Could your hormones be causing your dry eyes? Hormonal changes during perimenopause and menopause affect far more than hot flashes. They can impact your vision, eye comfort, sleep, mood, brain health, muscle mass, and overall quality of life. In this episode, Dr. Joseph Allen sits down with menopause specialist Dr. Jen Zelovitzky to explain how declining estrogen affects the eyes and why so many women develop dry eye symptoms after 40.

Together, they explore the science behind hormone changes, why dry eye becomes more common during perimenopause and menopause, the role of hormone replacement therapy (HRT), and the myths that continue to surround menopause care. Dr. Zelovitzky also shares her own experience with severe dry eye, how hormone therapy transformed her symptoms, and practical lifestyle strategies every woman should know.

What You'll Learn

✅ Why women are significantly more likely to develop dry eye during perimenopause and menopause

✅ The connection between estrogen, hormone changes, brain health, sleep, and vision

✅ The truth about hormone replacement therapy (HRT), breast cancer, and the Women's Health Initiative

✅ Simple lifestyle habits that support healthier hormones, healthier eyes, and better aging

Visit https://www.doctoreyehealth.com for trusted eye health resources, educational articles, and more information from Dr. Joseph Allen.

Timestamps

• 00:00 The Truth About Menopause, Dry Eye & Hormone Replacement Therapy
• 02:46 Can Hormone Therapy Improve Dry Eyes?
• 07:13 Understanding Perimenopause vs. Menopause
• 17:09 The 100+ Symptoms of Perimenopause
• 24:35 How Hormones Affect Nearly Every Organ
• 33:53 Why Women Gain Weight and Lose Muscle
• 41:49 Dr. Jen's Personal Dry Eye Story
• 50:04 Hormone Replacement Therapy Explained
• 58:18 The Truth About the Women's Health Initiative
• 01:06:21 Three Lifestyle Habits That Make the Biggest Difference

Key Takeaways

🔷 Hormonal changes during perimenopause and menopause are a major contributor to dry eye disease in women.

🔷 Hormone replacement therapy is safe for many women when appropriately prescribed, and much of the fear surrounding HRT stems from misunderstood research.

🔷 Sleep, resistance training, cardiovascular exercise, and whole-food nutrition play an important role in reducing menopause symptoms and supporting long-term health.

🔷 Dry eyes may be one of the earliest signs of hormonal change, making collaboration between eye care providers and menopause specialists especially valuable.

Continue Learning About Eye Health

Looking for more expert advice on dry eyes, eye health, vision care, and protecting your eyesight? Explore these trusted resources from Dr. Eye Health:

👁️ Dry Eye Disease: Causes, Symptoms & Treatment (Playlist)

https://www.youtube.com/playlist?list=PLzi60fSuOmPA3e0UObvyI-Rp9RIIWeQxb

💧 The #1 Best Natural Dry Eyes Treatment

https://youtu.be/4vAY4yA-OOk?si=P-_Uywbf7WdL8clD

✨ The Dangers of Eye Floaters: When to Worry

https://youtu.be/I9k3wLJafI0?si=M8yAk41aIP6c8WEg

🥕 Foods That Support Healthy Vision (Playlist)

https://www.youtube.com/playlist?list=PLzi60fSuOmPDbljRgRJ5Pjkh21vqKMw57

Guest Bio

Dr. Jennifer Zelovitzky is a Certified Menopause Provider and the Clinical Director of Women’s Health and Vitality at Medcan. She earned her M.D. from McMaster University and completed her residency in Family Medicine at Sunnybrook Health Sciences Centre. She has held staff positions at the Immigrant Women’s Health Centre in Toronto and at Sunnybrook, where she co-founded a survivorship clinic for young gynaecology-oncology patients. She is passionate about helping women thrive through the midlife transition and beyond. Dr. Zelovitzky lives in Toronto, Canada with her husband, 2 daughters and 3 fur babies.

Follow Dr. Jen Zelovitzky

Instagram: https://www.instagram.com/drjenzelo/

YouTube: @dr.jenzelow

Website: https://www.drjenzelo.ca/

Resources & Links

• Website: Doctor Eye Health https://www.doctoreyehealth.com/
• YouTube: Doctor Eye Health https://www.youtube.com/@DoctorEyeHealth
• Instagram: @doctoreyehealth https://www.instagram.com/doctoreyehealth
• TikTok: Doctor Eye Health https://www.tiktok.com/@doctoreyehealth
• Facebook: Doctor Eye Health https://www.facebook.com/DoctorEyeHealth
• LinkedIn: Dr. Joseph Allen https://www.linkedin.com/

👁️Disclaimer: This video is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified eye care professional or physician regarding any vision or health concerns.

perimenopause, perimenopause symptoms, perimenopause brain fog, perimenopause weight gain, menopause symptoms, hormone replacement therapy, HRT, menopause, estrogen, progesterone, brain fog, hot flashes, dry eyes, hormone health, women's health, healthy aging, Dr Jen Zelovitzky, Doctor Eye Health, Dr Joseph Allen

hormones are powerful, yet for many of us, they remain a mystery. So in today's episode of the Doctor of Health podcast, we get to learn from Dr. Jen Zelowitsky, who is a perimenopause and menopause specialist from Toronto, Canada. In today's episode, she helps us break down not only how hormones change throughout life, but affect our health, our mood, our weight, our sleep, and yes, even our eyes.

For example, worsening dry eye symptoms are actually quite common during menopause and perimenopause. This is in fact a very exciting episode for me because while I learned about the basics of hormones during my professional education, it's not my specialty. So this is an episode I feel we all really get to learn together. Before we get into it, do us a favor and show some love for the podcast by not only liking, but subscribing to the podcast here on YouTube or follow us on any of your favorite podcasting platforms. Now, I do want to just give one extra special thanks to Dr. Jen Zelowitsky for joining us today and sharing so much of her knowledge and expertise. But if you do want to follow her on social media, as I do over on places like Instagram, her handle is Dr. Jen Zelow. Now, from here, I do want to call out that this podcast is, of course, available for audio if you just want to listen in over on all your podcasting platforms. But if you do want to join the conversation, something that I love about YouTube is they do have a comment section. And in that comment section, I love when people not only share their key takeaways from the episodes and discussions, but also share their personal story. So I encourage you if you have a story or something that happened to you or a family member, a friend, where their hormones changed in their life or they changed maybe a lifestyle factor or even took a medication that made some a transformative change in their life, share that story. Because not only is it something that I actively try to read as many comments as I can, but I know other people do and reading your story might help change or motivate or help somebody else in some way. And I just love encouraging that. And I look forward to reading your comments in that comment section. But from here, let me just say thank you so much for joining us today. Keep an eye on it and we'll see you in that next episode. Before we get into it, do us a favor and show some love for the podcast by not only liking but subscribing to the podcast here on YouTube or follow us on any of your favorite podcasting platforms. So can you just share your clinical experience treating women with hormone replacement therapy and kind of the response they've had with dry eyes specifically?

