Amie: Yeah, such a pleasure. To introduce Susan properly, she, as I mentioned, is a women’s health expert, and she has been operating in this area of our profession for over 20 years, supporting thousands and thousands of women, to really set aside all of the noise, all of the hype, all of the trends around wellness culture, and actually distill down strategies that work for them, specifically, and the stage of life that they’re at, in a really clear and precise way.

She also is particularly interested in the area of genomics. She looks very closely at biomarkers, does biological age testing, and, amongst many others, an expert on pathology too, so that when she puts strategies together for all of her patients, but particularly women in this area, they are on the fast track to really supporting themselves in the most powerful way. And Susan, I’m so excited to speak to you today about women’s hormonal health in general, your clinical experience, the application of these two ingredients, plus the other amazing tools that you have in your toolkit. But, before we dive into that, I know that this is an area that, particularly for you, is something that you’re very passionate about, you’ve done a lot of extra work, invested a lot of extra time and energy into really exploring the rite of passage of what, you know, rightly or wrongly is being called reverse puberty, if we’re gonna just distill it down to something so overly simplified. I would love to hear your philosophy, your approach, and your passion around this chapter of women’s lives, and how that’s informed how you support them clinically.

Susan: Yeah, that’s a great question, and a good place to start. Over the last 20 years, more than 90% of the people I work with are women, so, women’s health sort of naturally became the core of my work. And as someone who sits in that Gen X generation, I really understand that perimenopausal transition through the clinician lens, but much as a lived reality. So, quite often, I am doing experts with an N of 1, myself, to work through what really works well for me. And it’s interesting, you know, menopause is having a very visible moment in the public conversation. And, on one level, that is fantastic, because we needed that positive shift, for women to finally have language and validation of their experience. But then, from a clinical perspective, it really does raise a risk, where complex physiology is often polarized, commoditized, and even reduced just to simple narrative or solution, when there’s so much complexity involved. And I just know, from a personal perspective, and also from a clinical perspective, that women arrive at this point of their life with a cumulative load. There’s been a lot that has happened, and by the time they’re walking through the door with perimenopausal symptoms, or really trying to step into that menopause transition, there’s a lot going on in other systems, other aspects of their health, not just a hormone decline.

Amie: Absolutely. And knowing our hormones are so informed by everything else, right, nutrition…

Susan: Absolutely.

Amie: …circadian biology, nervous system management. It’s, you know, a hormonal problem at any point is usually not a primary hormonal problem. But I’ve personally noticed, and including for myself too, that, for many of us, in our 20s, and maybe early 30s, habitual choices that maybe weren’t that supportive didn’t tax us quite so much. But of course, we continue with those habits that are maybe not so healthful, and it starts to really take its toll when our hormones begin that transition as well. And I know when you and I spoke first, prior to this interview, you mentioned, and I’ll just mention it right now up front, actually, Susan is publishing a book later this year, called, I think it’s called “The Health Edit.” Is that the final name?

Susan: Yeah.

Amies? Yes?

Susan: Yeah.

Amie: And “The Health Edit,” I can’t wait to read this myself, actually, “The Health Edit” is, and I’m gonna oversimplify this, so you can build on this in a moment, but is really a distillation of all of the advice Susan has found herself to be repeatedly saying over and over to patients, off the back of consultations, in between times, and is really just a, I guess, a bit of a guidebook, which no doubt began as a bit of a tool to support your clients, but also is gonna be a very useful resource for people who aren’t your clients either, to access. And it will, I have no doubt, be those practical, applied realizations. And I’d love, do you mind just telling us a little bit more about the book before we get into the core of the chat?

