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Misdiagnoses and Menopause: Advocating for Proper Treatment | Jenn Salib Huber

Jenn Salib Huber is a Registered Dietitian and Naturopathic Doctor and has a wealth of experience in perimenopause and menopause. She also runs an online program called The Thinking Woman's Guide to Perimenopause and Menopause, and it's a self study program that's open to women in any stage of perimenopause and menopause. And I'm, I've been hearing such great reviews about this program. So definitely check it out. 

What we Discuss

  • At what age do women's hormones change?

  • How do hormones change during perimenopause and menopause?

  • Why doctors may misdiagnose women in perimenopause and menopause and how that impacts the treatments you do receive

  • Treatment considerations for common perimenopause and menopause symptoms, including important information about melatonin dosing and time to take melatonin


Jenn Salib Huber  01:55

Something that became really apparent to me is that the hormonal soup that we're swimming in between 35 and 55 is very unique, so the first half of our reproductive life is pretty stable. You go through puberty, you have 20 years where you're churning out an egg every month or two. As a result of that, you had a pretty predictable hormonal soup.  You can certainly still have some shifts over the course of the month. Women can experience PMS, they might have bits and pieces that might feel a little ugly, but in general, it's predictable. 

Once you hit perimenopause, which is somewhere between 35 and 45, for most women, it becomes a totally different soup. All of a sudden, what was known and what was familiar and what you could live with and work with and manage becomes very different. And so women started coming in at 35, 36, and 37 with anxiety that they'd never had before or all of a sudden were having really heavy, painful long periods, or were noticing body changes that they couldn't explain. The research tells us that most women are misdiagnosed or not diagnosed as being perimenopausal. They're misdiagnosed with depression, with anxiety with insomnia with all of the labels that we try and treat without actually looking at the root cause.

Once I started to notice that in my practice, I became really driven to wanting to help women understand what's happening, because it is normal. It does happen to all of us - different experiences - but I really wanted to work to support women through this natural normal process and help them to feel empowered on the other side.

Georgie Kovacs  03:33
So let's talk about what is perimenopause. 

Jenn Salib Huber  03:37

So let's start with menopause because it's easier to actually start from there and work around that. Menopause is actually one day.  You are considered in menopause when you have not had a period for 12 months. Everything before that is perimenopause. And everything after that is post menopause. It's not a linear path. 

What I tend to see happen, and what the research tells us, is that there are three stages to perimenopause. 

  1. There's very early perimenopause, which is most likely to be women, often late 30s, early 40s, they might start to experience a missed period or a shorter period, or they might start to have a night or two of night sweats or hot flashes the day before their period. Maybe they're experiencing mid cycle, sleep waking that's new to them. And maybe it's not enough that they can piece all the pieces together. So they might go years without ever connecting the dots or having the dots connected for them that this is related to their hormones. They're looking at all of the other reasons. So very early, perimenopause is difficult sometimes to stage unless you're working with somebody who knows what to help you look for. 

  2. Early perimenopause is probably what's been more recognized over the last few years. This is when we're regularly starting to have some period changes.  You're not missing them from month to month, but they're also not the same from month to month. You might have a short one, a long one, a heavy one, a light one. It's  defined by that unpredictability.

  3. Late, perimenopause is when you're not having regular periods on a regular basis. So you're regularly going 2, 3, 4 months without having a period. 

Typically, it's the cycle patterns and the period symptoms that help us to stage people, which helps us to figure out what hormones are in play at that various stages.

Georgie Kovacs  05:20
What role does someone like you play in when someone comes in to work with you? Tell us what happens. And then I'd like to get to what happens when you're going to an allopathic or more traditional type of doctor. I'd love to do that comparison.

Jenn Salib Huber  05:36

In general, when people go to see an integrative practitioner, someone like a naturopathic doctor, who looks at the whole person, from a holistic perspective, the first thing that we do is to try and figure out what's going on. Sometimes, that means looking for things other than hormones, right? So oftentimes, women will come in and say, “I know it's my hormones.  Can you help me feel better?”  Over the course of talking to them and getting their history and learning about them, it's like, well, it actually might not be your hormone. 

The first thing is to really work with somebody who can look at your symptoms through the lens of perimenopause, but also has the experience and the knowledge to look for other things. That could be important too. Sometimes, people will get great advice from a friend or a neighbor or sister, but it's not the right advice for them, because maybe it wasn't the hormones. 

