Your Joyful Order With Leslie Martinez
Ever wish you had your own personal cheerleader or coach in your ear, whispering encouraging words? Telling you how to kick butt in life, plus showing you how to get there? That’s exactly what you’ll get when you tune into Your Joyful Order Podcast. Each week you’ll get a mixture of preaching and teaching from your host Leslie Martinez who is a Certified Life Coach, Business Owner, Wife and Mom. Listen along for some entertaining real talk about life, business and relationships. Leslie wants to help you to reach your goals and motivate you to live out your God given purpose, by bringing you insightful knowledge, resources and sharing some tips and tricks to take action. No topic is off the table here, just know that faith will always be the foundation of our conversations and an occasional kick in the butt might come in the most loving way! Get ready to take your life to the next level and learn how to chase joy!
Your Joyful Order With Leslie Martinez
#112 The Menopause Wake-Up Call: What Every Woman Should Know With Dr. Sarah Bonza
The mysterious, often misunderstood journey through perimenopause and menopause leaves countless women feeling confused, frustrated, and alone. With symptoms dismissed as "just aging" and proper care difficult to find, many suffer silently through what should be a supported transition.
Dr. Sarah Bonza, who found herself navigating her own perimenopausal symptoms without adequate medical guidance, transformed her experience into a mission. After additional certifications in wellness coaching, lifestyle medicine, and menopause management, she developed a comprehensive approach to women's midlife health that addresses the whole person—not just their symptoms.
What makes perimenopause particularly challenging is how it affects every aspect of a woman's well-being. Estrogen receptors exist in over 200 different tissues in our bodies, from our brains to our hearts to our metabolic systems. As levels decline, women experience not just hot flashes but profound changes in mood, cognition, weight distribution, and sleep patterns. The unexplained weight gain that frustrates so many isn't a matter of willpower—it's hormonal insulin resistance that requires specific interventions like increased protein intake and strength training to address.
For women struggling to get proper care, symptom tracking and self-advocacy are essential. By arming yourself with knowledge about hormone changes and their effects throughout your body, you can approach this transition with confidence rather than fear. Connect with Dr. Bonza's comprehensive Vitality Code Program at www.bonsahealth.com to receive personalized support through your perimenopause and menopause journey.
Connect with Dr. Sarah Bonza:
Website: https://www.bonzahealth.com
Instagram: https://www.instagram.com/drsarahbonza/
Facebook: https://www.facebook.com/drsarahbonza/
Could I Be Perimenopausal Quiz:
https://quiz.tryinteract.com/#/65dfee615fc06c00151a06b9
Perimenopause Symptom Tracker:
https://www.bonzahealth.com/perimenopause-symptom-tracker
Connect with Leslie:
Follow on IG: @yourjoyfulorderstyle
Website: https://www.yourjoyfulorder.com/
Email: lmartinez@yourjoyfulorder.com
to schedule- Speaking Events, Interviews or Life Coaching Sessions
Shop my SOAP the Gospels Journal on Shopify:
https://shopjoyfulorder.com/
Watch this Episode on You Tube: https://www.youtube.com/channel/UCsXoAYIM2mfclNtYiaOzIUw
Shop my Journal (Gratitude, Goals & Prayer Journal) on Amazon:
https://a.co/d/09Djvaw
Book a FREE 30 Minute Discovery Coaching Call: https://tidycal.com/joyfulordermedia/30-minute-meeting
Hey friends, I am so excited for you to join me in today's episode. Today, we're diving into a topic that affects every single woman, but it often is not talked about enough. So we are unpacking what perimenopause and menopause really looks like. We're talking about how to recognize the signs and what options for care exist and what support is out there for you. Whether you're in the thick of it, like me, or you just want to prepare for what the road ahead looks like, this conversation is going to bring clarity, hope and some much needed wisdom. My intention for this episode is to shed light on the complex changes that women face in midlife, to provide knowledge, tools and encouragement to help you reclaim your vitality, protect your long-term health and feel empowered in your wellness journey. My guest today is Dr Sarah Bonza, a board-certified physician and the founder of Bonza Health, a women's wellness practice focused on supporting women through perimenopause and menopause. With more than two decades in medicine and certifications in lifestyle and functional medicine, dr Bonza takes a deeply holistic approach to women's midlife health. She blends hormone therapy, nutrition, movement and wellness coaching to help women feel strong, clear and vibrant. I am so excited for you to learn from her.
Speaker 1:Let's get ready to get into this week's episode. Hey everyone, I'm Leslie Martinez and you're listening to your Joyful Order podcast. Each week I will bring you joyful stories that will motivate and inspire you and, at the same time, bring order to your everyday life. Let's just say the show will be a mixture of preaching and teaching, with a kick of motivation from your girl here. Welcome to your Joyful Order podcast, dr Bonzo. Welcome to the podcast. I am so glad that you're here today.
Speaker 2:Thank you, Leslie. It is so great to be back today. Yes.
