[Angela Foster] (0:14 - 0:23)
For a woman listening to this, how would she know that she was a really good candidate for menopause hormone therapy and it would improve things for her?

[Siobhan Mitchell] (0:24 - 8:27)
You know, the first thing I always recommend is active listening to our bodies. I think we all live in our heads and I've described it as though there's like a concrete wall between our heads and our bodies. And a lot of us are living in our heads and not really attuned to what's happening beneath.

And so many aspects of our culture and our society and our training, like tell us to block that out, block out your fatigue, have another coffee. You know, you're hungry, eat the convenience food that spikes your blood sugar and ultimately leads to insulin resistance and hangriness and brain fog, but you know, just keep going. We have so many messages around that in our work culture, in our societal culture, around motherhood, that it's sort of trained into us.

And then on top of that, we have a medical system that is reactive. So unless you're sort of a mess, you're highly symptomatic, your hot flashes are through the roof, you're miserable. We're like, oh, there's nothing to be done.

If you think about the 10, 15 minute visit you have with your PCP or your GYN, where they order some basic tests and do a very basic exam. And unless there's something really egregious, they sort of send you on your way. And that message also gets reinforced by our healthcare system, right?

You're fine. And so I recommend at Parsley, we have it on our website. We have a symptom score.

It's proprietary. We've published it in the medical literature multiple times. We developed it to be able to give patients a way to track whole body symptoms over time.

It's called the Parsley Symptom Index. And it takes two minutes and you do it online and it gives you a score. And it looks at nine body domains from your hormones, to your mental health, to your gut health, all of it.

And it allows you to assess. It's designed to be done at most every two weeks. So it's a two week look back.

Because beyond two weeks ago, do you remember how you feel? I mean, I don't even know how I felt like two days ago. Let alone two weeks ago, right?

So two week look back. So you're supposed to do it at most every two weeks. But it allows you to kind of begin to score and understand how am I actually feeling?

And it's a huge wake-up call. We have patients do it before every visit at Parsley. And it's such a wake-up call.

Wow. My brain fog. Wow.

I've got this new joint pain. Wow. I'm aching everywhere.

Wow. These headaches are out of control. Wow.

I really haven't been sleeping well. Wow. The things that we're kind of burying.

And so I always recommend first do this assessment. Because how you feel may show up before your period starts to change. Before even vaginal dryness and hot flashes.

Yes, menstrual irregularities, vaginal dryness and hot flashes are the big three that we associate with menopause. But far before that, you could be finding brain fog, inability to focus, sleep disruptions, hair loss, hormonal acne. Like I've been dealing with a huge hormonal acne issue for the past couple of months, brand new for me since a very long time ago, which is absolutely a combination of stress.

So I was stressed before, right? Life is stressful. Three kids, job, all the things.

Stress interacting with what is slightly lower progesterone. And that slightly lower progesterone is no longer quite tempering. Having a little bit of a softening, let's say, on my androgens, my testosterone, which is leading to breakouts around my chin and the lower part of my face.

These are sometimes the early signs. Joint stiffness, achiness, changes in libido, changes in energy level, weight gain, even subtle weight gain. These are all ways in which this can show up.

And so the symptom tracking is a really nice way to start to check in on that. And then adding to that, getting proactive blood work. So the old adage, the old classic medical recommendation is like, oh, don't test your hormones in menopause or perimenopause because they're going to be all over the place.

I'm like, that's literally insane. That's like, let's just fly blind. Who cares if your testosterone is cratered?

We're not going to give you testosterone anyway, so why bother to know? Well, if I'm working with a woman, I want to know where her testosterone is because I have some of my women who their testosterone is freaking fine. I have some patients who are like 70 years old and their natural testosterone is like a-okay.

It must be genetic. I don't know why. I'm freaking jealous.

That is not me. But it's some of us. Okay, cool.

You don't need outside testosterone. Fabulous. Or you probably don't need it.

Or if you do, you need very, very little. That's very different than somebody who does, right? I also want to see how is your oestrogen and progesterone moving over time?

So it is correct. One random blood test of your sex hormones is pretty useless. But if you get a baseline in your mid-30s, let's say, and then you test at least once a year or ideally twice a year from there, well, now we have a trend line.

And now if I'm working with you over time or you have access to your labs over time, you can see how oestrogen was used to be kind of here and now it's kind of here and now it's kind of here. And you can see how progesterone used to land after ovulation up here. And now it's still here.

You're still ovulating, but it's down here and so on. We can see the trend. And that trend is what tells us that, yes, you are changing.

And it will show up in the labs if you do them repeatedly and you track them over time. And so we track symptoms over time. We track labs over time.

And then we treat, right? And that's the last piece, which is so horribly missing in conventional medicine is this willingness to say, hey, let's be proactive here. You know, I love to prescribe cyclic progesterone.