We start with a really good history of what's happening now, but also what your reproductive history was. 

  • So did you have PCOS? 

  • Did you have endometriosis? 

  • Did you have difficulty getting pregnant? 

  • Was there any that did you have irregular cycles? 

  • Was there anything in your history that can help us to maybe figure out what's going on or to figure out if this is actually perimenopause, or maybe it's part of the other condition that you had? 

We might look at testing; we might look at hormone levels.  For the most part, perimenopause is diagnosed by symptoms.  There isn't a single test that can tell us whether you’re perimenopausal.

There is for menopause,  We can measure a hormone called follicle stimulating hormone (FSH).  If it's above a certain level, we can be pretty sure that your ovaries aren't working anymore. But we don't have a test like that in perimenopause because most women still have enough hormones that they're having a period. If you're still having a period, there's no blood test that's going to be able to tell us more than a history and good conversation will be able to tell us. 

A lot of what I would do with someone is to have a conversation asking:

  • How are you sleeping? 

  • Do you have difficulty falling asleep or staying asleep? 

  • Have you started waking up in the middle of the night? And is that new for you? 

  • Have you started to notice that you're feeling hotter or warmer a few days before your period? And is that new for you? 

  • Do you feel anxious for no reason? And is that new for you? 

So it's a lot of trying to figure out what's new, what's different, and when it's happening in the cycle. 

Once we can stage someone and say, ‘Okay, I think you're in very early perimenopause,” we can be more certain that we need to work on supporting progesterone, for example. And so we would use a combination of diet, lifestyle, herbal medicine, maybe acupuncture - those types of treatment options to help support this normal process.  

This is not a disease.  This isn't something that needs to be hit over the head in order to be  stamped out. We really just need to support the body through this process. And there's so much that we can do with food and with herbal medicine, and with integrative treatment options.

Georgie Kovacs  08:28
So the way I'm hearing this is as we enter this life stage, there are things that happen that can feel disruptive to your day to day, and there are things you can do to ease that.

Jenn Salib Huber  08:41

Yeah, so here's a perfect example. So because perimenopause, like I always say, is defined by inconsistency, understanding that a lot of that inconsistency has to do with fluctuating levels of estrogen. Because the number of eggs that we have and the number of follicles that we have shifts a little bit from month to month, our estrogen levels can actually vary pretty wildly. 

With perimenopause, we often think about estrogen decline as being the most important piece, but it's actually not.  It's the variability. And with that variability, we can have changes in sleep and serotonin production.  Estrogen levels can help to support serotonin production, so as estrogen levels go higher, serotonin can be higher as estrogen levels can be. Lower serotonin can be lower. We can also have effects of cortisol. Cortisol being a stress hormone, that can have an impact on other hormones. 

A lot of these things may not have even been noticeable in our 20s and 30s, because we have this nice steady level of hormones, are now very noticeable. They're now front and center. So if we can support that fluctuating level of estrogen, if we can support neurotransmitter production,  if we can support managing that stress level, then the hormone symptoms will be less noticeable and more manageable. So if  sometimes we're not treating the hot flashes, we're treating the things that are interfering with how your body copes with that change.

Georgie Kovacs  10:14
If you look at the optimal way a woman's body evolves, meaning, let's assume we have a woman that you're working with. She's not sleeping great, and it's been regulated. And then menopause happens and you have that whole shift in estrogen. We hear vaginal dryness. We hear you go on hormone replacement therapy. But then I also hear women say, “Oh, my God, your 50s are the best.”

Excluding Instagram posts of “everything is great,” what should we expect? And how do we live that amazing life in our 50s?

Jenn Salib Huber  10:49

That's a great question. One of my big “why's” is helping women to understand that perimenopause and menopause is not a death sentence. It is not the end of the world. Life does not go downhill after that. But it could be a rocky few years. I use the analogy of “you're going to get there either way, but you can choose to either take the bumpy road or the paved road.”  

The paved road is where you pull in your supports. 

  • Integrative practitioners

  • Pelvic floor therapist 

  • Psychologist

  • Family doctor or gynecologist

It's about building that team of people who can help to cushion you through those bumpy rides. When women don't get that support, when they're left to just drown and flail and try to make it to the other side of the lake without support. 

