Episode 76 | Mar 28, 2024

The Modern Menopause Toolkit: Redefining Solutions, With Dr. Suzanne Gilberg-Lenz

Six thousand women enter menopause in the United States every day. Yet many people don’t know the difference between premenopause, perimenopause, and actual menopause. This week, Dr. Sandi welcomes Dr. Suzanne Gilberg-Lenz to share her expertise. Dr. Suzanne is the Chief Medical Correspondent for the Drew Barrymore Show and author of Menopause Bootcamp.

Menopause isn’t “one-size-fits-all.” From plant-based options to pharma to self-care, Dr. Suzanne shares her menopause toolkit. She discusses various tools and treatments available for women to help with the effects of menopause. Moreover, she and Dr. Sandi discuss how health coaches can be an excellent resource for women during this time.

Menopause and post-menopause are significant parts of a woman’s life. It isn’t an ending; it’s a transition into a new period of life. So, let’s talk about it.

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Episode Transcript

Dr. Sandi: Welcome to “Health Coach Talk.” I am so excited because my guest today is someone I think you are going to want to know. She is Ask Dr. Suzanne. Specifically, this is Dr. Suzanne Gilberg-Lenz. She is a renowned OB/GYN physician. She is the chief medical correspondent for “The Drew Barrymore Show.” She has a book that came out, “Menopause Bootcamp.” She’s going to talk all about menopause, perimenopause, and beyond today and how health coaches can be a vital part of the collaborative care team for women’s health. So, welcome, Dr. Suzanne.

Dr. Suzanne: Thank you so much for having me, Sandi. I’m very excited to talk more with you and to reach out to your audience who I think are such an important part of the conversation around midlife health.

Dr. Sandi: Well, let’s start to talk about your journey because you were traditionally trained in OB/GYN. And what was that like? How did you then make that shift into more of a functional integrative medicine perspective?

Dr. Suzanne: Well, you know, first of all, it’s interesting because I do still practice in a fully conventional environment. But what happened is that I became well-known in the community for having a little more openness initially and then having been trained in integrative medicine. And, like, it’s funny because, I mean, having lived in this space for multiple decades, I think sometimes people get siloed. And I’ve had, actually, in my opinion, the good fortune of being able to, sort of, truly continue to integrate.

Having said that, I was trained in conventional medicine, and I think through my own explorations and through my own interests started getting more…wanting to expand things more. I felt like everything that l learned in conventional medicine was really, really important and vital, but it left a lot of stuff out. And a lot of what I found, once I started practicing clinical medicine, was that the connection that we have with each other and, sort of, the culture that we bring to the encounter, both the physician and the patient or the client, has so much more of an influence than we discuss on a regular basis.

And I started doing yoga and meditation for my own personal benefit, and through that, discovered ayurveda, which is the ancient Indian medical system similar to… A lot of people are more familiar with Chinese medicine. They grew up around the same time 5,000, 6,000 years ago and made use of both the mind-body-spirit paradigm but also really availed themselves of the natural world and specifically views are experienced as part of nature.

And in fact, the ayurvedic perspective is that disease is really our loss of connection to the natural world, that when we fail to appreciate our conection to the natural world and that we are actually part of the natural world, that’s actually what makes us sick. So, that’s a big, heady philosophical thing, but I found that to be largely true, right? And I started learning more and getting more interested and decided to actually certify in Ayurveda. And that led me to integrative and holistic medicine, which at the time was not a recognized board certification. So, I did that training before it was a recognized certification. It’s actually now recognized by the Board of Medicine.

So, that was it and really I was just, like, learning from my patients, you know, and reading. And the ayurveda part, like, I went in residence and I learned and I made my own medicines. I did an internship where I saw patients privately outside of my conventional medical practice. I was serious about it. I don’t do that in the office because I can’t. You can’t do a full diagnostic procedure and look at someone’s tongue and do their pulse and all that stuff. However, the mind-body-spirit connection has continued to guide my practice in many ways and has had a massive influence on my interest and openness in more cutting edge opportunities and, sort of, big picture ways that we can maintain our health, restore our health, and grow that community of resources.

Dr. Sandi: Can you speak about the specific tools that we can use to support women who are in perimenopause, menopause, and post and beyond. Post-menopause.

