Dr.Bri Botsford on Pause to Go

Bree Luck: Today's episode with Dr. Brianna Botsford was special because it looks at perimenopause not as an isolated period of time, but as part of a whole human story, a lifespan approach to examining a particular time period. Dr. Brianna Botsford who also goes by Bree said, don't be confused is a naturopathic doctor in Edmonton, Alberta, Canada. Dr. Botsford completed her education focus in sports medicine with a special interest in women's health and performance. Before she became an ND. Dr. Botsford had issues with severe menstrual pain that made it impossible to train properly and caused her to take time off of work. Mood swings and a history of depression left her questioning.

The impact her hormones were having on her quality of life. Seeking care from an ND, allowed Dr. Botsford to successfully compete in iron man triathlons and inspired her to go back to school to become a naturopathic doctor, which she did.

She now runs a successful clinic in Alberta, where she lives with her husband and their new baby. I also want to say that listening to this podcast should not replace seeking medical care. We hope that you will find the perspectives offered in this and other episodes of pause to go useful, but we encourage you to seek the help of your own medical practitioner for individualized professional care.

One of the things that I love about this conversation is how Bri relates menopause and other transformative periods of life. Of course, adolescence, we've talked about that one in other episodes of the podcast, but also pregnancy. And there is something about talking to a human who is newly postpartum that really struck a chord with me and this episode really pulled me out of my perimenopause bubble to examine the full hormonal story that my body is telling. And I wonder if it will unlock some new understanding for you as well.

Enjoy the episode. It's not often that I get to chat with another Bree. So I feel particularly connected to you. Yeah. The strange, parasocial meets, meets name overlap really sort of made for.

Fun connection. So thank you for indulging me, of course . So Brie, I'm gonna begin with a question that I ask everyone who comes on the podcast, which is how old are you and where are you in the perimenopause or menopause process? 

Dr. Bri Botsford: I am 34 years old. And I just had my first child, in may of 2021.

so I am not quite to my knowledge. I am not in perimenopause. although pregnancy is still possible in peri-menopause. I actually, but I haven't had a period for. Probably like close to 500 days now, because of pregnancy and breastfeeding, which is sort of like, I don't know if it's like a fun preview of what's to come or, you know, it's, it's, I, I don't really have any, symptoms, that would be similar to perimenopause other than

Dr. Bri Botsford: lack of estrogen. and that's because I'm not ovulating because I'm still breastfeeding quite a lot. And I'm sure that it's very soon, probably in the next few months I will ovulate again and I will get another period. so I'll kind of, that remains to be seen, I guess. but other than that,

I believe I am not quite there yet, but it's sort of, it's one of those things where you can start peri-menopause as early as your mid thirties. And that was a consideration in our family plan that we wanted to get rolling, with our first child, because, you know, I see, I work with people every day that are my age or younger that have either peri-menopause or symptoms or premature ovarian insufficiency.

So, that's where I am.

Bree Luck: So I'm 48. I'm right in the throws of perimenopause, even though I had no idea that I was, I don't have hot flashes. I don't have a lot of symptom symptoms. I don't want to say symptoms cause it's not an illness. Right. I don't have a lot of the effects that a lot of people 

who are in perimenopause have, but I have noticed some, some effects that are very similar to pregnancy. I have two kids, so I had, I had two full pregnancies and, and I had just noticed, and, and also some of the, some of the effects right after pregnancy. So right after having my kids, like an increase in

near UTIs. It's like that feeling like I'm about to get a UTI and then I don't it's okay. But it's like those kinds of things that come up. So it is interesting that you bring that up and see some of those similarities. And I think it's really, it's great. This, this podcast is, is really meant for women like me who are gen X, but it's also for millennials, right? For, for folks who are looking ahead, looking down the line at perimenopause and menopause and even just relating it to pregnancy and postpartum, I think is really useful because it's, it just helps us to be more aware of what's coming right. And to relate to it now. So you are a doctor of naturopathic medicine.

Yes. In Canada, 

Dr. Bri Botsford: way up here in the north, 

Bree Luck: do you have a lot of clients who are. In perimenopause now, or do you tend to have younger clients? Mostly? 