I think that's when women get to the end, and they feel exhausted. By the time they hit their 50s, they're like, “Oh my god, I have nothing left in me to give. I'm exhausted, I'm tired. I haven't slept for 10 years, I've been dealing with all this stuff.” It can take them a really long time to recover. 

But when women are supported, when they're taught what's happening, and when they're taught how to, sometimes I hesitate to use word manage, but when they're taught to cope with these changes as normal and natural, they feel empowered. When you come through this experience that you share with half the planet, because we all go through it in some way or another, it can energize you. It can really motivate you to want to do your best in other parts of your life. 

I think that what I really want women to understand and what I am starting to see on social media, and I love to see women saying it doesn't have to suck.  It's not that everything goes downhill. It's that everything changes. And let's work on that change together. And let's support you through that change so that you can actually feel better on the other side than you did before.

Georgie Kovacs  12:46
If I have this team, so you mentioned a few different ones, the pelvic floor physical therapy, what do they help with?

Jenn Salib Huber  12:54

Pelvic floor physiotherapists, I think, are the unsung heroes of women's health. So many of the ones that I've worked with have been amazing in that they help women to understand a part of their body that they may never have thought about or talked about. So unless you had severe incontinence or unless you have severe pain with intercourse, you may not even know that a pelvic floor physiotherapist exists.  They can help women who are having any  pain:

  • Bladder dysfunction

  • Irritable bladder

  • Overactive bladder 

  • Pain with intercourse 

  • Pelvic pain

  • Rectal pressure

  • Incontinence

These are quality of life issues for women. Once you get to be in your 40s, and if you've had kids, or if you have anything else happening, these might be issues that you don't bring up with your doctor or you feel like nobody has a solution. So you're just going to live with it. I often refer to pelvic floor physiotherapists, and they can make an amazing difference in women's quality of life.

Georgie Kovacs  13:53
The pelvic floor physical therapists can help but then also, what about the hormone replacement therapy? Can you talk about that, because I've heard so many different things about it. And it's unclear whether it helps, when you should use it, how long you should use it, and some of the side effects.

Jenn Salib Huber  14:09

Hormone replacement therapy (HRT) has probably been one of the most debated topics in women's health, I think really ever.  For the most part, it has had a mixed history. For the longest time, back when hormone replacements first started, women were put on it, and they were never taken off. My dad was a gynecologist, and there were women in his practice, who were in their 80s, who were still on hormone replacement therapy, because that's just how it was done. You're in menopause, you need hormones.  Here. You're on hormones.

I was still seeing that in my practice in Nova Scotia. People coming to me at 75 saying,  “I'm still taking this HRT.  Do I still need to take this?” I think that it was not properly used for a long time, but I don't think there's any question about whether it works. It does work for women who have severe symptoms that are disrupting their quality of life, and I think that it has an important part to play in helping women through this time. 

But there are a lot of other options that women can try before that. So in my practice, I used to say that probably about 5% of the women who came to me for help, weren't able to respond or didn't respond to integrative treatment options. I would refer them to another practitioner to look at hormone replacement therapy. And I think the goal now, based on the evidence we have, is that using hormone replacement therapy for up to two years likely does not come with increased risks, especially for people who don't have a history of breast cancer, uterine cancer, a strong family history, history of clots, or anything that would put them at risk.  Otherwise, using it for up to two years can be helpful, and it's safe for most people. 

I think that most of the women who choose to go that route, because they haven't responded to other things are happy with that choice. I think that's fantastic. But I think that, again, working with a practitioner who's knowledgeable and asks:

  • How do we manage the risks?

  • How do we use it for the shortest amount of time possible? 

  • What is the safest preparation? 

There's certainly still some debate between conventional hormone replacement therapy bioidentical hormones. The advantage of bioidentical hormones is that they can be customized to each person, so it's not a one size fits all prescription. It's very much a, this is the stage you're in. And so a woman who's in very early perimenopause, who's not responding to integrative treatment options might opt for a bioidentical prescription that has more progesterone, because that's the hormone that she needs more in that particular phase, whereas a woman who hasn't had a period for six months may opt for a prescription that has a higher amount of estrogen. So it can be customized to the stage. And I think that that comes with some advantages.

Georgie Kovacs  16:42
What is the role of hormone replacement therapy? Because if you hit that pause, and your estrogen levels, are they first of all, are they gone? Or are they just so low?