Susan: Yeah, absolutely. What led to writing the book was just this growing sense that midlife health wasn’t being explained in a way that actually helped women understand what was happening to them. And so the book is written in a way where it looks at the cultural conditions that women are living in, and it’s also got the science alongside it, to help explain what’s happening in their body. So, I created the Health Edit Framework, which just grew out of years of clinical pattern recognition. I could see the nine main areas of health that just kept coming up time and time again as areas that needed support. And I knew, with 20 years of clinical experience, what the one essential and accessible thing you could do for each of those domains of health, that would really move the needle and help people get those results that then reinforce the next step for them to take, and just build on that. So, I found it took the overwhelm out of health, because I oftentimes find people will either bury their head in the sand because it’s too hard, or have that analysis paralysis. And I find people don’t get healthier because of a lack of motivation or a lack of effort. I think it’s got a lot to do with overwhelm, so I just wanted to really take that out of the picture, so things felt easier, with a focus and clarity.

Amie: That sounds incredible. I often joke, with anybody who’ll listen, about how we’re born and not given a user manual for our body and for life and for health, and even wider, just what it’s like to be a human. And this really sounds like an excellent user manual for women, particularly at this time of life, but I’m sure the advice in there and the framework is gonna be applicable, and probably most useful if it’s applied prior to perimenopause too. So, really looking forward to getting my hands on that when that comes out. And I believe we’re gonna be putting a link, or some way of pointing you towards Susan and her book, when it is published. But suffice to say that this is something Susan’s been working on for a very long time. That pattern recognition becomes very strong in clinicians, especially those who focus on particular areas, and you see repeatable results, repeatable mistakes, repeatable patterns, and perhaps poor habitual choices amongst patients too, which is exactly why we’re talking to you today about specifically how to support women’s hormonal health, in your clinical experience. And I think what we might do is start with vitex. It’s certainly one of my favorite herbs, and can be applied throughout a cycling woman’s life, from the very beginning through to the very end, and often in between, whether it’s fertility or hormone imbalances. And, wow, I mean, I know this is a really big question, so please know I don’t expect a single-sentence answer, but I would love to know the kinds of patterns, presentations, maybe symptom pictures that make you think, “Hmm, vitex is gonna be a great option for this patient here.”

Susan: Yeah, well, I think all of us know, as clinicians, that it really shines bright with treating premenstrual symptoms. And it’s not always the right herb for PMS, so, of course, testing in that peak luteal phase is gonna be really important, and I am always guided by my peak luteal hormone results, and my day two and three hormone results, alongside testing the adrenals, looking at morning cortisol, looking at DHEAS, even looking at free testosterone, and of course, prolactin, which I’m sure we’ll get to, because you can’t talk about vitex without talking about prolactin. And so, that PMS picture, where, for a week or more, you are seeing a combination of signs or symptoms, particularly where there’s breast tenderness, sensitivity, pain, breast enlargement being reported, fluid retention, food cravings, mood changes, sleep issues in that week before the period. That’s when I think about vitex, first and foremost.

Amie: Yes.

Susan: When I’ve worked with women who are on a fertility journey, I will definitely think about it, have it on my radar, where there is no ovulation occurring. So, that’s definitely something we will consider. And then, I also think about it in situations where there are heavy periods but no estrogen dominance, or excess estrogen kind of picture involved. And it can sometimes be really useful in secondary amenorrhea, ovarian aging-type pictures, where we’re starting to see, you know, skipping of cycles, and irregular length of cycles. That can be shortening, and that can be a lengthening, so, yeah, that’s where it can also be used, usually, around that perimenopause phase.

Amie: I mean, certainly there’s no shortage of things that it can support, clearly. Which makes it such a valuable tool in the toolkit. Are you able to share a little more insight into what you’re looking for on, say, those cycle day two, three bloods, and where you might be like, “Yes, vitex is good for this,” or “this is not a great idea.” Or, conversely, those mid-luteal checks as well?

Susan: Yeah. I find vitex, I am usually looking at that peak luteal phase snapshot. So, ideally, looking at that sort of, you know, seven days post-ovulation, to see, is that progesterone quite low? Is that luteinizing hormone, in relation to follicle-stimulating hormone, not dominant? So, if you’ve got a high LH picture, you don’t want to be using it, as it will further increase that luteinizing hormone. So, that, along with a high prolactin at that time of the cycle, will be a really good indication for it being useful.

