerns outside of? You already actually brought up many important ones. Cardiac risk, bone risk, muscle mass. What are your concerns from an insulin standpoint, from a digestion standpoint? Are there changes that also happen? Because I know these hormones are quite involved with many body processes, and when it comes to mood, I tell us a little bit more about that, what's happening and why those changes are so important to acknowledge and why you may have to, again, unfortunately, do a little bit more during this time to make sure that you're covered.

 

What other changes are happening during perimenopause, relating from an insulin and digestion standpoint? Why are they happening and why is it crucial to understand what is happening?

Maria [00:36:37]:
Oh, gee. Well, we can start with mood, since that is a big one. And so we have estrogen receptors all throughout the body. And so when we lose the hormones, those receptors are not able to, they're not receiving a signal and they flatten in the brain. Right. Estrogen helps with serotonin. Serotonin makes us happy or content. I'm not sure which one.

Maria [00:37:03]:
So some women can be a little bit more genetically sensitive to that than others. So some women may experience mood issues.

Kristen [00:37:11]:
Progesterone and gaba. Right? So we need the metabolites and progesterone to estimate squirt gaba across the blood brain barrier. Progesterone is the first one that falls, falls precipitously. This is why women start to have some of that mood dysregulation, sleep problems, etcetera.

Michelle Shapiro [00:37:27]:
I think a lot of people experience dips in progesterone at like the end of their cycle every month, right? Those who are premenopausal at the end of their cycle every month, they will experience those dips and hormones as presenting as mood changes, potentially because those hormones again initiated energy, the experience of feeling energy or the experience of feeling calm. In the case of progesterone, too. Like it's a, it's more of like the, we think of progesterone as being more. I do as like the cooling and estrogen will like get you up and going basically, too.

Kristen [00:37:57]:
Interesting fun fact. PMDD, which is, you know, very severe case of PM's, is actually low estrogen. It's not low progesterone.

Michelle Shapiro [00:38:04]:
I'm so glad you just said that. I'm interested if people who do have true estrogen dominance, not just like everyone's estrogen dominant, but they've never seen a dutch test like, you know what I mean?

Kristen [00:38:12]:
Like real overproduction of estrogen, far exceeding the ability of their progesterone.

Michelle Shapiro [00:38:18]:
Yeah, correct. And metabolism issues with estrogen or shunting into the wrong metabolite. Right. I wonder if people who like in that experience and maybe those who have, like, endometriosis, that's something that I do see often, and then they have higher mast cell activity. I wonder if they, in perimenopause, also experience more peace for the first time in their lives because those huge hormonal swings have dictated so much of their experience and potentially their moods and personality or one or the other. Like you said, Kristen, before, too, it's.

Kristen [00:38:52]:
A great point because we have clients who, they understand that their health is at risk without their hormones, but because of their hormonal history, some of them, let's say, just massive histamine issues, mcas, things like that. They're so concerned and worried about starting HRT because they're like, I don't want to go back to that. Or it's adenomyosis in the uterus, and that can be very much stimulated with estrogen. The two cures for adenomyosis, hysterectomy and menopause. Right. And so a woman might go through menopause and then be like, my bones are brittle and my brain's not functioning and I want to start HRT, but, oh, my gosh, I don't want to deal with the uterine changes that this made of stimulate. So, yeah, absolutely. For those women who had significant dysregulation in, you know, premenopausal years, peri, as it finally starts to go down, when we get rid of the erratic nature, they tend to be happier.

Michelle Shapiro [00:39:45]:
Yeah, I was thinking that, too. Right? Like, they kind of feel better. Like it's. That's kind of dealing with the root cause. If the hormones are causing a lot of those symptoms, I'm sure. And it just. It just shows us how different every single person is. So someone, one person in perimenopause could be feeling amazing, and another person could be feeling terrible.

Michelle Shapiro [00:40:02]:
So there's no diagnostic feature of that outside of FSH, like you're saying.

Maria [00:40:06]:
Like, it's not.

Michelle Shapiro [00:40:07]:
The symptoms don't lead to that necessarily, because it's a different picture for everyone. So that's really fascinating to me and makes sense because I have a lot of clients who are premenopausal with endo, because I work with a lot of mast cell clients as well. And mast cell and endo travel together very often, immune conditions that travel together. And I can tell you that I'm sure they're looking forward to not having those vicious of cycles every month. However, I am also sure that because these hormones are necessary for longevity, like we're saying, you probably go very low and slow with someone like that, right? Like you start off and titrate, I'm assuming, like, or you're educating. But the practitioners they're working with, very slow and careful.

