Latest / Wellness by Designs - Practitioner Podcast / Confident and Integrative Co-Prescribing for MHT in Perimenopause and Menopause with Tracee Blythe

Transcript

Confident and Integrative Co-Prescribing for MHT in Perimenopause and Menopause with Tracee Blythe · Wellness by Designs - Practitioner Podcast

• 0:12
  SPEAKER_01: This is Wellness by Designs and I'm your host Amy Skilton and joining us today is the lady who needs no introduction, Tracy Blythe.
• 0:21
  SPEAKER_01: You will know her both as a practitioner and an educator, specializing in particular in integrative co-prescribing.
• 0:29
  SPEAKER_01: She has an extensive background in naturopathy and is one of the most evidence-based, grounded practitioners that I know.
• 0:39
  SPEAKER_01: And we're very lucky to have her chatting with us today about menopausal hormone therapy and perimenopause and menopause.
• 0:47
  SPEAKER_01: Tracy, thank you so much for joining us.
• 0:51
  SPEAKER_00: Thanks so much for having me, Amy.
• 0:53
  SPEAKER_01: An absolute pleasure to have you back.
• 0:55
  SPEAKER_01: And if anyone's ever heard an interview with you before, they'll know you're an absolute wealth of knowledge.
• 1:01
  SPEAKER_01: And the reason for our chat today is Tracy has actually just recently delivered an incredible webinar on the subject specifically called Confident and Integrative Co-Proscribing for MHT in Perimenopause and Menopause.
• 1:16
  SPEAKER_01: And the purpose of our chat today is to touch on that a little bit and also discuss some of the context and the mindset issues around this because I can imagine there are practitioners who've seen the title of this interview and gone, I'm not listening to that because I'm not interested in synthetic hormone replacement therapy.
• 1:36
  SPEAKER_01: And if that's you, you're not listening to this anyway, but if you have a colleague who you know has just gone, skip on this podcast, believe me, I understand why, because I graduated early 2000, where we had the living daylights scared out of us around synthetic estrogens causing estrogen-dependent cancers like endometrial cancer and breast cancer.
• 2:00
  SPEAKER_01: And so even though I've got a laundry list of things I want to talk to you about today, can we just start with that unfortunately turned a whole generation of practitioners off ever looking at the opportunity for synthetic hormone replacement therapy, either for themselves or how best to support their clients?
• 2:19
  SPEAKER_01: Because understandably, no one wants to develop those cancers.
• 2:22
  SPEAKER_01: But since then, a lot more has come out, the narrative has shifted.
• 2:29
  SPEAKER_01: We also have a greater understanding on how to support those pathways that might be affected.
• 2:34
  SPEAKER_01: So, can you give us just a little reality check to start with?
• 2:38
  SPEAKER_00: I can I can, Amy.
• 2:40
  SPEAKER_00: And what I suppose it's taking you down the same path that I have uh gone down.
• 2:45
  SPEAKER_00: I was invited to uh deliver this webinar months and months ago, probably more than six months ago.
• 2:51
  SPEAKER_00: And at the start, I was like, oh yeah, I'll be talking all about what's wrong with uh using MHT, what's the uh the issues around side effects, how we can support them, and what women can do as an alternative.
• 3:04
  SPEAKER_00: That's that was the I have to admit, that's the mindset that I kind of was going into.
• 3:09
  SPEAKER_00: Um I had been seeing a shift over the over the uh past few years with the number of patients and taking everybody seemed to have something that had a different name, and I'd have to look it up, and and uh there was always something different on offer.
• 3:22
  SPEAKER_00: And I also graduated in the early 2000s.
• 3:25
  SPEAKER_00: Um the Women's Health Initiative um was abandoned in 2002 because of increasing rates of various types of cancer, edometrial and breast cancer, and the and had a complete like hands-off approach myself.
• 3:40
  SPEAKER_00: Um, it's something that when, and I've successfully, and I'm sure so many other patients, uh practitioners have as well, successfully helped so many people um go through this transition and support them in understanding that that it is a transition, that um menopause isn't a disease, menopause is a transition, and to support women through that by reducing their symptoms um of what's going on, usually by looking at lots of things in their life where they need to perhaps stop doing X, Y, Z, do less of this, do more of you know some good nurturing things, and and they, you know, with some herbs and some nutrients, they get great outcomes.
• 4:17
  SPEAKER_00: But what's changed over the last what is now 20 to 25 years is the a number of things.
• 4:26
  SPEAKER_00: And a big part of it is what is available for women.
• 4:29
  SPEAKER_00: Uh, and I think that I I'm gonna forget the exact numbers, absolutely have to watch the webinar for me to be very precise.
