Lorne Brown:
By listening to the Conscious Fertility Podcast, you agree to not use this podcast as medical advice to treat any medical condition in either yourself or others. Consult your own physician or healthcare provider for any medical issues that you may be having. This entire disclaimer also applies to any guest or contributors to the podcast. Welcome to Conscious Fertility, the show that listens to all of your fertility questions so that you can move from fear and suffering to peace of mind and joy. My name is Lorne Brown. I’m a doctor of traditional Chinese medicine and a clinical hypnotherapist. I’m on a mission to explore all the paths to peak fertility and joyful living. It’s time to learn how to be and receive so that you can create life on purpose.
Welcome back to the Conscious Fertility Podcast. Today I have my colleague from Acubalance Wellness Center, Dr. Kali MacI Francis. She’s a registered naturopathic doctor with the College of Naturopathic Physicians of British Columbia. And prior to her naturopathic medical school, Kali earned and honors a bachelor of Science degree in biomedical sciences from the University of Waterloo. As I mentioned, she is the, or maybe I haven’t mentioned this part, she’s a clinical director of naturopathic medicine at Acubalance Wellness Center, and she’s been on our podcast already twice. We did one on diet and lifestyle and then we did one on functional medicine testing. But as times change at the time of this recording, April of 2025, there are other tests that we started to use, in particular the EVIE Vaginal microbiome test. And since Kay and I see each other often in the clinic and talk about some of the testing around our patients, I thought it’d be great to have a conversation around that in our podcast and then just review a lot of the tests.
The area we see, Kali is a general practitioner, however, she has a focus in women’s health, women’s reproductive health, meaning fertility, perimenopause, and menopause is what that kind of encompasses. And when we come to fertility, whether you’re trying to conceive naturally or through IVF and have been having pregnancy losses and the EVIE tests, we see women that do frozen embryo transfers with euploid embryos. So they’ve been genetically tested to be chromosomally normal and they’re not implanting. And so my understanding is this is a test that you like that will hopefully may uncover an issue that can be repaired to help with implantation. But I actually am learning with my audience about this test through you. So we’re going to go through several tests, but Kali, welcome to the podcast again. Can you talk about, first off this EV vaginal microbiome test. Why are you using it? What’s the population you’re using it for? What have you seen and what is the research around the EVIE vaginal microbiome test?

Kali MacIsaac Francis:
Sure thing. The E test is newly available to us in Canada as practitioners. It’s a test that’s been available in the United States for I think the past four years. And we were just sort of patiently waiting for them to launch Evie in Canada, and they did. So as of January this year, so just a few months ago, we’ve been able to get our hands on these kits and have our patients use them. So first off, I’ll talk about exactly what the EVVY test is. The EVVY test is a vaginal microbiome test that patients can do themselves at home. So it’s like a little at-home kit that you take home, you swab yourself, your own vagina, send it back to the lab, and then Evie is using this technology called Next-Gen Sequencing. But what they are doing is called shotgun meta genomics. And that type of test is able to look at essentially everything that’s growing in the vaginal microbiome.
So looking at various species of bacteria, looking for fungi and both on the end of the spectrum that could be dysbiotic or disruptive bacteria or microbes, and then also the healthy commensal species. So we’re sort of getting this turn on the lights in the room picture of everything that’s growing in the vaginal microbiome. Why I think that’s really exciting firstly is because it’s a really accessible test now for patients. Vaginal microbiome testing has been around for a pretty extended period of time. There were tests even, or sorry, research papers back in the nineties that we’re discussing vaginal microbiome links potentially with these fertility outcomes. But until recently, we haven’t been able to have this technology in our patient hands. So that’s one of the reasons I’m really excited about it. The second one is we actually have a pretty decent body of literature that’s looking at things like community stay types or microbial patterns within the vaginal microbiome and how it might be linked with both fertility outcomes. So things like pregnancy rates, early miscarriages, implantation failures with IVF, things like this. But then also looking at pregnancy specific outcomes too. So miscarriage being one of them, but also preterm delivery and development of things like preeclampsia, diabetes, other infections. And then even there are links between what happens in a woman’s vaginal microbiome throughout her pregnancy and the child’s risk of atopic conditions, which should be things like asthma, eczema, eczema, allergies in their life as well.

Lorne Brown:
Alright, I want to unpack that because pretty significant. So there’s data sharing that the microbiome people are aware of testing the gut microbiome, but you’re saying in the vaginal microbiome it can impact fertility, it can impact miscarriage rates, and then in pregnancy there’s gestational diabetes risk preeclampsia, which is risk to both mother and baby, and then even the health of the child, there’s some atopic conditions that you notice. So this test, as of 2025, is available in Canada. And as I mentioned to our listeners, this was April, 2025 that we’re recording this. So it’s accessible, you said, because it’s an easier test to do, it’s not as an invasive test. Tell us a little bit more than are you seeing any things that come back where people have been unexplained, why are they have an implantation failure, for example, and have seen things and have we seen yet in our practice where we’ve done an intervention to correct that microbiome and seen a different outcome.