Speaker 1:Yes, now I have to tell my audience y'all if you follow me on social, you guys will have known last week Dr Bonza and I we recorded an episode and then Zoom decided to have like an all user outage. Last week it even made the news. It made CNN, dr Bonza, the whole Zoom outage. Yes, it was on the news and it was kind of a sign of relief because I really thought it was a user error at first. I'm like what did I do wrong? Did I not hit record, did I not this? But it was Zoom. So my audience, my listeners, I want you to know how amazing Dr Sarah is. I let her know that we did not have the full recording and I'm like is there any chance we could do this again? And she's like absolutely, this is when I'm available and I told her anytime you're available, I'm recording this at 6 am in the morning on Wednesday, the day before we post the podcast. Y'all, dr Sarah is on East Coast time, she's in Ohio, right?
Speaker 2:Yes, Right On.
Speaker 1:Eastern time, 9 am her time, but we love you guys. So, dr Sarah, let's get right into this.
Speaker 2:Let's get right into this. I first want you to just kind of share with the audience just a little bit about yourself and how you kind of got into women's health and focusing on women during perimen physician for over 20 years now and I started noticing changes in myself a few years ago and there was nobody that I could go to that could explain to me what was happening and my concerns were very subtle energy levels, changes in my cycles, and when I would go to the doctor they said everything looked normal. So I went on this crusade, if you will, and tried to figure out how to make myself feel better and I became a certified wellness coach. I became a diplomat of the American Board of Lifestyle Medicine and I became certified in menopause, hormone therapy and well menopause society practitioner certified and also the Institute of Functional Medicine. I put all of those things together and I finally figured out how to help myself and now I'm bringing that to my patients and helping other women in a similar situation.
Speaker 1:Wow, and I want to emphasize, because my audience I've done a couple episodes talking about this and in my last episode that I did talking about hormone changes and all of that, I had mentioned how women can look for specific doctors and that's on the menopauseorg right, which is where you're certified through so doctor, I kind of explained all of that in a previous episode. So I love the fact to know and I didn't even know that before, like when I got you as a guest, because, as I'm learning, I'm kind of piecing all these things together and when you said that I'm like I was sharing about the menopauseorg I went to the site, so I absolutely love that.
Speaker 1:But OK, so let's just start with the big picture. Dr Sarah, you know we have perimenopause, we have menopause. And just for the women that just don't even know the difference, like, why is it important for us to understand the difference between actual perimenopause and menopause?
Speaker 2:So if we just start strictly with the definitions, menopause is by what we've learned in medical school, is you are identified as menopausal 12 months after your last menstrual period. So if you stopped having periods for four months and then you happen to have a cycle four months, in the clock resets for 12 more months and then they say you are menopausal. Perimenopausal can be leading up to 10 years before menopause and this is a time of significant transition for women, really akin to puberty. Honestly, the way our hormones change during puberty. For women, our hormones start changing before menopause and this can be 10 years leading up to menopause of changes in your cycles, changes in your mood, difficulty sleeping, insomnia, weight gain all of these symptoms fatigue they kind of are the hallmarks of perimenopause for women.
Speaker 1:So knowing the difference between perimenopause and menopause. Basically, menopause is like you're officially done with your period and you're into a different stage. Perimenopause is when you experience a lot of the symptoms leading up to it. So my question in looking at the difference of that, when you're in menopause, do those perimenopause symptoms still carry over into like post-menopause? Yes, Do they change? So are those symptoms like you're going to have them for the rest of your life kind of thing until you balance out your hormones and all that stuff which we'll get into a little bit later?
Speaker 2:Everybody is very different. All women are different and I don't think science has begun to capture what women experience and the whys. Everybody's experience of perimenopause is completely different. There is some hereditary component to this. But I just had a patient yesterday who has she's 59 and she's been on hormone therapy for years and now she's starting to notice symptoms again of irritability, of trouble sleeping again of irritability of trouble sleeping, of night sweats, which she didn't have before. And the traditional recommendations would be oh, you're getting up there in age, we should start backing down on your therapy. But all of her signs suggest that she needs a little more estrogen and progesterone and she's still showing those signs of lack of progesterone with trouble sleeping. So everybody is very individualized, everybody's experience is different and when I see women, that's what we go by what do you need? How do you feel? Because we can't just put everybody into one box.
Speaker 1:Yes, now you often say that perimenopause symptoms are kind of just the tip of the iceberg. So can you kind of explain that like the tip of the iceberg of what's next to come?
Speaker 2:Yeah, so this is like our warning sign.
Speaker 2:What happens with our estrogen levels is they start doing this roller coaster through perimenopause until they just taper off and your estrogen is so critical for so many functions in your body.
Speaker 2:We have estrogen receptors in 200 different tissues of our body, including our brain and our heart and our muscles and our metabolic system, and so what we see is that once women lose their estrogen and perimenopause is that warning sign that you're starting to lose your estrogen, that now we lose that protective effect. And when we say protective effect, we're talking about our brain health, our heart health, our metabolic health, our general inflammation, even some cancer prevention related to estrogen and the anti-inflammatory properties that it has on our system. So as women go through this stage, they really need to be thinking about their health and wellness and about really adopting healthy habits, because what you do now in perimenopause is going to set the course for what your aging process is going to look like. Are you going to have diabetes, hypertension, hyperlipidemia? All of these systems are affected by our loss of estrogen, but during perimenopause we're still in control to kind of shift what direction we're going to go.
