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.
I want to welcome everybody to today’s episode, and I am literally thrilled to have Dr. Nicky k, a leading expert in endocrinology and women’s hormonal health join us. She was introduced to us by our colleague, naturopathic friend, a Lara over in New Zealand, who’s a fellow Canadian, by the way. So big gratitude over to my friend Lara. Now, Dr. Keay is an honorary clinical lecturer at the University College of London. She’s a member of the British Menopause Society, the author of the acclaim book, hormones, health and Human Potential. She has over 30 years of clinical and research experience. Dr. Keay has a unique approach that integrates her deep medical expertise and her passion for optimizing health and performance in women of all life stages. And I do plan to talk about all those life stages with her today. And this goes from dancers and athletes to women navigating perimenopause, fertility, and menopause. Dr. Keay insights are grounded in cutting edge science and holistic, which is why I’m so excited to talk to you perspective empowering women to better understand their bodies and their hormones. Today we’re going to explore the intersection of perimenopause, fertility, and menopause, and we’re going to uncover practical strategies to support hormonal health at every stage or any stage of life. And I do want to let you know her latest book is The Miss of Menopause. So Nicky, welcome to the Conscious Fertility Podcast.

Nicky Keay:
Listen, thank you so much for having me, inviting me. Yeah, really thrilled and looking forward to our discussion.

Lorne Brown:
Really looking forward to this. I was thinking about some of my demographics and I’ve been known for fertility for so long. I’ve been doing this over 25 years, but there’s a demographics I’m seeing over 40, between 40 and 44. Many of them are not trying to conceive, but they’re experiencing perimenopausal symptoms because they’re still menstruating, but they are struggling.

Speaker :
Many

Lorne Brown:
Of them are still trying to get pregnant, but they’re in that perimenopause phase. So there’s huge overlap here. So I really think with the two books you’ve written, you are the perfect person to talk about this. And I want to share with my audience the Dr. Keay is a medical doctor. She has a big focus in endocrinology and her herself was a dancer, so an athlete. So we got lots of stuff to talk about. I thought we should look into, since we’re going to talk about generally over 40 here, understanding these hormonal transitions. And in your writings you often describe the hormonal system as an orchestra. And I was thinking how we can bring this into when women are trying to conceive or navigate perimenopause and menopause, how to better understand these hormonal shifts through this metaphor that you call the orchestra of hormones.

Nicky Keay:
Yeah, well, there are two metaphors I want to use if that’s okay.

Lorne Brown:
Yeah.

Nicky Keay:
I talk about the female hormone odyssey because it is a journey that every woman, every single woman will go through this odyssey, by the way. So starting off from when she’s a child, her periods start, she the menstruating years, and then as the ovaries wind down, perimenopause, menopause. And yes, there is life after menopause. By the way, newsflash. So we’re talking about this odyssey, this pattern. It’s a whole hormone dance that goes over the whole of the lifespan. But throughout that, every single, wherever we land in that odyssey, like you say, within that there is the hormone orchestra playing its part. And if we focus particularly, I mean the whole hormone orchestra, I think we would need a whole week talk about that. But focusing specifically on the female reproductive axis, by the way, I don’t particularly, although I use that term female reproductive axis, I’m not a big fan of it because the word reproduction might suggest that the only purpose of it is reproduction.
Absolutely. It’s the evolutionary purpose of the female hormones, I suppose you could argue. But these hormones have effects throughout the body, which is by the way, when they change and the orchestra changes, its tempo goes into a different scene or act. So thinking about the whole of the female Horman Odyssey, like a ballet for example, like Swan Lake, we have all the various scenes of Swan Lake and it’s going to go through this logical progression and it will change each scene. You might start off happy. The middle scene is quite, and especially the finishing scene, a bit fraught and things are changing. So those are all the analogies I want to bring to play and for people to think about that it is a female hormone odyssey and at different points in that journey, the orchestra, the female hormone orchestra will be slightly different in terms of it might have a different tempo.
And also as with any orchestra, we hope not, but there might be a couple of instruments out of tune and just one being a little bit off might throw the whole thing. So this is another, ideally there all, they’ve got a nice conductor, the pituitary gland by the way, the conductor of the endocrine orchestra. Hopefully you’ve got a conductor that’s keeping them all together on tempo, on score sort of thing. But things do happen and sometimes one of the instruments can go out of tune, although a little bit off misread the score or whatever it is. So that can be a little bit of a challenge as well. So yeah, I think thinking of the hormones as being dynamic and part of you, I think lots of people talk about, I don’t like particularly the expression hormone imbalance. It kind of points the finger that something’s wrong with the hormones, although as I said, sometimes they can go a little bit out of key, but they’ll come back on track as it were.
But nevertheless, it’s often what we do as well because what we do in terms of our choice of exercise, nutrition, et cetera, that influences the hormone orchestra and how it progresses through the odyssey. So yeah, I think there’s lots of interactions, which it sounds complicated, I guess it is, but trying to think of it in sort of a way that makes sense. That’s how I do it. To me that makes sense. A ballet makes sense, I get it. I can see there are different scenes and I can think of the orchestra and I can think of it like that. And there might be little bits where things don’t quite go right. Someone could take a slip on stage, for example. I’ve seen it. Things do, but nothing, things do go a little bit awry, but that’s life.

Lorne Brown:
Let’s talk about this odyssey in the orchestra to put it into clinical or real life terms for the listeners. Because through my lens of Chinese medicine, this odyssey going from your reproductive years, so when you’re capable or able to reproduce to when you’re no longer having children in Chinese medicine, it’s seven times seven women agents, seven. So it was always predicted and discussed that at age 49, this is when this time period ends very close to what we see in research, which is close to average, 51, right?

Nicky Keay:
Yep, exactly.

Lorne Brown:
There was no disease called menopause in the classics in Chinese medicine. Very interesting. We have definitely path pathologized it,

Nicky Keay:
The law it. Yeah, exactly.

Lorne Brown:
I’m tongue tied here. So with that, that’s unfortunate. However, that odyssey, that transition could be smooth. However, we do see people going to your orchestra where there’s things that are out of tune and like you say, and that could be hot flashes or night sweats, severe mood changes, vaginal dryness, poor sleep, joint pain. So there is a large group of women that are struggling because of this and from the reproductive fertility perspective, but we’re seeing these, that’s a sign that your orchestra is not in tune, which would impact your fertility potentially and impact how much joy you get into this transition. I do want to add one key part here about the Chinese understanding. So this idea of every month the resources, the qi and the resources of the body are going to the uterus to sustain life. And then when you go into, when you’re in menopause, so you’re no longer menstruating physiologically, you are more wise because that energy that used to go to the uterus now gets diverted to the heart center in Chinese medicine, which means you’re now wisdom years your elder, that you are more available with your wisdom because you have just physiologically you have more. So it’s such a beautiful way more resource. It’s not like, oh, you no longer can reproduce. You’ve reached your purpose, you’re done in Chinese medicine, you have new role in society,

Speaker :
Which

Lorne Brown:
Is very important. And again, that’s why we want this orchestra to be in balance. So why is it that the orchestra is out of balance when you talk about hormones then? So what is happening? Because so many people say it’s an estrogen deficiency or you don’t have progesterone or is it fluctuating? Can you talk about the axis, which you don’t like the term so much, but why is it that some women struggle during this time when they’re over 40 into having their last menstrual period? And then let’s talk about some of the things they can do to help smooth that transition.