Kali MacIsaac Francis:
So working our way through that process right now, essentially what I’ve done is I’ve tested, I would say probably 20 patients until now so far with the ebi. So it’s still a relatively new test to us. But what I found that’s super interesting so far is a couple of different things. So in the scenario where a patient’s actively trying to conceive has done maybe IVFs FBTs like you’re talking about with EU applied embryos and they just sort of seem to keep hitting a brick wall. I have a couple of patients in that category for whom we’ve screened the epi and they may not be terribly symptomatic, but what I’ve seen so far is I’ve yet to catch a really nice community state type one really robust, healthy looking microbiome in these patients who’ve been hitting walls in their fertility journey. So essentially what I’ve seen so far in a handful of people that I’ve tested is that the microbiomes skewed toward dysbiosis.
There may be some healthy lactobacillus species. We should say off the top that a vagina is generally considered a healthy microbiome when it is a relatively limited number of species. So distinct two or different from the GI microbiome. We like diversity and abundance in the GI microbiome. We like to see lots of different species in the vagina. We actually really like to see a predominance of lactobacillus that’s quite similar in the uterus too, which is not surprising. They’re very closely linked with one another via the cervix. But with these patients I might see that there’s a small less significant population of these lactobacillus species. And then we’re seeing dominance by some of these other species, which a lot of these species like Gardnerella or atop phobia or pseudomonas, they could create a BV like situation. So there’s potential there in the microbiome for that to produce a vaginitis.
So irritation, change in discharge, change in smell, things like that. And especially one of my patients has sort of said that she sort of has that tendency from time to time, but it never really turns into an infection. She’s always just kind of like there’s something not right down there. It’s changed over the years and it just never feels super healthy With pH changes with her cycle for example, there will be sort of tendencies for itchiness or discharge or things to just shift a bit symptom wise and then it never becomes a full infection. So we were able to sort of test the EVIE and see, yeah, you’ve got some lact bacillus, but the bulk of what’s growing in there is a Gardnerella species or these kind of opportunistic species. When they’re given the opportunity to, they can overgrow. So in that scenario, this person doesn’t necessarily present, she has bb, but her microbiome is sort of skewed toward that type of presentation.
And essentially what we know about fertility outcomes and the vaginal microbiome so far is science is still trying to figure out exactly what the right pattern is, but we know for sure that a lactobacillus dominated vagina is associated with better fertility outcomes, whether that’s at home, like a quicker time to conception in the bedroom or in an IVF context. So higher clinical pregnancy rates, higher live birth rates. So what I’m doing, these patients, even if they’re asymptomatic, I’m like, let’s just check the microbiome and see if there are any clues there that could hinder us in the right direction. And then we have protocols to rehab the vaginal microbiome, really flood it with lactobacillus species before we go and try our next frozen embryo transfer. So timeline wise, what I’ve done so far is test, find some stuff, treat to rehab, and then we’re now in the process of these patients are going to be going further next es. So we’ll see how much of a difference that will make.

Lorne Brown:
And what about, because this test has been available outside of Canada, so what is the reporting on? What have you seen or what are you aware of when you go in and do the intervention to correct this imbalance in the vaginal microbiome? Are they measuring and seeing changes in natural conceptions, lower miscarriage rates or increase? I mean the easiest one to study is frozen embryo transfers euploid mbs because

Kali MacIsaac Francis:
Within

Lorne Brown:
A very short period of time you prepare the lining transfer and a week or two later you test whether it worked or not. So what kind of data is in that area?

Kali MacIsaac Francis:
Yeah, that’s a really good question. So one of the better studies that I’ve seen on the vaginal microbiome and time to conception came out in 2022. So there was a study where they just took us, most of these studies are small groups, small group of women. It was 89 women, and they watched how long it took for these women to get pregnant after they had tested their vaginal microbiome. So they had these vaginal microbiome results at baseline and then they watched for fecundity or how long it took these women to get pregnant. Within one year, about 60% of women fell pregnant within that year. And essentially what they were able to show was that lactobacillus with populations were higher in the women who fell pregnant. And Gardnerella, which is one of these potential BV causing strains was higher in those who didn’t fall pregnant. So we have that kind of time to conception research in patients who were trying to conceive at home so far as the vaginal microbiome and a RT, one of the biggest data sets that I’ve seen was a 2021 made analysis.
So that included over 3000 patients, I think it was actually 3,500 patients. And essentially what they looked for was like the vaginal microbiome situation going into the IVF cycle. And they showed that dysbiosis in the IVF couples was associated with both early pregnancy loss and a reduction in clinical pregnancy rate. Now, what we’re not a hundred percent clear on in the literature is whether it’s actually just the vaginal microbiome that’s playing a role here or is it the other microbiomes within the genital urinary system? Right? So we know that fertility centers are checking the uterine microbiome with the Emma and Alice testing, and essentially what we know there is infection bad higher than 90%. Lactobacillus good from an implantation perspective in a frozen embryo transfer, that test is great. It’s also harder to access, it’s pretty invasive. We have to get a uterine biopsy to do it. But what we’re trying to figure out in the literature right now is how tightly are the vagina, the cervical, the uterine microbiomes, because they’re close in time and space. The suspicion is that a healthier lactobacillus vagina is also going to create a healthier lactobacillus uterus, and that’s why we’re having these apax.

