The Menopause Transition: A Clinical Herbal Perspective panel discussion

Welcome to the Virtual Herbalism Conference, everyone. We are excited for this panel discussion on The Menopause Transition: A Clinical Herbal Perspective. I am your host, Lindsey Feldpausch, and we are welcoming three speakers who will be exploring this life stage with nuance and respect and their clinical wisdom in this information-packed conversation covering many aspects of the menopausal transition period.

Our three participants bring deep experience in direct clinical work and education. Together, they'll help us unpack the physiology, the patterns, the challenges, and the opportunities of this time in a person's life and how herbs can help. We will look at herbal allies that can offer meaningful support, discuss clinical considerations, and explore how we can work with herbs to nourish the whole system throughout this profound period of change. Ladies, let's take a moment and have you all introduce yourselves.

Hi, I am Shona Richter MacDougall. I am a clinical herbalist. I hold my Registered Herbalist certification through the American Herbalist Guild. I'm a teacher here at the Herbal Academy. I've been with the Herbal Academy for about 10 years now, so it's been a while. I help out with course writing and curriculum and student questions, and I'm the lead teacher on our internal My Herbal Studies Facebook group. And then I have a small herb farm here in central Vermont, Earth Rhythm Herbal, and a clinical practice where I see clients, and that's a little bit about me.

I'm Selima Harleston Lust, and I'm also one of Herbal Academy's Lead Educators. And so I've contributed to the Kids course, the Garden course, the Menopause Intensive that we have inside of The Herbarium. And I also have my own company, Iwilla Remedy, where I see clients, and it's really heavily focused on herbal education as well. And I also teach An Introduction to African-American Herbalism at Spelman College.

Hi, I'm Pamela Spence. I'm a Medical Herbalist. You can probably hear from my accent that I'm not in the US. I live in Scotland, in the UK. I've been in practice here for almost 20 years now. I have a busy home practice where I see around 80 patients a month. I'm also a product developer, so I work with international brands like, for example, Twinings Tea, helping them to develop their benefit blends, and a lot of other companies besides. At the Herbal Academy, I've been contributing to courses since 2016. Now, along with Selima, I'm one of the Lead Herbalist Educators here. It's lovely to be here on the Menopause Panel.

Thank you, everyone. I'm super happy to have you all here. I know that you all are very deeply experienced in clinical herbalism and this topic in particular. Let's start off. Can you please give us a bird's-eye view of what is happening through the menopause transition? What are the common symptoms, and what is happening hormonally during this time?

Now, I thought I'd share a little overview of this period before other people go into more detail about what's going on exactly. So this menopause is a time in life where there's big changes are happening. And while the changes are hormonal changes that are happening, they affect everything that's going on in your body. And so these are really big changes, like puberty. When you go into puberty, you're not going back. Unlike pregnancy, when you have a pregnancy, and then often after the pregnancy and a postpartum period, you're going back into this pre-pregnancy status. And so menopause is really a period of time where this is the complete cessation of the fertile time of life, and it's the beginning of a new period of time in our lives. And so this often starts with perimenopause, which in Greek means around the pause of the monthly cycles. And so we're thinking about naturally occurring menopause here rather than medically induced, where these changes start slowly. You may not even notice them. They're so subtle, or you might attribute these changes to something else that's going on in your life or your body or your age. And so sometimes it's a little confusing this first complaint or symptom that shows up that it's the first start of the perimenopause journey. And this often happens in the early to mid-forties. But for some people, it does happen in their late 30s. We might see changes in the cycle, or we may see hair loss or hot flashes or night sweats, even headaches coming on with hormonal cycle changes. So any of these kinds of complaints might be the beginning of these changes. And they do happen differently for everybody. Some folks have very few symptoms, and some people feel like they have every single symptom in the book. And perimenopause lasts anywhere from about 4 to 10 years. And keep in mind that you're not going to have the same complaints the entire time. This is an ever-changing cycle. And so there's so many hormonal changes happening in the same time where the hormones are ebbing and flowing and they're not always moving in one constant linear direction. So you're definitely not going to feel the same every day, and you're not going to feel the same this month, as you will next month or in several months. So officially, you're in perimenopause until you're one year of no menstruation, and then you're in official menopause at that time when we need to be getting to think about or other changes have started to show up in the body that may need to be addressed. And so I just also wanted to mention that this menopausal or postmenopausal time period is now lasting a lot longer than it used to, one-third to one-half of a person's lifetime. And so people are beginning menopause earlier, they're living longer. And so we're beginning to see new long term concerns that arise that we want to talk about today. And so I just think the earlier in the journey we make some of the positive lifestyle changes that we're going to talk about today, hopefully that will help to make an easier transition for folks. But it does take time and you do have to do the homework.