Nicky Keay:
So just pick up on a few of your points. I think definitely menopause for the majority of women, there will be some women. It is true who have got had the, what we say, a surgical or medical menopause had to have the over removed for what a reason or treatment. So fair enough. But for the vast majority of women, fortunately that’s not the case. And as you say, average age of 51 range between 45, 55, it’s not an illness, it’s not a disease, it’s not a pathology, it’s just part of your odyssey, your life course, this is it. But I think that view of it is so tied up with getting old and negative. That’s the problem. And so like you say, the Chinese and the Japanese saying it’s a second spring, like you say, true, okay, that particular bit of that particular scene, that act of your female hormone or see that the reproductive years, okay, fine, that’s finished, but there’s more to come.
And as you can say, as you said, there can be some advantages. You are literally older and wiser and you can literally have the time and the resource whether you’ve got children or not, you might be running around your children, your family, whatever, stuff like this. But now, actually this is a time when you can use all that accumulated wisdom and to go forward. And by the way, that’s why I’ve got Athena, the goddess of wisdom on the front of my book, Mr. Menopause, because she is the goddess of wisdom to lead you through this challenging bit of the odyssey. So we don’t want to minimize it having said it’s not illness, not disease, et cetera. Absolutely. There can be some women who do have some particular challenges of this during this time. And why is that? Because the nature of perimenopause, the ovaries winding down is uncertainty, right? The hormones are well out of their new normal tuning. So they’re trying to transition from having this particular pattern of the menstrual cycle to the pattern of frankly just having a rest and retiring. But they go out, they don’t go out quietly.
There’s a transition bit where some of the instruments might think, oh, actually I’m not going to do it this time. I’m not going to play or I’m fed up or whatever. But the other instruments might be saying, fine. So what happens first actually is the progesterone isn’t produced so much during the menstrual cycle. That’s the first thing that happens. So typically, initially the woman might notice a shortening of her menstrual cycle, but you haven’t got so much progesterone, so relatively speaking you’ve got more estrogen. And so this can also not only give you shorter cycles, but actually heavier bleeds, which in itself is problematic, right? Okay. Now the cycle is less predictable, heavy bleeding, and also the other crucial thing. Some women do have more challenges than others, but why is that? Because we’ve each got our own individual response to these hormones. So some women will, yes, she will experience this fluctuation or really sort of slightly out of sync hormones during perimenopause, but it doesn’t feel quite so bad.
But others will feel it really, like you said, hot flushes, it disturbs your sleep and the whole thing gets bad. But that’s very individual. So this is I think what the problem is because women who are finding it particularly challenging feel like they’re weak or feeble or something’s wrong with them. Whereas another woman who is saying, oh, I’m fine and everything, but actually if you dig down into it, you will, even if you think you are doing pretty well, there will be things that have changed for you. So I think it’s acknowledging and accepting that these hormones are really powerful, that all parts of our body, all parts of our physiology, both brain and the physical body. So of course if they’re in a little state of slx like this during perimenopause kind of inevitably you will feel a little bit off kilter, literally out of tune, out of sync. But the good news is that it does calm down. Gerald and Pryor, who I know is a colleague of both Lara and mine and has written something for the book, she talks about the estrogen storm

Lorne Brown:
During

Nicky Keay:
Perimenopause, you see? And so yes, it is literally stormy time. And so if you are listening to this and you’re finding it really challenging, don’t worry. There’s nothing wrong with you, but you are experiencing, unfortunately you are experiencing it. It’s not uncommon to really struggle. I mean, thinking of myself, I think I did find it, even though I knew this was coming and I knew all the science behind it, when it actually happens, it is really bewildering. And I thought, my goodness, if I didn’t understand what, but I didn’t know what was happening, I’d be really scared. I think I was literally losing it.
So coming back to your original question, this is why the perimenopause I think is the most challenging time because of the unpredictable nature of the hormones. They’re sort of retiring at different patterns, different speeds, and they might have second wins. And it’s just really, it truly is very confusing and challenging. But the good news is there are definitely some positive things. Well, first of all, understanding this is what it is and accepting it and saying, okay, this is when I need to make some changes. And looking on it as an opportunity and maybe overdue opportunity, you could argue to revise and review and refresh what you’re doing.

Lorne Brown:
I reframe, I want to unpack some of the things you mentioned. So you talked about the progesterone, there may be some changes in progesterone, no progesterone or much less progesterone. This is interesting because when I look at some of the menopause medical doctor experts, most of them talk about estrogen and very rarely do I hear progesterone. So I’m going to ask you to kind of talk a bit about that. And we do have Gerlyn Pryor also on an episode on the subconscious

Speaker :
Podcast

Lorne Brown:
Put, so she’s on here. So this is something that’s not talked about so much. So I kind of want to ask you if we can just repeat some of the things. If the progesterone, why is it that there’s a shift in progesterone? Why is it so we can explain it to the women so they can understand how does this impact some of the symptoms they’re having then in this perimenopause period? And how is this affecting fertility then?

Nicky Keay:
So what if you’ve got Professor Jarron and Pryor coming on? She is definitely the guru, the go-to progesterone queen. I’m naming her, but so you are right that in generally it’s always estrogen. Everyone talks about estrogen, eastern and eastern and absolutely it’s a very important hormone that we’re not denying that. And progesterone is sort of the second fiddle you see and doesn’t get talked about so much. So I think the confusion is the following, that menopause when your periods stop, it’s like a point in the sand and over is officially totally retire then absolutely both estrogen and progesterone and be low. And because estrogen is such an important hormone or the one that talked about a lot, that’s why we talk about, oh, dropping estrogen levels. That’s not good to the cardiovascular health. That’s the main killer, by the way, of postmenopausal women, not breast cancer by the way.
So low estrogen we know has an effect on cardiovascular health. We know that estrogen is very important for bone health, osteoporosis, the silent killer. So once you’ve reach menopause and both hormones are low. So that’s why estrogen, the spotlight has been on estrogen I think to date. But actually Jaron imply will explain further how actually what is the first sign that perimenopause, the ovaries are being a little bit truculent. The first sign is actually the production of the progesterone. The estrogen is still trying, still going, but you might not even ovulate. Or if you do ovulate, you don’t produce a lot or sufficient sustained level of progesterone. And this definitely has an impact on fertility because by the way, progesterone broken down pro gestation for pregnancy. So well, obviously if you’re not ovulating, that’s kind of like a non-starter, right? Then you won’t have very low progesterone. But even just sub clinically as we call it, subclinical ovulatory disturbance, where you might have made the attempt to ovulate, but not a lot of progesterone is produced, and so therefore the endometrial, the lining of the uterus isn’t nice and juicy and thick and ready to accept the egg, you see if it is fertilized. So this is why fertility does drop, well, frankly, quite dramatically from the age of 40 onwards, even if you’re having a cycle,
It’s because of the progesterone not really doing the full variation that you would expect. So that’s first thing that fails. But the thing is that isn’t talked about so much, I suppose because everyone’s focusing so much on the estrogen. So how would that make you feel? Well, number one, obviously it’s going to affect your fertility, but Lyn Pride did a very interesting study in Canada where she found that one of the first symptoms of perimenopause are vasomotor symptoms, IE, these hot flushes, I call them flushes, you call them flashes anyway, right? Temperature regulation issues, and it disturbs your sleep. And anyway, you literally feel hot and bothered, often associated with, well, obviously not feeling good anyway. So she did a very interesting study because everyone’s talking about, oh, it must be estrogen that’s falling, but actually there’s no particular exact correlation with estrogen levels and hot flushes. But she did find in her study, I don’t want to steal all her thunder

Lorne Brown:
Repetitions always

Nicky Keay:
Good. She did a lovely study giving women micronized progesterone, so the same progesterone that’s identical to what we produce in our own body. And this improved the vasomotor symptoms. Heart flushes improved sleep, right? This was before, even before the woman even reached these menopause. So I think we need a reframing. In fact, she wrote a lovely piece for the book explaining that this is what we need to talk about more, that the first thing that goes a little bit arise actually the progesterone in early perimenopause. And that has an impact not only on fertility, but how you feel because progesterone is a nice relaxing hormone. It helps you sleep and now you’re going to get hot flushes, now you’re going to sleep so well. So the whole thing snowballed. So absolutely estrogen will of course ultimately drop as well.

Lorne Brown:
But in the perimenopause, I remember Jalyn saying it’s less of it being low, more fluctuations up and down, that’s causing so many of the symptoms. And the progesterone seems to be lower or absent. You may have a non-gay cycle.