Kristen [00:40:47]:
The on ramp is different for them. The on ramp to HRT is very different for them. Absolutely.

Michelle Shapiro [00:40:52]:
Yeah.

Kristen [00:40:52]:
And you know, you brought up like the insulin issues. So as Maria was saying, estradiol receptors literally throughout the body, catalysts over 4000 actions, one of them being our insulin sensitivity. As we lose our estradiol receptors, we start to lose our insulin sensitivity. We're going to start to see people's fasting insulin, glucose, a one c start to go up and up and up. Same thing with the gut microbiome. Huge. You know, it's so highly dependent. We call it a two way cross talk between estrogen and the gut.

Kristen [00:41:21]:
And when we lose estrogen, we lose that. Crosstalk we lose our diversity, we lose our quantities of bacteria. Then what does that lead to? Autoimmune concerns, it leads to food intolerance concerns, it leads to detoxification issues. If we're not pooping, it leads to nutrient absorption changes. There's so many things that are changing from a metabolic health standpoint. That's why even the women with endo, they need to understand what is at risk. And you know, I kind of want to dial it back and say those with endo and different things, it's not to shame, but to say your menstrual cycle is a vital sign. So if you're having those issues, like if you're a 25 year old who's listening to this podcast and you're really struggling with cycles, that's your body's sign that something's off.

Kristen [00:42:07]:
And you probably need to work with someone who's got a lot of functional training to figure out how to support your body and correct the shift. Right. Because that menstrual cycle really is telling you what's going on. It may be a harbinger of a really rough period to come and post menopausal years, or it may say you're going to have a couple decades and then it's going to get better, but then it really isn't because of all those other changes.

Michelle Shapiro [00:42:29]:
Absolutely. Yeah. Hormones are really interesting. Okay, I'm creating what I'm going to use as a slogan later on in life. I've used the phrase like all the root cause of all things is mold and trauma. I've said that, like, a million times. It's hilarious and not true, but I do feel that way sometimes.

Kristen [00:42:43]:
God bless you.

Michelle Shapiro [00:42:44]:
I think with hormones, you know, that there's a lot of, like, different conversations on social media that you, like. You can't balance your hormones. I think that hormones are not a root cause before menopause, and then they become a root cause.

Kristen [00:43:00]:
That is a really perfect way of saying that it is 100% correct, because.

Michelle Shapiro [00:43:06]:
In premenopause, you have the capacity to alter hormones in many conditions and states as opposed to. And this is something that is very, very fought against on social media. Everyone's like, you can't balance your hormones because balancing your hormones is not about drinking lemon water. Okay. It's about doing a lot more than that.

Kristen [00:43:25]:
You'll reduce, though, right?

Michelle Shapiro [00:43:28]:
Actually, interestingly enough, celery juice is how you balance your hormones, but. Right, exactly. It's not these random supplements and interventions. It's about creating a proper communication system between your ovaries, your gut, your liver, and your brain. That is what balancing your hormones means. But it's so much grander than these random interventions.

Maria [00:43:47]:
Literally the only person who has actually provided a reasonable definition for that.

Michelle Shapiro [00:43:53]:
Yeah, and it's because I'm citing the trolls. On the balance, you can't balance your hormones. You can't doing random stuff. But it's a communication system. Hormones are in pre menopause. They're not the root cause because they are the end of the. They're the result of all the things that are going on in the body. That's what ends up shifting.

Michelle Shapiro [00:44:12]:
Right. But when you're in menopause, they are the root cause, because if you don't have them at all, they are the.

Kristen [00:44:18]:
Reason there is have stopped. Yeah. Right.

Michelle Shapiro [00:44:21]:
There's no way to recover bone loss. In the same way, there's no way to prevent stomach cycling is not gonna.

Kristen [00:44:27]:
Get my bones back when I'm 55. Darn it.

Michelle Shapiro [00:44:30]:
Exactly right. There is that. Is it. There is no other answer. That is its own thing. And that's why with. I'm gonna pause, too. I'm still saying if you're on the slide, hormones are not necessarily the only root cause.

Michelle Shapiro [00:44:43]:
It's what is the result of the hormones that you have to deal with from a symptom perspective, are there biological reasons, or is there anything we can do to make perimenopause not happen as soon? Like, is that. Is that lifestyle driven at all, or.