• 4:35
  SPEAKER_00: But in the vicinity of 50 different types of medicine is available, uh, different types of um prescriptions can be made.
• 4:43
  SPEAKER_00: And these days, what we have is body-identical or bio-identical forms of estradiol and of progesterone available to women to be prescribed by their GP, don't have to be at a specialist clinic to be getting this.
• 4:58
  SPEAKER_00: It's not something that needs to be compounded by the pharmacy.
• 5:02
  SPEAKER_00: Uh, it is literally uh prescription medicine that is body identical and is indistinguishable from um uh what our body would be producing.
• 5:13
  SPEAKER_00: And the benefit for that, when we then, you know, that's down on that individual woman, we soon back out on where the studies are at.
• 5:21
  SPEAKER_00: The safety of using these is nothing.
• 5:25
  SPEAKER_00: There is there is there is actually cardioprotective benefits.
• 5:29
  SPEAKER_00: There are potential cancer protective benefits.
• 5:32
  SPEAKER_00: A couple of cancers have lower incidence rates when we're using, when we're steering clear of the synthetic, um particularly the conjugated equine estrogen and steering clear of the synthetic um progestogens, which are nothing like progesterone.
• 5:45
  SPEAKER_00: So that's that's where we're at today.
• 5:47
  SPEAKER_00: And that's the and so we're in a new world.
• 5:49
  SPEAKER_00: It's like it's like we've all landed on a new world, and this new world has so many other opportunities, and and the benefits to our patients are significant, um, when they're particularly when they're experiencing symptoms for which are impacting their life in ways that we can't imagine.
• 6:07
  SPEAKER_00: And and to say that this is just a transition, you just have to go through it, potentially there's there's alternatives for them.
• 6:14
  SPEAKER_01: I think that's such an important update.
• 6:17
  SPEAKER_01: I think it's fair to say, practitioners, you know, regardless of what type of medicine or health you practice, staying up to date with the latest research is just a mammoth job, even in your own niche.
• 6:31
  SPEAKER_01: So I think this is a really important place to start the conversation because certainly, you know, that's that I too saw the results from the Women's Health Initiative and it was just an absolute turn off.
• 6:44
  SPEAKER_01: And things have really changed.
• 6:46
  SPEAKER_01: Now, before anyone thinks that Tracy and I are paid um pharmaceutical plants, we're now promoting menopausal hormone therapy.
• 6:57
  SPEAKER_01: The point of this conversation definitely not.
• 7:00
  SPEAKER_01: First of all, no, if we're not, let's just say that.
• 7:03
  SPEAKER_01: Um, and nor are we suggesting that you should consider this for yourself or for your patients.
• 7:09
  SPEAKER_01: But if you have previously held the mindset understandably that this is a no-go zone and the the benefits are, you know, symptomatic at best and the risks are just too extreme.
• 7:21
  SPEAKER_01: That's not the case anymore for a few reasons, partly because of the development of medicines, what's available, the way that they can be delivered, the different types of, you know, molecular structures, the delivery methods, the way they can be combined.
• 7:36
  SPEAKER_01: But also we have access to much better ways of monitoring also the response and how somebody's uh body is actually detoxifying and metabolizing these things.
• 7:48
  SPEAKER_01: We have more tools on how to support them.
• 7:52
  SPEAKER_01: And really at this point, uh as it always was and always will be, we're looking at truly holistic medicine.
• 8:01
  SPEAKER_01: And if this is not a space that you've looked at since then or in a long time now, is a really great time to dive back in and actually see.
• 8:10
  SPEAKER_01: And I think it's really important, and this really applies across the whole board.
• 8:14
  SPEAKER_01: I know, particularly as a young naturopath, it was like natural medicine or nothing at all.
• 8:20
  SPEAKER_01: And I'm sure most of us are probably natural medicine first.
• 8:25
  SPEAKER_01: Um, but it's not an either-or situation, and there is, you know, it's an it's an ever-moving target in a transition, like menopause, also, which you want to be flexible and responsive about.
• 8:36
  SPEAKER_01: But in this case, it's time to revisit what's available.
• 8:41
  SPEAKER_01: So I think let's start with talking about unopposed estrogen versus estrogen that is being balanced out with progesterone, not the same as progestin, by the way, but also the types of estrogen, you know, how we've moved, well, I guess expanded beyond equine-derived estrogen.
• 9:04
  SPEAKER_01: And also the difference between, you know, an oral tablet versus transdermal versus vaginal.
• 9:11
  SPEAKER_01: It's just a very different landscape now.
• 9:14
  SPEAKER_01: Can you summarize briefly for us like that portion of it?
• 9:18
  SPEAKER_00: Yeah, that and that's a really important part.