Nicky Keay:
Exactly. So the estrogen, so yes, I’ve spoken specifically on estrogen in general, the progesterone going on the lower side, but what’s happening with estrogen, that estrogen can also be fluctuating a lot because it’s a time of uncertainty. And by the way, it’s a kind of a mirror image of what happens in puberty. So when girls first start their periods, you’ll often hear teenage girls saying very heavy periods, painful, not feeling good, et cetera. And this is because the first hormone to appear and the last one to disappear is estrogen. So in the teenager, she’s got lots of estrogen trying to find its feet, trying to find the right tune if you will, the rhythm to it. The progesterone isn’t so good, it takes a little bit time to get going. And this is exactly the image what happens in perimenopause, the progesterone is faltering, but the estrogen meanwhile is having a party. It’s going a little bit crazy, literally going a bit crazy. And so it’s the combination of progesterone going low, estrogen actually, if anything going high and peaking. So it’s the precise opposite of what we were taught. Frankly, as doctors saying, talking about estrogen actually is kind of the opposite. It goes high and crazy in perimenopause, and then eventually of course it will also drop down low.

Lorne Brown:
So these symptoms of cardiovascular health, osteoporosis, what are some of the, which hormone or is it both where women are just feeling the emotions are just out of sync and crazy irritable. My wife’s 52 and I tried to explain perimenopause what’s going on with her hormones, and she looked at me and said, no, it’s your fault. The reason I feel this way is because of you. Yeah,

Nicky Keay:
Well, yeah, well listen. Yeah, and listen, it’s tough not only for the woman, but for those round. Yeah, exactly. So I mean in perimenopause, so the health things that we talked about, the cardiovascular and the bone health as more are later on

Speaker :
When

Nicky Keay:
The estrogen truly is low. So that’s typically afterwards. So the first things to hit will be the effects of, like we said, the crazy fluctuations typically of the estrogen going up and down and the progesterone sort

Lorne Brown:
Of, and what are the signs of those that they’ll see in the body.

Nicky Keay:
So those are the vasomotor symptoms. 75

Lorne Brown:
Flashes.

Nicky Keay:
75, yeah, exactly. 75% of women will experience those. So quite a lot. That’s the top symptom, which in turn disturbs your sleep. And also with the fluctuating hormones, that also disturbs its sleep. So basically poor sleep is all part of that interesting evidence coming out that maybe the vasomotor symptoms are associated with the so-called brain fog, the forgetfulness, right? Because during those hot flushes, the blood flow is actually diverted from the brain. So I can tell you, you’ll become very forgetful. It’s like, oh my goodness,

Lorne Brown:
I like that’s a 0.1. So can you talk more? They brain fog, can’t find words forgetful, really concerned about Alzheimer’s. My women in their early forties that are So is that the fluctuating estrogen or is that the low progesterone? Is that both?

Nicky Keay:
It’s the combination you see, because they’re out of sync. Because they’re out of tune.
You see the orchestra, the hormone orchestra is out of tune. And I’ve got a professor at UCL where I work written a chapter which is entitled, am I Losing My Mind? And she is head of the cognitive function and aging and Menopause. And she said it was ironic, she does all this research and then when this happened to her, she’s forgetting things in the meeting, right? There are three points, one, two, and what’s three? And she said literally she thought she was getting Alzheimer’s, but then she realized it was actually the effect this flux of the hormones because these hormones cross the blood brain barrier go into the brain and help in cognition. So if the hormones are all over the place, and obviously you know your memory, but also mood, you mentioned mood and that’s very important, fluctuating mood, which I remember myself. It’s really weird anxiety, you can’t get things done, which you’ve always been able to do, but you just question yourself being very sad, very crying, angry.
It is like all the validity of the four seasons as I describe it, all mood all over the shop. But this is because of the hormones being out of sync, particularly doing perimenopause. So these are the typical symptoms of perimenopause. When there’s this fluctuation of the hormones, typically the estrogen going a little bit crazy in the progesterone going low, there’s a whole list of other ones. I call it Pandora’s box aches and pains, digestive issues, changing body composition. And ultimately yes, there will be uo, genital symptoms, vaginal dryness and problems, urine infections or wanting to go to the lu a lot. And then later on, after both of the hormones are now definitely low estrogen and progesterone, then we’re talking about the health, longer term health consequences in terms of bone health and cardiovascular disease. So there’s a little time course made a little graph in my book. It’s like these are, the symptoms happen first, the anogenital ones sort of near the menopause when both hormones are on the decline. And then the health ones, it is, you said which one? Well, it’s probably, well, it’s a combination of both, but now the estrogen’s going low and so now definitely the health potential risks start to increase a couple of years after menopause and onwards.

Lorne Brown:
It’s really unfortunate because what happens to a lot of these women is because there’s a holistic view that you have. I have, but a lot of physicians do not. And so you got somebody treating the urinary tract infections.

Nicky Keay:
Yeah, exactly. And

Lorne Brown:
Somebody put you on antidepressants because of your immune. You got the rheumatoid arthritis working on, you got the gastro, the GI doc working on the gut.
And really if you had a holistic view, it’s about getting this orchestra to be in tune. Again, I’m going to share something with you that may make you have a vasomotor flush right now. So in 2010, so over 15 years ago in our clinic we were working, we’re holistic, integrated, so naturopathic doctor, Chinese medicine doctor, and the naturopathic doctors often would use the term luteal phase defect. So if somebody who was trying to conceive in their forties or any age and they have a lot of spotting in the second half of their cycle and the ltil or their ltil short, we would call that a luteal phase defect. And we’d want to correct it through diet, through herbs, supplements, acupuncture or even bioidentical progesterone support. And the reproductive endocrinologist, this is where you may get a flush, said, luteal phase defect went out in the eighties. And so can you as an endocrinologist and a medical doctor, how do you take that comment? Because you’re saying that the progesterone is changing and we see this in women in their forties where they may not ovulate.

Nicky Keay:
Absolutely.

Lorne Brown:
Or they don’t have a strong ovulation, so they don’t produce as much progesterone, which progess affects fertility. So every doctor’s entitled to their opinion. I’m curious to your opinion, when a doctor says Ltil fis defect went out in the eighties, I think he said that because A, he’s he and B, because they had Clomid back then they still have clo letrozole, which they thought could,

Nicky Keay:
Well, I mean it definitely is a thing. I mean rather than calling it, I think we now Lyn will talk about it and she’s written an excellent paper, which really inspired me. So again, a defect to me sounds a bit of a clumsy word. So now we call it subclinical ovulatory disturbance, right? So it’s subclinical because the woman will say, I’m having a menstrual cycle, I’m having, well I’m having menstruation probably reasonably regular, but sub clinically underneath the surface. If you look at the orchestra, the progesterone isn’t pulling its weight. And there could be a whole spectrum of not ovulating at all, like you said, which is sort of clear plug, no ovulation, no,

Lorne Brown:
You wouldn’t ignore a short luteal cycle spine.

Nicky Keay:
No, absolutely no, absolutely no. That is definitely a sign. Lyn will definitely go into this more. So it’s definitely a thing, and I see this not just in perimenopause or women, but I work as you said, with athletes and dancers and we know that if they don’t fuel sufficiently for what their requirements, they can end up with reds relative energy deficiency in sport with when their peers stop entirely functional hypothalamic amenorrhea very sensibly. The body has saved resources. You won’t talk about resources. So in the extreme situation, if you don’t have enough energy, the body will switch off the hormone axis, the orchestra, and you won’t have any period at all. That’s kind of clear cut. We knew that. But there’s this gray area in between which gerlyn describes subclinical ovulatory disturbance where the woman might be having menstruation. But there is definitely a problem with the luteal phase.
So low levels and ovulation and ly will describe that. We can now look on this, monitor it using a ovulation thermometer. If you do produce a decent amount of progesterone like the area under a curve, effectively this will increase your metabolism. And like you said, resources, the body needs more energy. Literally you need more calories then. But if you don’t produce a decent amount of progesterone, then the ovulation thermology get that rise, you see? And so that’s an indicator. So I would say that rather than going out in the eighties, it’s come back, oh, well, I mean it never went away.

Speaker :
It

Nicky Keay:
Is there. And so it is definitely there and it is definitely a thing. But what’s the approach? Absolutely. If I pick up this in a woman, especially the younger woman where it isn’t perimenopause, then actually we’re going to address the balance of her lifestyles. So in number words, her nutrition is not sufficient for the amount of exercise she’s doing. And like you are saying, supplements look to all these things of sufficient rest, all that sort of thing. It takes resources, takes energy, the luteal phase, right? Because the progesterone’s got to raise the metabolic rate. So you haven’t got enough energy in the system anyway. Of course the body is going to simply adapt. It just responds to what you’re doing when you’re perimenopause. It is part of the physiological process that will sort of wind down a bit, but it’s essentially the same approach. You can support that. So yeah, I would argue quite strongly and I’ve got the evidence and Lyn Pryor I know will me up that it never went away is here. It is alive and kicking.

