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 back Dr. Nicky Keay to the Conscious Fertility Podcast. Now, if you haven’t already listened to her original episode with me, episode 91 is called The Female Hormone Odyssey, perimenopause, fertility and Beyond. And again, that’s episode 91. Check that out. Nicky, I had such a good time with you. I thought we should continue the conversation.

Nicky Keay 

Yep, absolutely. No, thanks for having me back. I’m looking forward to it.

Lorne Brown 

So I want to let our listeners know who you are because some of them may be hearing this for the first time and they’ll go listen to episode 91 after. And I’m going to do a very short recap because we’re not going to go over everything we went in episode one that was close to an hour. They can go listen to that, but I’ll give them a two minute recap. But first I’d like to just formally introduce our guest today, Dr. Nicky Keay. She is a medical doctor, specialized in an exercise endocrinology with expertise in hormone health or optimization for athletes, dancers and individuals experiencing perimenopause and menopause. She integrates her clinical experience and medical research and endocrinology exercise in sport medicine to offer personalized approaches to hormone health. Dr. Keay studied medicine at Cambridge University, became a member of the Royal College of Physicians and contributed to developing an anti-doping test for growth hormones. She holds an honorary clinical lecture position at the University College of London where she researches the impacts of lifestyle, nutrition and exercise on hormone networks. And she’s the author of Hormones, Health and Human Potential and Editor of Miss Menopause, as well as a regular keynote speaker at international conferences and on podcasts like the Conscious Fertility Podcast. So welcome Dr. Nicky.

Nicky Keay 

Thank you.

Lorne Brown 

So this is what we talked about last time just for our listeners. We talked about just how you use this idea of the female hormone odyssey and that there’s an orchestra and you compared the hormonal orchestra with the pituitary gland acting as the conductor. And sometimes we can get fluctuating symptoms or hormones in that perimenopause period, kind of resembling an orchestra that gets out of tune. As I mentioned to everybody, that’s episode 91. I want to start with what the listeners have been asking me when I told them you’re coming back on as a guest, they wanted to know about perimenopause and menopause and unwanted weight gain. So I want us to talk a lot about that today because in the last episode and your experience with exercise and how it affects hormones. But first maybe we should back up. Can you define or tell us what is perimenopause and menopause? I think they’re being used interchangeably, but they are different.

Nicky Keay 

Absolutely. Yeah. So menopause is the full stop of a sentence, whereas perimenopause is sort of like a comma if you know what I mean. So menopause is the full stop. It’s the point in time when the ovaries are retired. So going back to that female hormone odyssey, just to remind everyone, obviously as a child, as a girl, you’re not having periods. The ovaries are asleep if you will, and then the conductor of the endocrine orchestra gets going, many keys. That’s when the ovaries wake up. You start experiencing periods, the menstrual cycles, and this continues up until the ovaries retire at menopause. And now your ovarian hormones, the estrogen progesterone go back down to almost childlike levels, very low. So that’s what the definition of menopause is. It translates to pause or stop of the menses the period. So it means the time from which you have no further periods, but it’s not an on/off switch.

That’s really the key thing. It’s not that one day the ovaries are working and then the next day that’s it. They sort of perimenopause. I describe it as the time when the overs are going, there will be some cycles when everything is fine, the orchestra is playing nicely, everything. And then the next cycle it’s a little bit out of tune. As you say, the ovaries are a little bit more reluctant. And so this is the perimenopause by definition is the time of uncertainty and fluctuation. And that makes it a really challenging time because you wonder even if you’re imagining it, it’s like what’s going on here? And it’s so variable. So that’s really the definition. The perimenopause is the winding down in a slightly erratic way, if I can put it like that of the ovaries. And menopause is the definite full stop when the Aries are sort of stopped. And in that sense, once you’ve reached that point when the Aries officially and definitely retired, it kind of makes it a little bit easier to know where you are in terms of your hormones. So hopefully that clarifies it. So they’re very similar sounding terms, obviously perimenopause, menopause, but you’re absolutely right that it’s important to distinguish because they are characterized by different hormone signatures, if you will.

Lorne Brown 

And in menopause, the western medical definition is one year after your ovaries have retired, one year after you no longer menstruate.

So for those women, they can kind of understand some of these vasomotor symptoms like night sweats, hot flashes, disturbed sleep, mood, weight gain because they see their cycle for the women. And I think, I don’t know what the medical definition is today. I think it used to be above 45. clinically in my practice it’s 40 and above and you can see even before 40, but definitely 40 and above for them it can be challenging. Like you said, they think they’re going crazy because they’re still menstruating, but they’re having some really unwanted symptoms.

Nicky Keay 

Yeah, I think that’s just a few points you’ve made there to clarify. So menopause, it’s a bit weird. It’s what we say, a retrospective diagnosis. So say the average age of menopause is 51, but you could only be certain you’ve reached menopause. When you look back and say, oh, that’s a whole year now I haven’t had any periods. So now you’re 52, you reflect back and say, oh yes, it’s exactly a year ago when I was 51 when I had my last period. So only then can you sort of absolutely say that’s menopause. And so officially during that time, that’s sort of you’re in the waiting room as it were for that year, you’re on tender hooks because you’re still officially in perimenopause because you don’t know you might get another period, which goes back to this crucial thing about it being this time of uncertainty.