• 9:20
  SPEAKER_00: I think it's a big part in this shift.
• 9:22
  SPEAKER_00: Um, the you know, the history goes back of conjugated equine estrogen, literally um, you know, taken from pregnant horses' urine um and uh packaged up into a pill.
• 9:34
  SPEAKER_00: And, you know, from for a long, long time, uh, we're going back into the you know, the the 50s, 60s, 70s, uh, we knew that unopposed estrogen uh it might might have given some uh symptomatic relief for women, but that it unopposed estrogen as it does in the body without without a progesterone does lead to thickening um of the uterine lining and hyperplasia, so the inst increased in uh risks of of cancers.
• 10:01
  SPEAKER_00: And so quite early on it was realized if we give some uh progestogens of some synthetic uh progesterone-like compounds that they might do other things that aren't that great for the body, but they certainly prevent the thickening of that lining.
• 10:16
  SPEAKER_00: So they and and that so that's where the combination was born, always as a tablet.
• 10:22
  SPEAKER_00: What has happened in the last 20 or so years is that delivery methods, first of all, type have changed.
• 10:29
  SPEAKER_00: We have now estradiol that is um is no longer the conjugated equine estrogen.
• 10:35
  SPEAKER_00: Um, and then we also have progesterone available, the micronized progesterone.
• 10:41
  SPEAKER_00: I think that's that's it only within the last 10 years, probably even less here in Australia.
• 10:45
  SPEAKER_00: They've been around longer, but available uh under a prescription.
• 10:49
  SPEAKER_00: But a big shift, and this is across the across medicine, I think, it seems, um, a big shift in looking at alternate delivery methods.
• 10:58
  SPEAKER_00: And one of the one of the biggest things we see when it comes to reducing side effects from these medicines, like uh the it uh the effects that we don't want, and also um uh reducing risks of other things happening, is using the transdermal method.
• 11:16
  SPEAKER_00: So you can actually get a gel uh that is and you can get a gel that is uh or a patch that is is something that is able to really use the targeted doses for benefit without then having the hepatic first pass.
• 11:30
  SPEAKER_00: The lack of hepatic first pass is the absolute key that we then um don't we don't require breakdown, we don't have circulating levels at that you know start off really high and then go really low, and we don't have that daily dip, we have we have steady state.
• 11:47
  SPEAKER_00: We also have when it comes to vaginal estrogens, we have really localized doses and localized benefits.
• 11:55
  SPEAKER_00: So using again cream, gels, pessaries, and tablets, from what I understand, is and that they um with applying locally to the vaginal area, the genito-urinary symptoms of menopause are some of the most debilitating and often the least spoken about.
• 12:12
  SPEAKER_00: And that this can be that that there are options to benefit these that uh uh when we look at the clinical trials, um, have really good outcomes with zero changes to blood levels of estradiol.
• 12:26
  SPEAKER_00: Like no, that there's no systemic impact of that.
• 12:29
  SPEAKER_00: For most women, of course, you can be uh sensitive to uh to taking any hormones, but for the most part, there is there is zero systemic impact.
• 12:41
  SPEAKER_01: Yes, fascinating.
• 12:42
  SPEAKER_01: And I think again, this is where it comes down to personalized medicine.
• 12:46
  SPEAKER_01: If it is local atrophy of tissue, then local delivery makes the most sense.
• 12:51
  SPEAKER_01: Why would you be giving something that's oral and much higher dose to affect the whole body when it's just one area that needs a bit of extra support?
• 12:59
  SPEAKER_01: I love that.
• 13:01
  SPEAKER_01: And I also think something you touched on um before regarding bio-identical molecular structures is something I want to explore a little more because um I didn't know this, and there's I it's not often I get surprised, Tracy, but you taught me something.
• 13:19
  SPEAKER_01: Um, that the micronized progesterone that is biodenical progesterone that's prescribed is actually sourced from plants.
• 13:28
  SPEAKER_00: It is sourced from plants.
• 13:29
  SPEAKER_00: Yes, I'll get the I'm gonna get the name of this for you because this is um, I think this is super interesting, and it's something I learned in this process.
• 13:37
  SPEAKER_00: Um the name of it is uh it's so it can come from wild yam, fenugreek or soy.
• 13:46
  SPEAKER_00: Um and here in Australia, um wild yam and soy uh seem to be the primary one.
• 13:51
  SPEAKER_00: Um, and what is extracted is a is a compound called um diostrenin, and that this is extracted, and then via a chemical process um that I wasn't able to find, it's probably proprietary because I went down a rabbit hole on this.
• 14:05
  SPEAKER_00: Um, that it was that through, and it was a process of uh acetylation, oxidation, and hydrolysis, it was able to be converted into stable progesterone.
