#256: Coaching Clients Through Perimenopause and Menopause with Dr. Jessica Drummond

Coaching Clients Through Perimenopause & Menopause with Dr. Jessica Drummond

Working with women? If so, you’re surely coming across issues related to perimenopause and menopause. In this episode I’m joined by Dr. Jessica Drummond, founder of the Integrative Women’s Health Institute, to discuss how health coaches can be most helpful to this population.

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Blog post and free gift from Jessica: https://integrativewomenshealthinstitute.com/perimenopause-ending

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Full transcript:

Michelle:
Hello there, health coaches, I've been hearing from so many of you lately who are working with menopausal and postmenopausal clients and perimenopausal clients. The word menopause just keeps coming up again and again lately, and I feel like there's this big shift happening in the world and collectively we are finally talking about this time of life and we're normalizing it for women. So it's far different than when I started health coaching. I'm hearing about it so much more now. So if you're a coach who's working with women in that stage of life, I'm glad you're here today. If you're thinking about working with women, frankly in any stage of life, it's very likely you're going to come across clients that are going through perimenopause and menopause. So I'm glad we're here. Now, of course, we can only really help women through menopause by working with them, which means not just learning about it, but doing the work.
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That means we have to be able to find and sign clients. So if you're looking to sign more clients in the next 90 days, I want you to head on over to healthcoachpower.com/blueprint, and we are going to send you our free Healthy Profit University blueprint. Again, that is health coach power.com/blueprint. And then once we have the clients, it's like how do we help them? So I'm thrilled to have Dr. Jessica Drummond, who's the founder, and c e o of the Integrative Women's Health Institute here with us today to discuss. Jessica, thanks for being here.
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Jessica:
Thanks so much for having me. It's my pleasure.
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Michelle:
We've been looking forward to it. A lot of the members in our group are like, oh, Jessica, I love her. I've taken classes with her. She's the best. So like a huge fan base going on over here. .
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Jessica:
Oh, nice. So nice. .
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Michelle:
Before we dive into all the menopause, goodness, can you share with our other listeners who don't already know you, a little bit about yourself and how you got into women's integrative health? .
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Jessica:
Sure. Yeah. So I started my career almost 25 years ago now as a clinical physical therapist, and then I got sick myself. As many of us have had that experience where despite working in a women's hospital and knowing a lot of the clinical team, I struggled with some hormonal issues and what was at the time known as adrenal fatigue and some viral reactivations. And I found one of the earliest functional medicine physicians, and I began to recognize the real power through additional training and working on all this stuff in myself. And I eventually got a doctorate in clinical nutrition, that lifestyle medicine, literally the day-to-day things that are much hotter topics than they were back in 2006 when I was exploring them. But circadian rhythm and nourishment and nutrient supplementation and sleep really did matter. So I started integrating that into my women's in public health physical therapy practice. And I started this company, the Integrative Women's Health Institute in 2009. And we've been training, gosh, we've trained thousands of women's health and wellness coaches around the world now since then. And I also keep a small private practice and a group practice in endometriosis, perimenopause, menopause, and other kind of chronic hormonal issues for women. .
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Michelle:
So you're a busy lady. .
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Jessica:
Yes. .
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Michelle:
I can see that. Alright, well, in my own health coaching practice, and as I'm speaking with health coaches in our community, I'm going to go ahead and say that the number one issue that comes up with women once they're in that 45, 50 year old area is weight. That's the number one. Now, would you agree with that and what are some of the other common issues that we're going to see in this population? .
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Jessica:
Yeah, I think the struggle with weight loss resistance is very frustrating for women because the sort of strategies that they had where they were managing their weight from the time they were, gosh sadly, 11 or 12, it's a topic that goes deep into kind of how women have to present in the world to be taken seriously. And there's all this data around the impact of weight on work life and other life and how they present in corporate America. It really is a huge issue. And while a lot of that is negative and quite damaging, quite frankly, it is a physiologic change that does happen in perimenopause and menopause for women, roughly in that age range of about 35 to 55. It can vary from person to person where it becomes a real frustration because the tools that they use to maintain healthy weight and maintain a weight that they wanted to be at are not really working in the same way that they were. .