Speaker 1:Wow, you know I'll be completely honest, dr Sarah and I'm I'm certain that there's a lot of listeners as myself, when I started I or I didn't realize the impact that estrogen has on every receptor of our body. I really just attributed estrogen to my female organs you know my ovaries, my, you know my uterus, all of that, like my cervix. I'm like, oh, it's just like estrogen just keeps that part of my body thriving and I know that the estrogen and the progesterone, all of that kicks up if I'm carrying a child during my cycle, like all of that. Absolutely clueless on how much our hormones affect every aspect, like every functioning part of our body, especially our brain, and that's I love to study, like neuroscience. I'm just I say I'm a brain nerd and I'm not like I just love to read stuff about the brain, like I made it a point to kind of learn the different parts of the brain and what each part, how it functions, you know. So when I started to read and understand this, I realized how much hormones and that's not just estrogen, that just goes to all of our hormones they're like receptors for our brain, like you said.
Speaker 1:So my biggest challenge that I have been having one of my symptoms is brain fog, forgetting things, lack of focus. I can't function, I can't hosting a podcast Like sometimes I'm just like I go blank and I'm like what in the world just happened? That's why last week I really thought I'm like Did I screw the recording up? Like it very well could have been me, like I could have just stopped or something. But thank the Lord, or it was all Zoom right.
Speaker 1:But I have those moments, dr Sarah, and I think there's a lot of women like there's that whole midlife part where I think a lot of women, we think we're going crazy, honestly, like I thought, okay, am I losing it? Am I? What is going on, like ADHD symptoms, all of that. So I just want to talk a little bit about that part of it. I kind of joke, but in all seriousness, like I was feeling depressed. I was. I was feeling like anxiety coming back. I used to struggle with anxiety and like my late 20s, early 30s, but really bad. I also had a very stressful job at that time. Didn't know how to deal with anxiety. So anxiety coming back, depression, brain fog, lack of focus, adhd symptoms, all of that. Can you just speak a little bit on that and like what our brain is going through during this time, and maybe some relief of what women can do.
Speaker 2:That's a whole book in and of itself. Yeah, I know, I know, I just gave you a loaded question right now but just maybe some key points from that.
Speaker 2:And Dr Lisa Moscani just wrote about. She wrote a great book about menopause and your brain and so and my brain fog is preventing me from telling you the title of her book, but I know it's about menopause and the brain, but it's by Dr Lisa Moscani and she just published it this year so the things that come to mind when we talk about these changes in our thinking and our processing and our moods and I have trouble with highlighting this for women, because I feel like it's part of the stigma that women get when they're called hysterical and they're gaslit- so, I always am a little bit cautious when I talk about these very real changes that we see sometimes in our personalities and our moods and just that willingness to put up with things.
Speaker 2:And really estrogen plays a role in keeping us calm and even keeping us being people pleasers, how we were kind of brought up to be to take care of people, to please people. And as we're losing our estrogen, we kind of lose a little bit of that, and that's part of what contributes to the irritability. But there is a gut-brain axis that we're only really starting to uncover that our happiness hormones, our dopamine, our serotonin, are closely tied to our estrogen levels in our gut as well. So as our estrogen levels are declining, we're losing some of these neurotransmitters neurotransmitters involved in feeling good, involved in feeling motivated. And you know, even just doing estrogen replacement can sometimes help that.
Speaker 2:But it's important to understand that these are very physiologic changes that are happening in our bodies that are causing real changes in how we experience life and how we perceive things around us. And so you asked about what can we do to help these symptoms. So, short of hormone therapy, which is very helpful for many women not antidepressants, but hormone therapy other things that can be helpful are getting involved in some kind of aerobic activity that brings you joy, to help get those neurotransmitters firing and activated again. Exercise is very helpful, and we're not talking about doing aerobic exercise for losing weight. We're talking about doing it for your life, for your health, for your happiness and finding something that you enjoy, that you could stick with, and I think that is one of the best ways to help, as these transitions are starting. Dietary focus when it comes to mood. Complex carbohydrates are very helpful and, in addition, b vitamins. If we're looking for supplements, b vitamins can be helpful for our mood, especially for women who are vegetarians.
Speaker 1:Wow, now, as you're talking, all of this, I kind of I'm going to go off on a little tangent here because this isn't on my notes but I it just kind of made another click. Like, as I learn more, I kind of, as I read, I listen, I, you know, having conversations with other women, I start to like piece all of these things together. And would you say, dr Bonza, because even like, I talked to my mom, talked to some other family that have gone through perimenopause way before me, right, my mom, actually, her period stopped when she was only 41. So she was pretty young when she dealt with it. When she was going through it, though, she had shared that that was also in the midst of her divorce and trauma. She was going through a lot of stress and stuff. Have you seen any of that? Like, I want you to kind of touch upon two things Can trauma affect early menopause?
Speaker 1:And then also, have you seen at all a change? Because our society has gone more to like a processed food kind of you know culture, because you're talking about, like, the gut and the microbiome and all of that and the connection to our symptoms a lot more visible now because of the diet? Because, like when I talk to people before I start to share about some of the symptoms and they're like yeah, no, I didn't have that. It was really hot, flashes, hot. You know this. And that, like my mom once, she went into it early. Could it have been due to trauma, we don't really know. But then also, looking at what we're eating now, could that put us into not even just an early, but could that be causing some of the more severe symptoms that we have now, that maybe women back then didn't have you and I could be throwing a question you haven't even thought about before.