Lorne Brown:
So if somebody’s going to do the uterine biopsy, then you wouldn’t need to use the EVIE in that case because you’ve got similar information and you can treat, right?

Kali MacIsaac Francis:
I would say so, yeah, unless someone was symptomatic,

Lorne Brown:
But as you shared, it’s a much more invasive test to have the endometrial biopsies. So not everybody’s having that done. And it can take time to get into your clinic to do this. So the beauty of functional medicine testing as we keep evolving the medical fields, this is a test that’s now available that’s less invasive, and so it’s easier to get access to. And you’re not on a wait list for this. So this is now a test that you like. It’s been used, but we’re using to make sure that we can see a good vaginal environment, which hopefully will support implantation health of the pregnancy, health of the baby as well.

Kali MacIsaac Francis:
Yeah, exactly.

Lorne Brown:
Thank you for that one. All right. I learned something new every day. Let’s talk about, oh, I have a couple of other questions around the EVIE for now at this time. What’s kind of their turnaround time? If somebody comes into our clinic, is there a time in their cycle they can or cannot do it? And how long until you usually get the results back once the patient sends off their kit?

Kali MacIsaac Francis:
I think it’s generally recommended that if you are symptomatic, so IE, you’ve got some irritation or some discomforts and change and discharge, probably one of the better times to swab would be like when you’re most symptomatic, let’s catch the microbiome when it’s at its worst. Otherwise, I don’t know that there’s necessarily timing around testing other than probably a better idea to do it when we’re not bleeding or on our menstrual cycles, just swab at a different time during the cycle, it takes about a week and a half for the epi kit to get to you from the time that you order it. So they kind of ship it out from the state. It gets to your house, you can swab relatively quickly, you don’t have to freeze the sample or do anything to it. It just goes right back into the mail. It goes back to the lab, probably takes another week and a half to get to back to the lab and then I think it’s seven to 10 business days for them to sequence and process the sample until we get a report. So that entire process so far seems to be taking about a month, including shipping times and actually getting some results.

Lorne Brown:
And then is the approach kind of only herbal or you use antibiotics? What are you doing for these people that you see that come back flagged with issues?

Kali MacIsaac Francis:
So Evie has been a really great company to work with so far. I’ve been able to do one-on-one consults with some of their clinical team to help guide treatment making decisions. We have natural herbal therapeutic options available to us. So things that are very simple like boric acid, which we use in a lot of recurrent vulva candidiasis, recurrent bv, recurrent UTI protocols. So that’s incorporated in a lot of these protocols. Boric acid is a vagina acidifier essentially. So it’s changing the microenvironment in the vagina, which would be less hospitable to those dysbiotic bacteria and more hospitable to the lacto illa species. But it’s also a biofilm degrader. So when you have a population of apoian or gardnerella overgrowing in the vagina, what these sort of dysbiotic bacterial species will do is produce a biofilm. They sort of wall themselves off to the immune system into anything anti-infective that you put into the vagina behind a biofilm and boric acid is really useful to break up some of that biofilm before we hit it with something that might be antibiotics, that may be something herbal. It sort of depends on what the pattern is. And then really in all cases what we’re aiming to do is really foster more of those lactobacillus species. So a huge part of the protocol is actually using probiotics vaginally and or orally, again, dependent on the pattern, thinking about using prebiotics in that protocol as well. So to just really build up that lactobacillus population, make it super healthy, super robust, and really less likely to be disrupted by these other microbes.

Lorne Brown:
Thank you for that. Now I want to look at just some of the other testing and again, connecting it to reproductive health, which would include perimenopause or menopausal. I know I have patients come to me and they’re like, can you just test everything? They just like, and we’ve talked about leave no stone unturned. Let’s just do, they’re like, why do I have to wait until I spend so much money on things not working? Can we just do a big, we call it the health audit or a fertility audit? We just do a health audit and just look at everything and see what is going on. And so that’s kind of what I’m looking at here. Can we talk about some of these tests that we don’t do for everybody, but we do sometimes. And when do you feel they’re most warranted? So there’s a DUTCH test, can you talk a little bit about that with respect to when you use that for fertility, perimenopause, menopause, I’m going to list a few of these. There’s the DUTCH test, there’s metabolomics test. We have the genetic, the DNA testing that you’ll do only once in your life because your gene shouldn’t be changing. And I think you have that nutritional panel as well.

Kali MacIsaac Francis:
Oh, the SpectraCell, the micronutrient.

Lorne Brown:
And then feel free to share if there’s any other testing you’re doing. But sometimes they overlap, sometimes you have done them all. And then we have some patients that due to their abundance, they’re like, I’m doing everything, so just tell me anything and everything that could be done. And we explain and they’re like, I want it all. I want to leave no stone unturned.