Yeah, it's funny. So, you know, the data doesn't, it seems to be mixed.

But in my clinical experience, I'd say the overwhelming majority of women have found their dry eye has gotten better with hormone replacement. It makes sense to me that it would, after all, if the perimenopause was the driver of it, and if we get enough penetrance to the eye, and that seems to be really the one question mark is how much penetrance to the skin, to the eyes, are we going to get? But when it does get there, women find that their symptoms are tremendously improved.

Mm.

I know that, again, the data is mixed, but again, there's so many variables in the research, right, to think, you know, how old somebody was, dry eye in itself is so multifactorial, it's hard to really know, but I appreciate getting that feedback because, again, a lot of my patients, usually women get dry eye 20 years before most men do on average, and a huge variable in that is the hormone changes as we get older.

Absolutely, you know, and I think menopause care is one of those areas where you do have to lean into clinical experience because there's a paucity of data to be really frustrating to hold women back from trying a treatment based on absence of data when women were left out of clinical trials until the 90s. That's bad enough.

And then, well, nobody researches menopause. So we can't do anything about it because nobody's researching it.

And it's like, well, again, it's do no harm. What harm is a trial to see if it makes somebody feel better?

That's even one of the major motivations when I started posting online was just because I only had so much time in an exam with a patient. And a lot of times it's not just, oh, they need glasses. It's like, no, you've got diabetes and you've got cataracts and you've got this thing called glaucoma. And that patient has this history of not showing up and not taking their medications. And so I'm like, you know, maybe if I had the time to give them like a 20 minute lecture on how we test for this and what this all means and why it's so important to take the medication, then maybe their chance of following through or coming back for their follow-up would be improved.

That's kind of one of the reasons I even started investing so much time and effort to make content.

That's why I did it, too. It's because you took the words out of my mouth.

I literally said my motto is everything your doctor wants you to know, but doesn't have time to tell you. That was literally the pitch for my podcast that I did. You know, it's no longer doing, but my previous life I did a podcast. So, yeah, I'm going to.

start quoting you for that whenever I use that same thing. Right. It sums it up. Do you say Zellowitsky? Is that right? Yeah.

Yes, that's perfect. Thank you.

I had, I mean, it's spelled pretty phonetically, but I had to kind of like- Yeah, but you'd be shocked here at all. Kind of how I want to tee it off.

I did send some kind of lightning round to and false questions just to kind of get people's buzz and interest into the conversation. And I really wanted to have this conversation because as, you know, in my specialty, I, everybody kind of has to learn at least regular human biology and maybe high school. And then you touch on it maybe in human physic in like physiology, either in college or undergrad or the beginning first years of any med school program. And how much of the eyes do we have to think about like women's health? But surprisingly, not surprisingly, I should say, I see a lot of people, a lot of women, specifically for dry eye. And they're usually in that kind of 45 to like 65 age range. And there is quite a bit of discussion around aging and hormone changes during that time period. So I thought, you know what? I need to know more about this. And I know a lot of people are probably having questions about menopause and perimenopause. And all these questions are like, what is going on? So I figured this is a great bridge. Let's bring on someone like yourself who's an expert in this and let's demystify and better understand what's going on.

I absolutely love that. Let's do it.

enough again for your time here. So let's just jump in. Okay. First, kind of lightning lightning questions for you. True or false or fact or fiction. So hot flashes only happen at night.

In fact, most women notice they start at night first before they start happening during the day. Unfortunately, it's day or night.

Okay. Well, that's good. It's good to know. I think I've historically heard like, oh, they happen at nighttime. They wake them up. But that's good. How about perimenopause can start in your thirties?

So, the age range for menopause, that final period, is 45 to 55. Symptoms can start up to 10 years before that. So, I have met many women who started having symptoms in their mid to late 30s.

And that's, I mean, that's where I'm at right now. So all my friends that I grew up with and I'm still friends with, we still chat, like they're at that spot too.

So it's good to just, you can keep that in mind. It's not all in their head.

Yeah, it's possible.

Estrogen protects your brain.

Okay. This depends. This isn't it depends.

If it's our, if it's our endogenous estrogen, then it's a fact. Okay. Because risk of dementia goes up after menopause. Unfortunately, if it's hormone replacement estrogen, there's no clear evidence that it reduces the risk of dementia.

Okay, that's

is what estrogen we're talking about.

I appreciate that nuance because, yeah, endogenous estrogen that we make on our own has this cascade of effects that seems to be protective, but when we get it outside, maybe, I don't know, pill, cream, patch, it just doesn't seem to have that effect.

Not yet, not the evidence to date, but we know the evidence is a little bit lacking, so things could change.

something's more complex there. Yeah. How about menopause causes dry eye? That's

Two thirds of women in the menopause transition develop dry eye and it tends to be more severe post menopause. And that was one of my earliest and most severe symptoms.

So we can talk about that as well.

Yeah. Let's dive into your personal story actually at some point. I think that'd be fascinating just to hear. Sure. Because I think a lot of my patients and a lot of our viewers and listeners will probably get a lot hearing from somebody else going through that.

How about muscle loss? I've read and heard a little bit about muscle loss and weight gain changes, but just as a formal question, is losing muscle inevitable after the age of 50?

No, no, it's that's that's fiction. Okay, good. Lots we can do. Lots we can do.

And then going back to hormone replacement there because that's a big thing is HRT. Does it cause breast cancer?

As a blanket statement, that's fiction.

Okay.

That's fiction.

Yeah, but there's there sounds like there's some nuance maybe we'll touch in.

There's nuance. We can get into the nuance of the maybe, maybe small chance of certain hormones might contribute, but in a general sense, fiction.

and then diet can significantly impact hormonal symptoms.

connection.

Hmm. Does it play a role at all?

Yes, it can, but it's not a significant role and it's not necessarily in the way people think.

It's good to hear that.

to that a little bit too.