• 14:15
  SPEAKER_00: Um, but that's where we're that's where we're at with uh micronized, the micronized stabilized progesterone and why it's oral still, um because progesterone in other forms is not yet available in Australia.
• 14:28
  SPEAKER_00: And I don't, I I'm not um, I have really done my research on what's available here in Australia.
• 14:35
  SPEAKER_00: It may be that there is other things available, but for those that are progesterone sensitive um to taking actual progesterone uh orally, that they also use it uh as a pessary and that the micronose progesterone can be used in that way.
• 14:48
  SPEAKER_00: But when we're using it, using the patches and the gels that are both the estradiol, they are always with the progesterens.
• 14:55
  SPEAKER_00: So we we need our aprometrium is the is the trade name or whatever um of this progesterone.
• 15:01
  SPEAKER_00: Micronose progesterone um is always as a as uh an oral form, and a capsule form, yes, yes.
• 15:09
  SPEAKER_01: Yeah, and certainly in in more recent times, I feel like the last year, maybe a little more, it is now covered on the PBS.
• 15:17
  SPEAKER_01: So that's great news for women.
• 15:20
  SPEAKER_00: I have another number for you that I think is fabulous uh that I want to share.
• 15:24
  SPEAKER_00: Um, it is of the uh the drugs with the highest uh change in prescript prescription volume last year across the 250 million scripts handed out.
• 15:34
  SPEAKER_00: The highest change because of that, um, I believe it's because of that anyway, is the change in progesterone prescriptions went from we uh tripled the amount that we've given out, but out of 20, 250 million, um, 180,000.
• 15:47
  SPEAKER_00: And so it is it is uh from up from 60 odd thousand, though.
• 15:51
  SPEAKER_00: So it is number was number one on that list.
• 15:54
  SPEAKER_00: And it goes to show that when when availability that you know it's meeting demand, that there is a demand that that can shift like that in just 12 months.
• 16:03
  SPEAKER_00: Um it's it's it's meeting meeting women with their symptoms where they're at.
• 16:09
  SPEAKER_01: Yes, I think it's really interesting to have been watching, you know, the unfolding and intersection of our generation who didn't necessarily grow up with social media, but adopted it perhaps in their mid to late 20s and are very comfortable on that platform, plus breaking down the taboo and stigma about speaking about women's hormone problems and menopause, you know, and talking about the kind of symptoms that we're experiencing and then that becoming available, which is really, if you're looking at it strictly from a pharmaceutical point of view, is the first line of intervention for perimenopause because oestrogen is up and down very erratically, but progesterone is just on a one-way decline.
• 16:54
  SPEAKER_01: And I think, you know, to have access to an affordable option like that, I mean, affordability is always relative, of course.
• 17:02
  SPEAKER_01: But in terms of this, I think, even though I'm a you know naturopath, nutritionist, and herbalist who's natural medicine first, really warms my heart that women have now got much more easy access to things like that as such a low-risk intervention.
• 17:19
  SPEAKER_01: You did also mention, so this comes, they they source it predominantly here from um soy phytoestrogens and maybe wild yam, but there's also fenugreek.
• 17:30
  SPEAKER_01: Let's have a conversation about soy and other plant-derived phytoestrogens, because oh, that's one that can have very polarizing, conflicting views.
• 17:41
  SPEAKER_01: And understandably, what we know about research and study design is you can have a one study that says one thing and one study that says something else.
• 17:48
  SPEAKER_01: And there are a lot of variables that can produce that outcome, of course.
• 17:52
  SPEAKER_01: But originally, phytoestrogens were considered protective, they were considered to stand in for our hormones when there was a reduction in production, for example.
• 18:04
  SPEAKER_01: But then, with possibly triggered by the WHI and other concerns around excess estrogen, there were then questions raised about phytoestrogens possibly producing the same thing where they were in excess or unnecessary.
• 18:18
  SPEAKER_01: And there was between that and the demonization of soy, perhaps more tangled up in the GMO and potentially goitrogenic sort of realm, they got thrown in the bin as the bad guys.
• 18:33
  SPEAKER_01: Can you what is the what does the current evidence say around this?
• 18:38
  SPEAKER_00: Yeah, it's super interesting, isn't it?
• 18:40
  SPEAKER_00: I I think that you're absolutely right there, that it's a combination of factors, you know, avoiding non-GM foods uh when one of the most GM crops in the US is is soy is a big is a big story.
• 18:54
  SPEAKER_00: That was uh certainly a story again at the same era as WHI coming out and the idea that we need that phytoestrogens or estrogens, and estrogen is the devil, and we need to be uh that and that being that being the prevailing attitude.