Kali MacIsaac Francis:
And what I would say is for sure when we’re talking with our patients, we’re really, you and I are always, we’re sort of triaging these things in our minds, all of our practitioners here. It’s like we’re trying to figure out what’s going to be the best suited thing for the person sitting in front of you. So I’ve always got this list sort of running in the back of my mind and then as I’m speaking with someone, I’m like, ah, you know what? It might be pertinent to look at their GI microbiome. Or maybe we want to talk a little bit more about hormone metabolites. So when we think about your standard fertility workup, it’s going to be looking at like you say, our day tree hormones, we’re going to look at ovarian reserve, there’ll be a standard semen analysis as part of this. We get some really basic information but still really useful information from that level of basic testing.
And then the functional testing is really where we get to dive in on specific areas of someone’s physiology or what’s going on in their body to get a little bit more, like you say, laser specific with exactly what we’re going after or exactly where we think the block is potentially in their system that’s keeping them from falling pregnant and having a healthy, successful full-term pregnancy. So the cases where I would think about running a Dutch, there’s kind of two clinical scenarios where I would rely on a Dutch panel. One of them would be to get a bit of a closer look at what’s happening within the adrenal hormone system or the cortisol patterning for somebody through a standard life lab straw. All we can really look at is an am cortisol. We can look at your body at one moment in time when you went to the lab in the morning and drew your blood to see how much cortisol you’re pumping out.
And certainly if that’s really excessive or really low, that tells us a little bit about your pattern. But what’s really nice about a Dutch collection is it’s a dried urine test. You collect multiple samples throughout a 24 hour period and we’re really able to see that what’s called your diurnal or your daily cortisol rhythm. And then we can see how closely that matches with what would be considered an optimal pattern that could be useful for really honestly anyone along the fertility journey. It’s like it’s never not stressful is what I will tell my patients. Nobody goes through any version of a tricky fertility journey, not feeling stressed, and in some cases we don’t need to run a test like that in order to help support more steady cortisol levels. But in other cases, if it feels tricky or patient’s really interested in knowing we do that.
The other scenario I’d run a Dutch would be if I’m really curious about how someone is metabolizing their hormones, which may be useful in the context of an endometriosis case for example, where we’re trying to figure out that balance between estrogen and progesterone production and make sure that we’re not recirculating really inflammatory estrogen metabolites. But it also could be really useful to do prior to initiating hormone therapy with perimenopausal patient just to sort of see if the genetics test that you touched on really briefly, if we had genetics on someone, we might know what their tendencies could be genetically for how they want to metabolize their hormones in their body. But because lifestyle plays such a huge role, how they’re eating, how they’re moving their body, how they manage their stress, we may or may not exactly know from A DNA test how their body’s currently doing that. So looking at hormone metas could be useful.

Lorne Brown:
I want to just the DNA testing, so my understanding I want to unpack that is it’s kind of done once and like you said, it’s risk factors where you can potential to, for example, I have the genetics of salt induced hypertension, so I shouldn’t salt my food as an idea. And I’m also a poor methylator. I am good at making inflammation in my body and so that mean that’s my death sentence. I do test though every year some of those metabolites and markers, I look for inflammatory markers to see how my body’s doing with diet, lifestyle exercise to see if I’m able to not turn on that gene and end up with those potential risk factors. So it’s just a potential and my blood pressure is great, but I’m aware that I may have to eat differently, exercise differently, take care of my stress because of my cards, my genes being my deck of cards that I’ve been handed and even supplements and other things to take to make sure that the risk factors don’t become a reality. I’m understanding that correctly, right?

Kali MacIsaac Francis:
Yeah, for sure.

Lorne Brown:
And so from a hormone perspective, if somebody errs to a certain way with hormones pathways, they could be at risk of some of those estrogen cancers, for example. Or we know that some of our patients who go on birth control pill for their fertility journey or just for managing cycles or birth control have very bad side effects. And some of the women we see who do the IVF medications have crazy side effects and they’re often told it’s not the normal reaction and they’re kind of dismissed. We’re aware there’s a good chance they have that genetic predisposition where there may be erring to one way on that pathway, which is why they don’t do well on some of these medications, which this test potentially could give us that information so we could know in advance and also prepare the body in advance so they maybe have less side effects or even simultaneously treat while they’re doing these kind of therapies so they don’t get those side effects.

Kali MacIsaac Francis:
Yeah, I agree. Exactly. So thinking about that in the fertility context, but also in this sort of idea of perimenopause and we’re thinking about what we want to do with our hormones, if we have that genetics testing done and we know there’s a bit of a tendency for someone to want to detox their estrogens down a more problematic pathway, we sort of know that in advance, then we can use something like a Dutch to check those metabolite patterns and make sure that when someone’s using hormone therapy, it’s going down the pathways that are the most favorable or have the lowest likelihood of becoming problematic in the long run. For sure.

Lorne Brown:
And then you’re talking about the Dutch, so another way to test for hormones, metabolites. Did you finish the Dutch? Was there anything else you wanted to add? You were going to say something and I kind of interrupted you. I dunno if you lost that thought.

Kali MacIsaac Francis:
No, that was it. Those are kind of like the two populations I use it for would be the adrenals and then to look at the metabolites less so as a marker, different practitioners use these tests for various things. I would say that if I just want to know if someone’s like frank output of estradiol or progesterone, I’m going to just check that in the serum. I’m going to use a Dutch to look more at how they’re metabolizing their hormones and what happens after that.