I know I was listening in on another lecture and they commented briefly about some foods like alcohol, spice, and then just other lifestyle things like smoking, but they didn't dive into too much details.

if we're counting alcohol as a food and nutrition, then that's a fact. I just don't look at it as a food group. So it's a defense. I mean, it's-

I mean, yeah, it's probably not but it kind of falls into some some people's sure yeah so just just broadly because there's so much going on here starting at ground level for all of our listeners who maybe don't remember again what they took as an education class in high school or biology can you walk us through like the hormone changes women go through from age 30 to age like 60 like there's menopause which I've heard of but now there's perimenopause and correct me if I'm wrong there is a post menopause

Yes. And there's pre-menopause, right? So I think when you're talking about your 20s and 30s, we're talking about the pre-menopausal era. So this is the height of our reproductive life. And what the hormones typically look like during that time of our life is a nice, predictable pattern. If you can think of a waveform, right? That every month, the hormones from the pituitary gland and our brain and our ovaries, which are communicating with each other, they work in tandem, they're tightly coordinated. And this produces the predictable periods with symptoms every month.

Perimenopause is the time where that communication is starting to break down between the brain and the ovaries. It's not as well coordinated. And if you were to picture the waveform in that phase of life, picture a roller coaster. That clear, predictable monthly pattern is lost and it becomes a bit of an unpredictable free for all.

And this is why labs are not ever going to be able to diagnose or predict or help you manage perimenopause. And then menopause is actually a point in time. So menopause is the time at which, if you've gone through a natural menopause, you've gone a full year without a period. If you've had a surgical menopause, which is truly removal of the ovaries or say the ovaries have ceased to function because of chemotherapy or radiation or some other treatment, that's instantaneous. And right in that moment, you've reached menopause. And then we have the post-menopause. And at this point, about one to two years after that final period, imagine a flat line. The hormonal levels are completely flattened out because there's no longer that communication between the brain and the ovaries. So everything stays nice and level. The ovarian hormones, so we're talking estrogen, progesterone, very low. The pituitary hormones, so FSH and LH, very high, but they stay there.

So again, just to kind of sum up, especially in the pairing minor pause, that's when you're in that roller coaster.

Exactly.

And then when menopause clicks in at that point, is it more of a free for all but hasn't reached zero?

Oh, no, it's generally trending down. So amid the chaos of perimenopause, the general trend is that estrogen and progesterone are falling and follicle stimulating hormone and luteinizing hormone are rising, but it can take like a decade for that to happen. So it's just a chaos, but a general trend in that direction.

I recall some of these hormones. I remember learning them at one time.

I, if you learned about this, you learned more than I did. I don't think we even learned about this in medical school. So it's, it's not taught, which is why women are just not aware of what's happening in their own body.

Right. You know, and I think the next big kind of question to help kind of bridge this gap, because you said like doing even lab testing doesn't really give us consistency enough to even make a diagnosis.

It sounds like no. So so we probably have to go off of like clinical signs and symptoms, right?

Exactly. So the labs tell me, sorry, the labs just tell somebody what's floating around in your blood at that particular moment in time. We don't have a lab test that tells us what the estrogen receptors are doing. What is the body doing to react to the changes in the levels? If we had that test, that would be a game changer, but sadly we don't.

So you're right. It's a clinical diagnosis.

But that helps me understand a little bit. I'm a very visual person. So as soon as he said the receptors, we don't know what's changing there because especially with things like neurotransmitters and how those, you know, if you have too much neurotransmitter, then your body tends to diminish the amount of receptors you have. So this kind of changes my understanding. So I appreciate you kind of breaking down that point.

So yeah, the symptoms, what kind of symptoms? Because the only one I am most familiar with is like hot flashes. Because I remember my mother telling me, Joey, I'm getting hot flashes. And I was like, okay. But like, yeah, can you fill us a little bit more on the varying type of symptoms that somebody would get in the kind of the pre-menopause, perimenopause and forward?

Sure. How much time do you have? I mean, there are now over 100 validated symptoms of perimenopause. So it gets really interesting.

So yes, the classic is the night sweats, the hot flashes changes in your periods. So they don't necessarily have to change in terms of when you get them. But they can change in terms of how heavy they are, how long they last, how, how symptomatic you are before your period. So mood changes, and sleep disturbance can often be the first symptoms that women start to notice. And this can start to creep in, in the early perimenopause. So when you talk about premenopause, so again, when we're going way back to early reproductive life, and everything's humming along, women might notice that for half of the month, they feel very energetic, they feel like they're normal self, they're happy, they're functioning. And this that second half of a month after ovulation, a bit of moodiness might creep in a bit of bloating, sleeplessness. If you can imagine perimenopause is a time where you're starting to spend more and more of each month in that PMS state. And then menopause for some women can feel like living perpetually in the PMS state. It's a simplification of it, but it is at least from a sort of a metabolic perspective, often what is happening and what women are experiencing.

And I know, even just kind of hearing that there's sleep disturbances. I'm like, Oh, great.

So everything's gets, everything else in life is going to be like compounded. Right. Exactly. We talk about sleep quite a bit with the other professionals and all sorts of spaces, because it seems like if you get a few hours, reduced night of sleep a week like that, it's going to affect your levels of fatigue, your, your, your, uh, alertness, your potentially other, your immune system. There's so many things that are affected by that.

Absolutely. And then we touched on some of the lesser known symptoms like dry eyes, hair loss, dry skin, itchiness, irritability.

Women often feel angry all the time or that they're out of proportion in their reactions to things, brain fog, profound fatigue. And then there's vaginal and urinary symptoms. Women often start to experience discomfort with sex, loss of libido. There's bone density changes that are silent, but they can be happening long before we're aware of them or whatever be tested for them. So it's just a very, it's a whole body experience. It's a very complex phenomenon, perimenopause.

does it tend to come on all at once or is there like kind of a few symptoms that tend to occur first or people are just kind of first become aware of?

It's so highly individualized. In my experience, I do find the sleep deprivation or the sleep disruption. So women often fall asleep easily. They're exhausted.

They're waking up multiple times a night, whether that's from night sweats or just from being alerted and they can't fall back asleep. Irritability, anxiety, those are often early symptoms. And there's a symptom which we refer to as I just don't feel like myself. And it's that you can't put your finger on it. You just don't, you've lost your mojo. And it can be a very hard one to quantify. There's no diagnostic test for it. But when a woman says that to me, it really resonates because that is a validated symptom of perimenopause.

So, you said like when women go to you and for your consult and services, like do a lot of women reach out or do you think a lot of women just sort of are like, oh, I must be at that stage of life or is there, I'm not sure if, do people seek out care because should they be? If women are going through these symptoms, should they mention it?