Speaker 2:Yeah, it's. It's an insightful question and it's worth considering question and it's worth considering, and I guess. So part of that, the things that come to my mind are all of the foods that have soy could contribute to estrogen. Now, the phytoestrogens, like the soy, those actually bind tighter to our body's natural estrogen receptors than our natural estradiol. So in the naturopathic world they talk quite a bit about detoxing from these heavy soy products. So what you're saying, yes, yes, it's very possible. Have I looked at the research and can I cite you the studies? No, I can't, I haven't done the research, but your logic is sound and makes sense is what I would say.
Speaker 2:In addition to that, a lot of the foods that we're eating are pro-inflammatory, which causes a whole host of problems with our health. When it comes to the question of trauma and menses, I have two thoughts about that. So, yes, trauma can impact our hormones, but there also is premature ovarian failure, which I think is much more common than we give credit for. I have a colleague who is in her 30s and she is on estrogen, progesterone and testosterone because she has gone through premature ovarian failure. Ovarian failure, her levels have declined and the way that she was noticing symptoms were more perimenopausal symptoms, but also she was starting to see signs of chronic disease hypertension, hypercholesterolemia and she's a very active person and so it wasn't making sense. So once she started hormone therapy in her 30s she started feeling better and, mind you, she actually didn't stop having cycles before she started hormone therapy.
Speaker 2:So it's important for women to realize these symptoms can start early, can start early, but when it comes to divorce, we do see more divorce happening around this time, and some of it can be related to women are just realizing that they're not willing to settle, they're not willing to put up with some of these toxic relationships. Maybe they were willing to kind of. You know, there's a lot of suppression that happens with emotions. But as we start to go through these transitions, women start to change and from what I'm seeing in the women that I'm seeing, much of it is a self-preservation type of change. They're just not willing to take it anymore. And this reminds me of a statistic and I think it was in Louise Newsom's book that I read this statistic that the average age of suicide for women is 51 years old and the average age of menopause is 51 years old, and I feel like that should be a huge focal point for medicine and society in general, and I think it speaks volumes to what the lack of estrogen can do to our brains.
Speaker 1:Yes, and going back, that's how I wanted to just touch upon the impact that it has on our brain and, I guess, also how important it is for women that when they start seeing those red flags, especially with their mental health, to go seek help and consider that it may just be your hormones are out of whack right now, which is causing you to, you know, act out differently, have different thoughts I had read that statistic as well differently, have different thoughts. I had read that statistic as well, dr Sarah, that it was like between the average age of 45 to 50 is where you see the most divorce and the most suicides among women, and it's that age of you know that most women are going through perimenopause or beginning going into that menopause stage, and that is something that definitely is very important to address and that women are aware of that, the mental impact that the lack of hormones actually has to our brain. And then we get to that point, like you were saying earlier, like the estrogen kind of creates that, like people pleaser in us women, you know, and once that estrogen is, you know, kind of kind of gone or we have less of it, we just stop putting it up with the BS right, like we just were, just like I'm not having it anymore. I'm done people pleasing, like I'm wiping my hands of that, and it's it's like we set up those very hard boundaries at that point because we've done it all our life. And then now it's we've gotten to a point where I'm just like I'm tired of people pleasing, like I'm going to please myself first and I totally get it. I totally get it. Now. I want to shift gears a little bit here, dr Sarah, because I know that this is probably the number one concern of women and that is the weight gain during this time. This is a huge concern, I know.
Speaker 1:For me personally, I gained about 12 pounds during this time and it came out of nowhere. I didn't change my diet, I didn't change my exercise routine. I'm very active. I mean, for the most part, I like to eat. I like to think that I eat fairly well. I mean I do splurge every now and then. I love ice cream, I am a sucker for ice cream. I love cookies, but like Monday through Friday, we're pretty healthy eaters. Right Weekend is when we'll splurge a little bit, but not too much. And this weight came on and I'm like what? Like I have these rolls on my belly now that never used to be there. My body feels different.
Speaker 1:I typically am a petite person by nature, so for me it just there are parts of my body that just it doesn't feel like me so can you just explain about it and like there's almost like this shame, that kind of comes, like where we start to hide, we start to wear baggy clothes. Why, just why, explain why it happens during this time?
Speaker 2:so if we start with the why first of all, it is not your fault, it's not any of these women's fault, and I hate it when they go to their doctor and their doctor tells them eat less. No, no, that's not what's going on here. They need to understand. They're losing their estrogen and their estrogen plays a role in contributing to your body's sensitivity to insulin and the way that you metabolize your glucose. And as you lose your estrogen, you start to develop insulin resistance. And when you have a little bit of insulin resistance, you develop more inflammation and there's a whole inflammatory pathway that happens. That contributes to weight gain.