Lorne Brown:
I want to give a little shout out. You do iron infusions at our clinic, so for those that have low iron, low ferritin, we can help support that. Metabolomics is another functional medicine test that you’re not going to get at your medical doctor that we offer at our clinic. What is that for? When are you using that? And again, transparency. I had that test done. I thought it was pretty interesting. Again, I know my genetics, I wanted to see certain things that would show up to see how I was doing.

Kali MacIsaac Francis:
I love the metabolomics test. I often say to people, I’m like, I wish this test was free. If it was free, I would just get everyone to do it. It is one of our functional tests though that’s available to everyone. Essentially what a metabolomics is, it’s a nutrient metabolite test. What they are looking at is markers for nutrient status within the body. And it’s a little bit of a vague way of saying it, but essentially what they’re doing is they’re looking at biomarkers in a urine sample and in a blood spot sample of byproducts of enzyme pathways in the body. So an enzyme is something that does something in our body. It’s going to take some precursors, it’s going to change those precursors and then it’s going to spit something out. The other side of the equation, the things that those enzymes in our body spit out metabolomics is measuring how much of those things is present in the body, and that tells us if the enzymes in our body have enough of what are called their cofactor nutrients to do their jobs correctly, what that means to me, what we’re able to find in the metabolomics is regardless of what you’re taking in dietarily or what you’re supplementing with, what I’m able to see on a metabolomics is like, okay, your blood level of B12 looks fantastic, but a metabolomics is going to tell me if your cells and your enzymes actually would do better or would do their jobs more correctly if they had more B12 metabolomics breaks down nutrient requirement to essentially five categories in the body.
There’s a category looking at your need for more antioxidant support. So there’s an oxidative stress category, the need for mitochondrial support, the need for inflammatory support within an omega check, a need for reduced toxin exposure, and then a need for methylation support. So we’re sort of looking at five major areas of the body that would produce better cellular health and whether or not your body would require more nutrients in any of those categories to give better scores or to have all those enzymes function more optimally.

Lorne Brown:
So can you repeat then the categories you’re looking at again in the metabolomics,

Kali MacIsaac Francis:
Oxidative stress is the first one. Mitochondrial dysfunction or function is the second one. Those two are hugely important by the way, for egg quality, sperm quality fertility outcomes, there’s an omega check that’s looking for if we need more inflammatory or anti-inflammatory support, toxic exposure. And then methylation is the fifth category.

Lorne Brown:
I interviewed another reproductive endocrinologist for the podcast and she was talking about how important it is of oxidative stress on egg quality and sperm quality, and we need to deal with that in order to have good egg quality and sperm quality. So the metabolomics, like you said, can look at oxidative stress. I think most patients are aware of coenzyme Q 10 as a way to support egg quality and sperm motility in particular. And so it does that methylation. She was talking a little bit about the methylation. We have the genes, you got the cards, but it’s the methylation going to turn on and off genes. So you’re saying the test will look for that as well, essential fatty acids. And then was it detox pathways? Was that the last one?

Kali MacIsaac Francis:
It’s toxin exposure. So it’s markers for have you been excessively exposed to lead or mercury or certain heavy metals in the system? And if those toxin systems are overloaded, the requirement for more nutrients to make sure that you’re detoxifying properly.

Lorne Brown:
Looking at this test, talking to you. Now here’s where policies may change in a clinic. It’s quite common for us to recommend quite regularly for most people a vitamin D test, and we’re pretty favorable for thyroid panels to look for some of those underlying issues when we look at the antibodies. Just hearing you talk again about the metabolomics, I’m thinking that this should almost become one of our standard tests because it’s so important for reproductive health, but just the health of an individual. So many other health issues could come from toxic exposure, your mega fatty acid profile, and then obviously methylation oxidative stress and coenzyme Q 10. It looks at inflammatory markers too, doesn’t it? Or markers?

Kali MacIsaac Francis:
Yeah, so there are a couple of not standard inflammatory markers. When we look in the blood, we would look at A CRP for example, which would tell us is there generally too much systemic inflammation. Those kinds of markers aren’t checked for on here or screened for on here. The inflammatory markers really all have to do with when we look at an entire omega check on this panel. So that’s going to be looking at the progression between a LA all the way down through all of the omega threes on that side of the equation, all of our omega sixes. It also is screening for omega nines, which include things like oleic acid, which is all oil omega seven. So it’s sort of looking at the overall omega balance and that has a huge role to play in modulating inflammation. That being said, if we also have excessive levels of oxidative stress, that’s going to contribute to the inflammatory response in the body too.
So a number of the categories here could inform sort of root cause for why there’s too much inflammation. And what’s so cool is it’s not just looking at, I always tell people it’s not just testing your blood for how much B12 you have, it’s looking for while there, that blood level for you is enough for your cells and enough for your body to be able to do the things that we want it to do most optimally. And that’s a critical distinction because I could check someone’s blood level of B12 and it could be 700, which looks fantastic, but then I run a metabolomics and maybe their methylmalonic acid is off, and that shows me that the cells that the B twelve’s not getting into the cells or the cells still don’t have enough, even though the blood level looks good.