Amie: Mm. Yes, absolutely. And do you have in mind, obviously it’s a sliding scale with progesterone, for sure, and it depends on their goals, whether it’s fertility or it’s perimenopausal support. But where do you like to, perhaps that same perimenopause, keep their progesterone above, or, like, where would you go, “Yes, I definitely wanna use vitex here?”

Susan: Yeah. Ooh, excuse me. Are you talking about reference ranges?

Amie: Yeah. Like, you know, is this something where you would be like, anything less than four nanomoles per liter needs progesterone, or is it less than 20, or where do you like to consider this is gonna be most useful, assuming LH isn’t high, and nor is prolactin?

Susan: For progesterone at the luteal?

Amie: Yeah.

Susan: Yeah, I think anything that’s over 20 is acceptable. And if it’s below that, I’d be looking at using vitex to boost that up.

Amie: To boost that up. Yeah, fantastic. Thank you. That’s really helpful, I’m sure, for practitioners at home. And based on that, then, so, we’re looking at utilizing it for where there’s heavy bleeding, but it’s not an estrogen dominance issue, or is clearly more a progesterone insufficiency, or suboptimal progesterone, and all of those other symptoms that are sort of tied up amongst that particular type of pathway. But when we think about using vitex, and its influence via the pituitary, and the way it can impact prolactin and progesterone, what kind of signs are you looking for early on that the response, that you’re getting the right response that you’re looking for? And what kind of timeframe should people be considering using vitex for? And I ask this for two reasons. One, we live in a day and age of instant gratification, and I’m sure practitioners know that, you know, it doesn’t happen overnight, but it will happen. But, for many people in the general public buying supplements, particularly if they’re using them for other things, they’re used to quicker results, if you like, or fast results, more immediate, observable effects. By the same token, there is conjecture around the length of time vitex should be used for. And maybe in the context of a younger woman trying to achieve a shift in hormones, perhaps long, you know, longer-term use is maybe not so appropriate, but in perimenopause and menopause, it’s a different board game. So, I’d love to hear how you approach that in terms of first of all, counseling your patients, like, “Let’s review this in X number of days, months,” whatever, and also, when you’re planning out a strategic treatment plan for someone, what kind of length of time are you prepared to go to with vitex?

Susan: Yeah, it’s a great question. And I do frame things for clients so that they are aware of how long to be expecting to see a shift in signs and symptoms. So, typically, I’m looking at somewhere between two and three cycles to see very favorable responses to vitex. So, quite often, I will find, after a couple of cycles, clients are reporting that they’re experiencing less intensity and duration of their premenstrual symptoms. And then, usually, by about the third cycle, there’ll be them reporting that their period surprised them. They didn’t have any premenstrual symptoms arising in that lead-up to the period, or they might have felt a little bit irritable the day before it arrived, or tired before it arrived. And if they’re the sort of person that I know I need to kind of dangle the carrot, and provide them with the data that this is really working, we can retest that progesterone the next cycle, like, a month into being on vitex. And the numbers usually will show us that there is an improvement, even if it’s on paper, and not necessarily how they’re feeling it from a symptoms perspective.

Amie: Mm. Yes. Okay. That’s a really good point, and I think, you know, making a note of that, clinically speaking, that it’s important to have some objective, you know, quantitative data to look at too, because that can be really encouraging, to be able to show clients, to say, “Hey, this is actually shifting things. You’re just not feeling it.”

Susan: That’s right. Yeah.

Amie: But at the same time, how long would you continue along that path? Do you have a bit of a rule, like, there’s a time limit for vitex, or does it depend on what you’re using it for?