Lorne Brown:
I want to talk next about, so we know about, you listed the symptoms about when the orchestra is not in tune and where we’re seeing irregular bleeding, mood change swings, gut health, gut issues, urinary tract issues, and how this can all impact fertility. Now I want to talk about, so those that are in their thirties, so they can prevent their orchestra from having a bad performance and be able to reproduce in their early forties. And for those that are now 41, 42 that are still looking to grow their families or don’t want these symptoms or get these symptoms in the next couple of years, what is your approach? And I want us to talk, I’m assuming there’s some diet lifestyle. I will share that it seems like there’s been a rebrand around hormone replacement therapy, HRT now called menopause hormone therapy, MHT. And for transparency, our clinic does menopause hormone therapy. We offer bioidentical, estrogen and progesterone, but we do a lot of other things. I feel our clinic doesn’t give it right away. It’s not like here everybody take

Speaker :
Exactly,

Lorne Brown:
But I do see physicians, like soon as you’re in your forties you have any symptom, do the hormones. We tend to do diet supplements, other things first. But I’m curious, you wrote a book on this, the myth of menopause. What is your approach for women that are in perimenopause? So they’re in their forties, whether they’re experiencing symptoms or not. Can you talk about what they can be doing so their orchestra continues to perform well,

Nicky Keay:
I understand. I’m absolutely in agreement with you. And also here in the uk, the British Menopause Society makes quite clear that the first thing is absolutely the lifestyle approach. And I give you a reference, it sounds a very old reference, but it’s still valid today, 2000 years old, Hippocrates said if we could give every individual just the right amount of nourishment, just the right amount of exercise, not too little, not too much, we would’ve found the surest way to hell. So I’m referring back to him. He knew that these were the tools we have. I can now tell you updated, we know the mechanism. It’s the hormones because your hormones are impacted by what you do. Okay? So you can harness your hormones through these lifestyle choices to reach your optimal health and performance and it’s valid whatever your age. But to note, if your hormones themselves are changing like we’ve been describing just now, the female hormone oddity, perimenopause, then if they are changing, then of course you have to change your inputs. So it is a review refresh, an opportunity to review and refresh what you’re doing. So rather than looking negative, it’s like, oh gosh, I can’t train like I used to anymore. I can’t eat this and because it makes me put on weight or something. It’s like don’t look on it negatively. Say, well, okay, it’s like a spring clean
New resolution. Okay, my hormones are changing and my body’s sending me a message that it’s a time to look that second spring, let’s see what’s going on. Let’s do a review refresh. So absolutely, I’m a hundred percent in agreement with my first approach to a woman who sounds like she’s in perimenopause, IE from her symptoms. We don’t typically do blood tests because we’ve just described why there’d be a going up and down. So if you do the blood test, you might get it a high or a good one or a bad one. You can’t really say. But if the woman’s coming saying, look, I’m getting these symptoms, the vasomotor symptoms, poor sleep, irritability or whatever it is, as you quite rightly say, the tendency is to resort to polypharmacy. So we give a medication, an antidepressant for this, we’ll give an antibiotic for that. And the poor woman, you end up with a whole sack full of medications while the, let’s just look at the fundamental thing like Octi said, let’s accept and acknowledge the hormones are changing.
Let’s look at the inputs, what can we do? So the first thing that I always do, I’m totally in agreement, let’s review, let’s revise what you’re doing. Let’s look at your exercise. Maybe you are not doing enough, maybe you are doing too much. Maybe you’re not doing the right type of exercise. Let’s look and let’s look at the nutrition. Are you eating a varied diet and are you eating a regular fashion? All these very basic things. I would say that hypocrisy was talking about. That is the fundamental starting point. Get back if your hormones have retuned, you need to retune what you are doing to get it back in synchrony. And then once you’ve done that, that’s number one will feel really good because you feel empowered. You’ve done something yourself. Sure. At that point, if the woman says, look, I’ve done all these suggestions, but I’m still struggling with whatever it is, then okay, sure, then we will talk about HRT.
I still prefer the term HRT because, well, I don’t like the word replacement and it is true, but I like the, rather than menopause hormone therapy, the only problem is that some women who are not menopausal, we would recommend taking HRT. For example, the ones with premature ovarian insufficiently, they haven’t insufficiency, they haven’t yet reached menopause. So it’d be really unkind to tell 20 year olds, she’s got to take menopause hormone therapy when actually she’s not even menopausal. And the same for these women that have got this imbalance got reds, we might give HRT temporizing for bone protection and then definitely not menopausal. So it’ll be incorrect to say that. But anyway, that’s just semantics. So coming back to what your point is that absolutely, I think there is a place for HRT for women’s quality of life, but it’s only after you’ve addressed all the fundamental things, a choice of the lifestyle, then sure if you take hormone therapy without doing that revision first, it’s going to limit how much benefit you’re getting to get from that anyway. And also it’s giving the wrong impression that there’s a medication and it is the elixia youth or something like this, which it is not correct,

Lorne Brown:
But there is a place to use it. And we think about when you talk about Hippocrates Chinese medicine, that was 2000 years ago, three or 5,000 years ago. The whole idea was that first you change your diet and your lifestyle. And if that didn’t work, then we do herbs and acupuncture. Right,

Nicky Keay:
Exactly. Progression.

Lorne Brown:
So that’s how you do it. I’d like to go specific on diet because some of this stuff in reading your material, I’ve learned some new things and I’m really curious. So I’m thinking of some of my patients where they’re in their forties and their body’s changing. So what they’re doing is they’re working out even harder. But I’m hearing, well, your resources are limited, so maybe that’s not going to help. And they’re restricting carbohydrates. And there’s a few reis that are big into keto and we include carbs in our fertility diet. We like the complex carbs and we make sure we have a lot of protein as well. But I remember you introduced me to a term that I haven’t heard before, low energy availability. And I thought, can you just talk about diet and what is the research in your clinical experience with carbohydrates and exercise and how this can be impacting the cycle? So fertility wise and symptom wise,

Nicky Keay:
I think you mentioned complex carbohydrates. That is the main food source for doing quality exercise. I stress quality exercise and we said how important exercise is for body composition and for muscular strength for bone health. So you definitely want to be doing quality exercise, but you can only do that if you’re going to, I’ll give you another term fuel for the work required. So if you want to do a quality exercise session that’s going to have beneficial effects. You have to fuel it. I mean you wouldn’t get into your car and put your foot flat down on the floor and the tank saying empty, you’re going to burn out the engine, don’t you? So you wouldn’t do that. So why would you do that to your body? But I think it’s a fine balance because if you were to do that and you’re in low energy availability, that’s the term, you haven’t got sufficient energy in the system. Specifically carbohydrates, complex carbohydrates, quality carbohydrates, I suppose you could say female hormones really love complex carbohydrates.