Absolutely. And it's increasingly so because, you know, as you've observed, it's all over social media. Ever since, you know, about 2022, when it was put out into the media that sort of everything we thought we knew about hormone therapy was wrong, women started becoming curious about this again. More, more wonderful people jumped online and started educating women about this. I started learning more about it about five years ago, when I began practicing menopause care. And I was shocked at how little I knew, because we had been taught nothing. The little that we had heard was all based on a headline and not on actual data, which was quite shocking to realize as as a resident as a as a practicing doctor, that everything I'd learned as a resident was was incorrect. And so women, for the last 20 years, have had nowhere to turn except maybe more of the naturopathic, not that there's anything wrong with that, but they they were turning to sort of compounded options and things that might not be as tightly regulated, or might be out of pocket. Whereas now they're they're seeking out evidence based care, they're seeking out regulated options for hormone therapy. And I think that's a really beautiful thing.

So yes, I think I've seen it myself and even in the last five years, when I would meet with women five years ago, they'd start by saying, I really don't want hormone. I need to manage these symptoms. But I don't want hormones. I'm too scared of them. And now I find women are coming saying, give me all the hormones. Like, give me all the hormones. I want all the hormones I have been reading. And I know it's safe. The problem is I feel like it's reaching all of the women, but none of the doctors, you know, it's frustrating. So women are still not getting access to care.

Well, that's even again, one of the reasons I wanted to have you on is because even as somebody, I'm not going to prescribe probably hormone therapy, but if I have a patient, I should be aware of what's going on in their body and what could be affecting them. So I can educate my patient because they may not know what's going on or even how to get in contact with a specialist like yourself. So I can at least bring it up and be like, OK, well, let me get in contact with your family doctor. Let's see if we can get you at least speaking with somebody that specializes in menopause. So yeah, thank you for mentioning that.

I do have some questions specifically about hormone replacement therapy, kind of what you said about the headline and where it used to be. And now things are different. I definitely want to double click on that. But even before we start talking specifically about estrogen and HRT, because there's so many different symptoms, right, it's like it seems like almost every organ system is affected. It kind of goes back to just how powerful these hormones are. Right. They must have receptors in every part of the body, right?

It's true. There are receptors in almost every part of a woman's body. For estrogen, progesterone, androgens, estrogen, I always see that as the main character. That's often the driver for most of the symptoms, so that is a very important hormone to address first and foremost.

I think thinking of them as powerful, they're very powerful in their ability to calm those receptors down, but you'd be shocked at how low the doses are relative to what the ovaries were producing. We can use very low, safe doses that effectively keep a woman within menopausal range for her blood work or slightly above it, but make a profound difference in how she's feeling, and this is what's so beautiful about it.

So, again, I'm still trying to picture, like, what is all going on? Because it's like this symphony of many things happening, right?

Even though symphonies are usually beautiful, you can still appreciate the complexities of the human body. So even just thinking about hot flashes, is that occurring because of blood vessel dilation changes in the skin, or is that due to some changes in autonomic regulations?

both of those things. And if I can kind of explain, I get to explain it as in a, in a way that maybe we'll people will relate to. But if you think about our thermoregulatory center in our brain, think of it as the brain's thermostat, it has a tolerance window. So you know, it's everybody knows when you're working out at the point at which you're going to start sweating. Or if you're out on a hot day, you might feel fine. If you're outside and it's 15 degrees, you feel great. If it's 25 degrees, that that same walk down the block might make you start sweating. That's our that's our tolerance window.

estrogen plays a really key role in that tolerance window for women. So when estrogen becomes chaotic, but overall is declining in the perimenopause transition, what that does, it narrows our tolerance window in our thermostat. So that same so now maybe you're okay if it's 15 degrees. If it's 18 degrees, you're going to start sweating. So in other words, smaller temperature changes, set your brain off as though a large temperature change has happened. And then that starts the the nervous system gets going, the blood vessels start inappropriately constricting and dilating because your body's trying to cool you off. So whether you actually sweat or not, once the body feels it's cooled you off enough, the hot flash will be over. So it lasts about one to five minutes on average, it typically affects more the upper body, although I've seen it affect all parts of the body. And it's a very uncomfortable sensation. Some women don't sweat that they might describe it as a burning sensation in their skin, or, or just an overall discomfort. And of course, because of the autonomic symptoms, many women will develop palpitations, anxiety, as a result of the hot flash. So it's a very it is complex, it can feel slightly different for for women, you don't have to sweat. And this is where I think women will sometimes not recognize what's happening. Because like, well, not sweating, I'm not ripping my clothes off or throwing the sheets off. But it can still be the same disruption in the brain and the body that's happening.

Yeah, and I think I'm just thinking about how this affects so many different systems and certainly even neurologically, I know online I've read like I was, I don't know if you surf on Reddit at all, but I've seen people talk about things like brain fog and memory challenges.

And do you think that, again, is this kind of going back to this possible the brain is like having receptor changes or what might be going on?

So it was relatively recently discovered by fabulous neuroscientist Lisa Moscone, who's in New York. She actually did the first functional MRIs of women going through the menopause transition. And to everybody's surprise, actually, she saw that as women, as their estrogen levels declined, they developed, there was an upregulation of the estrogen receptors in the brain. So it's like the brain is just trying to extract every last drop of estrogen. It's so essential to our neurological functioning.

Brain fog is a multi-faceted symptom. So the underlying change is that there is a change in the synaptic connections in the brain. So when you're through puberty, your brain is wiring itself from motherhood. Whether you choose to have children or not, that is what reproductive life is intended for. So it's upregulating your executive functioning skills. It's creating a heightened sense of smell. It's like mothers know this, you have eyes in the back of your head, you wake up to every little noise, you're just firing on all cylinders, your processing speed is rapid. There's a natural reversal of that that happens as you go through the menopause transition. There's a slowing down of the processing speed. This can feel incredibly alarming to women. And it's sort of a relative thing. We were at a higher level of function, and now we're kind of meeting our husbands where they're at. But women go from being the superstar planners of the family to like, why did I walk into this room? What's that word again? And it's alarming. The good news is studies show that that does get better with time once you're through the menopause transition. The problem is this is exacerbated by again, sleep deprivation. It can be exacerbated by the chaos of the estrogen levels in perimenopause. The receptors don't know, sometimes they're getting enough estrogen, sometimes they're not. But often I find when we get to the root of the sleep problems, when women are sleeping better, the brain fog gets better. When they go through menopause and they get to the end of it, their brain fog gets better. But it's a very alarming symptom.