Susan: I used to wrap up using vitex around that eighth or ninth cycle. For myself, personally, I found it took a good nine cycles postpartum, when I had sort of weaned my last child from breastfeeding, and then wanted to kind of get rid of the PMS symptoms. And it took nine cycles. I find, clinically, it can take up to 12 months, and then I will say to the women I’m working with, “Let’s take a month off it, and let’s just see how we feel, and if we find we’re kind of reverting back to signs and symptoms coming up, then we will probably look at retesting, and may need to jump back on it.” But typically, once we have worked on the hormone balancing, there’s no need to really go back. It’s kind of done its work within nine cycles, typically.

Amie: Yes. Yeah. Okay. That’s really helpful to know. And certainly, I’ve got one last question around that, and this is maybe less relevant to this chapter of life, although I’m finding more and more clients who are in perimenopause are also trying to have babies. I’m curious to know about your stance on vitex in the first trimester of pregnancy. Now, for anyone listening, there are two distinct schools of thought, and I personally don’t think there’s one that’s right or wrong either. But in terms of some herbalists will say no once conception has occurred, and others will say that in that first trimester, it can be really helpful to support the placenta and maintain a pregnancy, particularly where miscarriage has occurred in the past. I’d love to know what you think about that, maybe, I don’t know if you’ve changed your mind about that over the years, what you see clinically. Where do you stand?

Susan: Yeah. Fertility is definitely an area that I tend to refer on. After we’ve sort of worked on methylation, and worked on hormone regulation, I will definitely move clients on to seeing fertility specialty naturopaths or Chinese herbalists. And I’m in the camp of it’s okay to use in that first trimester, but definitely not my lane that I swim in at all. But I think the action of vitex makes sense, in order to help with just supporting progesterone levels, to help support a viable pregnancy.

Amie: Mm. And I think…yeah, thank you for clarifying that, and I can totally understand you’re leaving it up to someone who’s caring for them specifically in that space. But as you said, as far as understanding its mechanisms of action, it makes sense why it’s applied that way sometimes, and I think, as clinicians, our responsibility is always, who is this human in front of us?

Susan: Absolutely.

Amie: Like, what is their history, their fertility history, hormone history, and where might this be useful, or where might it be unnecessary, at the same time? So, yeah, thank you for sharing that too. And, when it comes to your clinical toolkit for perimenopausal women and menopausal women, certainly, you know, there’s four stages that you are sort of looking at and supporting, and many of that, much of that is probably informed about symptoms that are challenging versus necessarily what’s on paper. But where does… So, vitex sits in there, I’m sure, more often than not. Around that, though, I would love to know, like, what else you might include for women at that stage of life, alongside vitex, for instance?

Susan: Yeah, well, I think, you know, we’re talking about menopause, and that very visible conversation. A lot of women are now aware that a protein-replete diet, and working on maintaining healthy muscle mass, is a really important element. And then also, that estrogen decline, finding some way to support them, to ensure that their estrogen receptors in the brain are being supported, their bone density’s being protected. So, that can look like menopause hormone therapy, with bioidentical estrogen. Some women still feel very weary, and there’s that kind of hangover from the WHI study, where there are wide-held beliefs that, you know, there are risks involved, so they really wanna stick to a natural or complementary medicine toolkit. So, we’ll explore things like soy isoflavones, phytoestrogenic herbs, dip into that kind of toolkit, to also support estrogen, alongside progesterone support. And also, I’m looking at the other hormones. I’m looking at how their thyroid is functioning, what their adrenal capacity looks like, how they’re methylating. I’m looking at the off ramp for estrogen support. You know, are they able to metabolize what we are supporting with? So, the liver function is so important as well. So, yeah, they’re the main things. I also really do dip into, I think my base prescription for every woman who’s over the age of 40 consists of, you know, alkalizing minerals, so, electrolytes, along with creatine, and that’s gotta support their strength training. And I find, yeah, the knock-on effects of taking those are that they just getting stronger, feeling brighter, their brains are sharper, they’re more energized.