• 19:07
  SPEAKER_00: But when we, you know, for um one of the most that for the a plant-based source of protein and good fibre and of the benefits that we know of legumes, that one of the highest protein sources of of um of plant-based food being being soy, it is one of the biggest crops globally for food consumption across the world.
• 19:27
  SPEAKER_00: So there are studies on soy can soy consumption and fine and uh soy, I say flavor and consumption in huge population group studies in in parts of uh different parts of Asia in Japan, in India.
• 19:41
  SPEAKER_00: Um there are some there are some big studies, there's some Korean studies that I've read the where it is an absolute way of life and part of the part of the dietary makeup of the population.
• 19:53
  SPEAKER_00: And the the demonized the demonization of what you know essentially is a food group on most people's plates most days, um, is you know, it has proven, I think when it comes to the studies proven to be unfounded.
• 20:05
  SPEAKER_00: The the risks um of uh of it being um uh like of the estrogenicity, there is a there's a systematic review and meta-analysis that uh found that it had no effect on the four measures uh in post-menopause women that where we need to be aware of in terms of promoting growth where we don't want growth.
• 20:27
  SPEAKER_00: Um so the the um the prevailing advice through the um AMS here in Australia is is that for those in in states like who are um currently being treated for hormone-driven cancer or have that personal history of it, that to keep it in a food consumption level, it's not that you can't have, you know, um some, you know, uh have some edamamo when you're out for Japanese with your with your friends, but it's certainly that you wouldn't be taking oso flavor and supplements.
• 20:58
  SPEAKER_00: But for the general population, when it comes to, like I said, from potentially forming part of your diet of the using whole food soy products, I always recommend there's certain things that I'm more, and it probably harks back to the days of um of the early early and mid-2000s around GM, that soy must always be organic to be then GM free.
• 21:18
  SPEAKER_00: That it again, you know, I feel like the the two nutrients that have had a massive heyday in the oh on social media in the last few years is protein, then now followed by uh fiber, which is very exciting for the then the natural past yeah, yeah, it warms your heart.
• 21:33
  SPEAKER_00: You're like every everybody's getting um, you know, having these big picture conversations about the macronutrients in their diet.
• 21:39
  SPEAKER_00: That's really exciting.
• 21:40
  SPEAKER_00: That what's a what's a fabulous solution to those, to those two, all packaged up in one, and that's that's your your soy whole food soy products, uh whole food andor fermented soy products.
• 21:52
  SPEAKER_01: Yes, I think you know, we are really lucky to live in a country where it is much easier to access higher quality.
• 22:00
  SPEAKER_01: Options and finding organic tempeh or tofu or edamame beans, you know, isn't outside the realm of possibility.
• 22:09
  SPEAKER_01: And I think, yes, the the renaissance of beans and legumes and the fibre story is so overdue.
• 22:17
  SPEAKER_01: Yeah, yeah, absolutely.
• 22:18
  SPEAKER_01: For all of us that were terrified into the Atkins diet, we're rejoicing.
• 22:24
  SPEAKER_01: And you know what?
• 22:25
  SPEAKER_01: I think, you know, as clinicians, we are doing our best to stay up with the research.
• 22:30
  SPEAKER_01: But I think it's been so refreshing to actually see not just that the research has changed, but the landscape of the medications have changed, the way that they're applied, our understanding of women's bodies and the way that they metabolize hormones and clear hormones has been enhanced, I suppose.
• 22:50
  SPEAKER_01: It's a bit more nuanced.
• 22:51
  SPEAKER_01: And we really have the opportunity now to cherry pick from whatever works for us personally as a middle-aged woman.
• 23:00
  SPEAKER_01: Um, myself, who's currently in that chapter of life, but also for our patients, it's not either, or I know you know, sometimes I have clients that are surprised by my openness to all options.
• 23:13
  SPEAKER_01: And it's really about what, you know, working out what is best for them and what's best for them right now might change in three to six months or in one to two years, or you know, if there's some acute issues, that then you can work on some underlying things, you know, alongside that and perhaps withdraw medications later.
• 23:33
  SPEAKER_01: There's all kinds of ways to approach this, but I know when you and I had a pre-chat, we discussed, you know, lifespan versus health span versus joy span.
• 23:46
  SPEAKER_01: And I want to riff with you a little bit on this too, because I know for me as a as a new grad, I thought I had the secrets to the universe as a naturopath.
• 23:57
  SPEAKER_01: I think we probably all feel that way when we learn about how the body really works and all these incredible tools at our fingertips to, you know, to make things go as well as they possibly can.
• 24:08
  SPEAKER_01: And I remember thinking, ah, I'm gonna do all the right things and live to 120.
• 24:12
  SPEAKER_01: It was like some goal.