Kristen [00:44:57]:
Is that totally predetermined genetically, it's very genetic. It can be influenced and made earlier and worse by your choices. But you're not going to prolong your ovarian life cycle by fasting or eating right or any of you're just not. They have mitochondria that are kind of on doing their own thing. And while you can support the function, you can't change necessarily the life cycle duration.

 

Can you overcome or compensate for the symptoms you experience during perimenopause? Or is it symptom management?

Michelle Shapiro [00:45:29]:
Got it. Toolbox wise. Right? So we know that there's insulin changes, we know there's gut changes, we know there's brain changes, we know there's mood changes, we know there's muscle loss. Again, if we are focusing on how do we mitigate these symptoms, even you know what's coming to mind, like, right off the bat. If it's something like progesterone dropping and you're not yet on hormones or not at the point where you're going to, but you're noticing those fluctuations, okay, then you may need to have gaba, right? You may need to help your body, facilitate your body. Can you overcome some of the symptoms even before you start going on hormones? Can you compensate? Is it really just symptom management, or can you help the body to, I guess, mitigate symptoms in that toolbox?

Maria [00:46:08]:
Is that possible? I think it's symptom management. That's not necessarily a bad thing. And I think, I mean, I think even some herbs can come into place. But I will say, like, I'll give you one, for instance, with low progesterone. Right. I think that chase tree vitex works for a spell. For a spell. And I think when women, like, lose again, that decoupling of the ovaries in the brain just gets like, maybe the chase tree.

Maria [00:46:33]:
This is super scientific. Works when the ovary decoupling is here. But when that you lose that ovarian response, you know, you're going to probably lose even the effectiveness of that chaste tree.

Michelle Shapiro [00:46:45]:
Well, it's what it's. That's what it's acting on. So if that doesn't exist, then it's acting on nothing.

Maria [00:46:50]:
So, yeah, there comes a point when it's just too far apart to kind of bring those two things into, you know, a better communication.

Michelle Shapiro [00:46:58]:
As we define the root cause becomes hormone loss. You can't work on the root cause without the hormones, but you might, and you might have to compensate. You might have to orally take gaba or something. It just. It might be, or you might need to have the building blocks for neurotransmitters by having enough protein, which we all talk about all the time, too. What role does protein play in perimenopause?

 

What role does protein play in perimenopause?

Kristen [00:47:18]:
Well, it's huge. I mean, we have so much catabolism happening in our muscle tissue. We have anabolic resistance occurring, meaning we're not going to be able to utilize the same amount of protein to get the same outcome. We're going to need more protein to get the previously identified outcome. And like that, we need certain amino acids in order to deal with our neurotransmitters to protect the lining of the gut. Like, there's so much that amino acids do in the body. Right now, the focus is on muscle and satiety and blood sugar balance. And Maria and I are, like, all in on all of those.

Kristen [00:47:52]:
Those are usually the first things that women will be like, oh, my God, I'm actually a pleasant person when I eat enough protein. I can't believe I didn't listen to you guys sooner. We hear that all the time, but it's obviously muscle maintenance, maintaining your architecture, things like that. But again, you lose that estrogen. Eating enough protein isn't going to prevent the switch from fast twitch to slow twitch muscles. Right. You might help yourself with the right stimuli to have the protein amino acids and strength training to prevent maybe muscle volume loss or to mitigate muscle volume loss, but the architecture change is still going to happen. So things like that, that, you know, and you guys brought up gabA.

Kristen [00:48:36]:
I mean, Marie, I think of, like, vitamin E and pycnogenol, those are two wonderful supplements that could help a woman's experience with hot flashes. But I think with this focus on symptoms is losing the plot because you may suffer less from the thermoregulation changes of a hot flash, but your arteries are still being damaged because of the loss of estradiol that was triggering that hot flash. Technogenol and vitamin E might dampen the hot flash, but they're not going to protect the arteries. Does that kind of make sense?

Michelle Shapiro [00:49:09]:
You almost have to go from a premenopausal to perimenopausal. You have to shift your mindset into a mindset of longevity. You actually have to change your mindset around things from symptoms. You want to use the symptoms to understand what might be going on underneath. And of course, give yourself support and anything you need to, like, make it through the symptom. You have to suffer for that many, like, no suffering, please, you know, for that long. But you are forced into the position where you absolutely have to focus on longevity as opposed to just focusing on the symptoms.