So that was the first point about menopause, strictly speaking as a retrospective diagnosis. And then when does, so perimenopause only finishes when you’ve looked back and said no periods during that year and you go backwards and when does perimenopause itself start? So when do the ovaries start going? And as you say, that’s a very variable feast as it were. I mean the age of menopause, average age is 51 with the range being from 45 to 55. So that’s menopause. And they say that perimenopause can start any time, maybe up to six years before menopause, but you don’t know. You can’t foresee when your menopause will be in the future. So I agree with you, I tend to think of it more like 40. So from the time of 40, maybe you’re going to have menopause at 45 or 46. So therefore you will start experiencing ovaries going to part-time hormone fluxes from the age of 40.

On the other hand, if you are destined to have a later menopause at 55, you might not start noticing symptoms of perimenopause until, what’s that doing the math there? 49. You see what I mean? So we can’t say there is a generic time for starting perimenopause because unless we can see in a crystal ball and know when menopause is, we don’t really know. But I tend to agree with you, and I’ve seen even some women younger in their late thirties who have the odd cycle, which is a bit, I’m not sure about that one. That wasn’t quite what we expected, so it could even start before that. But generally I agree with you, I think sort of roundabout 40, you’re going to have a high index of suspicion if the woman’s coming and saying her cycles have changed, typically they become shorter initially, maybe heavier, maybe like you say, not feeling so good, the occasional caught flush, call them over here or whatever. So things can start kicking off in those early forties. So this is why perimenopause is such a tricky one because it’s so, so variable.

Lorne Brown 

And that’s what I want to talk about though is how to help women in that transitional period of their life. And right now it seems that there are celebrities and celebrity doctors are really pushing hormone replacement therapy, particularly estrogen hormone therapy. As you’re sharing in that perimenopause, let’s say 40 and above, there’s a huge fluctuation of estrogen. And then when you’re menopause, there is a definite decline yesterday because you’re no longer ovulating and your progesterone is done as well because you’re no longer ovulating. But in the perimenopause phase, you are having a decline in progesterone just not as much as menopause because your ovulating may be less or the quality of that follicle that releases the egg isn’t as youthful or has that quality like it did in the earlier years, therefore, your progesterone output is not low.

So there’s the declining progesterone, but the perimenopause from our last discussion and from your colleague Dr. Jerilyn Prior shot out to her, she’s episode 89, and again, as I mentioned Dr. Nicky here is episode 91, she says that estrogen is not necessarily declining in perimenopause. It’s fluctuating and it can go really high. And it’s my understanding from the western paradigm because we have a whole Chinese medicine paradigm on this as well, that we’ll geek out about that a lot of these symptoms of sleep disturbance, heavy bleeding in irregular cycles and weight gain is related to estrogen fluctuating. So I’m curious, your approach is estrogen therapy kind of the solution because it is being pushed a lot right now, and we’re recording this in the spring of 2025, it’s being pushed a lot, but if you’re already having some high fluctuating levels of estrogen, I’m curious your approach, and then we’re going to go into things outside of hormone therapy, but I just wanted to ask you about that fluctuating period in those forties.

Nicky Keay 

Well, listen, I’m a colleague and a great mara and friend indeed Jerilyn Prior. So professor progesterone as I call her anyway, I mean yes, just the problem is this. I think that estrogen everyone has, well, most people have heard of estrogen, but progesterone has always sort of played second fiddle and not been talked about so much. But you’re absolutely right. If we look at the nitty gritty of this, the physiology of these hormone fluxes, the first thing to sort of falter is exactly as you say, it is actually the production of progesterone because as you say, you might not ovulate at all, so therefore you’re not going to get a core for lutetium. So you’re not going to get, even get progesterone off the starting block or as you say, the follicle maybe isn’t quite up to what it used to be when it was first made.

And so the progesterone production will be lower. And this often explains the initial indication of perimenopause with the menstrual cycle length actually shortening because of lower levels of product of progesterone. But as you say, in contrast, estrogen is having a whale of time. If not only is it staying at a decent level, it might even go up quite high. So as you say, it’s sort of ruling the roost and what’s the effect of estrogen? It thickens the endometrium. This often is why women in perimenopause can not only get short cycles but very heavy bleeding periods because there isn’t that opposing effect of progesterone. And by the way, it’s very interesting, and I probably no doubt Professor Pryor mentioned this in her piece, that this is exactly the mirror image of what happens to women teenagers when their periods first start. So when their periods first start, there isn’t quite that coordination.

It isn’t quite that slick. The conductor of the pituitary gland hasn’t quite got its act together. So often when teenagers start their periods, guess what? Teenagers often complain of very heavy, painful periods not feeling so good. Why is that? Because estrogen is ruling the roost and progesterone is a little bit not so great yet, and then things settle down. So if we reflect what the teenagers experience, what the perimenopausal women experience, it’s actually kind of similar because of the underlying similarity in the physiology. So we definitely need to be talking more about progesterone. So now if we say, okay, so early perimenopause it’s the progesterone that’s going low, the estrogen is fine, maybe even high, then does it make any sense to give more estrogen? No, and indeed, officially HRT or MHT, whatever we want to call it, I prefer HRT because sometimes we do use hormone replacement therapy in women who have not for menopause actually in young women whose ovaries are insufficient and suffering premature ovarian insufficiency or in athletes I work with or dancers where their menstrual cycles are stopped under fueling, their bones are suffering.

So anyway, H-R-T-M-H-T, whatever you can call it, it’s only officially licensed actually for menopause, not perimenopause. So we’ve got quite a lot of problems here with doling out HRT and indeed, certainly you should never give estrogen alone anyway for any woman who’s got a uterus because that would be really dangerous. It’s going to thicken that endometrium and potentially increase the risk of endometrial cancer. So we all want to do that anyway. So I think we have to be very aware of what’s going on and make appropriate choices. So I think that my approach is if a woman comes to me and she’s in perimenopause, she’s really struggling with really challenging symptoms that are impacting her quality of life, the hot flushes, the poor sleep, all this sort of thing, I would love to do what Jerilyn did in her great study in Canada, which is to give micronized progesterone first line because that will definitely help sleep in the hot flushes and everything.