Speaker 2:But we're not just talking about weight gain. We are talking about visceral adipose tissue. We're talking about visceral fat, which means fat that accumulates right here in the middle, and that is the most stubborn and frustrating kind of adipose tissue or fat to get rid of. And I tell my patients not to focus on their weight but to focus on their waist to hip ratio, because that's where you're finding out. Is this weight gain contributing to the potential that I could be at risk for chronic disease? Because at the end of the day, that's what we care about Fitting into our pants, yes, yes, we want to fit into our pants, we want to look good, we want to feel sexy, but we also need to be thinking about what this means for our future, and that is preventing chronic disease. So this weight that we're getting, it's not just this benign starve yourself and get back down to size.
Speaker 2:No, it means much more, and so there are a few things that I recommend for my patients during this time, and one thing is you know that the first focus should be increasing your protein intake, and the recommendations are 30 grams with each meal, which, when you try to do it, it's a very high amount, especially if you are a vegetarian, and I do find myself relying on protein powders to meet that number, on protein powders to meet that number. The second thing, and what I think is critical, is lifting weights. Lifting heavy weights, just getting into it, suck it up and do it, and I know, leslie, you and I talked last time about how we don't really enjoy lifting weights, but it's really something that we need to do. So that is something else that women need to be thinking about. You need to be building up your muscle to protect against some of these metabolic changes, because that's going to help kickstart your body back into a better metabolic state state.
Speaker 2:And I also have protocols that I offer for women, with supplements that I recommend on full scripts that women can try Things like berberine, things like acromansia, one of the probiotics that's supposed to contribute to weight loss, chromium supplementation, weight loss, chromium supplementation, myoinositol. So these are some supplements that I recommend to my patients and if I can tell you what I do in my practice as well, if you're interested.
Speaker 1:Yes, no, give us all the details, dr. Sarah.
Speaker 2:I am in favor of metformin and so I prescribe metformin frequently to my patients who are trying to lose those last 10 stubborn pounds, and they're just not going anywhere. There's been quite a bit of research in the benefits of metformin, not only for glycemic or blood glucose control. They do use it for women with polycystic ovarian syndrome, but they also use it for longevity, and metformin helps play a role in anti-inflammatory processes in the body. When you look at the studies, on average women who take metformin lose about eight pounds. What I see in practice is much more. What I have experienced personally is also much more.
Speaker 2:But everybody's different and metformin is a medication that is not without side effects, especially GI side effects, so not everybody can take it. But that is something that I use in my practice, and I'm not a huge fan of the GLP-1s. Yes, they will help you lose weight. They can also help you lose muscle. They're doing the studies and they're arguing that they don't cause or contribute to sarcopenia, but the margin of error that they're using is not acceptable in my mind. So I am really not comfortable with the GLP-1s, but I do recognize that there is a place for them and many women benefit from them.
Speaker 1:Now, dr Sarah, okay, the GLP-1s that's like is that like the Ozempic and stuff like that? Okay, gotcha, okay, now, touching upon that you were talking about, like how it kind of loses like your muscle mass and stuff like that. And I want to go back. You touched upon the strength training because I know that this is crucial for us, and can you just explain why you kind of touched upon it's important for us to have the muscle mass, but helping us strengthen now, like, what are we saving ourself from in the future? Basically, why is it so important? Because I know that estrogen it can cause like osteoporosis or the lack of estrogen can cause like osteoporosis and stuff. Can you just touch upon a little bit on that?
Speaker 2:So you're preventing osteoporosis, which means you're preventing fractures in the future and having a major bone fracture such as a hip fracture, a humeral fracture. Those are very significant indicators for shortened lifespan. So that's a high mortality rate following a hip fracture for women. So by strengthening you're literally prolonging your life.
Speaker 1:Yes, and you know, as I'm learning all of this, dr Sarah, I'm looking at the family dynamics also. So I'm looking at my grandmothers, my aunts. I'm seeing, like my family right now, you know, my aunts are in turning in their 80s or late 70s and stuff struggling with onset osteoporosis, struggling with arthritis, a lot of bone stuff that is causing them, you know, a little frailty and some challenges in their bones. And we see many women like I don't have any personally in my family, but I know of friends or you know, other loved ones that we have seen the decline in health once they break a hip, and primarily in women. You know they take a fall, they break a hip very easily and then the health decline that goes from that where eventually some of them actually it leads to their death because they just can't, you know kind of recover from that.
Speaker 1:And it's so important. That's why, like the strength training now you know, one of the things I started doing is even just when I go on my morning walks I throw on a weighted vest. I'm trying to add that into my normal workouts. And then because, as we shared the last time, I absolutely hate like doing squats and lifting Any leg lifting is where I struggled. The.
Speaker 2:RDOs.
Speaker 1:Yes, yes, the arm lifting, I got that all day long. I'm like, okay, I can do this. But when it comes to squats, or I'm just like, and my knees like crack, like crazy, dr Sarah, like it's like I joke and say I have snack crackle and pop in my knees, like it sounds like popcorn. Like just walking down the stairs at my knees, I'm like, goodness so doing squats, like you just hear my knees. And my son and my husband are both frequent weightlifters. You know, my son was a big football player so he's all about pushing weight. So he's always like telling me like mom, you got to get in there, you know. And I'm like, but like, even just to like squat, the bar is like I'm, I'm struggling, you know. So I just want to encourage the women to do this. Do it, just do it. Yeah, just do it, yeah, just do it, even if it just starts with putting on a weighted vest and taking a walk do it.