I prescribe it for women who have irregular cycles, PCOS, other causes of irregular cycles or lack of cycles in the fertility journey. We have helped so many women get pregnant by re-kickstarting their cycles, by addressing some of the reasons that they didn't have cycles in the first place underneath, and then using progesterone topically or vaginally in the second half of the cycle to get their cycles going regularly again, like too many to count. And on top of that, okay, now you're on the other side of the fertility journey as I newly am.

My youngest is four. I have three kids and I toyed with a fourth and I think we're good. But at this point, right, you're on the other side of the fertility journey and your hormones are starting to wane, but you still have your period.

So you don't want to take progesterone all the time because that will send things super haywire. And you may not even be ready for oral progesterone, which if you're not ready for it, can cause bloating and fluid retention and sometimes sleepiness. Like some people react to it a little bit.

Some people feel great, but you might be ready for cyclic progesterone again in the form of a topical cream or a vaginal suppository, which is the best, or sometimes even maybe an oral just in day 14 to 28 or so of your cycle after ovulation. And that might be just enough to help with the sleep issues and the breakouts and some of the symptoms that you're beginning to have. You might start with just that little bit of progesterone.

And so what is that? It's a willingness to track your symptoms proactively. It's a willingness to track your labs proactively.

And then it's a willingness to say, hey, let's get started with just a little bit of hormone replacement therapy in a very personalised way. And yes, maybe you're not ready for an oestrogen patch and oral progesterone and all the things that come kind of in later perimenopause to menopause, but you are ready for some level of intervention. And I think that's kind of the optimal trinity as it were for women in this phase of life.

[Angela Foster] (8:31 - 12:01)
I want to take a quick break from this episode to thank our sponsors. During perimenopause, your energy doesn't necessarily just dip because you're getting older. It happens at the cellular level.

Your mitochondria, the tiny powerhouses in your cells, stop replicating like they used to. And that's one of the reasons why you feel exhausted, foggy, and like your resilience is slipping. Supporting a process called mitophagy clears out damaged mitochondria and restores vitality, but your body's ability to do this naturally declines with age.

Urolithin A is the only known nutrient proven to trigger mitophagy, but around 60% of people can't produce it from food alone due to gut bacteria and balances. So if you're waking up tired, dragging yourself through the day or wondering why your workouts no longer give you the results they used to, supporting your mitochondria can make a big difference. Mitopure delivers a clinical dose of urolithin A, no gut conversion needed, and it's backed by over 500 published studies.

In clinical trials, it's been shown to boost muscle strength by 12% in 16 weeks, improve endurance by 17% in just eight weeks, and support cellular recovery and resilience. And that's why I take Mitopure every single day. It's really helped me get stronger in the gym and also recover faster.

And like me, many women have also noticed that their skin looks brighter and more radiant. And that's why Timeline have created a skincare range too. I personally use their serum and eye cream in the morning and their gorgeous night cream before bed.

It's become a non-negotiable part of my routine. And Timeline are giving you an exclusive discount off your first order of Mitopure when you use code ANGELA at checkout. Just head over to timeline.com forward slash ANGELA and enter code ANGELA for your exclusive discount. This is your chance to feel the shift in your energy, your skin, and your vitality from the inside out. Head over to timeline.com forward slash ANGELA and enter code ANGELA to get your discount. I'll also put a link with the discount code in the show notes below.

I think what I'm hearing from you there is just how bioindividual it is, right? And I think how each woman needs to be treated separately. Her labs need to be looked at, her symptoms.

I love the fact that you have this symptom index. I mean, it's interesting what you were saying there about the sort of breakouts around the chin. So I went through a real phase of that myself.

And I was thinking, oh, the androgens must be really high. And actually, my testosterone turned out to be quite low. And the trio of oestrogen, progesterone, and testosterone cleared up my skin.

I felt so much better. And as someone who'd had PCOS when I was younger, what my doctor was saying to me is you probably were used to higher levels of testosterone, which then affects your kind of mood and energy and things. And I think just what I've learned through my own experience and working with women and interviewing people like yourself is just how individual this is.

Do you also track other things like with wearable data, for example? Do you look at individual sleep? Do you look at their HRV?

What do you see going on with heart rate variability in perimenopause? Absolutely.

[Siobhan Mitchell] (12:02 - 14:52)
So I'm on WHOOP's medical advisory board. So WHOOP and Aura are sort of like the two big trackers in the world. And I love my WHOOP.

Actually, my WHOOP has been super illuminating for me. As I started Parsley 10 years ago, it was in the sort of Fitbit days when tracking was, in my opinion, kind of basic and kind of lame. How many times can you see how many steps you took?

I don't know. I just didn't find that information terribly useful. I'm a New Yorker, so I walk a lot.

So it was like, great, true, true, and what I expected. But I think that as wearables have gotten so much more sophisticated, what I'm so impressed by in my WHOOP is how much data and insight I get into things that, again, just like we all brush our symptoms aside, sometimes we brush our lifestyle aside. And I've been blown away by my own...

So this is the one I'm terrible at. My own sleep inconsistency is really bad. I am not good at going to bed at the same time or within the same 30 minutes every night.