And I know why women are concerned about it. And a lot of women come to me very fearful that they are in the early stages of dementia.

Which is scary, right?

scary.

And oftentimes at that same time in life, you know, somebody's in their 40s, maybe even in their 50s. Well, if they're taking care or watching their parents who are still with us, they're closer to probably in their 70s or older, and they may be in fact, seeing signs of dementia in their own parents. So yeah,

And then, you know, women are backing out from the workforce, a lot of women, they lose their confidence. It's terrifying to get up and have to give a presentation at work or have a meeting with executives and you've worked so hard to be in that moment in your career.

And then you lose a word and or lose your confidence. It's a really scary feeling for a woman to go through that.

Yeah, well, hopefully, you know, they're at least hearing this maybe even now and being like, okay, I'm not the only one going through this and certainly there's specialists who know more of what's going on. I know another thing that even my own mother commented on as, because my mother, hopefully she's okay with me sharing some of this. She was always very, she was more, she was motivated to exercise, to go running. She would love running. And it was probably a good, I think a good lesson for me as a young lad listening or seeing my mother say like, nope, I'm going to go for a run or she'd be physically active. And she always cared about exercising and taking care of herself.

But I know as she started to go through her first menopause symptoms, she mentioned, you know, difficulties with either, you know, managing weight or, you know, body changes there. What's going on with muscle and weight changes during that time? Because I know that can be a real challenge.

Oh, this is one of the most common questions and the most frustrating aspects of going through this time for women. So what's happening is we're actually starting to lose muscle at around age 35. And you know, at 35, you're not thinking about your muscle mass. And especially as women, most of us were running. We weren't lifting weights. You go to the gym and, you know, in high school or university, and what do you see? All the boys are on the weight machines. All the girls are on the treadmill. There's just this mentality that you need to run or do cardio to lose weight. And meanwhile, silently starting in our mid thirties, our muscle mass is declining and that matter has to go somewhere.

It converts to visceral fat. Now in women, the theory at least is there's a, there's this kind of push towards visceral fat because visceral fat cells are able to manufacture a little bit of estrogen. So when they look at studies, older women who are overweight or obese have fewer hot flashes than thin women. And so it's not the best way to get your estrogen, but that's at least the working theory as to why women seem to accumulate more visceral fat, especially in that midsection, than men do at an earlier age. So we really have to start thinking about maintaining our muscle mass. But then when you, again, layer on, lack of sleep, aches and pains, inflammation, which by the way visceral fat leads to more inflammation, it's pro-inflammatory, drives up insulin resistance, you feel even worse, you're exhausted, so you move less, you choose different foods. There's a study that shows women will eat on average about 130 extra calories a day when they're sleep deprived and it's probably not healthy calories. You're looking for quick hits of carbs and glucose because we all know how it feels to be exhausted and starving, you're gonna grab that slice of bread or whatever it is that's gonna give a quick hit to the brain. So it just, and then the less you move, the less you wanna move and the more pain you're in and it just, it becomes this snowball effect. So I do agree, I think it's awesome when moms set that example, like I work out, I try to move my body every single day. My girls who are now in their 20s, sometimes they'd come in as teenagers and say, mom, I wanna talk to you, I wanna hang out, like, why are you working out right now? And I'd say, well, I'm working out now for half an hour so that you don't have to carry me around when I'm 70 and you don't have to worry about visiting me in a nursing home. And I do think it's not that you wanna be abandoning your children. I just think it's good to set that example that you need to invest at least a little bit of time in your busy week to think about your future self, protect and preserve that muscle mass. It's the only way to keep it.

And so that sounds like doing a little bit more like either weight training or resistant resistance training is resistant.

Just since body weight is great too, you do not have to lift heavy. A lot of women are more prone to injury, right?

So there's a big social media push about lift heavy. Okay, that's great. If you want to look like a bodybuilder, lift heavy. If you enjoy lifting heavy, lift heavy, but anything that gets your muscles to that point of breakdown of fatigue works just as well. You just want to be doing it. If you're doing it, you're way ahead of 90% of the population.

Out of curiosity, it's kind of a sidebar comment, but have you ever done bar before? Like, my girlfriend, she won, I think about a year ago, she's like, I'm gonna do a bar. And I'm like, what's that? And so I'm like, well, I like a challenge. Let me try this. And I'm like, okay, it's like, it's basically exercise ballet. It is. And it was, still is, one of the hardest things I have ever done in my life in terms of like exercise. It's amazing. I can't finish a lot of the stuff when they're like, we're gonna do this. You're gonna do it like 15 times. Now you're gonna hold. And now you're gonna do it again. And I'm like, I have to take breaks every few sets.

And so it tells me one, my, like, especially my hips and my muscles there, my stability, small muscles that maintain my stability. I'm like, I need to work on these things. So, and that's like, you're not using heavy weights. Like if anything, you're gonna use one or two pound weights. It's all body weight.

don't look like that by accident. They are strong. And I think for any of the men.

who are listening in and Jean-Claude Van Damme, right, he's one of the more famous recognizable like martial arts faces from like the 80s. He was famous for doing a lot of like ballet to improve his martial arts performance and his acting.

So and he was said, I think quoted for saying basically the same thing. It's like one of the hardest exercises you can do. So well, good.

I do it once a week, so now you've mainly like even happier that I do it. It's getting the stamp of approval, but yeah, it is a hard workout and it's important to keep yourself interested and invested. You want to be having as much fun as you can exercising, it shouldn't be torture, it should be something you really look forward to as an investment in your future self.

Yeah. So just to kind of jump back. Do all women experience this? You said that some women who may not experience menopause as as intensely as others. Or is that a myth? I hate them. No.

No, it's true. It's true. I have met that unicorn before. Now, I guess the rule of thumb is about 20% of women actually are very blessed.

They have estrogen receptors that are highly adaptive. It's a combination of sort of genetic predisposition maybe that allows them to coast through it with minimal to no symptoms. Another thing to think about is your daily habits and your lifestyle can play a role. So people who exercise vigorously and regularly tend to get fewer hot flashes than women who don't because there's something about keeping your hypothalamus finely tuned to those temperature changes. That band seems to stay wider with respect to adapting to temperature changes the more you exercise. So I definitely think there are some ways that you can prevent symptoms in a sense, but genetics are the main driver of it. If your mom had a pretty easy menopause, perhaps you're going to luck out and have an easy menopause.