Although sometimes it can be a bit tricky because it’s so traditional to give both of them together, the estrogen and the progesterone. So I get round that by giving the lowest possible, just a smidgen of estrogen just to smooth it out really. And then frankly there’s the micronized progesterone that’s going to have the benefit there. And so it is something that I would suggest to a woman struggling during perimenopause, but with that proviso, we make the estrogen as low as possible just to smooth things out. But definitely ideally the micronized progesterone is really going to help. And sure once she’s then gone through and now is menopausal and the estrogen definitely is low, then we can maybe slightly increase the dose of estrogen. So that’s my approach and hopefully, well, I know that will reinforce what Jerilyn has discussed with you about the importance of progesterone. There are two hormones from the ovaries, not just one

Lorne Brown

For it is very similar to our clinic who also follows the research of Dr. Jerilyn Prior does the bioidentical progesterone and for sure in those women who are still cycling in their forties and then low dose estrogen. That study as you mentioned, because we’ve got to give a shout out because I’m a local Canadian, that’s a Canadian study. And when I was in contact with Dr Prior just recently, it’s evidence-based research showing that progesterone, so these oral progesterone, micronized progesterone effectively treats perimenopausal night sweats and sleep problems. So that’s data coming out of Canada. That’s not just anecdotal, that’s publishing.

Nicky Keay 

No, no, it is hard fact 2023 and it’s a lovely hormone. It truly does. Speaking from experience, you take the last thing at night, that’s really important. It will make you feel a little bit dozy. Well, which is good. So don’t take it in the morning is number one. And it really does do the trick because it helps with sleep and also because it’s helping also with hot flushes, then you’re not going to have disturbed sleep because of the hot flushes as well. So it’s a really brilliant hormone. And the micronized progesterone you mentioned, just to emphasize that, is molecularly identical to what you produce yourself. So this is totally different to the synthetic types of progestogen or progestins, whatever you want to call them. This is the real stuff, if I can put it like that.

Lorne Brown 

Well now let’s talk about some of the symptoms. And as we shared in this perimenopausal phase, there’s changing in cycles. So you can have lots of cycles in a month versus every 28 days you can get very heavy bleeding. And then the common questions we had were about unwanted weight gain and sleep issues. So firstly, what’s causing the unwanted weight gain and sleep issues? What is hormonal, what’s happening in the orchestra that you’ve talked about in the past that can lead to this? And feel free to touch on because people are getting aches and pains, people are having brain fog. So what is going on that all of a sudden it feels like you’ve gone crazy?

Nicky Keay 

Well, yeah, exactly. Well quite, what can I say? I describe these symptoms as, it’s like Pandora’s box, there is a lot, but fundamentally what is happening is the hormones are in a state of flux. And so the body is confused, if I can put it like that. 75% of women, the most common symptom are those vasomotor symptoms, the hot flushes. And that’s because the temperature control system located centrally in the brain noun really narrows what we call its thermo neutral zone. So if you just go a little bit outside of what it absolutely wants your body temperature to be, it effectively gets in a panic and starts causing you to have sweating and your vasal dilation. So you get hot and sweaty as though you are in a sauna, even though you’re not. But the body kind of thinks you are. And this is really interesting because these hot flushes, obviously they’re really annoying because if they happen during the day, inevitably during a podcast or an important meeting or something, it’s like, oh, not now anyway, but it is totally you can’t control.

And the other thing is if they occur when you’re trying to sleep, this is going to disturb your sleep. So that adds compounds to the problem with the sleep patterns, which are also disrupted because of the change in the estrogen and the progesterone balance, if I can put it that way. But the really interesting thing you mentioned brain fog, it’s thought that these hot flushes are linked maybe to problems with brain fog or cognitive impairment, whatever you want to call it, because during a hot flush, all the blood goes to the skin. That’s why you get hot and sweaty. But actually during that time there’s a restricted blood flow to the brain. So that’s why you don’t feel so good. And also by the way, it’s just horrible because this affects your mood. You have anxiety and things like this. That’s all that piece of it, if I can put it that way.

But coming round to other symptoms, the body composition changes and weight gain, that’s a really tricky one. Why is this happening because of these hormone fluxes and also not only women, we have it a bit tough. Not only are we having these big changes in the ovarian hormones, but also something we share with men because by the way, men get old as well in both men and women, an important anabolic hormone called growth hormone decreases. By the way, growth hormone isn’t just about children growing. We also produce some as adults, and this hormone is very important for maintaining a favorable body composition IE muscle mass versus deposition of fat, especially visceral fat around the organs. That’s not healthy. Growth hormone is really important for that. But as you’re getting older for a woman, you’ve got the fluxes of the female hormones, which in turn potentially influence your sensitivity to insulin.

Insulin. I think everyone has heard of insulin resistance. So we got that going on with the female hormones. And we’ve also got the backdrop of the growth hormone decreasing, which also tends to favor the deposition of fat over muscle. So this is this combination, the storm of all these hormones changing during this time. That is why you can notice, yeah, the scales, there’s a bigger number on the scales now. And also that you notice especially around the mid with things are a bit tighter around the waist area because that’s where the visceral fat will be deposited. So these are things that you might start to notice, but we’re going to come onto it, no doubt what to do about it. But also other things, just to mention typical symptoms, I think you mentioned aches and pains, so really kind of like random aches and pains, not necessarily related to an injury, but you think, oh, have I injured something?