I would say my, my practice does focus in women's health. So I do see like women's health across the lifespan. So I will deal with like even puberty and teenage patients, but then also, definitely perimenopause and I think it's a huge education point for me.

because. I think I, you know, the average age of onset, you know, we'll tell patients, oh, you could have menopause anywhere between 45 and 55, but. That's not really helpful and because it's a decade, and I, and I think that there's lots of, young and younger women that are experiencing effects of peri menopause that may not know, like you said, they're confused or they don't know what's happening.

and that's one thing that I really. I'm starting to love about the internet is that we're able to share this information in different ways. So yeah, I do work with a lot of peri-menopausal patients who may not know that they're in peri-menopause. So for example, they're having. mid cycle spotting or they're bleeding for like an entire month.

and they're not, they don't, they're all of a sudden, right. And they don't know why or they're having night sweats. those kinds of things. Just trying to explain what the differences between, the common symptoms that can occur with a regular menstrual cycle. And then the common affects of perimenopause that, lead us more towards that as a, like you said, it's not a disease, so we wouldn't necessarily say diagnosis.

Dr. Bri Botsford: Diagnosis in order to give them an answer about what is going on, because I think even having a label is more helpful than it being a mystery. And I think that's a really common population that I see is like this mysterious period issues, late thirties, mid forties. I like to say what the forties, like, you know, people are like, Like you said, like from that,previous guest, what, what fresh hell is this, right?

Like it's, you know, what, what is going on here? and, and so being able to explain a little bit about what is going on and why and why it feels like a rollercoaster, because it is with the, of what what's going on hormonally, I think really helps people to understand like, okay, I'm not crazy. This is really happening.

Bree Luck: It's so true. I wonder, do you have any resistance from your patients when you talk to them about it? Because I, I was very resistant. I was, I was a terrible, I'm a terrible patient. 

Dr. Bri Botsford: Okay. Like, I wouldn't even say as a clinician, you know, when I first started practice, I would tell people, oh, you're only 41.

There's no way you're in menopause. Well, yeah, menopause is one day. It's not like, you know, perimenopause is possible at a variety of points in the lifestyle, but even in school, they, they give us like timelines as a definition, as opposed to effects as a definition. I think like even in the past 70 years, our understanding has changed.

And part of that comes from the population. Like women are demanding better. And like I said, the internet having pros and cons of. People accessing different quality of information through the internet, but they're still learning more and then demanding more of their healthcare providers. So I would say even as a clinician in my early days, I would tell people like, oh yeah, there's no way you're in menopause.

Don't worry about it. And then now I'm like, I can't believe I would have said that to someone. And so yes, like it would come from patients, but also even from my bias, being that like, oh, I, to me like 40 anything. Is young and now I'm like 50. Anything is young. and you know, it's, it's, you don't want it to be true for them and patients don't want it to be true.

And then it sort of. Explaining, you know, this is not, this is natural and normal and it's not something to be feared. because I think, you know, my, my mom's experience of menopause and my experience of menopause will be totally different. and some of that has to do with, you know, she would have had menopause in the nineties/ early two thousands. And our understanding of even therapies like hormone replacement and things like that were very limited. And the research, was done in a way that made us really fearful. And I think that had a big impact for generations. And so now, my experience and the patients that I work with will have a different experience.

And then even a generation after me, hopefully there'll be less fear and there'll be more education so that we know this is normal and natural. And then here's how to navigate it in a way that is healthy. Be cause there are like, I always joke with patients. I'll be like, yeah, you can throw a party on your one-year anniversary of having no period.

And they're like, why would I do that? This is horrible. And I, and I actually think like I will throw a party when it happens to me because like, why not? Kind of, like another milestone to celebrate. I feel like I would also be that mom that if I had a girl, I'd be like, let's have a party when you get your first period and that'd be like, no, please.

So 

Bree Luck: yeah. Yeah. I, I, I have two daughters. There was no, there was no way they would've had a party for their first period, but I will, but I will totally have a menopause party. I think it would be so much fun and cheeky. And just, as you're saying, like there's an evolution in the understanding of perimenopause and menopause.

I also think that there, that as we have an evolution at that understanding, we also have this potential for changing the cultural stigma around aging for women. Because of course it's, it's ages and sexist, right? No matter what, and, and that's, that's why we freak out. I mean, on one hand, if you want to keep having.

Children. It's like, oh my biological clock. I want to keep having children and I want to have children this way. but then there's, but honestly, For me, I have, I have not used for a period. Like fair enough. I'm not like that. That can end. That's fine. That's fine. 

Dr. Bri Botsford: and that's just it, right? Like the, like you said are, well, I mean, we know our world is not designed for women.

Period. and, and, you know, with respect to our periods, like it's not designed for us in a way that we have a different rhythm, a different cycle that our bodies go through. That's not just a 24 hour cycle, it's a 28 or whatever number cycle. And then like, even, you know, my current experience, obviously being postpartum.

Like our world is not designed for mothers to mother well, necessarily. And I mean, I'm very fortunate that I'm a small business owner and I'm able to structure my time in a way that I can still work and be a mom and, and have, some balance there. even though I feel like balance is a myth right now, but like, you know, like I can structure my time.