Yeah, the well, it's good just to know that, yeah, there's some variability in that and just to reinforce, you know, the benefits of exercise and kind of a healthier lifestyle, active lifestyle.

So I know you mentioned you have a bit of a dry eye story because that was one of the first major issues you started facing. Is that right?

It really was. I would have been in my early 40s, or mid-40s, I would say. I was in my mid-40s, and I was definitely starting to have some of the menstrual changes, for sure, that women go through. But the predominant thing that I remember was my eyes were so dry.

I went to my optometrist. She said, yeah, you know, your vision's okay, but eyes are really dry. So she wanted me to start on some omega-3 vitamins. And she said, use some eye drops, preservative-free, eye drops a few tons a day. But I remember using them three, four times a day, and still feeling this burning, irritated, blurry vision. I really couldn't look at my computer for very long. And as a doctor, I mean, that's, you know, charting at night and stuff. You don't have a choice, right? And it was really debilitating, and I was just starting to really become, I was starting to become well-versed in menopause care at that time. So I didn't even recognize for myself that this was a symptom of perimenopause. And then for other reasons, I ended up starting hormone therapy. And the minute I started on estrogen, the dry eyes were gone overnight. I never use eye drops anymore. I just didn't need it. And the last time I went back to my optometrist, she didn't comment on dry eyes at all. So it's interesting. As I was doing some digging into the literature to prepare for today, I was saddened to find that the data is actually mixed with respect to response to hormone therapy for dry eyes. It seems to make some women worse, and it makes women like me better, and we don't know why. Again, it's very complicated.

Yeah. And you said it very well. Thank you for sharing that.

the radar, right? If it's not on your radar at all, you're not gonna see it.

If you educate yourself and you even realize, oh, this is a phenomenon and this can be one of the reasons why maybe it's not responding as easily or why it's out of proportion, you know, why is it so severe in this particular woman? Yeah, you're right. And I really appreciate when other healthcare colleagues at least just have this on their radar, even dermatologists, for example, it's a great one where they're like, you know what, I know you're not here for this, but I think you should consider if you're experiencing some of these other symptoms and see a menopause specialist because it may actually help alleviate some of your skin related concerns.

Uh, on that same note, so if let's say a patient came in and I suspected like, Hey, it's possible that your dryness, uh, with the eyes could be related to something like a perimenopause or menopause issues, what would be helpful for you if I was going to refer a patient to, to like your services? Is there anything as an eye doctor that would be helpful for me to share?

Well, I mean, I think just ruling out other potential underlying causes, right, perimenopause tends to be a diagnosis of exclusion in the sense that other things can mimic it, right. Thyroid disease is one of the big, big ones. It's a big mimic or a lot of the symptoms overlap.

But maybe they are having eye strain because of a habit. Like maybe it's the makeup they're using. Maybe it's their contact lenses. Maybe women are more likely to use those things. Right. So ruling out other causes that are ocular that would require that approach. And of course we work together. But if it's not necessarily those things or those things are being managed, then absolutely it's worth a try to see if we can offer some support for that. Because I guarantee if they're having that, they're probably having some of the other skin dryness, hair dryness, all of the other things that accompany it.

So that's, that's all really good feedback. And I'm happy that you touched on those things.

Cause right. Um, we all spend so many hours in front of the computer. That's a, that's a tough one to get around. Um, the thyroid is well established and known to affect dry eyes. Uh, we frequently in fact, when we, a lot of times we will order blood work and it's like, Oh, yep. The thyroid, that's a big one. Um, uh, and then yeah, a lot of cosmetics is getting a lot more attention. And because of so many ingredients that we didn't know affected the glands underneath, uh, or could be blocking the oil glands in the eyelids. It's like the Mybomian glands. And I see even doing this just this last week, I flipped a, I flipped a, one of my patients eyes, their, their eyelids inverted so I could look underneath. Cause she thought she had something trapped underneath there. Yeah. And we'll see foundation like skin foundation they're putting on their cheeks, I'll see that stuck, not just in their tear film. It'll be stuck and absorbed into their underlying parts of their eyelid. Uh, cause that's been sitting there for years and years and just constantly getting onto the ocular surface.

And then there's the lash glue and everything that people are using and hey, I'm all for it, you know, like go to the makeup store, live your best life. But sometimes I know my girls will go to sleep without taking their makeup off, right?

They'll fall asleep in their lashes and stuff. And it's like, it's not good for your eyes. We've got to take care of them. We only get one set, you know,

Yeah. I know one other practitioner out of Europe, she's an eye doctor, she treats a lot of dry eye, and she spoke specifically about not omega-3 fatty acids, but of GLA omega-6 through primrose oil. She recommends to patients, specifically women who are going through kind of that perimenopause, menopause part of life.

Do you know much about that? I haven't researched, I know of GLA omega-6 in some research specifically for dry eye, but I don't know if it's any effect on hormones.

I don't know that it would affect the hormones themselves, but it's an interesting, I know in Europe, they're so far ahead of us anyway. So it might just be that it hasn't filtered down to sort of the North American menopause providers yet where we've learned about it, but it's interesting.

It's something I could look into for sure. And if she's recommending it and finding it's working often supplements work in mysterious ways. And I'm all for something that causes no harm if it's actually helpful.

Now, before we talk more into lifestyle factors, supplements, anything like that, diet, let's tackle a little bit more information on the hormone replacement therapy. Can you kind of break that down for us, exactly what is all entailed, when people started, when is it advised to, no, let's not go that direction?

I don't know. I don't prescribe that, so that's fine. Yeah, yeah. No, okay.

So right, so who is it safe for basically or who is it advisable for so it is used for symptom management. So when the symptoms are affecting quality of life, that is the time when it's worth exploring whether your specific symptoms might be remedied by a combination of hormone therapies. In a nutshell, I mean everybody needs an individual assessment right but in a nutshell. Hormone therapy is very safe and the benefits far outweigh the risks for any woman who is less than 60 or within 10 years of her menopause. So if you had menopause at 55 up to 65 is your window to consider it. So the 10 years is more important than the 60 60 if you don't know when your menopause was right as a safe cutoff for women who have no personal history of breast cancer or high grade uterine cancer for women who do not have severe liver disease. I'm talking like liver cirrhosis for women who do not have a personal history of a heart attack or stroke. It's advisable to avoid hormones. There are other relative contraindications. Somebody with a history of blood clots or who's at high risk for a blood clot may not be a candidate for hormone therapy, but they might do well with one of the ones we'll talk about which is a topical, a transdermal form of hormone therapy. So that's the general sense of who might be appropriate and who might want to consider.