It is absolutely, at this moment in life, my Achilles heel. And I see in the WHOOP how it's impacting and raising my biological age significantly, actually by a year. And when I dove into the data on sleep consistency, for example, and how it's even more of a driver of ageing than sleep duration, seeing it in your data is a real wake-up call.

Because we can all... Again, I don't even remember all the times I went to bed last week. If I just was asking myself to remember that, I would just have no clue what time I went to bed last Tuesday.

It'd be impossible for me. But the WHOOP shows you that. And it gives you this real barometer of, oh, maybe this thing I'm doing is not helping me so much.

And maybe the reason I'm so tired is not this massive mystery. Heart rate variability, as you bring up, is another one that's heavily bioindividuated and starts to change in perimenopause and menopause. And it starts to, by and large, go down.

It also goes up and down, everyone, at different points in your cycle. So seeing your average HRV over months at a time is also really helpful. Because if you zero in too much at one point in your cycle, and you're like, my heart rate variability is low, get upset about it, it wouldn't be telling you the whole picture.

But it does show you how your stress, your cortisol levels, your catecholamines, like epinephrine and norepinephrine, which is that fight or flight side of your nervous system, that tampers down your heart rate variability. When that's always on, heart rate variability really responds. And then what you see is that in perimenopause and menopause, that heart rate variability is more sensitive than it used to be to those stress hormones and those catecholamines.

And so you have to do more stress reduction and more resilience building to bring it back up.

[Angela Foster] (14:53 - 14:58)
What do you see in relation to HRV when women start menopause hormone therapy? Does it have an impact on that?

[Siobhan Mitchell] (14:58 - 15:06)
Yes, absolutely. Absolutely. It makes your HRV more resilient to the stress you're under, period.

It makes your whole body more resilient to the stress you're under.

[Angela Foster] (15:07 - 15:23)
So you don't see, you know how there's sort of an association between HRV dropping in the second half of the menstrual cycle, when women start taking progesterone, do you then see a drop in HRV, particularly if they then move from cyclical to continuous progesterone, is there any impact of that on HRV?

[Siobhan Mitchell] (15:24 - 16:43)
I usually see HRV by and large, again, I'm not so interested in the HRV sort of like in a specific day of the week, as I am sort of understanding it over time. And by and large, HRV improves overall with hormone replacement therapy. Just like inflammation improves.

Yeah, exactly. And just like your ability to, you know, I was talking with a friend the other night and she was talking about how she turned 50 and all of a sudden she gained 20 pounds and was overnight. It was all around her middle and she experienced severe vaginal dryness and she was like, and her joints all ached.

And she was like, it was overnight. It was just like crazy. And she talked about going on hormone replacement therapy and seeing how not overnight, but over a matter of months, everything re-regulated itself and got better.

And it's not about going on such high doses of hormones that you're necessarily even all the way back up to your height at 25. But it's about being on enough that your body gets the anti-inflammatory, pro-dopamine, pro-metabolic, pro-bone building capabilities back that it can resurrect its own ability to do those things on a daily basis.

[Angela Foster] (16:43 - 18:05)
I hope today's episode inspired you on your journey to vibrant health and high performance. Make sure you check out the show notes for a summary of all the important links to everything we talked about. And if you enjoyed this episode, hit the follow button and share it with a friend on social media or leave a review over on Apple Podcasts.

Remember, achieving high performance health is about getting 1% better each day. So think about one thing you learned from today's episode and start implementing it today. Share with me what you've learned on social media over at Angela S.

Foster. I love hearing from you and connecting with you. Have a beautiful day and always remember, you are worthy of your dreams.

Now for the legal stuff. This podcast is for informational purposes only and does not constitute medical, nutritional, or other professional advice. Always consult with a qualified healthcare provider before making any changes to your health routine.

Some of the links I share may be sponsor or affiliate links, meaning I may receive a small commission if you make a purchase at no extra cost to you. That said, I only ever link to products that have undergone rigorous testing and that I personally use and love. And because I want to bring you the best value, I always work to secure exclusive discounts for my listeners wherever possible.

Your support helps keep this content free and allows me to continue sharing insights that help you optimise your health and performance.

Health expert and Parsley Health founder Dr. Robin Berzin joins host Angela Foster to discuss a proactive approach to managing perimenopause and menopause. 

Dr. Berzin emphasises the importance of listening to our bodies, tracking whole-body symptoms over time using tools like the Parsley Symptom Index, and utilising continuous blood work to catch early hormonal shifts before standard symptoms like hot flashes begin.

WHAT YOU’LL LEARN

• How to actively listen to your body and identify early, subtle signs of perimenopause before major symptoms like hot flashes even begin. 
• How tracking whole-body symptoms and blood work over time reveals personalised hormonal trends that one-off lab tests completely miss. 
• How optimising sleep consistency and monitoring heart rate variability (HRV) with wearables can lower your biological age and improve stress resilience. 
• How a personalised combination of proactive lifestyle tracking, lab data, and tailored hormone therapies can naturally regulate your metabolism, mood, and energy levels.