Speaker 1:So okay, dr Sarah, I have some questions from my community that I want to get in. I have pulled them and there was tons of questions and I want to make sure that we get to that. I want to talk about what the difference between birth control and HRT is. And HRT, ladies, is hormone replacement therapy, just so we can refer to it as HRT. But can you explain the difference between the two? I had shared a little bit about my story. I was on birth control. I learned how it is that synthetic form of hormone versus, like the hormone replacement, and can you just share the difference and what each does at this phase of life for us now?
Speaker 2:So there are two main differences that I usually highlight with oral contraceptives. So oral contraceptives typically have a much higher dose of estrogen for those that are the combined estrogen and progestin. And then the other major difference that you mentioned is the progestin is a synthetic form of progesterone. It is not chemically or even bioactively progesterone, it is progestin. So that early in life, what the naturopaths will highlight for women is that when you have natural menstrual cycles, your body is building up your progesterone levels with each cycle and your progesterone is actually instrumental in building your bone strength. So that's part of the reason that naturopaths recommend that women have those natural cycles.
Speaker 2:The oral contraceptives do suppress your body's natural hormone responses and natural cycles. So when women are talking about making a transition from oral contraceptives to menopause hormone therapy another thing to consider with that higher dose of estrogen in an oral contraceptive, you're actually at greater risk for blood clots or deep venous thromboses in your lower extremities as a result of taking that oral estrogen in the oral contraceptive. With menopause hormone therapy you're doing lower doses and most frequently you're getting transdermal estrogen. So what that means is that there is less risk for blood clots and you're getting the lowest effective dose that helps control your symptoms related to perimenopause and menopause, and the progesterone that we use for women who are going through menopause and perimenopause. We use oral micronized progesterone, which is very closely related to they call it bioidentical, which is a marketing term that we don't use in medicine, but it is closely related to your body's natural progesterone and that has the benefits of our natural progesterone, which includes breaking down into a hormone that helps us sleep, which is called alpregnenolone, and then it also helps with our mood.
Speaker 2:The progestins in the oral contraceptives can actually exacerbate our moods and our irritability, and the chemical structure is more similar to testosterone. Now, I say all of this and I fully recognize some women really don't want to have any more kids, and if you're perimenopausal and you're thinking that you want to switch to menopause hormone therapy instead of taking oral contraceptives, you need to have a backup plan in mind, and sometimes having a nice talk with your husband about a vasectomy is one way to go about that. Iuds is another way to go about that, but there are very real considerations for women who are not looking to expand their families, so I don't want to push the idea of starting menopause hormone therapy on women who really have other reasons for taking oral contraceptives. But these are the considerations that I talk to my patients about.
Speaker 1:Yes and so good. Yeah, Like I'll be 46. No, how old am I? I'm 46. I'm like I'm not trying to have no kids right now. Like I can't imagine getting pregnant at 46 years old. Right, and some do, Some do. I'm not like shaming any of those women. Like I have two older kids. Like I've done it already, I'm tired, I'm done. I love this phase that my husband and I are going into, that you know my kids are older now we can leave the house with no worries. They're independent. I just I love this phase. So those are all things that I had to consider.
Speaker 1:Switching to HRT also is like, hey, how is this going to affect me during perimenopause, Not just, you know, as a contraceptive, but also what birth control was doing for me with my cycles, because it actually regulating my cycle as opposed to more so like me worrying about it being, you know, a form of birth control, so to say. So that was actually my biggest concern is. I was like okay, as I transition to HRT, what are my cycles going to look like? Like, am I going to revert back to before I took it? You know, very heavy cycles and lots of other stuff that I'm like at this point. I don't know which one's worse, like the perimenopause symptoms or that. So I kind of outweighed and figured out what would be best for me as far as stopping the birth control and then moving on to like HRT, and that's basically what I did.
Speaker 1:Now, another question that my community have was basically how does HRT work for women who have had partial or full hysterectomies? What does menopause look like for, say, a woman that you know maybe had her uterus taken out but still has her ovaries?
Speaker 2:Well, it's the same. The symptoms can be the same, but you would not be experiencing or knowing changes in your cycle. But you can still have the full range of symptoms of starting to lose your estrogen. Range of symptoms of starting to lose your estrogen. For women who have a total hysterectomy boom, they go right into menopause and that's a very difficult transition for many women. Many women don't tolerate that well and they're moving away from doing the total hysterectomies and they're recognizing that there is some benefit to having our ovaries and our natural estrogen in place even without the uterus. But the symptoms can be identical.
Speaker 2:Now, when it comes to using menopause hormone therapy in women who do not have a uterus, there's two schools of thought that I practice by here, and the first school of thought is by the menopause society teachings, which tell us that if a woman does not have her uterus, there's no reason for her to have progesterone and she only needs estrogen solely.