Amie: Yes, I think the days of creatine being, you know, the gym bro supplement are now officially over. And certainly, I think the, you know, cognitive applications of creatine and cellular energy have been a game-changer for many people, especially women in menopause. But also you made a good point before about protecting muscle mass, and that becoming, you know, I think that’s been under-focused on for women for a very long time. And I think, thankfully, that’s another thing that’s changed in recent years. But women are often coming into this chapter of life under-muscled. You know, the younger generation, I don’t think will. But certainly, for those of us that were from the era of the ’80s and the ’90s supermodels, and thin was in, there was so much focus on just reducing all of our body tissues, that was really overlooked. And the knock-on effects of that to bone density, you know, metabolic sensitivity, even mitochondrial capacity, are just so huge. So, how do you navigate that with somebody who steps into your clinic, you know, in their early 40s, mid-40s, maybe late 40s, early 50s, and having a conversation around, first of all, active tissue mass support, but also supplements that are specifically for that, like creatine?

Susan: Yeah. So, quite often, we’ve just gotta talk about the mindset shift, and moving them away from skinny, and that kind of underfed, over-exercise from a cardio perspective kind of way that we’ve been conditioned to look at how we do exercise and diet, into focusing on strength, and we wanna be strong, not skinny, is kind of the motto that I have, and that you don’t have to be killing yourself in the gym in order to get that. I’m talking about the importance of the minimum viable dose in order to get the benefits. And so, quite often we will go off and do, you know, a full-body DEXA scan, to just get a sense of do we suspect that there is an issue here about bone density, and do we need to do a full DEXA with the GP, to look for osteopenia or osteoporosis? And then we wanna kinda get a sense of what training needs to look like, but giving it to people, you know, meeting them where they’re at, and just that step above, because it can, again, feel super overwhelming. We want you to feel like it’s enjoyable, something that’s sustainable, that doesn’t take over your entire life, but becomes a part of the person that you are. And then, at that point when I get that buy-in and that understanding, that we wanna be doing at least two strength sessions a week, and doing some stuff around bone density when it comes to, you know, jump training, plyometric training, and some sprint training as well, to kind of bookend those sessions, then I’m definitely bringing in electrolytes and protein and creatine, all to pre-fuel them before they train, and then make sure they’re fueling within 30 minutes after they’ve trained as well. And so, just building these habits of them understanding you’ve gotta fuel your body before you get going, and you can’t be, you know, working out or exercising in a catabolic state.

Amie: Yes. I think that’s so important, particularly because of that excessive cardio, and then the story around fasted cardio, and just really not giving the muscles what they need to be able to, A, perform well in the gym while you’re working out, but B, the recovery part, where we’re actually repairing and building lean muscle is just so important. And, based on what we’ve just spoken about, I feel like muscle loss or insufficient lean muscle mass is probably almost ubiquitous in women in this chapter of their life. What other patterns and signs, symptoms that you would think, oh, you’d really benefit from creatine, do you see?

Susan: Yeah, I think the recent research that’s been coming out about creatine and its ability to support brain function is super exciting. And so, as we’re seeing that estrogen decline, and I have, you know, women that will say, “I’m walking into a room and I don’t know what I went in there to do,” or, “I can’t find the word,” or, ‘my short-term memory is just really not what it used to be,” where there’s brain fog, where there’s poor recovery after exercise, and where I see lower energy levels, particularly after working out, creatine just shines here at that higher dose, and so it’s now looking like we can be giving 20 grams a day of creatine, in order to get those cognitive benefits for better processing speed, better memory, just that ability to focus and feel that bit sharper. I haven’t personally given or prescribed it at the 20-gram dose. I sort of sit around 10 or 15 grams, kind of taking into consideration the weight of the person I’m working with as well. Or I will go high when I know that they’re having a particularly bad time around sleep, or they’re changing time zones, and they’ve gotta show up and speak publicly, or, you know, address a boardroom meeting, you know, that kind of high-cognitive-load activity, I kinda use it as a pre-situational fuel, I guess.