Lorne Brown:
Now, I was really curious for a large population of ours are perimenopause, so basically over 40 and female
Or menopausal, no longer menstruating and haven’t been in practice since 2000. So at the time of this recording 25 years, the majority of the women I’ve seen are perimenopause or menopausal because in the last 25 years that’s where they are, and we get a lot of people looking for support during that time of transition. So knowing what you see for what happens in the hormonal profile, they fluctuating the estrogens, the progression start to decline, but just there’s brain fog, there’s achy joints, there is all of a sudden more mass cells like allergy symptoms, reaction, hot flashes, night sweats, irritability, vaginal dryness. What would somebody who’s coming in for perimenopause symptoms, menopause? Are you doing a Dutch? Is metabolomic something you’d be doing some of the, when you see somebody like that that’s having a lot of symptoms during this transition, what would you be thinking that you’d want to look at for this population?

Kali MacIsaac Francis:
It’s a really good question and it is always kind of very patient specific, but I’ll give sort of a broad thought of what I’m thinking about. We know that essentially the hormonal system from any time in honestly our mid thirties and beyond, when we start to hit that early phases of perimenopause, I explain it to people as if the estrogen or progesterone system is essentially defined by chaos. So there starts to be pretty significant changes in the stability of the energy levels in the system and in the amount of progesterone we’re able to manufacture. And that can produce symptoms that are really widespread or global throughout the body. And a lot of women may not ever even link some of the symptoms that they’re experiencing with changes in estrogen and progesterone. But that is not to say that everything that’s going on with someone’s health in their forties is all related to estrogen and progesterone.
So we tend to rely on this additional testing to help make sure that we don’t overlook or myth something happening in another hormonal system or within the nutritional system or within the microbiome that’s creating additional symptomology or might be more aggravated because of the underlying instability in the estrogen and the progesterone. I often get asked if I’m checking estrogen levels or I’m checking progesterone levels for women in perimenopause, and I would actually say that almost across the board, but as a pretty strong rule, we actually don’t recommend testing estrogen levels of progesterone because of that instability and that kind of chaos that you’ll see. I could test someone’s estrogen today and it’s going to look normal and I could test it tomorrow and it’s going to look excessively high because there is that kind of chaotic pattern. That’s not to say that you may not still consider looking at hormone metabolites through a Dutch, for example, if someone’s having extremely heavy flooding menstrual cycles to look and see if they’re also sending estrogen down a pathway that could make it more inflammatory, the GI microbiome could be useful there as well. There’s an enzyme in the gut that gets produced by some bacteria that can help to uncouple estrogen from its detox state and allow it to recirculate and react in the body making this kind of hyper estrogenic state for somebody. So we started use these additional functional tests to sort of take a step back from just estrogen and progesterone and say, okay, how much of what’s going on do we think is just your sex hormones? How much of it could also be related to your thyroid or to your nutritional status or to a microbiome change?

Lorne Brown:
And the hormonal profile is impacted by the gut microbiome. Buy your thyroid, buy your blood sugar, buy your adrenals like stress hormones. That’s the thing is we are not these individual parts. It’s an orchestra, a harmony of hormones happening, and it was Dr. Kayla Smith who we’ve had on that uses that metaphor. And so we don’t look at anything in isolation. So you’re saying just looking at your hormones, you may be looking, what’s that expression if there’s an elephant, but you’re blindfolded and you touch the tail and the other person’s touching the foot and the other person’s touching the trunk. They all have a different experience, but it’s an elephant, and so this functional medicine testing is not to get confused or we call them in. When I practice as an otter and as an accountant, red herrings
Don’t just, oh my God, the estrogen’s high. Well, of course it is. It actually, that’s kind of what’s supposed to happen in perimenopause and everybody who we see who’s trying to get pregnant over 40 is kind of in perimenopause. So they could benefit from often this kind of balancing through finding out what is out of balance. So I was just sharing that it’s important sometimes to look at other things because the root cause could be not the hormone that’s your symptom. Yeah, hormones are to balance, but what’s causing the hormones to be out of balance?

Kali MacIsaac Francis:
Yeah, yeah. I often say that I am viewing a patient’s body as a totally intricately interconnected web. All of the systems of the body are important to us because the symptoms that are happening in the GI tracts can be related to what’s happening in the hormonal system, and it can be hard from a surface level to sort of see that link. But once we start to learn about the effects of microbiome on your hormones and the placement of the immune system right outside the GI tract and how that could affect systemic inflammation, it all kind of starts to make sense.

Lorne Brown:
And you were talking about some of the symptoms. If a woman’s flooding like heavy periods, you would look at some of these other tests and to see where the imbalances are. It seems like right now in the media, menopause is really hot right now. Excuse that time, right? So hot. Yeah. All the celebrities are giving advice. It also seems like hormone replacement therapy has made a rebound with a rebrand as well. It’s called menopause hormone therapy, right? MHT.

Kali MacIsaac Francis:
Yep.