• 24:13
  SPEAKER_01: I mean, I'd and I don't know, Brian Johnson's probably the most famous person on planet Earth right now who wants to live live forever.
• 24:20
  SPEAKER_01: Personally, I don't think he's really living with the things that he's doing to stay alive.
• 24:24
  SPEAKER_01: But anyway, that's another conversation.
• 24:26
  SPEAKER_01: But my now that I am a middle-aged woman, you know, I and and I am experiencing things that an aging body is going to experience no matter how diligent you've been with your health.
• 24:39
  SPEAKER_01: My focus has has, you know, in recent, actually probably since mold illness, I think, when my quality of life just absolutely went down the toilet for a few years, my I shifted to health span rather than lifespan.
• 24:51
  SPEAKER_01: Like, what's the point living to 90, 100, 120, 150 if that's even possible?
• 24:56
  SPEAKER_01: If you feel terrible, your quality of life is poor.
• 25:00
  SPEAKER_01: But then in my health recovery journey, lots of things unfolded there, but you can also forget to make room for just the joy of being alive and giving yourself permission to feel good.
• 25:16
  SPEAKER_01: And I have absolutely done this more than once.
• 25:18
  SPEAKER_01: I'm sure I will do it plenty of times again in the future, but I've been guilty of muscling through things because I haven't wanted to lean on something synthetic.
• 25:30
  SPEAKER_01: But I do think we're having a renaissance in women's health and well-being, which I am so here for, by the way, in being heard, seen, taken care of, you know, assessed properly and supported properly.
• 25:43
  SPEAKER_01: Yeah.
• 25:44
  SPEAKER_01: I'd love to hear your thoughts on what you're choosing for yourself around those concepts, but also what you're seeing women are asking for, how you're supporting your clients.
• 25:55
  SPEAKER_01: What's what's the uh the temperature check on that?
• 25:59
  SPEAKER_00: Yeah, I have I'm so much uh a similar, like a similar pathway, Amy, in that I yeah, I I also had this uh along with uh everything else else you've said, I also then thought uh had this idea as a young naturopath, it's certainly changed now, um, of the health responsibility that we all carry, that we are all 100% responsible for our health.
• 26:24
  SPEAKER_00: And, you know, the concept of life, you know, lifestyle diseases that they are, you know, uh the product of certain lifestyles.
• 26:31
  SPEAKER_00: You change your lifestyle, you change your health.
• 26:34
  SPEAKER_00: And, you know, very quickly that um that idealism uh was uh my experience with patients, but also personal experiences of having diagnoses where you're like, well, that challenges that belief really significantly, and so I'm gonna have to rethink and reassess.
• 26:49
  SPEAKER_00: And I think if we ever stop rethinking and reassessing, then um, you know, uh that's what I'm done.
• 26:56
  SPEAKER_00: If you stop being flexible in your brain in the way that you think of things, but certainly when it comes to getting through something, you know, the the naturopath who pushes through pain because uh not nest naturopath, a person not nest naturopath, um, the person who who shuns the concepts of of uh of all the tools in the toolbox, opening up the toolbox and saying, what's in here for me that can help me have it help me live my life, you know, for length, help me uh be healthy in my life because there's living, there's being healthy, and then there's then there is the joy.
• 27:34
  SPEAKER_00: I I believe there is the joy in in our life.
• 27:37
  SPEAKER_00: That do we need is it always no pain, no gain?
• 27:40
  SPEAKER_00: Is it always the person who gets the most tough stickers uh for putting up with XYZ that wins?
• 27:46
  SPEAKER_00: Um and I I think that um it in a extortionate number of women uh for generations, uh either they were ignored and you know, we're getting in historical um concepts around how women may have been uh treated, uh, when particularly when it comes to hormonal health, um, ignored or told they were hysterical or they were crazy, etc.
• 28:08
  SPEAKER_00: That you then you've got to button it up and hold it in.
• 28:10
  SPEAKER_00: And and you know, in in more recent generations, it's uh, you know, we all all equal, we can all do the same.
• 28:16
  SPEAKER_00: And so we push through despite the fact that we might be, you know, doing it on, you know, not enough sleep, every joint may be aching, our brain may be a foggy piece of dust.
• 28:26
  SPEAKER_00: Um, that no, no, we can keep soldering on and soldering through.
• 28:30
  SPEAKER_00: That why not at that point look to where is the joy in life?
• 28:36
  SPEAKER_00: How, how much do I want to go out for a run and not have every joint ache?
• 28:40
  SPEAKER_00: Or how much when I tuck up in bed, do I want to get a night's sleep?
• 28:45
  SPEAKER_00: And do and to do that when we open up our toolbox.