Dr. Suzanne: Yeah, which is right and thank you for saying that because here’s the thing just to throw some stats at people. I mean, a lot of the people listening probably realize this, but in the United States, 6,000 women a day are entering menopause. And a lot of people don’t really know what menopause actually is because it’s all of a sudden being talked about quite a bit. The words are used interchangeably, and this is by the way why I created “Menopause Bootcamp,” because people aren’t speaking the same language, right? We’re not talking about the same things.

So, menopause itself is 12 months consecutively without a menstrual bleed between the ages of 45 and 55 for no other medical reason. Once you hit that 12-month mark, now you’re at menopause or post-menopause. That is a third to a half of our lives. That’s incredibly significant. This is not a moment in time. This is a huge portion of humans on the planet for a huge portion of our lives. So, I just want to, like, put the context on why this is so important.

The toolkit is really the same toolkit we should be using for everything. It’s the pillars of health, and this is where I think integrative medicine and the more indigenous, holistic traditional medicines really shine. I have, sort of, turned it into my own thing. I talk about what I call the six Ss of self-care, but they really are about how you restore and maintain health and they are: sex… because I always like to say sex first because that’s me. I like to say that. Sex, sleep, what I call sustenance, which is essentially what you’re eating, senses, everything you’re bringing in, okay, what you see, what you consume on your social media, what podcasts are you… I mean, it’s in your ear for God’s sake, what you smell, social connection, spirituality, also very, very important. Did I leave something out? I might have left something out, but if I think of it later, I’ll let you know

So, it’s the basic pillars of health. It’s how we are living our lives, right? It’s lifestyle medicine. Those are the buckets from which we should be pulling. It’s really not different for anybody else. I think what people need to understand and hear is that lifestyle, sleep… Stress is the other one. Thank you. Sleep, stress, all this… right? Those are the obvious things that we have to do for our full lifespan.

And then I think when we look at the products that we can avail ourselves of, I think looking at plant-based solutions is really, really important and also not throwing the baby out with the bath water. You know, pharma is magic. This is 2024. Hormone therapy is fantastic, and amazing, and safe for far more people than we have been led to believe. So, it’s not that everybody should be doing this or that. It’s, “Here’s the toolkit. What are the tools that are working for you at this moment?”

The tool has a job, right? I say this all the time to people. Because I have this background, Sandi, sometimes I have people who are a little bit like leary of pharma or conventional. And I’d say to them, “Look, a hammer and a screwdriver are not inherently good or bad. They’re tools for a job. You wouldn’t use a screwdriver for something that a hammer required and vice versa.” So, same thing with hormone therapy and supplements if we’re just going to go broadly. Like, they’re not good or bad. They’re used for potentially different reasons and different seasons. I want people to be open to that. That’s to me true integration.

Dr. Sandi: That is so true and I, as part of that generation, that was so frightened by the Women’s Health Study. And, I mean, a whole generation of women were basically turned off to hormone replacement because of that study. And of course now, in retrospect, looking at what was used and how it was performed, so there were many flaws to that, but the perception is still there and It’s like….

Dr. Suzanne: Yeah, yeah, yeah. And it’s just important to continue to learn and grow. I mean, we call it the practice of medicine because you’re never perfect at it, you know? You keep learning, you keep growing, you keep practicing it

Dr. Sandi: Absolutely. Well, I love that six Ss. That is such a good framework to look at what are these areas and that could really… It’s such a good way of integrating. You know, you’re talking about integrating the best of conventional with the best of holistic integrative approaches. And that’s really where it’s at. It’s not one good, one bad.

Dr. Suzanne: Exactly, exactly. It’s worked for me, and I think that the evidence supports it, you know? I try to take an evidence-based approach here. It’s hard to… You know, apples and oranges, when you’re looking at, like, you know, a national institute for health or a pharma-based study, they have a lot more powerful numbers because they have more money to spend.

Dr. Sandi: Sure

Dr. Suzanne: There’s evidence that supports a lot of these other “less conventional opportunities.” And I think we need to be aware of that and not shut those options down either for people. I think they’re really powerful.