Maria [00:49:46]:
We're trying to shift the conversation that way.

Michelle Shapiro [00:49:48]:
Yeah, exactly.

Kristen [00:49:49]:
If you're in your thirties and forties, like, you kind of think you're going to just never get old, right? And I feel.

Michelle Shapiro [00:49:56]:
I feel older now than I've ever believed I could feel. I can't even. I can't believe it, but I'm. No, I'm healthy, guys. But I mean. Yeah, wow. Go on.

Kristen [00:50:04]:
Yeah, no, we think it's like, you.

Michelle Shapiro [00:50:05]:
Know, there's an invincibility, of course, that people feel.

Kristen [00:50:08]:
Yeah, 43, 44. Maybe you're starting to realize, like, gosh darn, I hit 45. And if I wanted a whole number that ends in a zero, I gotta round up to 50 at that point. And that's when maybe for some women it becomes real. But I think you're right that longevity shift is important. But I think, you know, genetics and hormone sufficiency and other things really allow us to get away with crimes in our thirties. Dupe us into not thinking that we're going to have to make changes later on because that same behavior is not going to get the same result when we're 45.

Michelle Shapiro [00:50:42]:
I do have a huge benefit in that I was 100 pounds overweight when I was growing up. So, like, I definitely am used to not. This is a really interesting, weird thing. So, you know, a lot of times that I see on social media, people are talking about, like, oh, you know, toxic diet culture, which like, of course, is so freaking real. And what they are talking about is, like, when they were living in what would be considered normal sized bodies, just by any standard, they would be considered normal sized bodies and they wanted to lose, like, those ten pounds. It's so interesting because for someone like me, I was not ever phased by if one person was a little bit thinner than another person because I was a hundred pounds overweight. Right? So it's interesting because, like, what the goal post is or what's going to trigger someone is going to change over time, too. And the goal is, again, not at this age to literally look like you're.

Michelle Shapiro [00:51:36]:
It's not even in the thought process to look like your 18 year old, 20 year old self. It's to look like the internally and externally the healthiest version and to be the healthiest version of yourself within, like, what is real and reasonable for where you're at, of course. And wallets.

Kristen [00:51:53]:
You just identified exactly what we started this whole thing out, is that this frustration over these labels and victimhood, which I know you and I share that allergy, right? We share an allergy to that is that. No, everyone's version of what they want out of life is different as well. Right? And so that's why I think it's so hard to make the conversation coalesce, because the only place people can find community in this time of life is by donning the label. Right?

Michelle Shapiro [00:52:22]:
And it's always a negative. It's always a negative label, too. It's always a problem that we have. People have, like, 15 labels now for everything. That's why I'm like, perimenopausal is a label.

Maria [00:52:31]:
It's like everyone's different.

Kristen [00:52:33]:
I mean, we're just women with birthdays, you know, I think that social media, the, you know, visibility of platforms that are suddenly using the label more often, that's driving this, you know, the need to kind of feel like, me too. Me too. And that was something Maria and I kind of identified. We're like, oh, here come the 30 and 40 year olds. Because, and no offense to those ladies, but literally, when you're our age, you too are gonna look back on the 30 year olds who are raising this flag of alarm, and you're gonna go, calm down.

Michelle Shapiro [00:53:03]:
I'm early thirties, and I'm kind of doing that is what I'm telling you. I'm already like, yeah, no, no. Yeah. Even though their experience and life experience is the most important thing in the world to us, what they're feeling is the most important thing in the world. It's just a label that we don't care. I just don't care about it. Tell me who you are. You know what I mean? Tell me less about that.

Kristen [00:53:21]:
I promised you that at 55, you get to look how you did when you were 35. I'd like to know when we all signed the contract with that guarantee, who promised you that you aren't going to ever age and not be fertile again and maybe be overlooked by society as a sex icon or something? Who promised you that? So this kind of alarm over what they're losing is sort of like, well, when was that ever guaranteed? And then the bank to begin.

Michelle Shapiro [00:53:47]:
The only thing I will say to counter, even though it's never a real counter with us, is that you two are extraordinary. So it's a little bit. You're. You're a little bit both freaks, like, you, like, just get through life in a way that most people, and I mean, that freak is a very, very high compliment, but you both do get through life in a way and move through life in a way where you are so gracious and hard working. And so I will also say that there is some variation and that not everyone has to be as amazing as you think.