Jenn Salib Huber  16:59

For the most part, in our reproductive life, 95% of our estrogen comes from the follicles. So the follicles that grow the eggs are actually what produce the estrogen.  When we run out of follicles, we run out of that source of estrogen.  Because our body needs a little bit of it, part of our adrenal glands can actually help to produce a bit of estrogen. And we can also produce a bit of estrogen in our fatty tissue, adipose tissue or fat produces a bit of estrogen, and we get a little bit of estrogen from our adrenal tissue. So we do have some because we need some 

Getting on the role of estrogen. Estrogen replacement therapy is primarily directed at symptom management. So prior to the big debacle 10 to 15 years ago about whether or not it was safe or not, there used to be a lot of talk about its potential benefits in that it could reduce the risk of heart disease and osteoporosis.  

Those benefits are no longer really the main reason that women are choosing it, because the studies really aren't showing that there is significant benefit, or if there is, it's likely not balanced out by the risks when we're looking at the role of estrogen. Yes, it plays a role in heart health. Yes, it plays a role in bone health.  Yes, it plays a whole role in cognitive health. But whether or not hormone replacement therapy, benefits, those outcomes hasn't really been shown yet.

Georgie Kovacs  18:20
If it's ideal to be on them for only two years, and it's because of the limited not lack of limited estrogen in our bodies, what happens after that two year mark? If someone is in that position, where they really need to be on it, and now it's been two years, and they have to go off of it,  are they starting all over again with those symptoms? Or is it that once someone reaches a certain stage, in their post menopause phase that it doesn't impact them as much or they can do other things?

Jenn Salib Huber  18:54

So it's a great question. A lot of it comes down to genetics. Some people are genetically wired to have symptoms for a longer period of time. One of the ways that we can predict our own experiences is to look at our mother's experience and to talk to other women in our life who've gone through it.   In general, if your mother had a terrible symptomatic long menopause, chances are you might as well but genetics aren't everything. 

What we do before, during and after influences are experience and so that's the crux of where I think I come in. When I'm working with women, my goal is to introduce good sources of phytoestrogens and fiber into their diet to support their estrogen levels through the next 10 or 15 years.  If we can establish that and do the items below, one's experience of menopause is going to be very different than someone who's not doing those things.

  • Healthy ways of dealing with stress

  • Support healthy sleep

  • Incorporate joyful movement on a regular basis

If you suffered for five years, went on HRT for two years and didn't really do all of those other things, then chances are, when you come off of that, you may have some return of symptoms. Depending on your genetics and your circumstances, it still may be crappy. But eventually it does die down.  Women usually aren't having hot flashes in their 70s.  The symptoms will naturally die down on their own.  You're going to get to Rome one way or the other, but how you get there is up to you. And so that's where working with a practitioner, like myself, or someone else who's well versed in not just the hormone piece, not just estrogen, not just progesterone, is looking at the big picture, and how we can support the whole experience makes the difference on the other end.

Georgie Kovacs  20:42
Can you go on and off HRT after the two years, or is it a one-time thing?

Jenn Salib Huber  20:55

Two ears isn't a hard and fast rule. So we always have to interpret it in terms of potential risks and benefits for the individual. Many women can make the argument, rightly so, that if they're not sleeping, if all of these other things that could impact their health long-term, that maybe it's better to extend that hormone replacement for another six months.  When we're looking at the research, it's that, taking it for up to two years does not seem to increase the risk of breast cancer, in particular, which was the big bad outcome that came out of that big study years ago. We had this big drop in hormone replacement therapy and no one wanted to use it. More research was done showing that using it for a couple of years is safe but using it for 10 or 15, probably isn't. And so we want to use it for the least amount of time possible - is  the take-home message.

Georgie Kovacs  21:48
You were talking about fatty tissue and estrogen. I've heard, as you get older, it's harder to keep the weight off. Is this why our bodies are designed, as we get older, to make it harder to stay at a lower weight because we need the fat to help with the estrogen levels?

Jenn Salib Huber  22:13

That's a theory that I subscribe to. It's  One of those things that's very difficult to study.  It's very difficult to say.  We know that, in puberty, girls increase their body fat from 5-7% to upwards of 20% in order to be able to menstruate. That probably has something to do with the fatty tissue. And we know that 80% of women in perimenopause put on anywhere from 10 to 15 to 20 pounds without changing anything about how they eat or how they move their bodies. 