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I think other really key symptoms in the 35, 45, 55 age group is sleep challenges, brain fog, that feeling of all of a sudden I can't keep words in my mind, I'm forgetting things, I'm not as sharp. That's really frustrating. That sort of mild cognitive impairment is sort of the clinical term. And it's important actually because all of these things, while they may on the surface, everything from weight gain to missing words is not life-threatening yet. The problem is, is that weight loss resistance can become metabolic syndrome, can become cardiovascular disease, can become stroke, can become Alzheimer's, word loss, word finding issues, mild cognitive impairments within five years post menopause. If people are struggling with mild cognitive impairments in perimenopause, their risk of dementia is dramatically increased and quickly within by the time they're late fifties or sixties. And other common complaints, hot flashes, really common, other vasomotor symptoms, sometimes cold thyroid dysregulation and fatigue, fatigue related to the sleep issues and even people who don't have sleep issues can struggle with fatigue and also a real goal and interest in prevention. .
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I think something that's a bit on the horizon, but very important to start discussing in this age range. Ideally we start discussing it even earlier, but it's hard to get people activated to things they're not really thinking about yet are longevity kinds of conversations. And for women in this perimenopausal menopausal timeframe, bone health really matters. Fracture is the number one cause of death in women over 80. And prior to that the number one cause of death is cardiovascular disease. So prevention of those major drivers of mortality: cardiovascular disease, stroke, cancer, and dementia - this is the peak time that we have to prevent some of those things and help people increase not just their longevity, but what's known as the health span, the healthy number of years people live into their older age. Because it makes a big difference if someone lives with dementia for 10 years before they die versus if they live very healthfully until a very short timeframe before they die. .
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Michelle:
Yeah, makes sense. So I just wrote down all the different symptoms that you mentioned. It's a long list and this is what we hear from most of our health coaching clients, whether they're in menopause or not having a hard time with energy levels, brain fog, when you said word finding issues, I was laughing because for anyone who listens to this podcast regularly, every now and then I get stuck. I can't find the word. It happens and we don't edit the show. So you'll hear my 43 year old self having trouble finding a word. This is so normal. My mother used to do it all the time. So here's my question for you. With this whole long list of symptoms, are women out there in your experience and in your private practice thinking, I'm going through perimenopause, I'm having menopause problems, or I'm having hormone problems, or the majority thinking, I don't know why I can't lose weight. I don't know why I can't sleep, I can't think straight, I can't find words. I'm having hot flashes. Why am I so cold? Why am I so exhausted? Do you see people actually using the words perimenopause and menopause a lot? .
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Jessica:
Well, as you said in the beginning of this conversation, a little bit more recently, yes, because there is more of a conversation on social media in the media around what is perimenopause, what are some of the symptoms, because there are other symptoms, tachycardia, a worsening of dysautonomia. I think another thing we're seeing particularly in the last few years is with the combination of chronic infections like post covid and Lyme and Epstein-Barr and things like that combined with the exacerbation of the environmental issues. So more air pollution from wildfires, worsening water quality, synthetic microplastics. Essentially in almost everything there's a heavier toxic load. And so people are dealing with menopausal transition while they're also trying to deal with the immune and autoimmune dysregulation that comes from this increased exposure to toxicity, chronic postviral syndromes and other chronic illnesses that they may have managed pretty well until they hit this new stage of life. .
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And so I think a lot of things are changing. I think people are initially always going to be driven by the symptom that's most bothersome. That's the thing they're looking for. How do I sleep better? How do I get rid of these hot flashes? Certain things are more associated with perimenopause, menopause ... but I think one thing we might need to look at if we take a more holistic view of this is that it's perimenopause menopause at some level, but often that's the underlying drivers integrated with these other issues of chronic system breakdown, if you will. I hate to give people too many labels and diagnoses and things like that, but when the physiologic systems stop functioning on all cylinders, we get a myriad of symptoms sometimes in different combinations. So people are always going to be seeking, how do I improve this symptom? That's the thing that's most bothersome to them. .