Kristen [00:54:18]:
I appreciate that it comes from a place, though, of gratitude. And I think something we try and cover in the book is your mindset at 30 matters to your experience at 30. Your mindset at 40 is going to matter in your experience of your forties and the perimenopausal transition. And I think that, you know, Marie and I have just decided, like, we're going to choose this, right? We're going to choose this. And I appreciate the compliment, but I will push back and say, everyone is capable of it, right? Everyone's capable of it. And it's something not to get, like, too esoteric, but my brother was killed when I was young, and it was a violent and sudden death. And a lot of us were kind of reeling and wondering, like, oh, my God, what happened and why this? And this is so awful. And I remember my priest walked up to me and he goes, Chris, you have a choice of get bitter or get better.

Kristen [00:55:06]:
And it's a choice you got to make every day. And I've started to realize after, you know, having lost my brother 30 some years ago, is that we all have that choice, and it doesn't have to be even in the face of adversity, right? It's just a choice. Every single day we get up and we're like, thank you for this day. I'm going to make the best of it. It's not going to be perfect, right? Not going to be perfect. Nothing's guaranteed to me today. And I'm going to do what I can, and I'm going to allow myself to have bad days, and I'm going to forgive myself for those bad days, and I'm going to allow myself to enjoy the good days and whatever. And so I think there is a mindset that's kind of lacking.

Kristen [00:55:39]:
You know, people see life happening to them instead of them living life. And that's where, you know, Marie and I'll say, like, we just look at this as a place of gratitude. And not because we, like, I can hear the 30. Whoa. It's because you've already got a husband and kids and a career and all this kind of stuff. It's like, no, you don't know about us and you don't know our shoes. We've had a lot of really rough stuff happen to both of us. And I think it really just comes down to, like, regardless of you're coming from, you know, the rose patch or the thorns.

Kristen [00:56:10]:
Every day we have a choice to look at this and be like, I'm just going to do the best I can. I don't need to label it. I don't need to get recognized for it. I just, you know, we're just women aging every day, all of us. It shouldn't be complicated, you know, and we shouldn't be needing all these labels and these, you know, whatever, so.

Michelle Shapiro [00:56:30]:
Exactly. And I. And I think that it takes away from our unique spirit when we put labels on things and who we really are and actually all of our accomplishments and all these other amazing things that I want to learn about women outside of what transitional stage they're, which is important for how they feel. And I know it's important, but I want to know. I want to know everything else, too. You know, I want to know what their experience is. I'm also thinking of the Whitney Houston lyric. It's not right, but it's okay.

Michelle Shapiro [00:56:54]:
Not, yeah, it's not like great, whatever, but it just is a little bit. It is what it is. At some point, like, you don't have to be also super stoked about it, just neutral. It just is. This is just literally, you know, plenty.

Kristen [00:57:05]:
Of days Marie and I walk up and we're like, f this.

Michelle Shapiro [00:57:09]:
Yeah, it doesn't have to be great either, though. It just is. So if people feel really drawn to you guys and the work that you're doing, tell me, where could they maybe. Where could they learn more information? If you have any ideas for these.

Kristen [00:57:25]:
Fine people, move over. Michelle, I can't see if you are.

Michelle Shapiro [00:57:30]:
Listening to this and watching on YouTube. I'm covering every part of myself with their amazing book that is coming out very soon. When this podcast launch, people will be able to have it at their doorsteps potentially very, very soon. The great menopause myth by my dear friends. Tell us please, how can people work with you? Where do they get the book? Tell us. And we're going to put links, obviously.

 

How can people work with Wise and Well?

Maria [00:57:49]:
But tell us pretty much anywhere books are sold. So barnes and noble, Amazon, probably, hopefully independent booksellers. Kristen.

Kristen [00:57:56]:
Yep. Yeah, definitely. Yeah. Indie books. You can go to indie books and find it. Yeah.

Michelle Shapiro [00:58:01]:
And are you working with people otherwise as well, in your programs still too? Oh, we are beautiful. And you have now a team of practitioners as well.

Maria [00:58:09]:
So it's a total of seven of us.

Kristen [00:58:11]:
Yep.

Michelle Shapiro [00:58:12]:
So the sky is the limit. Is there anything about this incredible book that you want to just like. I know why, but can you tell people why they absolutely need this book and outside of just knowing your guys personalities, knowing the contents of this book. Why is this book essential for every single woman? Can you please tell us that?