But actually it just happened because the estrogen is going up and down. What else can you experience? Actually digestive issues because estrogen is very important for the estrobolome, the microbiome specifically dealing with recycling of estrogen. So you can get digestive issues, things like this, urinary tract issues needing to go into the toilet more and vaginal dryness. Those tend to happen a little bit further away as you’re going into menopause, official menopause. But still these are all things combined. What else are the headaches? Because maybe the cerebral blood flow, like I mentioned, is being disrupted, sometimes palpitations or them, I would always preface that by saying if you are having palpitations, you definitely need to make sure it’s not your heart or it’s just a temporary effect of the hormones changing. So there is a whole myriad of symptoms, potential symptoms, but I think this is why it’s also really a challenging and confusing time for women because you literally wonder from one day to the next, you think you are falling apart all these various symptoms or there will be some women who don’t seem to get so many and some who seem to get a lot and some women feel that they have to qualify to say, oh, I’ve got perimenopause to have this full house.

So just to emphasize, you don’t have to have a full house of all these symptoms I’ve mentioned and it will be individual and personal to you of which ones are more troublesome than others. So that’s why it’s really tough.

Lorne Brown 

And now I want to talk about our approach. You would think that okay, I am gaining weight here, I don’t want this weight gain. Logically you say, I’m just going to have to exercise more and eat less. But in our last episode you talked about, I got introduced to a term by you, low energy availability, LE, and you shared how undereating, especially restricting carbohydrates, negatively impacts hormone production and we’re looking to balance that hormone production.

And you also shared your work with athletes, you are a dancer yourself. So can you share what’s going on and explain because there’s women that are saying, okay, I’m eating less and better and I’m exercising more and I’m still not losing weight. So what’s going on? And then how do you address that then now I kind of want to know your approach. Oh, quick tangent. Chinese medicine paradigm, this fluctuating estrogen, we call it kind of a liver cheese stagnation, a liver mechanism, nothing to do with the western liver. And so if people have had a lot of PMS and really difficult painful PMS periods, that’s a mechanism in the liver cheese system and we would expect that they would probably have a more challenging transition into menopause. And we have herbal formula, acupuncture approach to help regulate cycles and also help relieve those symptoms in perimenopause. So that fluctuating thing is observed in the western medicine and can be measured. Chinese medicine kind of has an understanding of what’s happening to these systems where one becomes deficient like you say in menopause. But before when that system is retiring, if the system that regulates it isn’t healthy, then it’s chaotic, which is why some women

Have bad perimenopause and some sail right through it. So that was my quick tenure, I forgot to mention that, but

Nicky Keay

No, well actually let’s just quickly go on that before we get into the lifestyle approach. So that’s really interesting that the PMS symptoms can often get worse in perimenopause because like you say, the hormones are a little bit out of sync, by the way, remembering back to the teenagers,

Often that’s the case. So that all sort of fits with them being out of whack. So that’s another sort of thing to put on the list that you might notice. But some women, and we’ve mentioned this just now, some women might experience pretty bad perimenopausal symptoms and others still some but not quite so bad. So why is that? What’s the difference between these women? You are right. I really love that point that there is actually, well, I was going to say an official study, but a western study, if you see what I mean, based, which talks about this triad. So if you are a woman that during your, before you reach perimenopause, you have experienced PMS, maybe you’ve suffered with postnatal blues or postnatal depression even. It means this is indicating, I’m afraid that you might be in for a rough ride when it comes to perimenopause because it just indicates that you personal system, you’re very sensitive, your biological response to these hormones and as you say crucially, the changes in these hormones.

So it’s really interesting what you say about the Chinese. Of course you are onto it already anyway, so that’s the PMS story and the sensitivity to your own hormones. So going back to the sort of the lifestyle factors and there you are, and by the way, I’ve been there, done it. So I totally understand how people feel. You’re in your forties, you are suspicious that you are maybe going through menopause because of some of the things we’ve the worst PMS, shorter cycles, whatever. There may be a little bit of the hot flushes with some things like this. And you’ve noticed this annoying chain shift on the scale and shift in your trousers are tighter and things like this and you really don’t like it. So your reflex reaction quite understandably might be, oh, so I should eat less and move more and burn up excess energy and then that will help.

And then you get really frustrated and upset because you do that purposefully and it doesn’t work. Or worse case scenario, it even makes things worse. So what the heck’s going on? And so this is because like you say, you could fall into the trap of ending up in low energy availability. So absolutely you probably need to be more mindful. So let’s focus on nutrition. So what do we need to do there or consider there? So absolutely you should of course be mindful that you’re not eating surplus because that’s not going to be healthy for your hormones. But equally if you under eat, then that’s also going to have a negative effect on your struggling hormones, which actually needs some help. So my top tip in terms of nutrition is please don’t do anything crazy. No crash diets, no skipping meals, no, I lose track of the latest things.

Is it intermittent, fasted? I dunno. All these things, it’s like look, just keep it really simple. I suggest sticking to your three regular meals a day. Please do break your fast in the morning with breakfast and please do increase your protein, the portion size of your protein intake. So that’s what you do. So you keep everything, it’s all about keeping the fundamentals there in place, but changing the proportion so you have your three regular meals, increasing the protein, the portion size of protein at each because you need to give those sort of slightly flagging anabolic hormones helping hand, but also the carbohydrates don’t complex carbohydrates. I’m talking about cereals, bread, pasta, rice, all those things which people often associate with all putting on weight. You do still need some of those, but the portion size I do, that will vary. If for example, today I did a swim, so for my breakfast I had a really good portion of cereal before I did that, but on a day when maybe I’m not going to be exercising in the morning, maybe it’s going to be slightly less cereal, but it’ll still be the same amount of milk, still be the same amount of protein.