Lorne Brown:
And I know in our clinic, just to let everybody know, we use it in our clinic hormone therapy, bioidentical hormones. We tend to use noninvasive things first before we go down the line. So I think the progesterone and estrogens support that we do is usually not always the first line. But the things that I’m seeing in my social media feeds and people are sending me by celebrities and medical doctors is you take estrogen and you’re going to be happy, but that’s not been our clinical reality. So I just thought since you’re here, can you talk then about the approach of when you’re treating somebody in perimenopause or menopause and are you just doing estrogen or are you just doing progesterone or is it usually both? And kind of talk a little bit about it, and I guess I’ve never actually asked this. Maybe you’re one of those celebrity docs that thinks that estrogen’s going to cure all. I don’t know, but I just know it hasn’t been our clinical reality and we’re not paid by pharmaceuticals. Maybe they are. I don’t know why they’re all over it right now in the rebrand, I got to emphasize this, we are not anti the hormone. We actually prescribe these hormones in our clinic

Kali MacIsaac Francis:
For a lot of people. Yeah,

Lorne Brown:
I just don’t think we’re as excited and subscribe it so fast and so early as what I’m seeing other people talk about in our practice. And I very rarely see us just doing estrogen, which is what a lot of them are saying, just estrogen. So can you talk about synthetic versus bioidentical and just a little bit education so they can advocate for themselves when they see their healthcare provider?

Kali MacIsaac Francis:
Yeah. Myself and Dr. Ashley, we’re the two naturopaths here. We both have our prescribing licenses and we do both manage quite a number of patients through perimenopause and menopause. And how we think about hormones is, it’s one of the tools in our toolkit being holistic practitioners. There’s no way that a hormone can outcompete a really poor lifestyle, is what I’ll often talk to my patients about. So diet, the sleep, exercise, stress reduction, all of these sort of pillars of overall foundational health that we talk about all the time, day in and day out with our patients, those are critically important to have in place, not only for our health and longevity, keep our bones strong, keep our heart healthy, keep our lean muscle mass on our frames. We need to be doing those things day in and day out from a preventative perspective for our longevity.
But also what we find is that when we have those pillars in place, we’re also giving ourselves the greatest likelihood that adding some additional hormone therapy in what’s well indicated for a patient is also going to give us the best return on investment. We’re going to get a better response out of somebody who’s eating well, sleeping well, exercising, doing all of the basic already or on the ground level. So I would say that in some scenarios, I would prescribe hormones on a first visit with a patient when it’s really well indicated. We’ve had a great discussion, informed consent, we’ve done risk assessment, et cetera, but I’m never giving hormones in isolation. So I do think that the downside of all of this awareness on social media is that we’re learning about health in these 32nd clips or two minute clips, and really all we’re hearing is like, oh my God, the estrogen’s going down and everybody just needs estrogen, and that’s just going to fix everything.
Yeah, estrogen is extremely important, as is progesterone extremely important. Keeping those levels in our system through perimenopause and especially post menopause will reduce a woman’s lifetime. All cause mortality risk due to cardiovascular disease will help keep her bones nice and dense, reduces her colorectal cancer risk, may also mitigate some dementia risk in the long run. So hormones are extremely important, but again, never in isolation. The way we move and the way that we eat and how we supplement is also going to have these protective effects as well. That’s also, I think, important to keep in mind for patients for whom hormone therapy isn’t the right answer. So bioidentical hormones aren’t right for even everybody. Some women, despite all their best efforts, don’t respond well to them. Keeping in mind that we can have hugely protective effects with all of those very basic principle therapies, I think is also important.
You asked briefly about synthetic versus bioidentical hormones and how the older school version of HRT has now been transformed and rebranded as menopause hormone therapy. A lot of that has come about over the past 25, 20 to 25 years since the Women’s Health Initiative, the way that we used to do hormone therapy is different from how we do it today because we’ve learned from research that’s how medicine should go. We’ve done studies. We found out that maybe synthetic weren’t the best way to go when it comes to replacement of hormones. We found out that there’s a timing hypothesis with hormone therapy. Giving hormones to women who are 60 plus who’ve not had a period in over 10 years is a very different scenario to giving some hormones to someone who’s navigating perimenopause or who has just finished her final menstrual period. So nowadays, in 2025, all of the hormone therapy societies and menopause societies that exist in North America, we have nams. If you look at the NIH criteria, the recommendation is to use bioidentical hormones, so use of estradiol, oral micronized, progesterone. These are the same hormones that our bodies make. They are synthesized in labs, but they are the exact same molecule that you’ve always produced in your own body. And people who are doing hormone therapy today are using those hormones because we have very good data on both their safety and their efficacy.