Right. Me well, because I'm the boss, but a lot of folks in corporate settings or otherwise may not have that opportunity to structure their life. You know, for example, if, and when I have sleep disruption, I can adjust my days and my schedule to fit my. And I think if we had more flexibility for our population going through sleep disruption or, bleeding for weeks or days , just changing the structure of our, work environments, our home environments and our understanding and, and making it comfortable for women to ask and talk about those things would allow for a better environment and better health for everyone. Because the typical nine to five, Monday to Friday grind stress makes a lot of the effects of perimenopause worse, and can even trigger things like hot flashes for some people. So like we have to figure out how to navigate that and I do think that that will happen, that we will see some changes in how our world operates overall. Because folks going through these symptoms are going to start demanding better. 

Bree Luck: Yeah. Yeah. Well, thank you for helping to champion that change too. I mean, and, and of course not just for perimenopause and menopause, but throughout lifespan it's, it's just, it's, it's crucial.

 Can you tell us a little bit. About. So I know what functional medicine is we had a functional episode 1 of pause to Go was with the functional medicine doctor, what is naturopathic medicine? 

Dr. Bri Botsford: Naturopathic medicine, is leveraging natural therapies so whether nutrition, lifestyle, herbs, nutritional supplements. there's many things that fall under the scope of naturopathic medicine. Like we could talk about all the modalities that we use. but then there's essentially the goal is to leverage the, the body's natural healing capabilities. So that obviously applies more to the context of a disease state, natural healing abilities, but also the idea of a body that knows how to be balanced and knows what it needs. our job is to help the patient and the patient's system figure out what it needs to be in balance and to feel well and to thrive, because the patient and the body knows it's more just sort of an uncovering of, of what, Is needed. So whether that's through an and I think the thing that's very challenging with naturopathic medicine is that our scope of practice varies greatly between jurisdictions. So, for example, in Canada, we're regulated by province, in the states it's by state.

So there are states where naturopathic doctors are licensed and there are states where they're not. And so that's important because in a state or jurisdiction where a naturopathic doctor is not licensed. that means anyone can call themselves a naturopath. And so you could go to school or, or not, and, and use that title, whereas in jurisdictions where it's a protected title, you know, you're a naturopathic doctor.

There are rules and regulations around what you can and cannot do. I'm most familiar with the states on the Western side of the country, because I will go to Portland and California and whatnot for conferences. but I would say like naturopathic medicine in the states for the most part is very similar to,Conventional medicine and scope of practice, meaning we can order lab tests and prescribe medications, and hormones.

but it really does depend, for example, in Alberta, where I practice, I can order blood work and lab tests and I can, use herbs and supplements. I can do injections. I can do those sorts of things. but I'm actually not able to prescribe a pharmaceutical medication. where I practice, whereas down in Oregon, they can.

Dr. Bri Botsford: So, it varies quite a bit in terms of what we can actually do, but I think something that's really important is to know if, you're seeking naturopathic medicine. Is your practitioner licensed and is your state regulated for naturopathic medicine? 

Bree Luck: Is there a site that people can go to to look that up.

 I can add it to the show notes. Yeah, 

Dr. Bri Botsford: there's AANP. So American association of naturopathic physicians, is the, is the overarching body. And I actually was able to go to Colorado for AANP conference in like 20 14 or 13. and it was, it was really cool to be around that many naturopathic doctors, because for, for context, like where I practice in Alberta, there's probably 400 naturopathic doctors compared to going to like the American association. Thousands of naturopathic doctors. And I was like, whoa, this is incredible.

but they will have a directory as well as information about what states are licensed and then each state, usually if they're licensed and regulated in that state, they'll also have their own directory. 

Bree Luck: That's really great to know. Of course, healers can come with, with all different backgrounds and credentials are, or are not credentials, but it is really, it's very helpful to know what people have learned and what they've gone through that they've gone through certain steps of being credentialed and at least thinking critically about those things. No matter what your choice is can help to,Lessen the chance that we might succumb to snake oil salesmen types of approaches. And that's, that's a real problem right now.

It's a real problem. One of the things that I really loved about your presence on the internet was that you weren't doing that. You, you, you don't do that. You, you're very clear that each person is an individual. I have to say. I think people should follow your Instagram because it's very entertaining and very personable.

Dr. Bri Botsford: Thank you. 