You see what I mean? So you can be flexible with your carbohydrate, but never I’ve nice seen it time and time again like you described and I totally understand it and I totally appreciate the intention behind it to restrict what you’re eating, to restrict the carbs and now you’re going to try and exercise and you haven’t got enough energy, you’re not going to do effective exercise, so you’re not going to get even the benefit from the exercise you are doing because you haven’t got the energy to get the benefits from it. So that’s the nutrition piece. But as I mentioned here it is in combination with the exercise piece. So again, the tendency, I’ve got to do lots of cardiovascular exercise to burn these excess calories and people go on the treadmill or long runs or all this sort of thing. Absolutely, you should of course still do some cardiovascular exercise, but just as with the nutrition, you are shifting your focus to the protein with the exercise, you’re shifting your focus to the strength work.

Okay, so why strength work is brilliant is the most effective anabolic stimulus there is because when you do strength work, you’re engaging all the muscles in your body generally, and muscles really suck up the energy, so that’s great. They’re going to use them up. And also by doing the exercise fueled appropriately, you’re going to get the benefits. Now the muscles are going to increase hypertrophy of these muscles. So now you’ve already improved your body composition by doing this, encouraging muscle over fat. And also the muscles are very metabolically active. So now your metabolic rate is raised not only while you’re doing the exercise but also for some time afterwards. So that I suggest is that the approach that people don’t chuck out all the things, they have those fundamentals at their disposal of the nutrition, the exercise and the sleep, the recovery, but it’s just within each of those you’ve got to just change it, the proportions or the emphasis just as your hormones are changing, you have to respect that the hormones are changing and you have to change what you do to give them the support they’re looking for.

Lorne Brown 

Thank you for that. And so what other things that you like to do? So we got weight training, you talked about diet and then do you use progesterone therapy for these women in their perimenopause phase? And do you have supplements because they love that. People love to know. Are there a few supplements you recommend I can take that can help regulate my blood sugars or help with my hormonal balance? Or maybe it’s so individualized you don’t have something to suggest, but I’m curious if you have a few of your faves.

Nicky Keay 

Yeah, sure. Well definitely my approach is always all these lifestyle things we discussed and then on top of that, sure then we are maybe going to discuss HRT if that’s all sort of dealt with the emphasis on the progesterone element of course. But in terms of supplements, I mean it will depend, but my go-to which is absolutely for everybody by the way of any age is vitamin D because although I commented before we started or got some sunshine in the uk, which is a rare event, I can tell you nevertheless the source of vitamin D, the main sources, the action of sunlight on your skin and certainly in the uk, even if you wander around naked or winter, you’re not going to get enough sun on your skin to produce vitamin D. So you absolutely have to supplement at the bare minimum over the winter months. I mean personally I take it throughout the year. So that and why is vitamin D, why vitamin D wellbeing, but also for bone health, muscle recovery and immunity. And it sought to work in synergy with the sex steroid hormones, so the estrodiol and the progesterone. So vitamins I think are an absolute go-to must. Other things I think can be helpful. There is some evidence now coming out about creatine for muscles and brain function.

So that’s a possibility if you are a vegetarian, B12, vitamin B12 is a must go-to other things that have been mentioned or I find sometimes useful magnesium, I use magnesium spray, I try to not load the gut too much. The thing I find so many women or people in general, they come with a whole shopping bag of supplements and it’s like number one, how much did that cost? And number two, is it actually doing you any good? And it’s really confusing and lots of them are oral, so it’s a lot of load for the gut. So when it comes to magnesium, I think the spray version, it’s well absorbed through the skin and it can also help sleep. I spray it on my calf muscles before I go to sleep, have my little routine, take my progesterone, spray my calf wash muscles with magnesium, we could even get it infused with lavender and apparently it’s meant to help. So I think that it would, it’s not an essential one, but I think it would be a recommendation. And then depending on your darts, Omega-3 maybe, I mean person, I eat quite a lot of oily fish, so that’s another one. I mean there’s lots of other, so many we could go on and make a whole list of other things.

Lorne Brown 

Vitamin D, got it. Love that. Creatine. Interesting. That’s what my teenage boys used to take to bulk up.

Nicky Keay 

Yes, exactly. Exactly.

Lorne Brown 

B12, you mentioned vegetarians, so I want to go back to that in a minute. Magnesium is also another staple. The adrenals love it. As you said, sleep calm, that anxiety for aches and pains, it is just one of those staples. I often like myo-inositol as well as the blood sugar regulation. Do you like that one as well?

Nicky Keay

Yes. So I think if the person really does have a problem with blood sugar, exactly, that one is very helpful and you don’t need a prescription. And it’s a lot frankly, milder than something like metformin, which is hell for the gut. Although sometimes you do have to use it if the person is officially a type two diabetic. But yeah, my nool, I think it wouldn’t be like the top one. You’d work your way through all the others, but then if there was a particular individual, actually I was concerned about blood sugar regulation despite doing all the lifestyle things with the exercise, the nutrition and everything that we’ve discussed, then sure, I think that’s got evidence that that is helpful. Yes.

Lorne Brown 

And again, talk to your doctor, your Chinese medicine doctor, your naturopathic doctor to get a supplement dosage and write for you. What about, you talked about the diet and increasing your protein.

Nicky Keay 

Yes.