Some of that can likely be explained that there's a natural slowdown in metabolism that happens to everybody, men or women. But it makes sense to me. And it makes sense to other people who work in the field of intuitive eating and health at every size.  That this is a big reason why women tend to notice changes in their shape and size and distribution, even the fat in their body.  Even if the scale isn't changing, how their body carries that or how we're finding that on their body changes in their 40s and 50s. It very well could have something to do with the fact that that little bit of extra fatty tissue produces a little bit of estrogen. 

There's even been studies which have looked at women, for example, who are in the lowest range of BMI actually benefited the most from having that little bit of extra fatty tissue put on in menopause. So it does seem to carry a protective role. And hopefully there'll be more research to confirm that. But I use that as a normalizing experience, like when women come to me and the biggest concern that women have often isn't the hot flashes and night sweats and anxiety. It's the fact that their body is changing. 

For women who have been immersed in diet culture for 20 years, it feels like adding insult to injury.  “I've spent 20 years trying to maintain my body and to do this and that and all of a sudden, here I am, I'm 40. I've put on 20 pounds, and I don't know why and my body's changing.

Explaining to them that it's nothing that you did.  This isn't your fault. This isn't something that you can even maybe necessarily change, and that 80% of the women around you are going through the same thing. This is what women talk about all the time, right? It's almost a joke that you turn 40 and you put on 10 pounds overnight. Well, there's a reason and that it's probably because our body is trying to prepare for this next phase.

Normalizing the experience isn't always easy to like but normalizing it helps to take away so much of the blame and shame that women feel in their 40s. 

Georgie Kovacs
How do you meet them where they're at? And what you can do, for example, and I don't even want to call it diagnostic testing because if you're diagnosing someone with a problem, and in this case, not diagnosed with a problem, so I almost want to call it investigative testing. 

Jenn Salib Huber

So yes, I like that better too. When we're talking about perimenopause, measuring estrogen, progesterone, FSH, LH, aren't likely to have diagnostic value. 

FSH is a perfect example. It can fluctuate from one month to the next. So when you're in perimenopause, you can have one month where your FSH would suggest that you're still Fertile Myrtle and you can have a baby tomorrow and then the next month, you're knocking on menopause’s door. So it's very difficult to use that diagnostically. 

Similar to LH  It doesn't have as much prognostic value as it does when you're trying to have a baby, right? When you're trying to predict ovulation, LH is the be all and end all. 

Measuring estrogen and progesterone also fluctuates. And so if women are having regular periods, chances are estrogen and progesterone are going to fall within normal ranges. And some of the testing that's out there, especially saliva testing for estrogen and progesterone hasn't been shown to be particularly predictive either. 

One hormone that I would often check is cortisol. If I'm trying to understand other things that could be influencing a woman's mood, body composition, energy, sleep, and she's 42, and she has a really stressful life, I might want to measure cortisol.  In this case, a saliva test is a really great at-home way for them to do that. That has been shown to be as effective and as reliable as measuring it in the blood. There are definitely some situations and where other testing can help. 

If we're strictly speaking perimenopause, there really isn't a test at this point that is as helpful as cycle tracking. Measuring when your period starts and when it ends, trying to identify when you're ovulating just by symptoms. Are you noticing mucus changes? Are you getting any symptoms around that time?  In perimenopause, a lot of women will start to have what they call a mini PMS around ovulation. And that's because there's a surge of estrogen.  That surge of estrogen for some women can cause sleep changes, mood changes, and bloating. 

Trying to pinpoint when they're happening and what other symptoms are happening, and trying to identify what's happening in the cycle has the most value to me as a practitioner, and I can teach women this so that they can understand. If they're tracking their cycle, and we've talked about a few cycles, they're able to say, “Oh, I'm feeling this way, because I'm at this point in my cycle,” and that's where the empowerment comes in. 

Instead of waking up thinking - Why am I bloated? Why do I have a headache? Why am I feeling so tired? - and not having any idea. That's the part that I love about this too, is that it's something that women can do on their own once they understand what's happening. 

I want to say something about melatonin. I love melatonin, but it is misused. So often, understanding how melatonin works and when to take it can be a game changer. You should always check with whoever prescribed it.  I often see people taking too much or too late.  