Bree Luck: You did a little reel/ TikTok type of thing with Ursula. Yes,

Dr. Bri Botsford: totally. Yeah. We want to know everything about our patients. We want to understand them and I, and so yeah, there is no TMI in my office. People will always do this. They're telling me about their bowel movements. I'm like, no, I was, that was my next question. So just go ahead. 

Bree Luck: Yeah, and that's great. And, and that also building time for that, into your practice, and it really sounds like you do is also part of removing the shame and stigma, right?

Like, let's talk about all the things so that we're not afraid to talk about all the things. 

Dr. Bri Botsford: I mean, one thing I will always ask about is, like, you mentioned that sensation of having maybe a UTI. And so patients won't always tell you things like that because they don't want to talk about their vulvar health or their vaginal health.

And, and so for me, I will always ask, especially if I'm suspecting peri-menopause, I will say, you know, do you have any vaginal dryness or do you have any vaginal irritation or vulvar irritation? And like here's what your vulva is. And here's what I'm talking about because if you don't ask, people might not tell you.

And then, you know, not only are you failing them in terms of not being able to give them help or good information. but they don't feel comfortable, bringing it up. So I like, you know, for me even postpartum, I was like, oh, like this, that feeling is horrible. Like, feeling like you're gonna have a urinary tract infection, but you don't and then just like dry and uncomfortable. And I'm a cyclist. So like being on my bike, you know, after everything was healed and I was good to go, theoretically, like supposedly good to go on the bike and sex and everything else. I didn't feel comfortable. I actually got a prescription for vaginal estrogen.

And I'm, I'm fine to talk about that because I want other people to know that like, it's, it's okay to need something to, to help with that. And whether it's vaginal estrogen or some other kind of moisturizer, like there's there's options and it's okay to ask it's okay to talk about it because like, I think I was even probably raised to like, not talk about that part of my body.

Yeah, I'm so glad that you mentioned cycling because I was just, I just did a, a 10 day solo retreat in Mexico and I was cycling and walking everywhere and. After day two of cycling, and I was so excited because it's flat and I really like cycling and flat places where it's just easy and I can take it in.

And man, was it painful? Yeah, I will be prepared next time. 

Yeah. I mean, there's lots of different - with cycling it's tough 'cause like you can it's can be your saddle, like your seat, it can be your shorts or like all these different things. It was 

Bree Luck: all of the above, all of the above. Perfect storm of perimenopause, cheap rental bike, sand, water, shorts, like all the things. So on talking about TMI. Now everybody knows all good. 

Dr. Bri Botsford: Now they'll know that their trip to Mexico for cycling, what, what to do and not do. 

Bree Luck: That's right. That's right. so let's, let's talk a little bit. You mentioned vaginal estrogen.

Yeah. What was that? Tell us about that. And let's talk about hormones a little bit, cause I also know that you, that you are a hormone Maven. Thanks. 

Dr. Bri Botsford: I like to, well, I mean, so prescribing hormones is not in my scope of practice in Alberta, but I'm always keen to educate people about hormone replacement therapies because there's a lot of stigma and.

Lack of understanding, even in our, my profession, the medical profession, like about the safety and the utility of these things. And a lot of that comes from early studies in the nineties and the early two thousands that were sort of poorly designed. And, and then also just not. Not really telling the whole story as far as hormone replacement.

So, I mean, vaginal estrogen is incredibly safe. there's very few, Contra indications or reasons why we may not use vaginal estrogen, but in my practice, patients will often come to me because they don't want hormones. they don't want to use hormone replacement. and so. for me, like we will usually start with different vaginal moisturizers, whether it's hyaluronic acid, or vitamin E different things like that-- unless the patient is open to it and then we will refer them for like a vaginal estrogen. And so your vaginal and your vulva tissue are sensitive to estrogen, just like many tissues in your body. And so as our estrogen levels naturally decline in peri-menopause. So perimenopause being different than menopause in that, like after we've had that one year anniversary of no period, we basically have very little, if any estrogen sort of floating around in circulation, cause our ovaries have kind of hung up their hat and decided they're done. Whereas in perimenopause we might have a cycle where we make a great amount of estrogen or a lot of estrogen. And then we might have a cycle where we have. No estrogen or very little estrogen. And so our ovulation quality is poor and we're having these, this like fluctuation in our levels of estrogen.

And this is I think, where people can feel like I have symptoms this month, but I didn't last month or I, I haven't had symptoms for three months or affects for three months, but now all of a sudden I feel like crazy. And so like vaginally and in the vulva area, we can see like, it's the worst name, atrophic, vaginitis.

now we're calling these things, genital urinary symptoms of menopause. So we're not really giving it this like horrible. Sounding name 

Bree Luck: and crumbling. 