Lorne Brown 

But then you said complex carbs, be careful of the simple carbs. What about vegetarians? Because protein, there are vegetarian proteins, but protein’s easy for somebody who is not a vegetarian to eat beef, for example. But how do you help or can you advise vegetarians? Because a lot of vegetarians are eating a lot of carbs that are not what you would call your carbs as well.

Nicky Keay

Yes. Well they will be eating. I mean it depends. Lots of those ones are, although we say, oh, they’ve got vegetables, got complex carbs in fact they’re not very digestible. Lots of ’em have fiber in. So it’s not so much the carb load I’m worried about it is the mean facts. Facts. It is harder and more challenging, although not totally impossible to increase your protein intake using vegetable sources. But it really depends. You have to be really mindful of it and target and make sure you are hitting it. And if you can eat fish for example, some vegetarians are okay to eat a bit of fish or eggs or other things to get that protein because otherwise it’s just quite a challenge in terms of volume. So it’s possible

Lorne Brown

Sometimes in our practice, my focus in my early years of my practice has been reproductive health fertility, and we do so much around perimenopause and menopause and I’m often asked, how can you do both, right? Well, and I’m like from a Chinese medicine perspective, it’s the same. We’re balancing hormones, we’re improving ovarian health. Yeah, same principles,

Nicky Keay

Same principles,

Lorne Brown 

Same principles. One wants to have a baby, but they both have irregular bleeding, disturbed sleep, night sweats. Point one is happy when the symptoms are gone and the other one’s only happy when they have the baby. But the treatment is very similar or the same. So with women that are vegetarian that we see in Chinese medicine, suede deficiency, a blood deficiency, it’s not quite what we’d call anemia in the west, but often we’ll check in if they can eat meat and treat it like a medicinal for a short period of time, can we treat it like

Nicky Keay

Medicinal?

Lorne Brown 

And if not, then we find other ways. And then in Chinese medicine, gynecology, so irregular cycles or cycle issues, fertility and the perimenopausal symptoms that people experience, herbal is a big part of it. And I mentioned that liver system, again, not your western liver, liver, it’s just how it translates into English. It’s responsible for the shift from follicular to auditor and it’s also responsible for the shift from luteal to the next period. And so that’s in a micro cycle and then in the macro cycle from its the shift into puberty helps and then into menopause. So that’s why

Nicky Keay 

Yeah, that covers those two ends. Yeah,

Lorne Brown 

So that’s why the acupuncture herbal approach is something that I will invite our listeners to check out locally. If your acupuncturist also does herbal medicine, it’s something that may help you during this time of transition, whether you’re trying to conceive or not or whether you’re experiencing these things.

Nicky Keay

Yeah, absolutely.

Lorne Brown 

And then we talked about supplements and we talked about diet and we talked about exercise and you talked about progesterone, bioidentical progesterone.

Nicky Keay 

I would actually like to ask you a question. Being a medical doctor, I’m very familiar with the lifestyle with HRT, with some specific supplements like we mentioned, the vitamin D, et cetera. From my reading and understanding, I think there are probably some herbal supplements that can be beneficial for the individual woman. I just want to ask you about your experience, what do you find works? What doesn’t work?

Lorne Brown 

Yeah. Well, there’s a modern formula called for my colleagues, Ang, which is menopause high blood pressure syndrome is what it’s mainly used for. And there’s multiple formulas. So there is no, hey, what’s an herbal formula for night sweats or perimenopause? Chinese medicine is always individualized in taking the individual and finding their disharmony and treating that because both could have the same, you could have the same symptom, both could have hot flashes, but their underlying imbalance is very different. So it’ll get treated differently. For example, both have hot flashes, but one’s hot when they’re not having hot flashes. One’s cold, one has constipation, one has diarrhea, one is thin, thin, thin. The other one’s overweight. One has really dry skin and brittle nails, one has strong nails and glowing skin, one sleeps like a baby, one has insomnia. So you start to see, they would not get the same formula for hot flashes.

And then there could be people that have very different symptoms, but their pattern, their underlying imbalance is the same. It’s just based on their makeup that it shows up differently on their body. So one could have urinary incontinence, one could have insomnia, so a different person could have brain fog and they all have different symptoms, but their patterns are the same. So the formula would be very similar. So you’d get a key formula and then you’d modify it. Now myself in my practice and people that are seeing a lot of women and treat women for fertility or in the perimenopause, menopause, you kind of have your five formulas that you kind of know you’re going to go to and then you would modify it a bit based on the individual. And what I see most common is what we call the liver, liver heart syndrome in Chinese medicine, those organ systems which are off. And so that’s how we address it in myself. Anecdotally, clinically, the way I address it is somebody’s coming in and experiencing symptoms in their perimenopause or menopause. I’m usually seeing them for acupuncture twice a week for about four weeks.

At the same time they start their herbal formula, the goal is the acupuncture to give them some symptom relief while their herbs are doing their thing. And then within that four weeks I’m expecting a change in symptoms and then the acupuncture dosage can come back. They still have the herbal medicine they’re doing and then they’re doing well. And then I reduce the acupuncture more. Maybe they’re coming in twice a month for acupuncture still on the herbal formula. And then eventually they’re doing the acupuncture once a month and they’re on the herbal formula. And I would expect somebody to be on that formula for about six months and then we see how they’re doing and then we could start to pull back the formula bit and then they may go on and off it as needed. And so that would be my approach. And people like why or how acupuncture work. There’s a whole Chinese medicine thinking, but the western paradigm, it’s releasing, helping you release endorphins, it helps regulate the hypothalamus pituitary ovarian axis.