Amie: Excellent. Oh, that’s so clever. And I think, for me, the cognitive benefits of creatine are particularly exciting. My own personal journey with toxic mold, and the damage that that did to my brain and my memory, has really got me very interested in its impact on the brain. And one of the studies that came out not that long ago, that I found really fascinating, was, again, using high-dose creatine after a poor night’s sleep. Now, you don’t have to read a single research paper to know if you’ve had a terrible night’s sleep, your brain is a bit mushy the next day. And, that being said, the study actually showed, again, high-dose creatine, in this case, it was about 25, 30 grams also, was enough to…well, enough. It was the dosage…at that dosage, it was able to restore brain function to the point that the brain actually functioned better than if it had had a full night’s sleep. And so, a bit like you, I’m finding there’s this sweet spot in the middle, and it is dependent on the individual, to some degree, and what you’re trying to shift, where somewhere between maybe 10, 15 grams is enough to improve exercise tolerance, exercise recovery, reduce physical fatigue, but also improve mental clarity, cognition, recollection, the speed at which the brain is functioning. That even though we may not be using the doses, the high doses that these studies are saying, they’re still actually producing good results. So, I think, overall, the messaging here is treating the person in front of you, being mindful of their body composition and overall body weight, to sort of gauge in a, I guess, ratio kind of way how much they’re gonna need. But starting low and building up is not a bad thing, I think, to get that result. And actually, that makes me think now, too, in terms of vitex dosage, just to circle back to that for a moment, what do you normally aim for when you’re starting someone on that herb, or what’s the dosage kind of sweet spot that you find is enough to move the needle for women hormonally?

Susan: Yeah, I find going low is enough. So, at that 180-milligram dose works quite well, and it will do for quite a long period of time. I’ve never had to titrate up. And in that perimenopause kind of picture, where we’re seeing that early peri kind of shortening of the cycle, where we wanna get the lengthening happening, or the irregularity when we’re in later-stage perimenopause, where we start to see that lengthening, and we wanna support that healthy prolactin, along with that healthy progesterone, that knock-on effect on the corpus luteum’s function, I will do the 180-milligram dose, but I’ll have someone on that for 12 months, two years. It could be three years of being on vitex. And they will find, if they don’t take little breaks from it, that the clinical efficacy of the herb will drop. So, what I’ve learnt through doing wonderful training with Rhiannon Hardingham over the years, around how to dose vitex, that works really well, is to get them to stop taking it on the first and second day of their period, each cycle, when they’re on it long-term. And then, once a year, they’ll take a full cycle off it, and I have found that has meant that I haven’t had to go up in dose, but what I do know Rhiannon has recommended has been also to go as high up as 500-milligram dose, if that clinical efficacy is dropping and you’re finding it’s not working as well as it once had.

Amie: Mm. Okay. So, it sounds like, by just intermittently withdrawing at, say, cycle day one and two, there’s a bit of a reset that happens with that hypothalamic-pituitary axis, which allows the re-sensitization, which, by the sounds of it means, rather than just constantly increasing the dose, to either enhance the effect or prolong it, actually, less is more, by the sounds of it…

Susan: Yeah.

Amie: …in this case.

Susan: Yeah.

Amie: Actually, can we nerd out for a moment, like, how vitex actually works? Like, where it functions in the brain, how it’s actually influencing the ovaries from there?

Susan: Yeah. And that’s the thing I love about it. It’s such a clever herb in its action. It’s not working directly on raising a particular hormone. It’s working as a signaling hormone further upstream, at the level of the pituitary gland. So, that prolactin that’s released from the pituitary is what’s having an impact, and so I think of the pituitary like it’s the control center for the ovaries, and how it’s functioning, what it’s coordinating and releasing, hormone-wise, will have this ripple effect on what does ovulation look like, what’s that corpus luteum function gonna be like, further downstream. So, when we see those premenstrual symptoms, particularly where there’s that kind of mood change, it’ll often be that stress-reactive hyperprolactinemia. We’re getting that prolactin release, that is sensitive to stress, whether that’s psychological load, or whether that is physiological stress load. And so, in those situations, that’s where vitex comes in, with its dopaminergic action, to help modulate that release of prolactin. So, we’re not getting this excess, and that way, when prolactin is more stable, the pituitary is able to send clearer, more coordinated signals to the ovaries, in order to just help with healthy ovulation, a really nice, gradual progesterone withdrawal, as we get to period time.