Dr. Bri Botsford: That's what atrophy means is, is like shrinking and deterioration of, of tissue. And I mean, without estrogen, like things will be less like plump and moisturized and, and we can have pain with sex and tearing with sex and or insertion.

Right. And so I think that that. Important because it affects our quality of life in different ways, but also like we even talked about cycling, like, you know, it's just uncomfortable. and so topically, there's not a lot of absorption through your whole system. If you're using. vaginal, product, which is kind of nice for people who may not be a good candidate for systemic hormone replacement.

so th that's like, you know, I think the genital urinary symptoms, are with, with respect to hormone replacement are quite simple. and, but then I also don't want to discount the importance of like, Physio and like the actual muscular health, because we talk about this a lot. Like I'll have patients where we talk about it after, after babies and postpartum, but then it's like, oh yeah, like now you're all fine.

Dr. Bri Botsford: You've had your pelvic physio. You're your pelvic floor muscles were great, but we don't talk about it again. And then sit down in perimenopause and there may be prolapse. There may be. And that can happen again because of that lack of estrogen, our tissues are not as strong. and so it's still worth seeing a pelvic physiotherapist in order to have an assessment and a treatment.

And lots of people feel uncomfortable with that because they're like, well, those. Those therapists are for women who just had babies. They're not for me, but they are for you. They're for every they're for everyone that has a pelvic floor. not just everyone that has a vagina, but like men, people that have, pelvic floor.

So, it's, it's, it's important. That's an important piece of that puzzle. And then like systemically, I think the thing that always gets to me the most is when people come in and they say, My doctor says I'm depressed and they want to put me on an antidepressant, which these medications. Like they're, they're awesome.

They, they are necessary for some people at some points in their lifespan. I will never say like I, I had times in my youth where I was on antidepressants and I will not say that they're not necessary, but in perimenopause it's. Okay, you can have depression, but is the depression because of serotonin and do we need a drug for serotonin or do we need to see what's going on with our hormones?

Because we know we have estrogen receptors in our brain and we know that the fluctuations in our menstrual cycle, even when we're menstruating regularly will affect our mental health. And so it's kind of a process for me of can we do, can we affect mental health outcomes, whether it's anxiety and I would say anxiety, it looks a lot like rage sometimes.

Like people don't really think that they're the same, but it's that like short fuse, like reactive. I'm just like freaking out at everything for no reason. Well, there's a reason, but it's a small reason and it normally wouldn't set me off, but now. Crazy. And that to me is like, okay, well, what can we do to kind of bind estrogen receptors and, and, and trick the brain into thinking it has estrogen when, when it does it have very much.

and can we work on that or do we actually need something that might act on serotonin? And is that a herb or natural health product, or is it a medication like, these are the discussions that we'll have, because like you said, every person is going to be unique and I don't ever discount pharmaceutical options because

Dr. Bri Botsford: each patient needs to have a choice and that's informed consent. They need to understand the pros and the cons of both a natural health product or a pharmaceutical or a hormone prescription, and then choose what may feel best for them. And that choice can change. Right? And I think that people forget that, you know, they go to their doctor and they get a prescription and they forget that they don't have to fill the prescription.

They can talk to the pharmacist before they fill the prescription. They can ask more questions. They can, they can fill the prescription and take the prescription for. One month, three months, six months a year, and then ask different questions or want to have a change, like, just because, it was the first thing that was recommended.

Doesn't mean it has to be the forever treatment plan. 

Bree Luck: That's a really good point, and it also really speaks to the importance of just being curious and thinking about things and rethinking about things, right? Like something that, that you might need at some point, like antidepressants, at some point you might not need down the line.

There might be another option. And, and I can imagine sometimes it can be hard. So as we talked before, it can be really hard to, to really share with one's medical provider. And, and when I, what I hear is. don't, don't assume that because you've been given a prescription that that's sort of the end of the conversation.

Yeah. And, and the end of being able to be curious around it, that you can keep looking at it and talking about it and figuring it out and finding a path through, because it is a time. My understanding is that much like puberty. It's a time of, of major fluctuations. So, I mean, I, so I have two kids. One is 16.

One is 20. The fluctuations that they went through between ages 11 and age 20 are huge. Right. And, and they're not linear and that is, both physical and, Cognitive. I mean, the cognitive shifts that are happening and, and also emotional, right. That I'm, that I'm and social, right.

How that manifests socially and, and the same thing, different, a parallel process in many ways is happening. As I understand it, it's happening during this perimenopause process. Yep. So, so early perimenopause. Or one point and it may be like the 11 year old, right? Yes. Then at some point we're at the 16 year old in terms of the shifts that have happened.