So you’re talking about the orchestra that lost the conductor. So if we’re able to bring some balance back, usually the symptoms will shift. It helps with that autonomic nervous system to get you out of sympathetic and to parasympathetic. We didn’t really talk about it today, but stress aggravates all your symptoms of diseases and symptoms of hormonal imbalances and acupuncture helps with blood flow, it helps with regulating inflammation, helps with mitochondrial on a cellular level. And I think really if you’re addressing the autonomic nervous system, if it’s having a nervous system reset, if you’re able to really go from high beta brainwaves to overwhelm to alpha detached relaxation or some sympathetic and to parasympathetic, the body can heal. And so anything, so that’s acupuncture. Look, if you do breathing and visualization and put your, it’s not like anybody has an acupuncture deficiency, just like for patients that are depressed, they don’t have a Prozac deficiency,

Nicky Keay

Not quite

Lorne Brown

Right. So there’s many ways to engage the body’s innate healing and that’s what the acupuncture is doing, which is why if it is able to create the rebalance and your body regains its harmony, when you stop the acupuncture, the symptoms are not supposed to come back because the body is now maintaining homeostasis. We’re not overriding the body, we’re supporting the body to regain its homeostasis. And then when it does, you’re supposed to be able to pull back the acupuncture herbs.

Nicky Keay 

This is really interesting because now I’m translating this to my Western medical thinking medical approach that of course women, of course you’re going to have different symptoms even if your hormone pattern is the same because you’ve got different individual biological responses to your hormones. You can have two women that have exactly the same level of progesterone, one will say, I feel dreadful, I’ve got PMS. And the other one will say, I feel fine. So that explains, we are individuals by the way, not clones, and we have our own biological response. And the other really important point you make there I think, is that there is this interaction with the conductor and the external world or more precisely how you process information. So the example I give is you can be sitting in a traffic jam and you almost have a choice how you respond to that. You can feel really stressed, get really annoyed, activate that fight or flight thing and get the cortisol up and work yourself into a real lava. Or you can say, look, this is really annoying. It’s out of my control. I’m just going to accept it. I’m going to shut my eyes, I’m going to meditate, I’m going to listen to music. Well actually maybe don’t meditate while you’re trying to drive the car. But anyway, you know what I mean. It’s your choice how you respond to these things.

And we know that this has an effect on how the hormone system works. This is why cognitive behavioral therapy, CBT works for some women with FHA functional hypothalamic amenorrhea, you can’t, you’ve done everything. I’ve done everything with them, the nutrition, the exercise, I’m feeling pretty, they’re doing everything. They’ve ticked all the boxes yet why their period has not started. And this is where acupuncture or CBT or something that is more like you say just rejigging or whatever at that cerebral level, almost that’s crucial. And by the way, it’s no coincidence that the conductor of the endocrine orchestra of the pituitary clan and the hypothalamus above it is located deep in your brain just where the optic nerves cross over. So it’s the seat of processing all the information from the outside and how you interpret that and then directing the appropriate response. So I think we’ve come full circle here.

Lorne Brown 

And it was interesting how you said the hypothalamus, you said the optic nerves, they’re crossed over.

Nicky Keay

Yeah, they’re crossing over there and it’s just literally there. 

Lorne Brown 

So it can, and look what we’re

Nicky Keay 

Perfectly positioned.

Lorne Brown 

And so when you change, because I use this wording so it fits perfectly for this. I say you experience the world through the lenses of your subconscious programming, and if you want to have a different experience of reality, then you change the lens of your lens. So you change your programs and then now you’re going to perceive that same reality differently because the reality you experience is different than somebody else, even though you’re both looking at the same reality based on the lens of your subconscious.

Nicky Keay

And also this affects this, what we’re talking about, how you perceive it or how you interpret or process. This also directly affects the hormone production incredibly.

Nicky Keay 

There’s been a study by Mary DeSouza, I think she’s in America anyway, and she found that going back to the reds thing, the relative energy deficiency in sport, she found that, and also I found this in another study of a PhD I student I was supervising anyway, just the cognitive, the anxiety of feeling I should restrict what I eat, even if you didn’t follow through and restrict what you’re eating, even if you’re just thinking about it, the anxiety of it, that actually decreases the T three, which is an indicator of energy availability. So there we go. We have definitely come, as I say, full circle, full circle, not only how you process it, but how you process that information or interpret that actually we have proof directly can affect some of those hormone systems and not just the neurological system. So there we go.

Lorne Brown

As we wrap up, because you’re also involved in the myths of menopause, is there anything you kind of want to share with our listener, just certain myths that you have seen over the years, hence you’re involved in the book that can help these women advocate for themselves when they see their health provider and just also give them some comfort that they’re not crazy?

Nicky Keay 

Yeah. Well first of all, I think one of the main myths that we’ve already discussed, and Lyn of course wrote the chapter on that, is that estrogen is the key hormone and that’s the one that drops first. So we’ve sort of covered that progesterone story, but the main myth is really to reinforce what we’ve discussed just now that lots of people or lots of women, it is a really confusing time. So number one, you’re not going crazy and it’s very individual. So that’s sort of the first thing. You know your body best, so don’t question it. If you feel that something is off and something’s going on and you are of that age, you are probably right because it’s so variable. It’s not helpful to do blood tests because people like certainty. I think this is the problem, this is the main myth. Everybody wants certainty, but perimenopause by definition is uncertain.