  • If you're taking melatonin just before bed, and if bedtime is after nine o'clock, you're taking it too late. 

  • If you're taking more than three milligrams, and it's not working, you're probably taking too much. 

Optimally, people should start with half to one milligram between eight and nine o'clock because that is when our melatonin levels are starting to rise naturally. 

What we're trying to do with melatonin supplementation is we're trying to piggyback on what your body's already doing. So we're trying to get the wave to crest just a little higher. 

If you're having difficulty falling asleep, melatonin used that way can be a game changer for people. But if you are taking it at 10 or 11 o'clock and you're taking five milligrams, chances are you're not going to get a great night's sleep and you're going to wake up feeling really groggy in the middle in the morning. Definitely talk to people who might have a lot of experience with melatonin and not just take what's on the side of the bottle because you could buy 5, 10, or 20 milligram tablets and that's just way too much. What I usually tell people is that if you have to take more than three milligrams and you find it's not working, chances are it's not the right option for you.

Georgie Kovacs  29:28
I remember going to Whole Foods. I'm looking at the aisle -  one milligram, two milligrams, with chamomile, with lavender!

Jenn Salib Huber  29:38

Melatonin for women and perimenopause is brilliant and is a game changer and it's often my go-to, but for women who are in late perimenopause or in menopause, it can actually worsen their estrogen symptoms because melatonin actually can block estrogen receptor activity. So there are some studies that are looking at it for use as a natural tamoxifen because it might be associated with reduced risk of breast cancer. But I definitely have seen it essentially  cause hot flashes in women who aren't having a regular period. And that's not going to help you sleep. So another reason to  consult with someone who's knowledgeable, especially about perimenopausal and menopausal sleep,

Georgie Kovacs  30:19
You've been talking about seeking an expert, the typical path that we women go on is if we are good about going to see our OB GYN, assuming one goes on a regular basis, and some would argue going to naturopaths is ideal. I just want to acknowledge on this podcast, it has never been my intention to talk so much about naturopaths. But given the limited data on women's health, and even one of the reproductive endocrinologists who did get trained as an OB GYN, and then specialized in RE did acknowledge what OB GYNs are trained on, which was shocking to me. So this is a doctor who went through the training who's shared they are trained on birth control, a couple of surgeries, and doing pap smears. And that's it.

Jenn Salib Huber  31:01

I think that the integrative approach is what needs to be sought. My dad was an OB GYN. I have great respect for that fielD.  I had two C-sections, and I'm super grateful for the OB GYN that I had and the care that I had. 

I think that’s where naturopathic medicine shines -  is in this integrative whole woman experience of menopause. I think that our training and our philosophy and the tools that we have in our toolbag support this natural transition.  We're not looking at treating disease in the same way that maybe conventional medicine would typically look at this. You want to have that person on board, if you do run into issues, because there are times when there are symptoms that do need to be managed medically, that is absolutely a reality of working with women in menopause.  If a woman has extremely severe bleeding, that needs to be managed medically.  There might need to be a drug option.  There might need to be an IUD put in. There might need to be an ablation offered. Having the people on your team that you trust, that you can have open and honest conversations with about what's happening and not just saying, “Oh, yeah, it's uncomfortable, but I can live with it.” 

You need to be able to describe in detail. “I'm soaking through a pad every 45 minutes, and I have to set two alarms through the night so that I don't soak through my bed.” You need to be able to have conversations like that with your health care practitioners and feel totally comfortable saying that. Whereas oftentimes when I talk to women, and I ask 1) how many pads an hour, 2) how many tampons, 3) can you leave the house, 4) do you have to set an alarm? They'll say, “No one's ever asked me that before. But yes, I have to set an alarm at two and at four, otherwise I wake up to a bed soaked in blood. Okay, we need to do something about that. That's priority number one, because they can become anemic. Tthat makes them tired, and that makes them feel like they have brain fog, and then it affects their mood. And, and, and.

Having the people on your team that you trust, but who are also knowledgeable, is absolutely key to having a better menopause. When we talk about the old days of the doctors knowing everything, everything was just the top of the iceberg. They were really just taught what was above the surface. And over the last 40 to 50 years, we've learned that so much of health is below the surface. 

  • It's what we're thinking.

  • It's what we're feeling.