• 28:49
  SPEAKER_00: And as naturopaths, we have the most, it's like we have I picture we open up our toolbox and it's like the big ray of like the rainbow comes out, you know.
• 28:56
  SPEAKER_00: We've got so much.
• 28:58
  SPEAKER_00: We can we can work on all that stuff that you see, those memes on on uh on uh or reels on social media, you know, I've got to eat my protein, I've got to get my morning sunlight, I've got, I've got to, you know, get eight hours sleep, but I've also got to get an hour's exercise, including resistance exercise three times a week, and you know, etc.
• 29:15
  SPEAKER_00: We've we've we've got to do all those things.
• 29:17
  SPEAKER_00: But that's you know the magic of us as practitioners.
• 29:19
  SPEAKER_00: We open the toolbox and we can select from that that that rainbow of what's gonna be most beneficial for our patients.
• 29:27
  SPEAKER_00: But in pulling those out, are we are we um going to, to the detriment of our patient, ignore other things?
• 29:35
  SPEAKER_00: Are we going to say to get that good night's sleep and you're gonna do all these things and you're gonna tick off at least three pages long um of sleep hygiene and and then you're gonna get into sleep when a distinct lack of progesterone, actual lack of this hormone, a deficiency, if you like, is the underlying driver.
• 29:54
  SPEAKER_00: Are we root causing our patients or are we are we popping are we popping band-aids on top?
• 30:00
  SPEAKER_00: That's a that's a question I don't have the answer to necessarily.
• 30:04
  SPEAKER_00: But that they're but then to learn and go, huh the difference in progesto progestogens and the progestins and the progesterones and and understanding that and the option that the patient can just go to a regular GP and get a regular old script at a for many uh an affordable price and uh and and you know pull that out of the toolbox and then get a good night's sleep, as just an example, this as an example, that then uh that you know of what their joy of their life is gonna be when they wake up that next day, uh, as opposed to chronically as an example, chronically under sleeping.
• 30:41
  SPEAKER_01: Um that's a brilliant example, and I think one that's really relatable because you could do your 30,000-step health routine each day.
• 30:54
  SPEAKER_01: But even if you were achieving the outcome you were looking for, can we really call that a life?
• 31:01
  SPEAKER_01: And if an intervention as simple as bioidentical progesterone to balance out the chaotic estrogen levels in that initial stage of perimenopause, for example, allows someone to get a deeper rest so that they have more energy the next day, so that they can do their workout routine and their body is not in pain and their mood is more stable so that they're more productive, and perhaps they can achieve the same level of quality of life without having to work so hard just to keep their head above water.
• 31:35
  SPEAKER_01: And you know, sometimes these interventions are circuit breakers, maybe they're for a season or a short period of time.
• 31:41
  SPEAKER_01: Maybe they might buy someone some time while you're working on underlying things, and it isn't intended for a more medium to long-term approach.
• 31:50
  SPEAKER_01: But I think, yes, even though we have this really comprehensive, incredible toolkit, we are doing ourselves and our patients a disservice not to consider the toolkit of other modalities, and in this case, menopausal hormone replacement therapy, and where our patients could dip in and out of you know, uh both of those toolkits.
• 32:14
  SPEAKER_01: I mean, if we're truly practicing holistic medicine, that's what it means.
• 32:17
  SPEAKER_01: What's truly holistic medicine?
• 32:19
  SPEAKER_01: Taking advantage of every opportunity with assessment, you know, diagnostic, treatment, support, rehab, all of those things.
• 32:28
  SPEAKER_01: And I think I mean your webinar covers so much.
• 32:31
  SPEAKER_01: If I can just uh point that out for anyone listening, Tracy goes through pharmacokinetics and pharmacodynamics.
• 32:40
  SPEAKER_01: And so this is not just about delivery route of medications, estrogen and progesterone and androgens, by the way.
• 32:47
  SPEAKER_01: I've also seen, particularly in US midlife influencers, a lot of talk about testosterone, which I'm absolutely here for.
• 32:56
  SPEAKER_01: But you also talk about in the webinar like how to improve metabolic outcomes, you know, naturopathic interventions to reduce the side effects of the medication, naturopathic interventions to actually enhance therapeutic outcomes.
• 33:10
  SPEAKER_01: And what that potentially means for patients is they can use a lesser dose and get the result that they're looking for when used in combination with, you know, other things that can really support that.
• 33:22
  SPEAKER_01: And for anyone who's still feeling a bit nervous about this, I totally understand that.
• 33:28
  SPEAKER_01: But Tracy also goes through the caution list.
• 33:31
  SPEAKER_01: So the herb drug interactions, the nutrient drug interactions, the red flags to look out for, the cytochrome P450 and trans border considerations, um, specific patient phenotypes that might require a modified route.