Dr. Sandi: Yeah. Speaking of powerful, let’s talk about plants. What plants… Because I know you talk about plant, plant medicine, what do you go to? What are some of the go-to’s in your toolkit?

Dr. Suzanne: Well, in my toolkit specifically for this time of life, I love chasteberry or Vitex. I think it works really, really well to help us, kind of… especially in the transitional period, so with plants… Look, we don’t know exactly, exactly always how they work. We know what some of the more active ingredients might be doing, but one of the things that, and it looks like this, this wonderful plant does is that it probably helps increase progesterone production.

And so as people are entering into getting closer to menopause and what’s called the perimenopause, those years leading up to the sensation of their cycles, their ovaries are functioning differently. And the ovaries are where progesterone is made. That’s really the only place progesterone is made, and that’s what dominates the second half of a reproductive cycle, so from ovulation to menstruation. That’s where I see a lot of people having, especially mood symptoms, a lot of anxiety will come up, breast tenderness, fatigue, hot flashing, and chasteberry can be really, really great in that area. I love, love, love it.

The other one that I love is… I mean, I think that the data on black cohosh is actually quite strong. Pycnogenol, which is also called French marine pine bark, is fantastic. Russian rhubarb or Siberian rhubarb is great. That’s actually what’s called a phytoestrogen, Sandi, so it is a plant-based… It can act like an estrogen.

The other ones have actually a lot more wide-ranging impact. So, like, Pycnogenol has a lot of other benefits. I think there’s some vascular, endothelial vascular impact. So, that’s probably why it might be helpful for hot flashes. So, those last three that I mentioned—the black cohosh, the Pycnogenol, and the Siberian rhubarb—all are really, really good for hot flashes.

I mean, I can go on and on. Sleep becomes really a big issue as we get into our middle age, things like cava, jujube… Melatonin is a little controversial, but I think melatonin works really well. It’s not plant-based actually. Passion flower. I love valerian with caution. I grow valerian actually. I grow some of these things actually in my backyard, which is really fun and interesting.

And then there’s other things that I just like to grow like nettles, which be careful because they will take over your entire backyard. They actually have lots of iron in them, and they’re really good for inflammation and pain. I make salves out of these things. I’m not suggesting everybody wants to do this, but I like this.

And then just, like, garden herbs like kitchen herbs, they’re medicine. So, in ayurveda, if you look at Indian cooking, a lot of that is, like, the… It’s sort of they almost embody ayurveda in food culture, right? Turmeric, cumin, black pepper, you know, all of these things, mustard seed, and you activate them in oil to cook and then you put them in your food. I live in Southern California so mint, oregano, marjoram, rosemary, basil. These all are shown… There’s tons of data on how important these are as anti-infective agents, right? They’re antimicrobial, and they’re also pain-reducing. I have homemade… You better shut me up, I’ll keep going.

Dr. Sandi: I love this topic.

Dr. Suzanne: I have homemade infused oregano oil that we use for cuts and burns and all sorts of… Like, it works because I want to say something about this. I feel like your listeners probably know this, but it makes me, depending on my mood, either laugh or annoys me but, you know, at least 30% of pharmaceuticals are based in indigenous medicine. The plants are there for medicine for us. They make these compounds to protect themselves, right, in the natural world. Over the millennia that humans have existed on the planet in the plant world, we discovered what worked for what.

So, that’s just been taken into conventional medicine, Western medicine, and pharma. So, when people in the conventional world start, like, calling it woo, it’s like, “What are you talking about? Where do you think you got aspirin from? It’s willow bark, friends. Antibiotics are from mold.” So, it’s not like camps either/or. This stuff all exists for a reason, which we’re not even going to get into that, but we don’t need to be so, like, oppositional to each other. We’re all trying to do the same thing and also we’re all actually pulling from the same toolkit. We just didn’t always realize it.

Dr. Sandi: Absolutely. Well, that’s such a good point. And so seeing the spices that are… And the spice rack in your kitchen, those are medicine, and they can be very powerful. Plus, they add such great taste to food.

Dr. Suzanne: Yes, exactly.