Amie: Yes. It’s so fascinating, isn’t it? And I think, for many clinicians, understandably, when we think of vitex, initially, we think, oh, progesterone-promoting, but it’s actually a bit more of a global effect than that. And, you know, certainly, with a short follicular phase, you, of course, have to consider excess estrogen, or estrogen metabolism issues, more specifically. But interestingly, vitex also works on the anterior pituitary, to increase sensitivity to estradiol, so that FSH is going to generate more of a response, too. So, I think that’s also something worth considering. And, I know this is also something that can not just support the development of follicles, and support ovulation, but it has an influence on AMH too, doesn’t it?

Susan: Yeah. So, it can actually support egg recruitment, so that infertility, with, you know, and ovulation picture, is where it can help raise anti-Müllerian hormone, in order to support, yeah, more eggs. So, that’s, yeah, again, not my wheelhouse, but an awareness that it can definitely help in that fertility space. But it also, I’ve found, through training again with Rhiannon, was interest to see it, in animal studies, has been able to raise testosterone, so, whenever you’ve kind of got that high-androgen kind of picture, like a PCOS, or androgenic acne kind of picture, it’s the herb to not use. So, I’m not sure how that translates from animal to human studies, or…but it’s just an area where I will not think about using it. It won’t be part of the plan.

Amie: Yeah, sure. Well, I think that’s an important one for clinicians to be mindful of, because, in the case of PCOS, where LH isn’t raised, it is often reached for, but I think understanding its potential to influence testosterone in women’s bodies too, particularly, if the conversion to estrogen is interrupted, or there is upregulated DHT production, and as you said, taking a wider view, looking at the adrenals, DHEA, like, there are so many things to consider when you’re actually looking to adjust that symphony orchestra of hormones for women, especially because it can be such a moving target at the same time.

Susan: Absolutely. Yeah. It can sometimes feel like you’ve just gotta, yeah, retest, and just try and connect the dots, and sometimes it is a moving target. And you are guided largely by their signs and symptoms, to get a sense of where you need to be intervening, and helping support more hormonal balance.

Amie: Mm. I think one of the tricky things I’ve noticed with this is, because estrogen can fluctuate so wildly, some months, the focus might be on estrogen metabolism, clearing it, and other times, it’s like there’s actually an absence there, which we need, a gap we need to fill. In terms of how you set your clients up for making those adjustments, is that something that you would monitor each cycle, for instance, or do you give them a bit of a toolkit, and say, “If you’re feeling like this, do this. If you’re feeling like that, do that?” How do you approach that?

Susan: Yeah. It depends on the individual, but I’ve definitely had clients who’ve become very well-versed in times of the month where they’re taking detoxification support nutrients, like calcium-D-glucarate, and they’re working on clearance, and then there’s other times of the month where we’re kind of, you know, you, bumping them up, using our estrogen-promoting nutrients and cofactors. So, it, really, they become kind of experts, but I have a very close working relationship with my clients, so they’ve always got that high-touch support between sessions. And quite often, we are nutting it out in a message to one another, or we’re getting on the phone and just having that 15-minute conversation about where things are sitting, how they’re feeling. So, yeah, it is something to closely monitor, and when you’re at that perimenopausal stage, sometimes, as much as we wanna kind of test and treat things like a day two, when they haven’t had a period for 84 days, it’s, yeah, it can feel like that, you take that information with a pinch of salt, and you really are guided by how they’re feeling.