Dr. Bri Botsford: It's things level out, right? Like that's, that's what you're describing is like, initially it's like, you know, oh my God, what, what is this? And then, okay, this is what it's going to be like, this is how I'm going to manage. And then eventually. Okay. I actually don't need management because it's, I I'm, I am at balance like , the effects that I was experiencing, I I'm this sort of different version of myself, like, and I think another parallel for that would be motherhood, right?

Like you experienced a huge shift or at least I have so far with. Brie before baby and Brie after baby are two different people. And there was a Rocky patch in there where I didn't know who I was or what I was doing. Right. And I, and I think that like, we have many of these different experiences in our life, but we don't always talk about all of them or any of them.

And so like having a discussion about it, whether it's with your girlfriends or your friends, or, you know, your healthcare provider, To normalize that experience. And then to understand that, like you said, it may not be linear. It may not be this like gradual improvement or gradual decline. It's, it's sort of this like up and down.

I always picture it literally like a roller coaster that goes way up and way down. or like if you like math assigned wave. and so that, like, that's how I picture it because there's highs and there's lows. And then eventually the bumps in the road become a little more smooth and we kind of know what to expect and what our new normal.

Bree Luck: Yes, absolutely. And, and you really just made me think about how, when I, when, when this Bri had, ha. My first child, the, the identity shift that happened there, which I attributed so much to just the practical shift, right. That, that suddenly I was a mother and this was, and there was a whole new set of responsibilities.

And the way that people related to me culturally was very different from how. How I felt in the world before I felt that suddenly I was put into this other box that I both embraced and resisted as I think is fairly normal. And then, but that there's a similar identity shift that happens at menopause too.

That is both physical and cultural. Right. There is, there is a real shift there that gets to, the invisibility factor. I don't know how much your, your patients have talked to you about that. I hear it a lot. From from women. But I actually felt that way as a mother, I felt like I was no longer seen as an individual that I was seeing, that I was seen as a mother.

And, and that was, and, and that happened certainly at work. Now this was 20 years ago. Right. So hopefully that shifted somewhat, but. But that's also what we face in menopause in a very different way. 

Dr. Bri Botsford: So I think it'll be interesting. This is something I want to learn more about is, and you mentioned like anthropology and I'm very interested in that in terms of like how different cultures and different, like my understanding is that there's some cultures where there's no word for menopause because it's not.

event of great relevance. I don't know if I'm describing that the right way, but does it something I don't know a lot about, but I'm interested in. And the reason I bring it up is that I think there's this like power in and, and we need to honor our folks that are. Peri. And post-menopause because there's like there's knowledge and experience and like, and value.

Dr. Bri Botsford: And I think like what you're describing a sort of being like swept under the rug as far as , well, you're not ovulating, you're somehow less of a woman or something like that, but isn't that kind of more like you're coming into your power in some way? I don't know. I, I, like I said, I I'm keen to learn more about it and maybe.

It's that's a future area of progress of, of, research for me as far as like other cultures and their experience. But I know that we have to value women across their lifespan. and obviously like in Western cultures, typically where like, it's like the young, hot things that are valued and, and placed on a pedestal, but like, I dunno, like I picture like Helen Mirren, right?

Like she's like, like, you know, like, and like Meryl Streep, like they are like Queens, right. And, and , so like what was their process? and how can we value that differently? I'm not articulating this well, but that's, 

Bree Luck: you are, you are because they are Great examples of thriving post-menopausal humans.

And it's important to see more of that as, because that, that reminds us that there is, there is so much power in there and, and I had other guests on this podcast who have talked about sort of the Eastern philosophies around, around this time period, which I think is what you are alluding to a little bit, because, because there's the notion of that phase of life as being a second spring, which is a time of empowerment of, of stepping into one's own of not putting up with bullshit anymore. And, in many ways not being tied to the moon cycle. Right. What happens if we're released from that? Like, that's something I've, on a, on a personal level. Been sort of celebrating right now. I'm I menstruate regularly.

 I can look at the moon and see like where my cycle will be. And, and there's been a beauty in that, but I've also been lately sort of saying, oh right now, this is it. What will happen when I'm freed from that tether? Just emotionally. It's kind of exciting. so I I'd love to. Return to your practice a little bit.

Bree Luck: And, and this is a really tough question. I know because there is no one size fits all approach to anything, but what is one bit of advice or one thing that you would offer to, to people who are going through a perimenopause? 

Dr. Bri Botsford: Well, so the reason I got into women's health is because I actually did my training in sports medicine.