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Michelle:
Yeah, that makes total sense. And I think one thing that we can do as health coaches is not to diagnose anyone or make them feel like they're just in a shit storm of being in their forties and fifties, but to help them see if they come to us with weight loss issues or fatigue to help them pull together the pieces. Well, what else is going on with your health? Oh, you have an autoimmune thing going on. Oh, tell me about your Lyme disease. Oh, what about this? And help them see that it is this larger constellation where everything's connected and we can actually address all of it together, which I found that clients are so happy to hear that there's a commonality between their many symptoms, even the ones that they weren't even thinking of too much. Like some would just say, oh, I don't know. My doctor has me on this thyroid medication. Oh really? Can we talk about that? So that's one way that I see health coaches as being so helpful. We have the time and we have the desire to actually converse with our clients and see the big picture with them. They don't get that when they go to the endocrinologist, when they go to the whatever, insert specialty doctor here. So that's one way I think we're really important. How else do you think health coaches can be really helpful to women going through perimenopause menopause? .
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Jessica:
Well, I think that listening to the complete story is one of the most valuable things. Any health coach and any clinician who integrates with health coaching or who works with health coaches or who also is a health coach can do because at the core health coaching is a communication skillset around really helping people get confident that they know some of their best next steps. So the first step is, Hey, what's going on with you? Let's take the time and the space as you mentioned, to really hear the full story. When were things triggered, was there a big stressor? When was the last time you felt really well? And a lot of times by the time a woman's 48 years old, she's like, I can't even remember when did I last feel really well before I had kids? I don't know. So we want to kind of integrate what are your goals? Because my goals for a person to optimize their weight, say to mitigate their stroke risk, they might not care about that at all. .
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So let's really listen to our client's goals. And when you really help them to create the space to write down what is the full picture of what's going on with their health from a physiologic standpoint, an emotional standpoint, a spiritual and support standpoint, then we can help them pull together the right team. And so I think that's one of the most valuable skills in health coaching is creating that, is having that space for people to say, okay, or even sometimes they don't even need more people on their team. As you said, they're already seeing an endocrinologist, they're already seeing a pelvic floor PT, they're already seeing a nutritionist, whatever it is. And what they haven't done though is looked at, okay, here are all the things I know already would be helpful to me. Let's map out a schedule. What do I actually have time for? .
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What do I just don't know how to do and need some help with? I really think that piece is where a lot of the health system really skips and we end up just giving clients more and more, well, okay, that didn't work. Try this drug that didn't work. Try this supplement when really the client hasn't yet even done the program. Whatever the program is that they know they needed to do, whether that's a bedtime routine or taking a medication consistently or getting some support around an accountability around consistent exercise, meal prepping. There are so much of those foundational lifestyle medicine skills. Health is really a skillset and a practice that people might know intellectually but aren't doing. And I'll give you a quick example of this. I did a retreat earlier in the year in Italy with us, some of our professional students, and we had a breath work session and they all came excited looking to learn tons of new tactics. .
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I taught five of the simplest breathwork strategies in the world. You could learn 'em on YouTube right now. And everyone was like, oh my gosh, I feel so much better. And I was like, how many of you knew these breathwork strategies? 80%? How many of you do them at least 10 minutes a day? Zero. And that's the such most important bridge of what health coaching can do. And I think in this life stage it's so important because women have so much going on. You're 45, you're 48, you're 42, you're 52, you have aging parents, you have kids navigating middle school, high school, college. You're in the peak of your financial and professional career. You still have to cook dinner, you got to take the dog out. Like what? There's just not a lot of room for a really streamlined, efficient healing or health practice of the skills. And when people do that, they don't need all the complex much less. Sometimes they need some but much less complex intervention. .
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Michelle:
I love how you described the practice of health coaching because sometimes I noticed the more educated health coaches get, and I love that you all are doing so many trainings and learn so much about functional medicine, and I love it too. I like to nerd out on all of it, but sitting there and having that conversation and just piecing together and having the client say for themselves, this is one thing that my doctors keep saying or this is one thing that I think would really help me because I've done it before in the past. It is implementation that health coaches are here for not having the answers, not diagnosing, obviously even in your head, remember, don't try to diagnose in your head even if you don't say it out loud, it is not helpful. What is helpful is allowing the client to walk their own path, make their own decisions, and supporting them in the implementation. .