So doing a blood test won’t necessarily help because you might catch the hormones in a good cycle or a bad cycle, but it doesn’t really inform you what’s going to happen next. And so that’s the first myth. I’m afraid you have to kind of go with it. But the most important thing is also like we discussed, that you do have agency, you do have control of the situation, and also it’s not an illness, it’s not a disease, it is a natural physiological event, albeit challenging the female whole mono odyssey. This is a challenging time, but women I know are up for this challenge. So take control, recognize it for what it is, take control of the situation, look to those lifestyles and those supplements that we’ve discussed. You can definitely make big improvements on that. And then yes, I think you should at least consider and have that discussion about HRT because you can’t really predict whether, because I have lots of, some women say, oh, I’m never going to touch that stuff.

Or some say, oh yeah, absolutely, I’m going to take it. So it is very polarized. The view in my book, I describe it Scylla and Charybdis, the two portrayed as two equally evil things. Somehow you have to navigate. There’s one camp saying definitely take HRT straight away and the other say, no, no, no, don’t take it at all. But I think you’ve got to make that informed decision for yourself. Having made all the lifestyle changes we’ve discussed, if you are still struggling, it is for quality of life, that’s what it is, then absolutely. I think it’s totally reasonable to at least try and also be discerning in your choice of HRT. Like you said, the molecular identical type of HRT is definitely the best one. So typically that is estrogen through the skin. I prefer the gel because it’s more flexible in its dose and that bypasses the liver.

So we don’t have any problems inducing enzymes and whatever. And then the micronized progesterone we’ve mentioned as per gern prior, that’s really the best combination. But the guiding principle is always start low because the problem is sometimes, like you mentioned at the very beginning, women are prescribed or ask for very high dose of estrogen and the micro progesterone, but actually that could even make it worse, like you’ve said, because it’s not really a problem with estrogen, frankly, initially. So that’s the other thing to bear in mind, make sure you’re asking for the good stuff and that you are asking for the lowest possible dose of estrogen and then the progesterone is the really good one. And then also be aware that it will take time to have an effect. I have lovely women who take the HRT and then they send me an email a few days later.

I don’t feel any different. It does take time for the hormones to smooth them out. So it will take time and you might have to change the dose in the future. So that’s the other myth that there is only one type of HRT. You have to take the max dose. This is the dose, it’s fixed. That’s not the case. And also, how long should you take HRT for? It’s like how long is a bit of a string? There is no absolute deadline. It used to be said, oh, you take it for five years and then you stop. But the British Menopause Society says that there is no arbitrary limit to how long you take it. So those are some things. And then the other thing, which is always an awkward point of discussion, that vaginal symptoms or the genital urinary system of the menopause, those symptoms can be awkward to discuss, but we will vaginal dryness, urinary tract issues, wanting to go to the lure a lot that’s easily reversible or helps with vaginal estrogen.

And this is just absorbed locally, so you can take it in addition or standalone to the systemic HRT we’ve been discussing. And there’s a chapter in the book written by my colleague, it’s provocative. I think the title is something like No Sex After Menopause. So don’t worry, that’s not the case. And she puts you right on that. I think those are the main ones, and I think that the main point is lots of women feel like, oh, that’s the end of my enjoyable life. It is like a really bad thing to happen, but I think a more positive outlook and saying it’s just part of this female hormone odyssey, and actually it gives you an opportunity to maybe explore things that you haven’t had time to or didn’t think about before, and you want to make the most women because of the increased life expectancy, we might be lucky enough to expect to spend a third of our life in menopause. So it’s not just, oh, I think again, encouraging women to make the most out of all of their life, including this bit, there are definitely some positives to it, and it’s a good opportunity to refresh and revise what you’re doing to get the most out of your life.

Lorne Brown 

I always enjoy our conversations. I want to refer to where people can find you and let them know that again, we have a podcast, episode 91 with Dr. Nicky Keay, and that is titled The Female Hormone Odyssey. So I invite you to listen to that episode 89 with Dr. Jerilynn Prior decoding hormone balance, the power progesterone. We mentioned her, and we have a few other Peter writes on here, and Larry Bride and others that have talked about menopause and perimenopause to check out. And then Nicky’s on, she’s got a website, she’s on Facebook. We’ll put that in the show notes, but it’s Nickykeayfitness.com. And on Instagram is Dr. Nicky Keay. It’s on Facebook, Nicky Keay Fitness, and she has, again, you can go to her website, Nickykeayfitness.com to find her books as well. So that’s all in the show notes. Dr. Nicky, I really enjoyed our conversation again today. Thank you so much for making the time to discuss what’s happening to a lot of these women over 40, and that there’s hope and solutions so they can have, as you said, the later third of their life. They can be better than the first two

Nicky Keay 

Things. Yeah, exactly. Exactly. Yeah. Thank you so much for inviting me to discuss. Always a great conversation. So thank you so much.

Lorne Brown 

Thank you. Just a wrap up. I really enjoyed my conversation with Dr. Nicky. I hope you enjoyed it as well. And I mentioned a few resources that I’ll repeat on the Acubalance.ca website. There are lots of blogs on menopause and mar perimenopause, so information for you there. We have a longevity diet, which is an anti-inflammatory, low glycemic index diet, which would be excellent for those wanting to balance their hormones. And then check out other episodes on the Conscious Fertility Podcast. We have several related to the perimenopause and menopause topic, so hopefully you’ll find that of interest. And then conscious work part, I see people besides fertility that want to work on, they’re in their healer, I guess, and there’s lots of information on the Acubalance website regarding that. If you’re curious to know more about how to rewire or change outdated subconscious beliefs or limiting beliefs that are no longer serving you,

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 Acubalance Fertility Diet and Dr. Brown’s video for mastering manifestation and clearing subconscious blocks. Go to acubalance.ca. That’s acubalance.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, Lornebrown.com and Acubalance.ca. Until the next episode, stay curious and for a few moments, bring your awareness to your heart center and breathe.