And what happened was women were coming to see me who were athletes, but were still experiencing hormone changes. Whether it's PMs, PMDD peri-menopause, doesn't matter anything throughout their lifespan. They were like, K, but I'm an athlete. Like I can't this, I can't have this. Right. And so I was just basically like pulled into women's health because, because my population was demanding that of me like become an expert in this because I need you to, and I, and I love it.

And I'm very grateful that that happened. The reason I'm telling you this is because that's one of my biggest pieces of advice is so when I talk to athletes, I'll say train the body that shows up today. So you can apply that to any area in your life. Whether it's training, whether it's work, whether it's parenting, whether it's, your relationships, your social connections, like be the body and the human that shows up that day because it might change and that's okay.

Right. And then two, again, because of my bias in sports medicine. Strength train, please. Strength, train,. And that's not hormonal, it's not nutritional, it's not a natural health product or herb. It's not that sexy, but it is so important because when we have changes in our estrogen, we see changes in our bone mineral density, and we know that our peak bone mineral density occurs at age 25, , and so if we haven't done a lot of weight-bearing exercise leading up to that point, we may be at a greater risk for osteoporosis or osteopenia.

So like bone loss and, and it's really, really important to me that people maintain not only their bone mineral density, but their ability to do really cool things. and I think that strength training is the answer to a lot of that. So like, if you can get into the gym or into your basement or wherever you are and pick up something heavy and move it around, I think that that is going to lead to better outcomes.

and certainly there's evidence to support that, both clinical and in the research, but I think. It's something that is changing in, in women's health, where I'm spending less time, like trying to convince women, or, you know, the, that they need to lift weights or that they need to be strong.

Dr. Bri Botsford: They're like, yeah, no, I get it. I want to be strong and like, okay, great. Perfect. But it's something that, like, when I first started practice, I had to spend a lot of time explaining why. Running isn't enough. Like it's good. And it's, it might be a good stress relief or, you know, cardio isn't, isn't the end all be all.

And I think there's a shift happening with what's going on for people with exercise and their relationship with exercise. But I do love strength training as a blanket, recommendation, like you said, there's no one size fits all. Certainly there's different types of strength, training, and movement that benefit different people in different ways.

But that would be my one thing. You know, be the person that shows up that day. And then, and then don't forget to pick up something heavy. 

Bree Luck: So I'm going to ask you then a personal, a personal question. I had chronic Lyme disease and I am mostly asymptomatic and have been for many, many years. But one of the long-term effects of this has been the, I have not been able to do repetitive, repetitive weight-bearing activity.

So, so like weightlifting, I used to lift weights. I used to love to lift weights and I can't do it anymore. It's it's I get sick. Like, I, I even just a little bit, even something, even something tiny it's like, it just doesn't work anymore. And, I have a wonderful physician. And, she said, you know, you can keep trying it occasionally, but this may just be something that you have for life.

There are other things that I do. I love to go hiking. I love I can wear a backpack. I can do other things. For people who cannot do repetitive weight-bearing activity, will that kind of thing have a similar effect? 

Dr. Bri Botsford: Yeah, absolutely. I mean, I think that the benefit of like hiking, walking, anything that is, you putting impact on your muscles and your bones is going to have, a similar benefit, meaning like you're still, so if you were like, all I can do is water walking.

I'd be like, well, that's probably not going to help maintain your bone mineral density or your muscle mass as much because that's the other thing is like estrogen changes will affect our ability to maintain our lean muscle. and so estrogen helps us maintain our muscle mass. And so lots of people will say, like, I just don't have the same amount of muscle as I used to.

And then our basal metabolic rate goes down. So like the amount of, of calorie that we burn at rest is less because we have less muscle. And we're tired because we're not like, is this the whole like perfect storm, right. But like movement, going for a walk on your feet on not in the water. and certainly like water walking is going to be better than nothing.

Right. So somebody who has severe hip osteoarthritis, like they can't weight bear because of a condition. Like, they're still going to benefit from movement. Absolutely. No question. But like you said, like hiking with a backpack, that's essentially weightlifting. Cause you're moving more than your body, more load than what your body is up a mountain or up, down across a forest or whatever.

Right. And so that's still going to have major benefits for your spine and for your hips and your like all of these things. And I think that's still very beneficial. but yeah, that's a really good point. Not everybody can do weightlifting and I will also hear like people because of this effect on lean muscle people also experienced more injuries.

and so whether or not just like, we're not talking about like ancient injuries where it's like, I felt when I broke my hip kind of injury, we're talking about like, I tried to do some deadlifts and I threw out my back right away. You know, like these kinds of things are more common. Where people will be like, yeah, like in my twenties and thirties, I could do anything and I never got hurt.