Dr. Sandi: Experimenting with them is fun and many people are just afraid of the kitchen. And speaking of fear, I was never bothered by hot flashes. I remember being in a dance class. This was many, many years ago when I went through menopause, but going into a dance class and just, “Yeah, I’m a little hot, but so what?” But I would teach people using biofeedback and positive imagery the opposite. Instead of almost going into a panic when they were feeling uncomfortable with hot flash or night sweats, focusing on the opposite like, “Oh, imagine cold water.” They would come up with the image themselves plus, you know, like, swimming and feeling like this really wonderful temperature water or being out someplace that was just completely relaxed or even channeling some positive images about heat like a resort that they were at in the tropics, and they welcomed the heat, and they welcomed feeling that warmth. And it was very effective to have that mindset and also that this will pass and soon I will feel fine again. And so the power of the mind to generate those images to also be able to tell yourself you can bear it. I can withstand it.

Dr. Suzanne: Yeah, absolutely. I think that that needs to be an option, but I got to be honest with you. When people who are suffering greatly are not sleeping all night, like, that’s not going to work. And when people have to be at work all day, it may not work for them. So, here’s where I land on that, and I’m actually kind of… This has been an interesting week because there was a huge article published in “The Lancet,” which is one of the most prestigious British medical journals we have that was basically a rehashing of the Women’s Health Initiative. So, the Meno-verse [SP] that we would like to call the Meno-verse has been on fire, and I think there’s this… It’s so interesting.

Yet again I find myself in, kind of, an either/or space when I am, sort of, a “Yes and…” person. So, I am fully committed to as integrative lifestyle as possible. I just told you, I do meditation. I do yoga. I think things like what you’re talking about, which is essentially a version of cognitive behavioral therapy are phenomenal. And I’m also a big proponent of really making sure we re-examine this narrative around menopause being this horrible ending, when in fact it’s an uncomfortable transition into a beautiful period of life. That’s the way I see it. That’s been my experience.

But not everybody has the same experience and not everybody has the same access. And I think we need to make sure… And this is why I said something about hormones. We need to make sure that we are not cutting off possibilities. We’re not saying, “Plants are bad. Hormones are bad.” And, you know, we are having a full conversation about the range of options for people that are all effective, and safe, and evidence-based. So, I’m not saying that I don’t love your thing, like, that’s amazing, but that’s not always available to everybody, you know? So, I just feel like because of the week we’re having, I need to say that.

Dr. Sandi: Yeah, exactly. And there is…it’s the belief that, yes, taking a medication for example, but it’s okay, and the power of, “This is going to help me,” or this bridge into a better place. And so it is, you know, just going back to that mindset, and I think that’s where coaches can place such a valuable…

Dr. Suzanne: Yes, oh, my gosh. Yeah.

Dr. Sandi: …in helping people to embrace whatever changes they’re going through and whether they’re transitory, they’re temporary, to feel resilient as well as to support them, and that whatever choice they make, that it’s not good or bad. It’s a feeling like you’re empowered and you have that control. And so that will help you as opposed to, “What’s wrong with me? And I have this horrible condition,” or, “I can’t stand it. I can’t stand feeling this way.” And coaches can help them in that way and help them find the right resources, whether it be plants or prescription medication, if that’s in order.

Dr. Suzanne: And you’re saying something really, really truly important. I want to, like, kind of, harken back to what I said about the six Ss. Social connection and support are so vital. And one of the things that I noticed just in my own lifetime but definitely in my practice and when I started doing more and more menopause work was that, because there’s been this loss of social connection and community networks, people weren’t giving information about these vital transitions in their lives. It wasn’t being talked about, and you’re right. You’re 100%. You nailed it, which is why health coaches are so important. Because if people feel alone, or ashamed, or isolated, they don’t seek help, they don’t know that there are resources available to them, then they really suffer.

And there’s even data on this, you know, that loneliness is more dangerous to your health than cigarette smoking. I mean, there are physiologic consequences for isolation. And so when we have these opportunities to educate and support one another, the medicine…I talk about this all the time. You know, honestly the community is the medicine. That’s where a lot of the medicine is.

Dr. Sandi: Absolutely. It is so, so critical to have conectoin and also to have… It’s essential you’re not alone. And I think a big part and I love to hear your perspective would be humor. So, it’s still running but “Menopause The Musical,” I never saw it, but people would gather and get together with groups of girlfriends, and they would go see this musical and laugh about menopause. And so, I mean, we’ve traditionally used humor as a way to cope. I’d love if you could share your thoughts about that.