Lorne Brown:
Say that again. There are people that want to get pregnant. There’s people that want to have good hormonal health. What’d you say that hormones like

Nicky Keay:
Complex carbohydrates,

Lorne Brown:
Right? To our listeners because a lot of them aren’t eating carbs. I just wanted our endocrinologist, our doctor just said, hormones benefit from carbohydrates, good carbohydrates,

Nicky Keay:
They love them. I mean, people say if you ask people, they’ll often say, oh, it’s fats. But it’s true. The steroid hormones of the ovaries are made of cholesterol, which comes from fats, but it’s like having a whole box of Lego pieces if you have a whole load of pieces, but you can’t put them together because there’s no one’s got the energy to put them together. So you need the energy to drive the system. You need someone to get that orchestra going. So that’s where the complex carbohydrates play a part. But I’m just to reiterate, I’m not saying I’m not advocating. You go out and eat like loads of chocolate cakes or whatever because we use the word complex carbohydrates. So these are ones that are in bread, pasta, these sorts of things. And so they take time to digest and break down. So you’ll feel full.
You’ll feel like actually, because if you do a chocolate cake, you’ll get a high quick in insulin and you’ll feel good. But then you actually, you might start feeling hungry again quite soon. So complex carbohydrates is what hormones love and they like it nicely, consistently. Please. There is a very good evidence from studies by Anna Mellon’s group in Denmark showing that even if a woman eats sufficient amount of energy, including carbs in total over the day, if you do a sort of a tally what was needed, what was expended, what was taken in, if the balance books are good, but this individual has not eaten any carbs in the morning or very few and very few at lunch and she’s put them all in the evening, then this increases course decreases estrogen. So this is not what you want to be doing for your fertility or your general health at all.
It’s kind of moderation. And the portion size and the timing, those are the crucial bits. It’s not excluding any particular, so group you mentioned increasing carbohydrate as we get older, very important to mitigate the tendency to lose muscle for sure. But you are going strengthen your muscles by doing exercise. And exercise needs to be fueled with complex carbs. So you see what I mean? They’re intrinsically linked and the timing of them a consistent intake over the day fueling to the work required is the term we use. And on a forward looking schedule. So when you sit down, you have your dinner in the evening that’s thinking about, oh, whatcha going to be doing the next day? I think lots of people do lots of stuff in the day and they’re frankly under fueled in low energy availability. They come to the end of the day, they have a big dinner, but now dinner, how can it possibly refuel you for all the stuff you’ve, all the expenditure, it can’t balance the books, can’t do that and be ready for the next day. It’s impossible. So take care of your energy requirements, tick it off as you go through the day, and then you can sit down and enjoy your dinner, which is going to be setting you up for the next day. So that’s another term you mentioned, low energy availability or low carbohydrate availability, which we definitely want to avoid for female hormone health. And also think about it fueling for the work required, what you are personally going to be doing and think about it in advance. Those are the my top tips.

Lorne Brown:
Great. And then let’s talk about some of the testing. So you don’t do a lot of testing and we don’t do a lot of looking at the hormone testing because they’re fluctuating. So much of you look at the symptoms, but we do look at other hormones when somebody’s coming in with perimenopausal symptoms. So we’ll do a full thyroid panel.

Nicky Keay:
Yes, I agree.

Lorne Brown:
We like to look at the lh and I love to do a little deep dive on this funny story, but not so funny. One of our patients in Canada, if we order the test, the blood test, they have to pay out of pocket. But if their GP medical doctor orders it, our British Columbia medical plan covers it. So we usually say your to order this

Speaker :
Good.

Lorne Brown:
So we asked them to do the day three hormone, so FS, H and LH and estradiol and prolactin. And we also asked for a 21 day progesterone test. We wanted to see ovulate and is it a nice progesterone? And their doctor came back, said progesterone’s not part of a fertility workup, which it’s actually on the BC government website medical. And in Canada, I don’t know what it’s like in the uk, but in Canada we can’t even get doctors. So you can’t leave your doctor and find another one. You’re lucky to get a doctor.

Speaker :
Oh no.

Lorne Brown:
So she had to pay for that test. But in Canada also in bc, they only will test the TSH here, unless they really see symptoms for it, they’ll do a T four. It’s pretty rare unless you’ve already been diagnosed with a thyroid issue and you’re on medication to even look at your T three. In our clinic, a thyroid test always includes TS, H, free T three, free T four and TPO, the thyroid

Nicky Keay:
Body antibodies.

Lorne Brown:
And when I was listening to getting ready for our interview, I got more aware about how important T three is for you to look at for this low energy availability. Can you talk about T three and lh, why you like to look at these and the progesterone tests then just again for our listeners so they can advocate to their doctors why they want this. And if you’re in BC or in Ontario and Canada, I will share that your naturopathic doctors can order all this. You just have to pay out of pocket. If your MD is not willing

Speaker :
And

Lorne Brown:
They’re not expensive compared to a lot of tests that are

Speaker :
Functional

Lorne Brown:
Medicine tests, they’re not free, but they’re definitely not crazy expensive like a gut microbiome test or a DNA test.

Nicky Keay:
Yeah, so the vice, well certainly what we do here in the UK is that if you are over 45 and you’re gutting symptoms very suggested for perimenopause, then that’s good enough to diagnose. You don’t have to do a blood test varying a lot. However, I do agree with you, if you are under 45 and you’re getting some symptoms of fatigue and things like this and weight change, then it could still be perimenopause. But we know that especially in women as we get older, we are more predisposed to developing autoimmune thyroid conditions and underactive thyroid. So I agree with you. If I’m not sure or I’m just wondering then absolutely a thyroid function and what sort of thyroid function. Unfortunately we have the same problem here in the UK that generally speaking the NHS will only do TSH generally. But this seems crazy because by the way, as you say, it’s very cheap and straightforward and it goes in the same, the analyze machine.
It’s not like someone’s got to pet it anymore. It is just like in the machine automated. And if you get TSH thyroid stimulating hormone, T four, thyroxin free, T four and free T three, it’s easy. And also the auto-antibody I think is if you can, but if they’re really making a fuss then it’s okay, but please do the T three. So the reason for doing a thyroid test, absolutely for women, we know we’re more prone to develop a thyroid problem which can masquerade as perimenopause, right? And then the T three story is interesting because that is a very good surrogate measure for the energy availability we’ve been talking about. So there can be a confusion. You see, the thing is perimenopause, it has lots of symptoms like we’ve discussed the Pandora’s box and the underlying reason could be the ovaries going part-time and retiring, but there could be other reasons. There could be low energy availability, ovulatory disturbance and all this

Lorne Brown:
And some of those symptoms. And again, this is me remembering from some of the material I’ve been reviewing. I think you said you can have your regular shortened cycles if you have that low energy availability.

Nicky Keay:
Yes, exactly.

Lorne Brown:
And fatigue, mood swings, heavy bleeding are signs of this, which is another reason why we like to look at the thyroid. And if you’re having all that heavy bleeding, we also like to look at your iron and ferritin levels.

Nicky Keay:
Exactly. You see this is a thing. These symptoms could be just, well, I say just perimenopause or it could be the low energy availability. There’s an overlap or it could be a thyroid problem per se. And by the way, a thyroid problem per se, you’re quite right. If you are typically got an overactive thyroid as it happens or underactive, underactive typically gives you heavier bleeding and overactive gives you less bleeding. So there are lots of factors. And so we wouldn’t want to say to a woman, oh, it’s whatever perimenopause when actually all along she’s under fueled or all along, she’s got a thorough problem per se. So I think there is an argument in certain situations where you would do those tests. Certainly if the woman’s under 45 and certainly if she is a master’s athlete or dancer, and I’m not sure, is this are her symptoms?
Like you say, there’s no overlap. Is this perimenopause, is this res or if there’s even a thyroid condition per se? And this is where the T three will come in very useful because we have published evidence information from the IOC consensus statement that T three is the really good surrogate indicator of energy availability. We could work out energy availability doing a diary estimating your resting metabolic rate, your energy expenditure. This is known to be fraught with problems and Ines, so guess what? Hormones come to the rescue. Yes, we do a C3 and we see where it is in the range. So I agree with you that this is an important test to have for you then absolutely it is worth frankly paying. And as you say, in the relative scheme of things, it’s not as expensive as some of the other fancy tests, which I would argue and think you’ll probably agree some of these other fancy tests actually they’re not worth the money. But this one definitely, definitely is.