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I can't say that enough by the way, if you're here live, because I know some of you have joined us live. What questions do you have? And also what have you seen among the perimenopausal and menopausal group? Are you working with women like this? What issues are they having? Are they aware that it's menopause? Oh my goodness. I'd love to hear what your experience is. So tell me in the chat, if you're here live and for all of us working with women, like you said, between 35 and 55, I'm going to say that's most of the population of who health coaches work with or women 35 to 55, what do you think are the most impactful lifestyle changes that we can help them with? .
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Jessica:
Well, let me start with an unpopular one. .
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Michelle:
Go ahead. .
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Jessica:
Releasing alcohol, less alcohol. That's really hard in this population, and I heard it described well. People always kind of come back to the research of, well, I heard a glass of wine a day is beneficial. And yes, physiologically there are some benefits in certain hormonal pathways. However, really if you look at the bulk of the research on alcohol for women in midlife and really for anyone is that alcohol is a mild toxin that is worth ingesting if it keeps you connected to your social group. Social connection is so valuable that people who smoke and have friends are far healthier than people who don't smoke and have no friends. (Michelle: Wow.) So let me put it this way, letting go of alcohol is beneficial to your neuroendocrine system in general, but if you occasionally drink alcohol as a part of your connection with a strong social group, that's more valuable than not doing that. .
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So that's I think a really interesting thing is that so many women become lonely in midlife because they're so focused on their kids for so long and maybe they have other parents they know at different activities or things like that, but then either empty nest syndrome or moves or divorces or really immersed in taking care of aging parents. Sometimes people in this stage can become so busy that they're also lonely. So I think a combination of social connection, reducing alcohol or only using it as kind of a pleasurable connecting thing, not like a calming the nervous system thing. And that brings me to my second most important thing is nervous system regulation. We test this with all of our clients. We give them an HRV tracking watch. You can use a HeartMath system, you can use Ora Ring, you can use, we use the Garmin Vivo Smart for a tracking watch. .
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There's lots of different ways to track HRV now, and we want to look at stress in real time, especially during the day because, and that's why we use the watch tool that does that. I know the heart mats does the same thing. You can do it in real time. I also like the ora ring because over time it looks at overnight overnights kind going to give you a more general HRV improvement over time. But what I really like is for women to see what are my stressors, because most women are really, really good at tolerating a lot of pain, tolerating a lot of stress outwardly, and actually we have really good research on this from the military. Women in the military are much more effective and efficient and sort of making good decisions in a stressful situation. But internally, their blood pressure's a mess, their heart rate's a mess worse than their male colleagues. .
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So we have to look at what are a woman's stressors, and then is she even identifying when she's physiologically stressed and then practicing implementation, as you say, nervous system regulation strategies all the time when she's stressed, when she's not stressed. A lot of times people are like, only use breath work. Only use downregulating strategies when they're anxious, but we need to do this all the time. So the set point of physiologic or nervous system rest is constantly, we're constantly shifting back into that. One of my students was asking me recently like, well, how long each day should we be in kind of parasympathetic rest recovery? Dorsal vagal activation? I said, 24 hours a day. Unless you're being attacked by something that's the resting state, unless there's a need to respond emergently. And most of our stressors are not true emergencies that we have to respond to in a physiological way, in the way that they were when we were literally running from tires. So the more often we can be in that rest and recovery state, the better. So I think those are two really helpful ones that work are helpful for every situation of perimenopause and menopause. .
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Michelle:
I love that. Oh my gosh, it was funny. I was thinking last night as I was walking into yoga class, I heard a woman in front of me say to her friend something about nervous system regulation and that maybe she's a doctor, a practitioner, I have no idea. But the way she was talking, I really felt like she wasn't, she was talking about seeing someone and how it had been good, but she had to go back. She wanted to do more of it. But anyway, I was like, wow, these words, they're creeping into everyday people, the terms, people are hearing them, they're more open to things like this. Again, very different than when I started health coaching 14, 15 years ago. Yes, thank you for sharing that. I think that could go a really long way versus let's talk about calories. That's just really not the game. .