Speaker 2:And so typically and traditionally, women who don't have a uterus would take estrogen replacement therapy only. And that is because estrogen stimulates the uterine lining and it can stimulate having menstrual bleeding for women, and we use the progesterone to counterbalance that effect so that women who have their uterus. The progesterone counters the effect of the estrogen in the uterus. In the naturopathic world they talk about other benefits of progesterone, which includes sleep and mood. So even in my patients who have had a hysterectomy, if they are telling me that they can't sleep at night, that they're extremely irritable, that they're suffering from terrible anxiety, for those patients, I will explain to them. Look, if we go by what menopause society says, you don't technically need progesterone. But if we go according to what the biological benefits of having progesterone in your system are, let's go ahead and replace your progesterone and see if this helps with your anxiety and your mood. Now, that's the way I practice. It's not the way all physicians would practice.
Speaker 1:Now here's another question for my community, dr Sarah. Do pelvic floor issues and menopause, are they related? Yes, okay, you hang out.
Speaker 2:Yes, okay, what is pelvic floor issue? I don't even know what it is. Can you explain a little bit on that? Our bladder and our uterus and these muscles help with our really the main symptom women experience is urinary incontinence. So they'll start to notice changes with being able to control their urine, whether it's they laugh and they have a little leak, or they're noticing that when they have to go, they have to go. They have to go now. They got to run. Sometimes they don't make it in time, and those are all parts of what we call the genital urinary syndrome of menopause.
Speaker 2:And even in perimenopause, women will start to notice some irritation and dryness in the vaginal canal and that may just present as painful intercourse with their partner. And what happens is you have a lot of estrogen receptors. You have a concentration of estrogen receptors at the bottom part of your bladder and in the vaginal canal and at the opening of the urethra, and as you're losing estrogen, you're losing these protective barriers and you can also lose some of the strength in your bladder. It is a muscle after all. So for those women who are starting to notice issues with pelvic floor dysfunction and a urinary tract infection, mind you, is a sign of the genital urinary syndrome of menopause. And now they suddenly have them and their doctor tells them they're just getting older. No, they should be on vaginal estrogen therapy and it helps protect the pelvic floor and it helps protect the bladder and the vaginal canal and everything. They should start vaginal estrogen therapy.
Speaker 1:Okay, thank you for that information. I didn't know when this question was brought about from my community. I'm like what is pelvic floor issue? But it's all the like urinary pelvic struggles that you have, like your bladder control and all of that. Okay, I totally get that now, thank God, and it's not a symptom I've struggled with yet. I hope Just wait.
Speaker 2:Yeah, I know, I know Right, and I forgot to mention that there is pelvic floor physiotherapy. Just like you can, you can meet with an exercise trainer to help you build your biceps and your quads. There are physical therapists to help you build up your pelvic floor muscles.
Speaker 2:Oh wow, and they are critical. And on my website I have Kegels weights that you actually insert into the vagina to help you build up your muscles in your pelvic floor. Okay, these are not muscles that we flex and contract very often and it's really hard to actually think about those muscles. But now's the time.
Speaker 1:I never thought of weights. I didn't know that they have that. Dr Sarah, that's very interesting as you're saying it. I don't know what my face looked like because I wanted to laugh. I'm, in all honesty, I'm like what the heck they have that? I never knew of that, but it makes. It makes sense. Like that muscle controls your bladder. So I get it. It's not just about like what that muscle does for other functioning you know parts, but having control of your bladders is a real thing.
Speaker 2:It's a real thing.
Speaker 1:Yeah, women and I've seen it in people I know that struggle with that and I totally understand it. Now I get it Okay. So my next question for my community, dr Sarah, is how does, or what effect does, alcohol have on women during this time of perimenopause and menopause?
Speaker 2:So the effects of alcohol can be more pronounced during perimenopause and menopause. You're not quite able to metabolize it now, like you were, say, 20 years ago, and many women notice that their tolerance is not what it used to be and typically hangovers last a lot longer than they did when you were in your 20s. So that's something to be aware of. Alcohol does interact with your serotonin and your dopamine and your GABAergic receptors, which is really key in your happiness, and your dopamine and your GABAergic receptors, which is really key in your happiness and your mood. So alcohol can be more disruptive to your mood. It's more disruptive to your sleep.
Speaker 2:A lot of times. After women drink, initially they may fall asleep, but then typically they wake up right away, and that's why alcohol should not be used to help you sleep. In long-term use, it's going to affect your mental health and you'll also notice more weight gain now related to alcohol. So all reasons to at least cut back, if not abstain, from alcohol at this age. And alcohol is also an independent risk factor for breast cancer that women should know. Yeah.
Speaker 1:Yes, okay, thank you so much for that. So the last question that I have for you as we begin to wrap up. I know there are many women out there that you had mentioned that you know they feel like they're getting gaslit right. They go into their doctor's office, they're giving a list of symptoms and these doctors are just like oh, this is, you know, it's just welcome to the club. It happens as you age, kind of thing. I know that's at first what I had got, like oh yeah, it looks like you're in menopause, welcome to the club. Well, what does that mean? But how can women advocate for themselves? Is there specific things that they can go into their doctor prepared with? How can they walk into the doctor's office and get the support that they need? What are some questions they can ask, maybe even tests that they can request, so that they can begin to advocate for themselves?
Speaker 2:So there are two things that I would recommend in that scenario.