Amie: Yeah. Yes. I think, at the end of the day, that experience inside their bodies is the one that we have to listen to, more than anything else. And I think, you know, your patients are so lucky to be getting, you know, the health edit distilled into an actual book, very soon, to sort of stand in for, between appointment support. And I think we’re also very lucky to be getting our hands on it as well. Before we wrap up today, I would love to hear, is there anything else you, A, wish women knew about menopause and perimenopause, that you think would make a difference to their journey, or any other little clinical pearls that you think clinicians should probably know?

Susan: Yeah. I think we can’t underestimate the role of decades of chronic stress, and how much that has an impact, because so many women come to me, and they’re really despondent or disheartened about the weight gain that they’re experiencing, and it can be as sudden as, you know, 9 kilos in 6 months, you know. And they’ve never had a weight problem, and, you know, it’s how they present themself to the world. It’s a very sensitive area. It’s very understandable that they would, you know, be quite upset by it. And, just, once they get an understanding about that sort of cortisol influence, and the spread, and the ripple effect, and how cortisol, you know, impacts their progesterone levels with that pregnenolone steal, like, it’s a real eye-opening, aha moment for a lot of women, to understand the role the stress they’ve carried has played. And so, we really, I want them to know that the more that they look after themselves, delegate, get support, you know, and let go of the stresses that they can control, the better their body is gonna respond. So, yeah, just that education around the role of stress, and the ripple effect it has across the entire system.

Amie: Mm. That’s such an important component, I think, in terms of a support strategy for anything, really. We have so many incredible tools in our toolkit, and herbs can be really powerful. I think it’s really easy for people to think, “Oh, I just need to take a pill,” or, “If I find the right dose, or I find the right herb, everything will be better.” But it really does boil down to those basic fundamentals, and you’re so right. Just, it’s a war of attrition, chronic stress, and I think when your hormones, when you’re cycling and making optimal amounts of progesterone, you can probably get away with it, a little more, carrying a little more, but the load definitely gets very heavy, and harder to carry once that hormonal shift starts to occur, and the adrenals are required to step up and do more. What are your favorite little strategies around nervous system support, whether that’s lifestyle, nervous system exercises, minerals? Any last little tips?

Susan: Yeah, that’s a really great question. I think, after all of these years of practicing, you know, I’ve spent a lot of time kinda leaning into using sedative nervines, and adaptogens, and I’m acutely aware of the cortisol-raising element of licorice, and, you know, the very specific ways to use various adaptogens. I find, for some people, they respond really well, all right? And they definitely prop them up, and they can continue living the lifestyles they do, which tend to be very busy, very full, probably a little bit overloaded. And some people don’t have control or choice to be able to really do a lot about the load that they carry. But increasingly, I will look to lifestyle changes, and the really big one, I find, that delivers results around stress management, and perception of stress, is exercise. It is incredible as a stress management tool. And so, I’m really trying to encourage people to kinda use their body the way it’s built, and to incorporate movement on a daily basis, and to build on that. So, for me, that feels like the big lever to pull, around making stress more manageable. But yeah, you know, I’m often trying to get clients to meditate, or box breathe, or… I’m like, “Find your thing.” What’s…for some clients, it might be pottery, you know, and the mesmerizing, meditative element of just kind of perfecting a thing on the wheel, you know. So, we workshop what that is for each person. It’ll be different.

Amie: Yes. Okay. Wow. Fantastic. There’s been so much gold in this conversation today, Susan. I really wanna thank you for coming along and sharing your own clinical wisdom for all of the practitioners supporting women in perimenopause and menopause. So, thank you.

Susan: Thank you.

Amie: Well, thanks again for taking us through your incredible strategic toolkit for perimenopause and menopause, and to our audience, thank you so much for joining us today. You can find all of the show notes, and a link to connect with Susan, and find out about her upcoming book, “The Health Edit,” which will be available later this year, and, of course, all of our other podcasts, on the Australian Designs for Health website. I’m Amie Skilton, and this is “Wellness by Designs.”