• 33:46
  SPEAKER_01: I mean, it's I can't even believe you fit all of this into one webinar, Tracy.
• 33:49
  SPEAKER_01: But if anyone can do it, it's it's you.
• 33:52
  SPEAKER_01: It was in time.
• 33:53
  SPEAKER_01: I'm sure it was.
• 33:54
  SPEAKER_01: Um, and you also covered off when to refer and co-manage.
• 33:58
  SPEAKER_01: So if this is, you know, something you want to brush up on, or you've actually just been avoiding it entirely because of the abysmal options we had two decades ago and some of the problematic outcomes that were occurring as a result.
• 34:16
  SPEAKER_01: Please take this as your sign to dive into this webinar and actually have a look.
• 34:22
  SPEAKER_01: I mean, Tracy goes through the 50 different medications and combinations for menopause.
• 34:27
  SPEAKER_01: To say there is a smorgasboard of options here for women navigating this particular life chapter is really a total understatement.
• 34:38
  SPEAKER_01: Look, Tracy, this has been an amazing talk.
• 34:40
  SPEAKER_01: I could pick your brains for another hour, but I think we really just need to send people to your webinar.
• 34:46
  SPEAKER_01: But in closing, do you have anything else you feel really compelled to share, say, guide, direct, or things that someone might benefit from knowing on this subject?
• 34:59
  SPEAKER_00: Oh gosh, now now I'm on the spot.
• 35:01
  SPEAKER_00: I think though something I was thinking of as you were just talking is the idea that, and we've and we've covered it a lot, it's not one or the other, is that when we because when we when our patient comes to see us and they're wanting support, that to pass to to to to you know to support them whilst they're using MHT, or to if they're particularly if they're asking what's your thoughts on it, and you and so you refer them to say, you know, look, if this is something you want to do and you go talk to your doctor about it, that it isn't in the same way as we might refer them to get a remedial massage, we might refer them to a women's health physio, that that that doesn't then mean we don't keep doing what we're doing.
• 35:42
  SPEAKER_00: That what all the things that we're doing, absolutely, these are the foundations, these are the things that underpin joy into older life, health into older life.
• 35:52
  SPEAKER_00: And if we and if we get some of these patterns and processes and habits in place for our patients now, we're setting them up to a for this, the fact that you know it is only midlife, that there is another 40, 50, 60, 70 years of healthy life left, you know, that we that you know, we're that and we're uniquely positioned.
• 36:14
  SPEAKER_00: I always see that when when we have our patients, that there's it should be you know ideally a team of people around them, that we're we're we're a keystone of that team.
• 36:23
  SPEAKER_00: And to be to be um having conversations with our patients around this, which is usually uh in my experience, it's 100% patient-driven, not not by me, but by the patient, to be empowered to support that is is to is to help remain our position as the keystone for our patients.
• 36:41
  SPEAKER_01: I think that's a lovely note to wrap up our conversation on, and that is even if a patient chooses to use MHT in any way, shape, or form for any period of time, it's our job to really support them in setting up those underpinnings, even if it's for the rest of their life and not necessarily for the hormonal transition they're going through, it's going to be beneficial anyway.
• 37:07
  SPEAKER_01: And and I I fully agree, as a our form of medicine is a keystone in someone's health always, and I think it's often at these times of transition that people really poor habits catch up with them, and even just reminding people of some of those basics can have a really, really powerful effect.
• 37:27
  SPEAKER_01: Oh, Tracy, you're just a wealth of knowledge, as always, and for anyone who'd like to connect with Tracy, her Instagram handle is safe underscore co-prescribing.
• 37:40
  SPEAKER_01: It is an incredible resource for you as a practitioner.
• 37:43
  SPEAKER_01: And of course, Tracy offers mentoring and training in other areas too.
• 37:47
  SPEAKER_01: But if you haven't already had a look at her webinar, please do.
• 37:51
  SPEAKER_01: It is certainly one for the ages, I think, and the reclamation of women's health and hormones at this time in history.
• 38:00
  SPEAKER_01: So we appreciate you so much.
• 38:02
  SPEAKER_01: Thank you so much for taking us through all of this.
• 38:05
  SPEAKER_01: Absolutely.
• 38:06
  SPEAKER_01: Anytime, Amy, thanks so much for having me.
• 38:08
  unknown: Bye.
• 38:09
  SPEAKER_01: Pleasure.
• 38:10
  SPEAKER_01: And thank you everyone for joining us today.
• 38:13
  SPEAKER_01: Remember, you can find all the show notes, links that we've mentioned, and other podcasts on the Australian Designs for Health website.
• 38:21
  SPEAKER_01: I'm Amy Skilton, and this is Wellness by Design.