Speaker 2:The first one is having a symptom tracker, and I can share that with you, to share with your community, and it has a list of symptoms that women may experience in perimenopause.
Speaker 2:The list is massive, it's huge, and if we track those symptoms along with cycles, we can start to piece together that there's a rhythm happening here with these symptoms, both for your knowledge and for your doctor's knowledge. In addition, there is a scale that we use to determine if a woman could be perimenopausal. We call that a green climacteric scale, is the name of it, and I do have a quiz that is based on the green climacteric scale. It's not exact, but it's based on that scale and it gives you a number rating for what's the likelihood that you are experiencing perimenopause, and so the scale can be found online, and I'll also share the link to my quiz so that if your women, if your patients sorry patients if your followers would like to have a number, they can take that quiz and they can get a number Now, will their physician take that information and listen to it? I hope so. I hope so. If you've got a clinically validated number to show them. I would think that they would take things a little more seriously instead of just blowing it off.
Speaker 1:Yes, oh, that's so good, and I think the most important thing is just gaining knowledge and wisdom on it so that you know, I know, for me that was the biggest thing once I started like seeing these changes and I'm like wait a minute, am I kind of in that phase? And for me I really thought that a red flag would be when my cycle would start like changing a little bit. You know.
Speaker 1:Well and my cycle was still consistent, like every month, same time every month. I never had a inflectuation of my cycle. And then I started learning about symptoms and just started piecing it together and then completely went down a rabbit hole of all of this like learning about it.
Speaker 1:And I'm like good Lord, I'm in full on perimenopause, like everything started to make sense and that's when this last year compared to last year's well women's visit with my OBG to this year I went in with a list that I had and telling her you know, doctor, this is what I'm experiencing and this is what I want. I did my research on HRT and I learned, I think this is going to be the best option for me. So well, dr Sarah, I want to value your time. You've already re-recording this. I just want to say thank you so much, but I have a couple of just like fun wrap-up questions and then I want people to be able to connect with you, but just first share with us something that brings Dr Sarah joy.
Speaker 2:Being with my kids. I mean honestly.
Speaker 1:And you have, okay, remind me how old your kids are A 15-year-old and a 13-year-old, so you're in the thick of the teen years. Yes, and that, and, like men, perimenopause those are challenges in itself, right there. And then, what book would you recommend for the listeners during this season of their life? You had mentioned that one by Lisa Moscone.
Speaker 2:Yeah.
Speaker 1:Any other book also, that would be great.
Speaker 2:Mary Claire Haver's books are excellent they really are so I would also recommend hers. Really are, so I would also recommend hers. Tamsyn Fadel just came out with another one, and there's so many great I guess I know them by their authors right now.
Speaker 1:So I know exactly what books you're? Trying the new menopause is Dr Mary Claire. Actually, I literally have it right here. I listen to it on audio and then I'm like I need this. This needs to be a reference book that I can go to. So I winded up buying the actual physical book also. And then Tamsyn's book. I heard of her. I know her book just recently came out, so those are great. And then, lastly, Dr Bonsa, how can our listeners connect with you and learn more about what you offer?
Speaker 2:Sure, my website is wwwbonsahealthcom and on the site I have programs available.
Speaker 2:The one that we are promoting right now is called the Vitality Code Program, and this is a comprehensive wellness program for women who are entering the perimenopause and menopause phase, and what we do is they do a consultation with me.
Speaker 2:They can do a consultation with a naturopath doctor who I collaborate with. We also have 12 weeks of wellness coaching that women go through to help them adjust their mind and get in the right mindset of making healthy changes and adopting healthy habits into their life, and then we also have an exercise physiologist who can help women figure out what the best way for them to start implementing weights into their life. Sometimes you need to work with a trainer, sometimes it's a matter of setting up a home gym, and I have a consultant who helps with my patients and she sees them and figures out what they need. It's a one-year-long program that we have. Women are able to text me at any time, any questions, and we have activity tracking, nutrition tracking, journaling and recipes for women, and it's a community that we have available to anybody who joins. Oh, wow, that sounds amazing available to anybody who joins.
Speaker 1:Oh wow, that sounds amazing and that's just to be clear. That's available for any, anybody outside of Ohio. I know you had mentioned you practice specifically in Ohio, but that is available for any of my listeners right now. You guys can hop on that and we're going to put the links for the tracker. And what was the other thing that you were going to? You sent me Dr Bonza.
Speaker 2:The quiz the green Climax hair scale.
Speaker 1:Yep, yes. So those links are all going to be in the show notes. And make sure that you guys go and follow her on Soch, because her Soch is amazing. So again, thank you, dr Bonza and ladies, I hope this episode just leaves you feeling inspired and informed. This phase of life, it's no joke. It's important for you to learn, to gain knowledge and to be your own advocate. Perimenopause and menopause does not have to be scary. It can be a powerful invitation for you to care for your body in just a new way. So if this conversation resonated with you, send it to a friend, send it to another girlfriend that you know that this will help. But, most importantly, give yourself grace during this season. It's a rough transition in our lives right now and grace will go a long way. So thank you again, dr Bonza, and to all the ladies out there, continue to chase joy.