Maria [00:58:31]:
It's a manual. It's a healthy aging manual. It talks a lot about HRT, but that is.

Michelle Shapiro [00:58:37]:
Bye.

Maria [00:58:37]:
No means, you know, it is by no means limited to that. We have options for women who choose not to, can't, don't want to use HRT. We cover gut health, liver, adrenal health, mindset, movement, nutrition, and I would say it's, you know, it's not the only menopause book out there. There's quite a few. It's different. And I'm gonna let Kristen explain why it's different.

Kristen [00:59:03]:
Yeah, well, I mean, I think, you know, we try and educate in the beginning, I think so many. One of our favorite chapters is hormones beyond fertility. Right. That women had this pulled up when.

Michelle Shapiro [00:59:12]:
I was reading it before. Yeah. Literally, we were talking about how the brain is interconnected with every single part of the system.

Kristen [00:59:20]:
Yeah. And that the estradiol is kind of creating this thermostat in the body. Right. Regulating everything at all times and surveilling things for you. So we want women to understand why this matters. And again, if you're a woman with ovaries, it matters regardless of your age. And the sooner you learn it, the more empowered you will feel, because empowerment comes from information. And then the more maybe calm you're going to have coming into this time, which is what we would love for all of our 30 and 40 year old friends, is just be calm, you know, it's cool.

Kristen [00:59:51]:
And then, you know, we go into. I mean, Maria said it's not all about HRT. I think Maria, we only have about three chapters that are about HRT, to be perfectly honest, out of 14. So to really hit home that we do try and cover all the levers that women have within their control, because we think that's really important. This is not, again, out of your control, not happening to you. So you do have some role to play here in your experience. And then, yeah, we explain the HRT, but we also, prior to even getting that, explain the history of the use of hormones medicinally and get women to understand why there might be bad connotations or their doctor might be saying no, or it causes cancer or whatever. So, like Marie said, it truly is a manual.

Kristen [01:00:30]:
We tried to cover a to z. You know, we heard from a lot of women, like, I'm in such and such a country, or I. I'm not going to do HRT. Can I even work with you. And we're like, yes, you can. But we wanted to have an opportunity to be like, read our book, really just understand the situation that you will live or are living or have lived as a woman. And then honestly, for any guys listening, I don't know how many guys you have in your demographic, Michelle, but whether you are a woman or you love a woman, you are going to go through menopause, right? And so partners, the male partners, you know, it does not matter. They're going to be wondering what is going on just as much as you are.

Kristen [01:01:13]:
And so we've had a lot of men read this book and be like, oh, my gosh, I get it now. Like, maybe my wife doesn't not love me. She's just struggling with something. And so that piece of it, we really just want to say, it's really for everyone. All kind of walks of life, all stages and ages. And we do cover, you know, non hormonal interventions. Anyone could go and pick up some herbal supplements that could address this concerns that they've got at the moment in.

Michelle Shapiro [01:01:41]:
The art of fairness as well, if women have to experience it, men could read the book. That's all I'm saying. I'm just saying, you know what I mean? That they could read the book. It's really funny. I have a client who, you know, guys, I'm like such an aggressive feminist. You know how I am. I have a client who is so funny. He's just, he's just a lifelong learner.

Michelle Shapiro [01:02:01]:
He's just that person. And he just loves to learn. And he is like an avid listener of my friend Amanda Montalvo's podcast re menstrual. And you guys have been on her podcast also and are friends with her as well. And he's just like. But he'll have, like, colleagues who are like, what are you listening to? He's like, this podcast, are you menstrual? Because minerals are for all of us, too. So she doesn't only talk about the cycle, but it's not only important to learn about our own bodies, but to learn about our loved ones bodies and their experience as well. I think it's so insightful.

Michelle Shapiro [01:02:26]:
Thank you both. I love you both. I am so grateful for this conversation. I'm so excited for all of you listening. Just, it's the one purchase you would absolutely never regret. This book is incredible. And I am. I'm sure we'll have the next conversation.

Michelle Shapiro [01:02:40]:
We have to go five years before, by the way. We're going to go pre perimenopause, and we'll just go keep going down like that. You guys will also see the link to our first episode that we did on menopause on the podcast. Thank you both so much.

Kristen [01:02:51]:
Thank you.