And I also want to give a little shout out because there are non hormonal options that are on the market now that can help with hot flashes and sleep and are non hormonal. And it's quite miraculous that we now have these direct medications that work right on the center in the brain to help turn off hot flashes. So all hope is not gone if you are not a candidate for it. But the types of hormones, so estrogen is always the main character because for all of the reasons we've talked about, estrogen decline and deprivation is the cause of both of the symptoms that women experience. So you want to have estrogen and in Canada we have it as a pill, a patch or a gel. So I know in the States they have a sublingual, I believe it's a, no it's a spray. It's a skin spray. Sorry, I stand corrected. So they have different options in the state that we don't have here. So you guys are really lucky. Then there are, if you have a uterus, you also need a form of progesterone or a progestin. Okay, so there's natural progesterone, which is sort of a clone of the estrogen that comes from the ovaries. And so that's usually what we start with. Otherwise there's progestins, which you can think of these as more synthetic hormones that are more similar to a low dose of something in a birth control pill, you know, to compare it. And all of those serve one purpose, which is to protect the uterine lining against the effects of the estrogen. So if I were to give a woman with a uterus estrogen all by itself, her uterine lining would get thicker and thicker over time. It would develop what we call hyperplasia and then potentially a malignancy could develop so they can get cancer. So it's always very important to use a form of progesterone or progestin with your estrogen.

The nice thing about natural progesterone is that in the brain, it also serves a very important function, which is it tends to have a calming effect. It can help with sleep a little bit. So a lot of women find the progesterone has that little added bonus with helping with sleep.

But that estrogen is going to be what's going to really manage the hot flashes, the night sweats, a lot of the mood symptoms and protect your bones. So those are the two main players. Testosterone is having a bit of a moment. Testosterone is produced in the ovaries, but it's also produced in the adrenal glands. So unlike estrogen and progesterone, which really decline at menopause, testosterone tends to decline really slowly till about age 60 or in your mid 60s. And then it actually starts to increase a little bit again. Because again, we're not purely relying on the ovaries. So it's not typically something that most of us would start with. However, for women who find that despite being really on an optimal dose of estrogen and their progesterone, they're still struggling with persistent, hypoactive sexual desire disorder. And I'm talking about more responsive libido. Like they can't, it just feels dead. Like nothing's happening, nothing's working. And they're really struggling because it's having an impact on their relationship, their quality of life. This is what we know testosterone is effective for. There are some small studies that indicate there might be a role for testosterone in mental clarity, like brain fog, mood, sleep. But unfortunately, the data is not really robust there. And I've prescribed testosterone a lot in my practice. And I think for a lot of women, it ends up being a bit of a letdown because they are hoping that it's this miracle cure for so many of their residual symptoms.

And we need more research. We need more research to know how to optimally use testosterone to really help benefit the women the way they're looking to be helped. The final one is vaginal estrogen or vaginal DHEA, which is a prostrone or introsa. And these are excellent for women who have vaginal dryness, recurrent bladder infections, irritation, repeat yeast infections, difficulty with sex because of pain, dryness. Local vaginal estrogen or DHEA is safe for almost everybody. And it's incredibly beneficial. And the symptoms of the genital urinary symptoms of menopause tend to start later and be progressive. So those can get worse and worse and worse as a woman gets into her sixties and seventies. And the great news is there's no cutoff for starting that. You can start it at any age. You can start it at 99 if you're struggling and no one's ever offered you support. That is something you can try right away.

So it was a long answer, but it's a very complex. It's such a complex topic. And every woman does have to have an assessment to see what the right fit is for her. But I want women to come away with the idea that the vast majority of women can safely use hormone therapy and the benefits will far away the risks.

Uh, thank you for that amazing summary. Clearly you've, you are an expert in what you, you do and you understand and you teach it very well. So I, I appreciate that.

Not just, I appreciate that not just, um, is sitting here listening, but also this as a professional, I'm like, I can tell you that you actually know this pretty excellent at a high level. Um, I know one thing I wanted to clear up because I was curious about it early on in the conversation, you mentioned that when you were maybe going through schooling, there was like a headline on like a study or a case report that kind of maybe led people astray or confused people. Um, but that has been kind of debunked now, right?

I'd love to tell you the story of the Women's Health Initiative. So the study we're referring to is the Women's Health Initiative. It's crucial to understand why this study was done and the setup of the study and what it found, to understand how we got to this crazy place where for 20 years women were denied access to hormone therapy. So if we were to go back to the 70s, the 80s, tons of women, it was kind of like today. Women were talking about hormone therapy. They had discovered that it was incredibly helpful. It took care of all of their symptoms. Women were going to their doctor. They were saying, I really want hormone therapy. Felt great. There were some small studies that were coming out at the time, observational studies, that indicated that hormone therapy seemed to have health benefits. So it was looking like it definitely improved bone density and could prevent osteoporosis and fractures. But there were also some studies that were signaling reduced cardiovascular disease in women if they were on hormones and reduced breast cancer risk. So this idea was sort of floated that should we be using hormone therapy for prevention? And sure enough, women are asking their doctors to prescribe it to prevent disease, even if they're not having any symptoms. And the FDA stepped in and they said, we need to prove that this actually prevents cardiovascular disease. Otherwise, we're going to have all of these older women on hormones, and it could actually be harming them and causing cardiovascular disease. That was the genesis for the Women's Health Initiative.

So they enrolled 27,000 women in the hormone arm of the study. And there were women who had a hysterectomy, and there were women who still had their uterus. And then there were the women in each group on placebo. But all of these women were asymptomatic. And that's important. They didn't want them to have symptoms because they didn't want them to know if they were on placebo or not. There's a randomized control trial, so it had to be blinded, right? So off they went. And the women, by the way, were aged 50 all the way to 79. That's another really key thing. So 79-year-old woman, 30 years postmenopause was handed her estrogen and her progestin, and off she went. All right, so I moved my earbud. They looked at the data after five years. And they saw in the group of women that had had a hysterectomy, so again, they were just given estrogen. They didn't need that progestin. They had a reduced risk of breast cancer to the tune of about 23% over the placebo group. So estrogen seemed, looked like it reduced the risk of breast cancer. In the other group, the estrogen plus progestin group, and progestin is the key word. It was a progestin called medroxyprogesterone acetate, which is one of those synthetic progestins. We still do use it today, but I would say not very commonly. But in that group of women, they saw an increased risk of breast cancer to the tune of eight additional women per 10,000 over five years' abuse compared to placebo.