Lorne Brown:
Thank you for that. And again, you’re tending to use both in progesterone and estrogen support in a lot of this population,

Kali MacIsaac Francis:
For sure. Yeah. Yeah. The only theory in which you would ever consider using estrogen alone might be in someone who’s already had her uterus removed. And even in that scenario, I would argue there are benefits to progesterone outside of just protecting the uterus against the estrogen therapy, which is how it’s classically sort of sold. If you ever want to take estrogen, you have to take a progesterone or a progestin with it to protect your uterus from hyper proliferation. But we know that progesterone has effects on bone density, for example, we know progesterone has impacts on breast health, and we suspect that it may have more widespread benefits as well when it comes to treating, especially sleep changes. So insomnia, anxieties, changes in moods through perimenopause and menopause. Progesterone is like one of my favorite tools in my toolkit because it really does. It hits the GABA receptor in the brain, and it can really bring down that antic tendency, calm the nervous system, help with the sleep and insomnia stuff. In fact, I would say that most frequently in earlier perimenopause, I tend to introduce progesterone first and then we add estrogen later in many of my patient scenarios. As the need becomes more significant for estrogen, we’re almost always using the two of those hormones together. It’s just when we introduce one or the other is dependent on what’s happening in someone’s picture.

Lorne Brown:
Yeah, I just thought we weren’t trending because most of what I’ve seen in those 32nd one minute clips is it’s all estrogen and it was missing the progesterone, the yin yang. It wasn’t balanced. And I noticed we have a different approach in the research we look at, especially the local endocrinologist, Dr. Ly pryor, to showing using the bioidentical progesterone versus the synthetic. Also because when you know better do better, so now that we have access to the bioidentical progesterone makes sense to use it. Do you do any monitoring? So once you put somebody on menopause hormone therapy, or even our patients that have some severe imbalances that are still trying to get pregnant in their forties, I know sometimes we’ll use some progesterone support. What kind of monitoring are required, if any, and safety wise? Are they able to stay on it for a long time or is there a washout period that you’d like people to come off it?

Kali MacIsaac Francis:
So for what we know now in 2025 about hormone therapy, we don’t tend to monitor things like blood levels or really salivary levels or anything really from an estrogen and progesterone perspective, it’s been found so far to not be particularly useful. We tend to use our clinical feedback or judgment about how the symptom picture is changing to let us know, okay, do we think there’s enough estrogen present here? Do we think there’s enough progesterone? How do we adjust doses over time? It’s specific to perimenopause and menopause. What we typically tend to do is we start it on a protocol and then we let that protocol steady out over the course of about eight weeks. It takes about that long for hormone levels to get really super steady in someone’s system for us to know exactly what the impact of that particular prescription is going to be for somebody.
And then we adjusted over time. If someone had heavy periods to begin with, we started in on some progesterone and they’re still too decently heavy, we may increase the dose because of that or other symptoms telling us that the body is not quite exactly where we want it to be. So far as how long can women take these hormones for in a fertility context? A lot of the time we’re using luteal phase progesterone with every cycle. We’re sort of waiting for someone to fall pregnant, and then we tend to continue the progesterone if someone’s already using it for the first 10 to 12 weeks of the pregnancy until we’re quite confident that the placenta is set up and they no longer need that exogenous progesterone in a perimenopause slash menopause case. I would say that kind of a blanket statement, most women will choose to continue to use their hormones for the rest of their lives and go to the grave with the estrogen patch on.
Aside from the clinical scenario where someone develops a direct contraindication to keep using her hormone therapies, or she just decides at one point in time she would choose not to use these anymore, they kind of today is no reason to believe that we can only use hormones for 10 years. We only had 10 year data for a long time. We now have longer term studies that suggests that aside from any of these contraindications being present, there’s no strong reason to pull someone off of her hormone therapy. She may change doses or administration routes as research changes, but yeah, you could continue them longterm.

Lorne Brown:
Awesome. I always enjoy getting on a call with you like this and sharing it with our listeners. This is what happens in our clinic. We geek out, and then every once in a while, this was happening Last week, we were geeking out about the EV test, like we got to go and share this. So I was looking, the episode that you did the last time on functional medicine testing called Leave No Stone unturned was episode 20 over two years ago. We did it in early 2023. It

Kali MacIsaac Francis:
Doesn’t feel that long ago.

Lorne Brown:
No, but it was time for an update. An update for sure. I’m glad you did that today with us.

Kali MacIsaac Francis:
Yeah, thanks. It was fun.

Lorne Brown:
Yeah, thank you very much. So this was Dr. Kayley mc again over at Acubalance, and I see that she’s at the Acubalance Clinic. Kayla, I invite you to go jump on the sound table now and chill out and enjoy a little RNR.

Kali MacIsaac Francis:
Definitely going to do that. Yeah, thanks.

Lorne Brown:
All right. Take care.

Speaker 3:
If you’re looking for support to grow your family contact Acubalance Wellness Center at Acubalance, they help you reach your peak fertility potential through their integrative approach using low level laser therapy, fertility, acupuncture, and naturopathic medicine. Download the Acba Fertility Diet and Dr. Brown’s video for mastering manifestation and clearing subconscious blocks. Go to Accu balance ca. That’s a ACbalance.ca.

Lorne Brown:
Thank you so much for tuning into another episode of Conscious Fertility, the show that helps you receive life on purpose. Please take a moment to subscribe to the show and join the community of women and men on their path to peak fertility and choosing to live consciously on purpose. I would love to continue this conversation with you, so please direct message me on Instagram at Lorne Brown official. That’s Instagram, Lorne Brown official, or you can visit my websites, Lorne Brown com and Acubalance.ca. Until the next episode, stay curious and for a few moments, bring your awareness to your heart center and breathe.