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Jessica:
No, I mean, and honestly, even nutritional plans, if you will, because it's so individual based on the physiologic systems needs. So in every case, we need to get people more in that parasympathetic recovery state as much as possible. Then once they're there, some will benefit, and these are therapeutic nutritional plans. So a lot of times we need to collaborate with nutritionists, but sometimes we use something like a ketogenic diet to help with metabolism. Sometimes we need to optimize gut microbiome diversity, so we may not need more carbohydrates, but things like beans and grains and fruits and vegetables and seeds. So there's these ranges of healthy diets that I'm less and less inclined to have people doing strict elimination because by the time, the problem is because our culture is so steeped in dieting that even though there's a time and a place for elimination assessment, being that I'm also a clinical nutritionist, the problem is that it gets wrapped up in diet culture. .
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So we want to think about how can we add nourishment and then look at therapeutic nutritional plans in a more time limited way, if that makes sense, so that they're working on shifting something physiologically, but it's not a always, never this much that much tracking dah, dah, dah, because I really think that's been harmful, and I think it's similarly harmful when we have people just strictly avoiding almost anything because of that nervous system issue, and not just foods, but gosh, mold and going outside and going inside, and there's a fear that gets implanted in the nervous system that overrides the benefit of doing anything strictly unless somebody goes into that particular therapeutic protocol for a limited period of time with the expectation that it's going to kind of shift something physiologically. It is almost being used medicinally by their clinical team, and that's reasonable and useful in the short term. .
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But I think what happens is because so much of health coaching is kind of confused with nutritional medicine, if you will, or just lifestyle medicine. There are all these sort of strict rules always do this, take this every day, do this every day, that it becomes that we lose the, what is the person's body need today, now for the next month or so? In the short term, because as we see women in particular, they navigate through changes all the time, even if everything else is relaxed and healthy and normal, which by the way, it never is. People are going through stuff all the time, but you still have puberty and fertility, supportive periods and preconception, conception, pregnancy, postpartum moves, new jobs, perimenopause, menopause. So there's never going to be like, take this supplement every day forever, be on this nutritional protocol every day forever, go to bed at exactly this time every day forever. It's just not what the body needs. So we really have to help our clients. That's where that time and space comes in, hear their own intuition about what the next little step is, because there's a lot of all or nothing thinking around perimenopause. Every perimenopausal woman needs to be on HRT or it's dangerous for everyone. It's neither of those things. .
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Michelle:
That's really an interesting way of thinking about it. I hope you will all rewind, listen to everything Jessica just said. Again, this is also why I have been known to occasionally suggest that one of my clients just order a pizza tonight and sit down. Yes, sometimes it's the healthiest thing they can do, even though that will make most in the health world gasp. How could you say that? But sometimes that is the best thing, and I wish we had so much more time to talk about this, but we have just run out of time for today. I understand though, that you have a free gift for our listeners. Can you tell us about that? .
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Jessica:
Yes. So I wrote a guide recently for you called Outsmart Hormone Havoc. So if you or your clients have any of these things, the hot flashes, the weight loss resistance, the insomnia, any of that, and you want to navigate that, I've sent a blog post that we also wrote about how to tell when perimenopause is ending and menopause is starting. I think that's a little transition time that people don't know about. We also have a recent post over on the site too, which talks about, Hey, can you get pregnant in perimenopause? Another little hot topic. But all of that is over on our blog at integrativewomenshealthinstitute.com/blog or /perimenopause-ending, .
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Michelle:
And we'll put a link to those in our show notes. Thank you so much again for joining us today, Jess. .
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Jessica:
Thanks so much for having me. I really appreciate it. .
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Michelle:
And if you're listening to this and you are jazzed to be able to help more women relax, maybe order a pizza, maybe drink a little bit less alcohol, remember, you cannot help anyone if you don't know how to market yourself as a health coach. So we can help. If you're looking to add more clients to your coaching practice in the next 90 days, get our free Healthy Profit University Blueprint at healthcoachpower.com/blueprint and I'll see you all next time. Have a great day, everybody.