Lorne Brown:
And I’ll share just with the audience. One is good luck getting that from your MD or T three test. So you may need to see a naturopath. It’s just even harder to get the TSH done. But my background before Chinese medicine, Nicky is a CPA chartered accountant, so auditor. So I like to dig and I will share that the women that come see me that are trying to conceive, they want to dig and look for any underlying causes. They don’t want to wait a year and say, oh, it’s been a year. You haven’t gotten pregnant. The I VF didn’t work. Now we’ll test this. They’re like,

Speaker :
Test

Lorne Brown:
Now before I do an IVF and the women that are coming in with hot flashes and their clothes are wet from sweating at night, they’re not sleeping. They want to kill everybody. They also say, yeah, that’s why I understand why they say, give me the menopause hormone therapy like
I’m not suffering. And also we will talk about the suffering part because I don’t think women should wait the 10 years for this to pass. They should get support right away so they can enjoy these next 10 years from 40 to 55 or 15 years. Exactly. But we like to test. And so you’re going to have to talk to your naturopathic doctor to get the T three and the tsh T four done. We’d like the TPO with the antibody. I can’t tell you, there is a huge big handful of women that I’ve seen where they were subclinical and their hormones came. The T three was good, the T four TSH, but they had the antibody and so

Nicky Keay:
Yeah, so you’d have to keep an eye on it. And again, that is absolute, that’s medical evidence. We know if you have got a positive antibodies, these TPO ones, it advised we have to keep an eye on it because obviously that’s giving you a little warning signs like the indicator warning signs, something’s awful. So then you would want to recheck and see, you might not want to give thyroxine at that point, but you want to be on the front foot.

Lorne Brown:
Well, here’s what I tell them. I never know if I’m going to see them again. They’ve come in and we have this and I say, here’s what I want to tell you. If things work out and you have a baby and you think you have severe postpartum depression and they want to put you on antidepressants before they do that, having them retest all your thyroid hormones. It could be the Hashimoto. It’s a thyroid acting up that it’s not antidepressants. You need thyroid support.

Nicky Keay:
That’s excellent advice. And what I would say as well, because if you do get pregnant, then what happens? Your body’s very clever. It dampens down your immune response because you don’t want to reject your baby, obviously. So if you have got lingering there, some antibodies ready to jump on the thyroid, then this is when it’s going to happen
Either during the pregnancy or afterwards. So absolutely, that’s a really important point to make that, listen, I’m all for hormone testing, by the way. Let’s get the facts and the figures and the numbers. But on the other hand, we don’t want to just rely on that. It must be in the clinical context with the individual. I think we’re going to agree on that. That’s kind of obvious. But getting as much information as you can and being proactive as you say, let’s find out before you run into trouble. Let’s try and find out what’s going on beforehand. That’s obviously a much better approach.

Lorne Brown:
With the interviews I’ve been doing lately, I really feel I can retire soon because when I start, because of I call them, you’re like, doctor 2.0, the way you said that. You don’t have to test everything but test the hormones. You’re talking about diet and lifestyle. You said, look at the clinical though. Don’t just look at the test. In 2000, when I was practicing, most of the medical establishment physicians, MDs were very big on the blood test, and you could be cold and fatigue and miscarrying, but they’re like, your bloods are normal
Or have severe symptoms, but your bloods are normal, right? You’ll pass in 10 years. And the need I filled in opening up ACU balance was to create that integration because they weren’t getting the holistic approach of here’s how you change your diet. Here’s some exercise, here’s certain supplements, herbs, acupuncture to support the body while they’re doing the drug or hormone replacement, and here’s some tests that we’ll check to monitor you. But hearing you, your medical doctor, an endocrinologist, all the docs I’ve been talking to, they’re doing, you got the medical understanding, you’re able to test, you’re able to use drugs and surgery and hormones, and you’re now counseling about supplements. You’re counseling about diet, you’re counseling about lifestyle, and you’re using the labs, but you’re also listening to the person in front of you for their symptoms. That’s

Nicky Keay:
The key thing.

Lorne Brown:
So that’s why I can retire.

Nicky Keay:
Well, listen. Well, yeah. But the problem is, yeah, I’m in England anyway,

Lorne Brown:
But there’s so many physicians like you, is what I’m saying. 25 years ago in 2000 when I started, this was rare, but this is good. I’m excited that the time has arrived where I’m seeing medicine has changed and that physicians are practicing with that holistic approach. I think it’s amazing. It’s fantastic.

Nicky Keay:
Well, listen, but the thing is, why did I become a doctor in first place? Yeah, I am a scientist. I want to know the facts and figures, but I am dealing with people. I want to listen to them. I want to hear what they’re feeling. And that otherwise, their scientist just looks at the facts and figures. And to me, that’s a little bit boring. You have to put it in the context of the individual. But going back to the blood test thing, the other thing I often hear, Lorne, is that a woman say in her thirties whose periods have stopped because she’s not fueling, she’s got reds and she’s had a blood test, it’s like, oh, well, at least you’ve got a blood test. And she’s told, oh, there’s nothing wrong with you because all the, they’re in rain, the F-S-H-L-H in a range, it’s like, hold on a minute. But in the clinical context that your amenorrheic can’t say there’s nothing wrong. But the thing in wrong, in this case, not in the medical sense, I suppose you could say, but actually it’s because you’ve got Hippocrates.

Speaker :
You’ve

Nicky Keay:
Got the imbalance in your lifestyle. So I think that absolutely, having the test and the information is really important often to exclude things, right? Exclude a medical thing. And that really empowers the individual then I say to the woman, the good news is you haven’t got a medical condition. And the further bit of good news is you can do something about this yourself.

Lorne Brown:
You have a lifestyle condition.

Nicky Keay:
Yeah, yeah, exactly. Can take control of this and make a difference. And so of course medicines, I think it’s great. We have got the possibility of medicines and surgery, but these are kind of in various stages that might help. But you’ve got to get the fundamentals right. And then we can talk about other things.

Lorne Brown:
So we’re going to move from testing and diet and go to, I want to talk about exercise for a moment. I do want to do a shout out for the diet where we have good fats, proteins, carbs, and it’s written with me and my colleague, Dr. Kali MacIsaac, naturopathic physician. We have a fertility diet and a longevity diet for free. They’re actually the same diet with recipes, just different covers. It’s the same principles

Nicky Keay:
Works. The fundamentals are the same, the fundamentals are the

Lorne Brown:
Same, but works for fertility, will work for perimenopausal longevity and basically it’s anti-inflammatory, low-glycemic index diet, mostly plant-based, but you can have animal protein as well. So that’s available at ACU balance. For those that want to know more about the diet, we talked about the carbs,
But if you really want to have recipes and see more about the Ethereum principles, download that for free. I just want to review some of the testing that we do. And there’s lots of testing, but some of the basic testing as an auditor, as again the people I see look for the underlying cause. I don’t want to try a bunch of things. Can we just test some? So we like to do the day three tests of fsh, lh. We didn’t talk about lh, but LH is another thing we can look at with the ratio of FSH to look at the

Nicky Keay:
Energy. PCS maybe. Yeah.

Lorne Brown:
Yep. Prolactin we look at and we do it, we like to do a vitamin D test and a thyroid panel and we like the T three now even more so because you said it can highlight an indicator of energy sufficiency or insufficiency,

Speaker :
Which is

Lorne Brown:
Important for fertility and hormonal health. So thank you for that. And then a day 21 progesterone test, which doesn’t have to be day 21. Basically a week after you think you’ve ovulate is when we like to see if you have your peak progesterone there. Do you have a level that you like to see for what you consider that’s a strong progesterone level when you do a peak? I’m just curious. You had a number, you

Nicky Keay:
Might. Yeah, typically in the UK we say if it’s like fertility, then it’s probably you’ve got funny units over there

Lorne Brown:
Per I’m Canadian. We use the same.

Nicky Keay:
Oh yeah. Oh great. Right, right. Good, good. 13 animal per is the standard thing. But just to stress that peak thing, Lorne, I think we need to say it is typically called the day 21, but that’s assuming, that’s assuming it’s 28 day cycle. By the way, the average is 29, so it’s not going to work anyway. But just to highlight your very important point there, or you are aiming for the peak, which will be roughly seven days after you’ve ovulated. You can get an LH urine strip to see when you’ve got the LH surge, you can do that, right. And all you count back seven days from when you’re predicting your next menstrual cycle will be. So you’re trying to give yourself the best possible opportunity to get that peak level because the hormones do fluctuate a lot. Right. But fortunately we published study relatively recently showing that the main variation determining the length of menstrual cycle and the follicular phase. So once you’ve done that ovulation, it’s like the strike of midnight on the clock. It’s like, well that’s your really time point. And then you try and pick up the peak level there. So typically in fertility, for fertility purposes we say 13 nano moles per liter. But there’s also debate saying, well maybe you did ovulate blocks.