  • It's what we're eating

  • It's what we're how we're moving our body

  • It's how we're managing stress

  • It's how we're dealing with life.

It's all of those things that there's no test for, so having a practitioner, who you can develop that relationship with. Some of my most satisfying relationships as an ND are with people that I have been seeing for 15 years, people that I saw before they got pregnant, as they had their babies, after they had their babies, when their babies were learning how to eat solid food, as they started to go through perimenopause. 

Just being able to have that consistency and that continuity of care of saying, “Oh, yeah, I know, this happened to you 10 years ago.  This happened before you just don't remember it, but I have a note about it.” So I can help you remember it and be able to remember or talk about stressors because we have that friendship almost that you get when you have worked with someone for a really long time. And so much of our interactions in healthcare, because they're symptom based, are very much about what's happening now. Not yesterday.  Don't ask me a question about tomorrow. I just need to know about now because that's how the system is designed. And that doesn't help people to understand what's happening. And it doesn't give them the confidence to ask when something changes.

Georgie Kovacs  34:39
So I do like to always end on a solution oriented note. So , what would you advise women to do? And we've talked about hormone replacement therapy. We've talked about ways to help with sleep and things like, generally speaking, what are a couple of takeaways?

Jenn Salib Huber  35:05

So the most important thing I think, is at any age, but especially once you hit 35, you need to learn from someone that you trust or teach yourself what is happening with your body. What is the normal transition through perimenopause and menopause?  

  • Know that it's defined by inconsistency. 

  • Know that it's normal for things to change month to month.

  • Know what is considered perimenopause.

Just like you would when you're having a baby. Most people, if they have the ability to plan for a pregnancy, take the time to learn about it before.  They learn about what they should eat, what they shouldn't need, who they need to see what they need to do. 

Once they become pregnant, they become very focused on what are the best decisions that I need to make for me and my baby, and they have all the support to do that. They have prenatal care providers, there are public health nurses or doulas or midwives. There's all these people who come together to support mom and baby.. 

We don't do that for women and perimenopause. So the onus is really on us to understand what's happening and understand and seek out the people that you can have as part of your care team. I think that that's probably my biggest take home is don't go into this blind, don't  decide that you're going to wing it, because you might have a really easy time. And I certainly wish that on all women and some women do not. Everyone thinks that this sucks, right? Like not everyone has hot flashes, not everyone experiences sleep changes. Not everyone experiences body changes, but you should know that it could happen.  Hopefully, with the understanding of what's happening, You can have conversations with the people that can help you. But just know that menopause is not the end, it's just another beginning.

Georgie Kovacs  36:50
As I was listening to talk, it seemed you are speaking to the menopause version of self care. You were talking about reading books and preparing your body. It just sounds very soothing. And I hope women see that it's not, “Oh my God. Now I have to call these doctors!”  Instead, it’s how do you take care of yourself to feel better, and I think your tips are spot on. And I appreciate that you've taken your new living situation as an expat and turned it into a different way to still support women because having an appointment to go to and knowing that when you go to that appointment, it's a bunch of women who are going through what you're going through, maybe not experiencing it in the exact same way, but a vulnerable group. 

Jenn Salib Huber  37:51

So far, it's been a great experience for everyone, including me because it's a way for me to connect, since I can't do the one on one face-to-face care that I had done for 16 years, and I and I miss my practice and my patients, it's a really great way for me to still connect with people and help them.

Georgie Kovacs  38:08
So I like to always end on outside of the solution. What is your greatest hope for women's health?

Jenn Salib Huber  38:14

My greatest hope for women's health is that it becomes as prominent as other aspects of healthcare. We always hear about the big ticket items, right? So we hear about cancer care and infectious disease and those kinds of things, but women's health care tends to be almost specific to certain situations. Oh, you can't get pregnant. Okay. Women's health care for fertility. Oh, you are pregnant. Women's health care for pregnancy. But we're not really looking at women's health care through the reproductive life cycle, right? We're not looking at how to support healthy and normal over a lifetime, instead of just in these pockets of life. So I would really like to see its definition broadened so that women can be supported and taught to support themselves.

Georgie Kovacs  39:09
A big thank you to Jen for joining us today on the empower health podcast. She definitely has incredible expertise on perimenopause and menopause. Be sure to check out the show notes for her online program The Thinking Woman's Guide to Perimenopause and Menopause, which is a self study program. 



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