Dr. Bri Botsford: I was like, well, you may have gotten heard. You just may, maybe didn't feel it the same, or, you know, and a lot of it has to do with nutrition and maintaining our activity level. And I think sleep is a, is a pinnacle in that because a lot of people, when they stop sleeping well, whether it's from night sweats or hot flashes or what have you, they stop moving as much.

And so it becomes. Like I said sort of spiral, but if we can, when we know that activity also helps us sleep, so it started a double-edged sword. Right. but yeah, the movement, the walking, the hiking, the biking, I mean, it's all, it's all beneficial. Yeah. 

Bree Luck: That's great. Thank you. Thank you for indulging me.

Dr. Bri Botsford: What's an important question. You're not the only one that has, that has that question. 

Bree Luck: Yeah. And it's it's I always feel this little bit of like, oh, I can't lift weights, but it helps me to know. 

Dr. Bri Botsford: Yeah. And, and like yoga, Pilates, like these things are still beneficial and when we talk about energetics, like there's going to be different times where it feels better to be grounded in a yoga sequence than to go out and pound the pavement and that's okay.

Right. But yeah. And that's part of training, the training, the body that shows up and being the person that shows up that day, is knowing like today's a yoga day. Right. Versus pounding the pavement kind of 

Bree Luck: day, but don't let it be a do nothing day. 

Dr. Bri Botsford: Yeah. Yeah. I mean, if you can, if you, yeah, yeah. 

Bree Luck: Even just being thoughtful about it, even just, just, Carrying the groceries going, 

Dr. Bri Botsford: I think about, yeah.

I mean, that's true. Yeah. I mean, I want to be able to get all my groceries into the house in one trip. I think about it every time I carry the baby in the bucket seat, I'm like, this is why I lift weights. 

Bree Luck: Oh, totally, totally. And I'll tell you, I have, I had two precious little nephews now. Spent time with them on Thanksgiving.

And I thought I may not be able to lift weights, but I can lift 

Dr. Bri Botsford: knees. 

Bree Luck: I will go lift all the babies. That will be my fitness. Perfect regimen. wonderful. Thank you so much for joining me today. Thank you for, for all that you do to help support. Women in, in their whole lifespan. I really appreciate it. I appreciate you.

And how could we find. 

Dr. Bri Botsford: I am on Instagram. Like you mentioned, I'm at dock bri bots, but that's Bri bots. and, and I have a Facebook page. I have, I'm a clinic owner, so our clinic also has good information and that's, flow white EEG. and, I also have a personal website, Dr. Bina botsford.com.

So. Those are my, those are the ways to reach me. Yeah. Thank you so much. 

Bree Luck: Well, lucky Canadians for having access to you as a doctor, and thank you also for having a social media presence so that we can all benefit from your knowledge in one way or the other. 

Dr. Bri Botsford: Well, thanks so much for, for carrying on this conversation and for doing this work with, your podcast and of course your clients.

Bree Luck: Here are my key takeaways from this conversation with Dr. Bri Botsford number one, I was really moved by Brie sharing that her understanding of menopause and perimenopause has shifted over the years. And it reminded me that our medical practitioners are learning along with the rest of us. So keep having these conversations with your doctor and notice if they are curious about finding new ways to see, explore or understand what you are going through.

 Number two. If you're interested in seeing a naturopathic physician check to see what your states or provinces regulations are, and if you're in the us, you might want to refer to the American association of naturopathic physicians for directory of licensed providers.

And I've provided the link for that in the show notes. Number three. Don't discount sensations as being irrelevant. When you do speak with your physician and know that the conversation doesn't have to end when you've gotten a prescription, whether this is about vaginal dryness, emotional ability, or your pelvic floor, your body is going to change.

And there's probably not going to be a one-time cure-all that eliminates discomfort forever. Four, and lastly, we've heard it before, but it's worth the repeat. Keep looking for ways to incorporate strength training in your regimen, whether that's lifting weights at the gym or going for hikes. Like I do weight bearing activity is crucial for your long-term bone health.

Hey, last week, I said that I would give away a copy of what fresh hell is this to one person who left a written review on apple podcasts. And a copy of the book is going to Gail E who had this to say about pause to go.

" I've been listening to these interviews with delight, learning something in each one and feeling less alone. Bree luck has tapped into a wealth of insight and connection that is truly inclusive to discuss women's bodies, health, and the transitions of life that are not well-recognized in our culture. Highly recommend."

Thank you to Gail and to other folks who have left reviews on apple podcasts. There is no better way to spread the word about perimenopause and menopause than to share resources like this one.

And a written review is a great way to do that. Thank you so much.