Lorne Brown:
It’s not accurate because you don know when somebody ov.

Nicky Keay:
No, we don’t know. We might not be exactly because you might not. I’ve got the peak.

Lorne Brown:
What level to confirm ovulation do you like? If you see a five at 10 or a 15 pico moles per liter, which one are you saying you’ve ovulated? Do you have a number?

Nicky Keay:
Well, for the progesterone in mol per liter, it’s 13 MLEs per liter. We can absolutely or greater, we can be pretty

Lorne Brown:
Convinced. You’re saying 30

Nicky Keay:
13

Lorne Brown:
Per

Nicky Keay:
Liter.

Lorne Brown:
I think here I think 15 is considered. You definitely ovulated, but that’s not like a robust ovulation.

Nicky Keay:
Well exactly that. Exactly what I’m trying to say. So if you’ve got 15 or 20, we can probably say, well that’s good because usually the progesterone during most of the cycle, you’d be lucky if it’s one in the follicular phase. So definitely it’s moved. So you probably, but if you are focusing specifically on fertility and is that enough? Is this enough gestation hormone, then we make it a little bit of a higher bound, certainly in fertility circles. But you’re certainly in a good reasonable, if you’ve got 15 or 20, you’re in the right ballpark. But this is where the ovulation thermometer might be helpful, you see, because that will indicate if it’s been sustained over that length of time. You’ll have to ask Lyn about that.

Lorne Brown:
Yes. So now we’re going to talk a little bit about lifestyle in particular exercise and the reason lifestyle, again, in Chinese medicine, your movement, your nutrition, your sleep, your emotional state affects your health. So we would say hormonal health, they didn’t know hormones existed. 5,000,

Nicky Keay:
No, exactly. Like hypo. Exactly, yeah.

Lorne Brown:
But they definitely knew it affected how your expression of health for the body. So that’s why I want to talk exercise. And interesting enough, in our practice because of Chinese medicine influence, we look at menstrual cycle as a health indicator. So if you have a lot of PMS or pain or clots or not ovulating or that tells us there’s something that needs to be supported, do you subscribe to that just as a tangent?

Nicky Keay:
Oh yeah, yeah.

Lorne Brown:
This

Nicky Keay:
Is so lovely. All the things you are saying. It’s like I talk about being the barometer of health, right? The menstrual cycle, as you say, it’s a fifth vital sign and it’s really good indicator if your hormones are, you can’t sort of see them in, maybe you can’t easily measure them in any way. They’re quite labile. But actually if you’re experiencing a good menstrual cycle, if I can put it like that, then as you say, that’s a really good indicator, barometer. And also menstruation. It’s a free monthly medical check, so it means you’re on the right tracks.

Lorne Brown:
Well that’s why I like treating women over men because they have a menstrual cycle. So I love it. And it’s a game, right? Yeah. Good

Nicky Keay:
Indicator. Yeah, exactly. Yay.

Lorne Brown:
And also they show up for treatment where men don’t, well yeah, that’s a problem. They’re easier to treat for that reason too. They just don’t. They don health professionals. Okay, exercise. I want to talk about this on two levels. One is because women start to ask a lot more about exercise, not because of I think some of the research about how exercise can affect your menstrual health, but because so many have done IVF, the ones I see, and they’re always told they can’t exercise. Now that reason for not exercise is because their ovaries are enlarged and there’s risk toward the ligaments. But I want to talk about because of your work as a dancer and working with athletes is how does exercise impact the hormones and menstrual health? Because we were talking about energy availability. So is exercise a good great thing to do or can exercise impact women having regular cycles and their fertility?

Nicky Keay:
Well, it really depends. The question is how much, and the question is the balance of your exercise with your nutrition. So in general terms exercise, absolutely it can actually help with the menstrual cycle. It’s good research showing if you do probably more gentle exercise. It’s true during menstruation when you might have some cramps. Gentle Pilates, swimming, I always use to find helpful. We know that can be helpful. And also if you’ve got PMS, then doing some exercise can also help. So we know that exercise is definitely beneficial for your menstrual cycle health for sure. But with everything, it’s how much So you can overdo it if you are doing a lot of intense exercise node rest days and you’re not fueling sufficiently, that’s the key thing. That’s when now we tip into low energy availability and that starts to have an adverse effect on the menstrual cycle.
So I’ve got a little diagram and I have little dials, I have exercise, nutrition and sleep. And you’re aiming for the green zone in each of those three categories all at the same time. It’s tricky. It’s not as easy as it sounds. But if you are doing, for example, a lot of exercise but too little, it’s reading low in the nutrition thing, then that’s not going to be a good outcome for your hormone. So exercise in general, of course is one of those key things. Chinese medicine, we know that for sure, no doubt about it. Mental physical health, hormone health, absolutely. But it’s a case of the balance, not too much, not too little, just like hip said and in balance with your nutrition. So I think that’s really the key thing. And generally, apart from particular situations, like when there’s been ovulation induction and the ovaries are literally swelled up, but generally, and even during pregnancy, women are encouraged to keep active and everything.
In fact, it’s quite funny. In my dance class, they remember when I was pregnant and I was doing ballet class, which is a long time ago, by the way, my boys have grown up. So it’s a case of doing what the exercise is that you are used to. Being pregnant is not a time start doing skydiving or something, for example, or marathon running or something if you’ve never done that before. So I think exercise in general is absolutely super important or hormone health, menstrual health, but just be aware, you’ve got to get the right balance for you in combination with the nutrition and the sleep.

Lorne Brown:
And in our clinic, the clinical side of it, if somebody cycles all of a sudden are shortening or getting a lot lighter, we would wonder whether they’re not fueling enough compared to the amount of exercise they’re

Nicky Keay:
Doing. Exactly. Exactly.

Lorne Brown:
And I love this, rather than saying cut back on the exercise, maybe we got to just improve the fueling. They really love the exercise.

Nicky Keay:
Yeah, yeah, yeah, exactly.

Lorne Brown:
And now we can look at T three then as well just to see what T three looks like that will

Nicky Keay:
Tell you exactly. They would do exactly. Because if they’ve got the shorten cycle could be the subclinical ovulatory cycle that lyn’s going to tell you all about, right? And the progesterone a bit low. So yeah, it could be that they’re under fueling. So let’s see what the T three is and also the timing of that complex carbs. There is a tendency on all fasted training, blah, blah, blah, blah or this sort of thing. But actually, like we’ve discussed, female hormones love complex carbs. So again, it’s not just how much are you eating, but when are you eating it? It’s the timing fueling for the work required. Are you in a consistent way fueling for that exercise? And if you are doing exercise before work, then please have something to eat before you do it. Even if it’s a banana or something, something. Have something in the tank to do the exercise, as I said, you wouldn’t drive your car, you wouldn’t drive your car with it on empty, would you?
In the morning? You wouldn’t do that to Carl. Why would you do that to your body? It’s crazy. And I know people will say, oh, but I’m in a rush in the morning. I haven’t got time. Yeah, I know that there is a time factor, but as a youngster, I used to get up every single day of the week. I used to do competitive swimming. We had to be poolside at six o’clock every single day. Every single day. I got up at five 15. So I would have time to eat my banana, my small portion cereal and do there so you can make time. And as I said, it doesn’t have to be big, but something in the tank just as you would for your car before you’re doing the exercise in the morning and then refueling afterwards. So it’s just looking at the amount, but also the timing is really crucial.

Lorne Brown:
And then I think will be the last question, but I’m going back to somebody that’s 42 and we’re seeing some perimenopausal symptoms and they’re also wanting still to conceive, the symptoms are, they’re not ovulating all the time. So they’re having non observatory cycles, they’re having a lot of forgetfulness and brain fog and body pain. They’re concerned about doing menopause hormone therapy is like, well interfer, I won’t be able to get pregnant if I was still trying. I’m just wondering if you used this with women trying to conceive, and I’ll share with you my understanding so you can critique it or edit it, is we’re not doing birth control pill hormone therapy where we’re going to prevent ovulation. They would get the body identical estrogen and we’d be monitoring them and then we would give them some progesterone to support that second half. But not necessarily. It may not necessarily at a level that would prevent ovulation, but we do want to balance the body and help get that rhythm back. And I’m just curious if you’ve had any experience using MHT, menopause hormone therapy. That’s what they’re calling now. So I’m using that

Speaker :
Term,

Lorne Brown:
That’s the term with women that are still looking to grow their families.