Dr. Suzanne: Oh, my God. So, I always like to go back to the science. Like, there’s just the common sense aspect of it. Like, who doesn’t want to laugh? That’s fun. But why is it fun and why does it make you feel so good? And if you’re thinking about an experience of laughter right now, where are you even feeling that in your body? For me, it’s in my heart. You know, it’s like your heart, kind of, opens, and there are physiologic changes that occur to us when we feel joy, when we’re in flow. Like, we are more relaxed, our blood pressure goes down. We are able to bring more oxygen in, which is going to help our brain function. You’re going to downregulate that fight or flight and upregulate parasympathetic and relaxation and calm. So, there are things that are actually happening in your body that are beneficial, which is why we seek those experiences. You have changes in dopamine and serotonin. I could go on and on and on. And that will probably have an impact, by the way, on gut health and blah, blah, blah.

So, these experiences of joy and laughter and fun and sharing are critically important for our health, right? We are tribal human beings or tribal beings. Humans are meant to be together and to be with each other through the bad times and the good times. And it’s true when you can take something that is uncomfortable or painful or scary and turn it on its head, it’s not so scary anymore, right? It’s approachable. Like you said, you develop resilience around that. So, that’s beautiful. You’re, like, proving all of my points for me. Thank you.

Dr. Sandi: And I know we have so many listeners. We have so many people becoming health coaches because they know their experience of being in perimenopause and menopause or post-menopause and they want to help people. They want to help people feel empowered, women to take charge of their health, to seek the right treatment, to look at whether plants would be an option or looking at support for going through this phase of life, and so I know it is a very important area that people want to know about and want to specialize in as health coaches. So, ask Dr. Suzanne. Where can people find you? Where particularly on social media and also your book?

Dr. Suzanne: Yeah. Well, thank you for asking. I mean, I think the best thing to do is either to head over to my website, which would have all the links to all my socials, and that is thedrsuzanne.com. I’m probably most active on Instagram, and I have my @askdrsuzanne and also @themenopausebootcamp accounts. That’s probably where I am the most.

And I think, for your health coaches, if this is resonating, reading the book and if you like the book, signing up for the certification program, because I designed the bootcamp, like I said, to help level the playing field, educate people, and resource them appropriately. And honestly from the beginning I realized this was something that I was going to want to share with other people. This is not a “how to treat menopause.” This is not, like, a masterclass for doctors or nurse practitioners. This is a “how to be a human being going through menopause.” And health coaches are exactly the sweet spot for this, because it does a bunch of things. It educates your clients. It brings in more clients, and it is a community-building experience. It’s resourcing the community. So, you’re, kind of, giving back and you’re getting… One of the things that I found when I started doing it was I thought I was doing it for education, Sandi, and I very quickly realized that I was building community for myself as well as others, and I have found tremendous community with other providers and thought leaders and visionaries in this field that has been… I mean, I create a lot of content for people for free to be honest, and I treat my patients, and now I have this offering. But I think I get as much if not more back from that.

So, for people who are interested in that and really helping to continue to grow this grassroots movement of awareness around midlife health and what the narrative can be and should be… I mean, you’re a great example of what someone is doing in their midlife and beyond. Look at what you’ve helped to create in this world. So, to say that, like, you know, you turn 51 and it’s over is just insane. And if that’s something you are interested in, I think you will like the book. That’s available HarperCollins, Amazon, and everywhere online. And definitely reach out to me about the certification program because it’s something that I’m excited to share.

Dr. Sandi: I love that and, yes, it is possible to have career change. So, I started FMCA when I was 65 and that was 9 years ago. And many people become health coaches during this phase in their life. Perhaps it’s a second career, perhaps it’s even a first career, but it is something that you can do or even now to plan for when you are in your 60s, 70s, and beyond because we need more health coaches. And focusing on helping particularly women in midlife and beyond. And you have such a wonderful mission and I know that our listeners will be attracted to your resources, your programs, and I’m so glad that you’re here so that they could get to know you. And this has been a great conversation.

Dr. Suzanne: Thank you so much for having me.