They did not see a convincing reduction in cardiovascular risk. In fact, in the older women, they saw a bit of an increased risk in cardiovascular events. So they said, uh-oh, not only does it not prevent cardiovascular disease, it actually might increase it.

That's huge. Thank you for sharing and breaking that down because I know the nerd in me who loves reading scientific studies and breaking down sometimes, how the statistics were done. It makes me happy.

It makes me frustrated that that sort of thing happened because those headlines can be malicious. It's even happened in iCare too. But thank you for breaking that down, knowing it so well and certainly sharing it with your patients and certainly with us here today. The kind of big takeaway I would say is one, talk to your specialists about this sort of thing and certainly if somebody's hearing this, they have family members who are maybe saying like, hey, isn't that going to increase your risk for XYZ disease? Well, you can always refer them either to this episode or to your content or certainly check out the research for themselves. Be intellectually curious about that.

Absolutely. There's some fabulous books out there and lots of interesting ways to find this information for yourself.

I feel like watching it or reading it, whatever, but it's important. You're right. Intellectual curiosity is one of my favorite terms these days. We need more of it.

The just kind of quickly, you know, for time's sake is outside of hormone replacement therapy or medications. What other just like quick lifestyle takeaways can can somebody think about?

Okay, if I could start on just three things in this next week that could maybe help on their journey. What are the kind of like the three biggest things?

Okay, sleep is number one, prioritize your sleep. In midlife, it is not a flex to get by on five hours. We need seven to eight hours of good restorative sleep to combat those, the weight gain, the cognitive decline, the heart disease, to feel our best and to minimize symptoms. So I would say if you're not sleeping, get to the root of it and solve what's causing that.

Number two is exercise. We've talked a lot about weight training. It's so important to get that strength training at least 60 minutes, ideally 90 minutes a week of something making yourself stronger, but we still need cardio. We do need cardio for our brain health and our heart health. So we need them in combination with each other.

And the third is nutrition. I'm not big on diets and calorie counting. What I'm big on is start thinking of food as something that is fueling your body. You don't want empty calories. You want everything you eat to have meaning. You want to prioritize fiber and protein. Get all the colors of the rainbow in your diet. Eat as many whole foods as you can. Avoid processed foods. If you start thinking intentionally about what you put in your body and how you treat your body, those move mountains.

Lifestyle is the cornerstone of not only weight loss, but perimenopause management. I'm on hormone therapy. I still exercise every day. I still have to think very carefully about what I eat. And I still get seven to eight hours of sleep at night because if I don't do that, the hormones are not going to solve all these problems for me. They're good at certain things, but they can't do the, they can't lift the weight for you.

Well, I really appreciate you sharing and stressing those three points because all of those also interestingly affect the eyes. So it's not a surprise that everything's connected, right? And if you could do these three things, focus on the sleep, the exercise, focus on what you're eating, it's gonna, it's not just going to help with hormones, it's going to help with the eyes, it's going to help with the brain, how you feel, how you think, how you how you carry yourself in every situation throughout the day. So those are all amazing takeaways. Thank you for sharing those, Jen.

But it's boring, but it's true, right? Like the boring idea, I don't have a magic pill. It's, it's, it's the boring, consistent things that move the needle.

the kind of the final thing. I have two final questions for you.

The first one is just simply for women who are going through this, whether it be perimenopause or they're having symptoms of dysregular menopause. How does somebody find a specialist in that area? Do they start by just asking their family doctor? How do they even go about that?

Yeah. They can certainly ask their family doctor if the family doctor is not, I mean, some women are surprised. They think their family doctor just doesn't know anything about this, but some family doctors have training in this, right? So start with your family doctor.

If they are dismissive, say there's nothing you can do, it's just the stage of life or hormones cause breast cancer, then you kind of know you're dealing with someone who doesn't know what they're talking about. That's fine. We weren't taught this. Ask them for referral to somebody who is a menopause specialist. But sadly, a lot of menopause care is private is through private, uh, funding. I know here in Ontario, Canada, a lot of it is not covered by our government. So a lot of us work in private care as I do myself. But the good news about that is there's no barrier to entry, right? Like you can literally look up menopause certified. You want to look up a menopause certified provider who's certified through an institution like the menopause society, which used to be called the North American menopause society. The menopause society has a link to search accredited providers based on your city within North America. So those are some ways you can, you can seek out care.

And yeah, that, that would be my recommendation. Don't settle for being dismissed. Don't ask for blood work because they will just do it and tell you it's normal and say, look, it's normal. You're fine. Go home. That's, that's, that's false. That's, that's a fiction, you know, as we started off by saying, so that, that would be my advice around that.

And then my final question is just a fun question for you, and I love asking any experts or specialists this kind of question, but outside of your specialty, what is something that you've read or have studied just independently that you thought was just fascinating and kind of tickled your curiosity?

Oh my gosh. That's such a great question. I am really into documentaries. I love learning about history.

I love taking these deep dives into mysteries that have happened in the past or lately I've been watching documentaries about the building of the Colosseum because getting ready to go to Italy. I'm not a big fan of scripted TV. I really love just hearing real stories and learning about real people and history. So I don't know if that's what you had in mind but that's sort of like my jam when I had free time.

No, that's, that's perfect. I love hearing that.

Um, I love documentaries and things like that too. Sometimes, uh, you know, they'll do like a medical documentary and sometimes I'm like, I don't know if what they commented on that is, is 100% true though. But, uh, I feel like I always still learn something or at least get a different perspective on things. So, uh, I love that you're doing that. Your brain's always learning.

Oh, I love it. I love it. But if that feels more passive, I don't have to then go and like, tell someone every little detail about it, you know, I can just enjoy it and take what I want from it.

Well, Dr. Jen, thank you so much for being here and sharing your brilliance with us.

From here, if people want to be able to connect with you, I know you're pretty active on Instagram. Do you also post on other channels as well?

So I'm on Instagram and YouTube at Dr. Jen Zellow.

Um, I do have a website, um, where I have some, uh, blog entries about, you know, how to know if you're in perimenopause, what are options for hormone therapy. And that's just at dr. Jen Zellow.ca. Um, and yeah, and if you're in Toronto, I practice at med cam Toronto. So you can call up and, and ask about joining my program there to see me in a clinical consultation.

Perfect, well thank you so much. We'll make sure to put those links to all of that in our show notes for everybody who wants to be able to find it easily.

But again, thank you for your time and hope you have a wonderful trip to Italy.

Thank you. Ciao. I'll see you when I get back.

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