Nicky Keay:
Yes, you’re absolutely right. And that’s a really important point to make. That distinction between M-H-T-H-R-T and the birth control pill or as we say here, oral contraceptive pill.
So the point, the clues in the name oral contraceptive pill, it’s against contraception. So the type of hormones in there are synthetic, they’re not the same as your own body. They’re not molecularly identical. And the intention is to suppress ovulation, make all your hormones flat line and so you don’t get pregnant. But this is totally different to HRT. Sorry. Well, MHA everyone knows what with it. This, especially if you choose wisely, like you said, do you take the body identical or molecular identical form of the estrogen typically through the skin gel or patch? I personally prefer the gel is you can titrate the dose more easily and the micronized progesterone, that’s the same as your own body, then you’re not going to interfere with your own production. You’re just going to help it. So you’re going to boost it. And so if it does come round to the, you do need ovulation induction for example, then actually your body will already be in a better way to receive that and respond to it.
So that’s a really important distinction. And by the way of extra evidence for this is that in the women, young women with a premature ovarian insufficiency, so this is where the Aries A, they’re kind of like in the perimenopause state, I suppose. Well literally they are. They’re just hanging on by thread to literally sort of thing, not working that well. We would absolutely advise you that they take HRT, especially if they want to think about fertility treatment, everything, because it keeps the hormones at a decent level. So I agree with your approach that if we’re talking about, I think she was a 42, your woman, you had as an example, who is experiencing perimenopausal type symptoms. Of course all the lifestyle we’ve discussed, but absolutely they shouldn’t be scared. In fact, I would agree with you and say it would be helpful to take HRT at that low dose and don’t worry, it’s totally different. Don’t the contraceptive

Lorne Brown:
Pill, they’re suffering. She wants to grow her family and so she’s willing to suffer, but I think they don’t need to suffer. They can still optimize the fertility and it will

Nicky Keay:
Help. Exactly.

Lorne Brown:
Reduce

Nicky Keay:
Cover both reduce those

Lorne Brown:
Symptoms. Yeah.
So that’s why I want to hear from you and you talk about talk, the POI, premature variance efficiency. I was working with a woman in her mid thirties that had stopped ovulating, been about eight or nine months. And we again, just like you, we don’t always go to MHT right away, but for her, she was with an REI. So that was, we couldn’t touch that anyhow because they were running that part. And we did the acupuncture and low level laser herbs and really worked on the diet and a lot on mental health and motions because hence the Conscious Fertility podcast. It’s a big part of what we do in our practice. And her cycles came back on and she conceived and had a daughter. It was really

Nicky Keay:
Neat. Wow, that’s fantastic.

Lorne Brown:
And when you talk about A MHT, to me it’s not like it’s just about giving the body the supporting needs. It could be acupuncture, it could be diet, it could be talking to a counselor, it could be hormone therapy. You’re just supporting the body when the body, when the orchestra has the conductor doing the right thing, again, things happen. And so I’m not attached to, it has to be this way or that way. It’s just,

Nicky Keay:
It’s a combination.

Lorne Brown:
Combination. You have the body what it needs and you’ll be amazed what will happen to it. And so there’s many ways to support it.

Nicky Keay:
And can I just pick up on that, the mental health aspect, really important. We were talking about the conductor of the endocrine orchestra of the pituitary gland, which is located deep in the brain by the way. It’s deep in the brain. So where the brain is processing. So literally it’s processing. I want to come back to that point you made about literally how you sink and how you respond to the environment. It’s your choice to a certain extent. You could be sitting in a traffic jam and you can respond in one of two ways. You can get really cross and angry and cursing and swearing, or you just say, look, it is what it is. I’ll get there eventually. And it’s your choice how to respond to external stuff. And your body will appreciate that because if you’re flustering the conductor, right?

Lorne Brown:
So you can’t control being in traffic, but you definitely can control how you choose to respond to

Nicky Keay:
That. Exactly. It’s the

Lorne Brown:
Response you, your said than done, which you shared tools how to do it because you got to rewire the brain. We have our lenses, how we see the world. For my listeners, go check some of the previous episodes

Speaker :
We

Lorne Brown:
Go into detail. But again, why I think I can retire very soon, Nicky, is the fact that you’re talking about how your thoughts and feelings impact your hormonal health. And the fact that you just said, if you can just reframe what’s happening will change. I’ll have an impact on your body is I am so close to retiring, I got to find something else to do. I always like to find a need, but I feel like if physicians are saying this now my work is done, I can move to another thing. Listen,

Nicky Keay:
Not all of us, not all of us, I’m absolutely loving this as well. We are so much in sync. But by the way, it’s called the neuroendocrine axis for a reason, neuroendocrine

Speaker :
Because

Nicky Keay:
Even one level above the conductor is the hypothalamus. That’s the neuroendocrine gatekeeper
Taking in all this information from inside and outside. But then it’s literally you have a choice how you respond. Because when people say, oh, I’m stressed. No, an emotion is not a thing. You say, I notice I am feeling stressed. So you’re sitting in the traffic jam and you think saying, well, I could feel stressed or I could, but it’s like your choice to respond. I agree with you. It’s very difficult to do that, but that’s your challenge. Right? And also there’s research showing that if you are stressed about your eating patterns, I’ll just quickly say this, fascinating. I was supervising a fantastic PhD student in Slovenia of all places anyway, and she found, she did a study. And even if thinking, getting anxious about eating like anxious, I shouldn’t eat that carbohydrate. I shouldn’t. Oh, I’m worried about my body and my shape, whatever. This actually has an effect on your hormones. Of course it does because of the neuroendocrine gatekeeper, because you’re processing this information, you are making the choice to feel anxious and stressed about I shouldn’t do this. And so I said, this is the main finding of your PHD. This is amazing. And it actually has done another study showing that the T three is lower, just thinking about it, being anxious about it. So it’s absolutely incredible. The power of the mind. There we go.

Lorne Brown:
Yeah, the power of the mind. And so in my practice, I used to be really body focused.

Speaker :
And

Lorne Brown:
Because I’m trained as a clinical hypnotherapist as well,

Speaker :
I

Lorne Brown:
Like to change the programs and beliefs because your behaviors, your actions are always congruent with your programs. So rather than going in and working on the behaviors, if we go work on the programs high level there trickles down, like you said, the hypothalamus level, right? It trickles

Nicky Keay:
Down. Go right up there. Yeah. Oh gosh. We could talk all night. This is,

Lorne Brown:
We can talk forever. We’re going to wrap.

Nicky Keay:
We can both retire.

Lorne Brown:
I want to tell my listeners then go back to start with episode one. And I also encourage you to check out on Dr. Nicky Kay’s books. She has Hormones, health and human Potential, and then her latest book, miss of Menopause, I Guide to Increasing Your Menopause Wisdom. And you can find out more about Nicky. We’ll put it in the show notes, but her website that I have here is Nicky k fitness.com. That’s

Nicky Keay:
It. Are

Lorne Brown:
You on Instagram as well? Can they find you there anywhere else?

Nicky Keay:
Yeah, I’m that for social media. It’s at Nicky k, spelled N-I-C-K-Y-K-E-Y. Yep.

Lorne Brown:
And she spells it N-I-C-K-Y, everybody.

Nicky Keay:
Yep,

Lorne Brown:
Exactly. NEAY. But again, it’s in the show notes, Nicky k fitness.com. Nicky, thank you so much for taking the time to chat with me. I’m so glad that Lara introduced us and we have a lot of people in common with Dr. Lyn Pryor. And thank you for writing your books. I can’t wait to get my hands on the miss of menopause. I’m really looking forward to it.

Nicky Keay:
Thank you so much. You’ve been absolutely, well, so lovely speaking to you, discussing so many shared areas of interest. And yeah, we could speak all night, but I think that we should wrap it up. So thank

Lorne Brown:
You very much. It’s for you in the uk, and I got to get my day started with patients here in Canada. I’ll talk to you later.

Nicky Keay:
Okay, cheers.

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