Thanks, Shona, for that overview. I think one of the key things that we all will have heard about around this menopausal transition time will be the change in hormones which are fluctuating. So just to give you a little bit more detail on that. Most hormones are dropping—that's what we're used to hearing about—but there are actually two that will be rising, and that is your follicle stimulating hormone and your luteinizing hormone. So these are the two hormones. Hormones, remember, are just messengers. The body's asking for ovulation to happen, and ovulation is not happening, so it's asking and asking and asking. And those rising levels can be tested, and they could be a marker to show whether you are in perimenopause or how far along that journey you are. Those things are rising, but at the same time we have progesterone falling. It falls first. Progesterone is very much related to your fertility, but at the same time, it's also governing things like anxiety and sleep and things like that. So that's why some of those first things you can notice are raised anxiety levels, disturbed sleep. And also with progesterone begins to fall, you can have very heavy periods as well. That can be one of the things that happens. So progesterone falls, and actually during that time, because progesterone and estrogen balance each other out, you actually end up with an estrogen... You've got more estrogen that's unopposed by the progesterone. So you're almost like in an estrogen excess, if you like. So progesterone drops, estrogen follows, testosterone also drops. As estrogen drops, you can get things more like hot flushes and some of the other symptoms that we're going to talk about today. Testosterone also dropping, too. So it's important to think that we also have testosterone going on here. So that's your socializing hormone. Some people won't be too surprised to find out that sometimes that drops and you feel a little bit socially isolated. You don't feel so confident because testosterone is the confident socializing hormone. So we got a bit less of that going on as well. Huge changes across the board. And like Shona just said, nothing is staying the same. This is a transition. We're going from one state to another. It's not always a nice gentle curve. It can be pretty bumpy that way.

I think one of the most important things that both Pamela and Shona touched on is that this is a whole body experience. It's not just one or two symptoms for people. It can really touch every aspect of their physical health and mental health and emotional health. Some of the symptoms that we already mentioned were that there can be menstrual period changes. I think sometimes people think that as the period is starting to eventually going away, that that means that they'll get consistently lighter or shorter, and that's just not the case. Sometimes it can be heavier, sometimes it can be intermittent, it can be longer. Of course, hot flashes are a symptom. Those sudden waves of warmth that people experience is probably one of the most well-known symptoms. Night sweats can occur and then occur with sleep challenges, really interrupting our sleep. Emotional shifts can manifest as well. In addition to vaginal dryness, urinary changes, there are shifts in our bone density, and then shifts in our weight, which we may not have expected. Even when we feel like we're doing all the right things in terms of diet and movement, our weight patterns change, and that might be something that really people struggle with in addition to all of these. And I think that having this conversation around what occurs during this time is really important so that people understand that the changes are happening together. They're happening together. Your whole body is shifting. You might have new joint pain and muscle aches that you've never experienced before, or they are worsening now and not understand why. It might not be arthritis. It's related to menopause, as well as pain and headaches. That's just an overview of the symptoms that we're experiencing during this time. Hopefully, you're knowing in this conversation that we're having that you are not alone.

I am really impressed with the amount of information you all were able to convey in that brief overview. Thank you for sharing. I do feel like it can be overwhelming, though. One of the things that I think is so important is that we're discussing menopause, which is a thing that in the past has been tucked under the rug and nobody spoke towards it. But here we are, we're discussing it, we're naming all these symptoms. But there also is a lot of misconceptions that go along with this period. What do you think about menopause in the misconception field? What conditions are there that we want to fix versus looking at it as a natural transition that we just need to support?

I think one of the things that I really honed in on, I'm speaking from my experience with my mother and not really having a deep or any conversation about menopause or perimenopause was that witnessing her experience hot flashes and kind of thinking that that was it. I think that a lot of people have the misconception that it's just hot flashes and that there aren't all of these other symptoms that can occur. I think it really does reflect a deeper issue, which is about our health concerns have not been prioritized as much when it comes to research and funding and education. There's a much broader conversation happening now around perimenopause and menopause, but that wasn't always the case. And so we need to have these multi-generational conversations. And of course, we need the research to support it as well. We know now that it's over 90 symptoms that can occur. But I think that conversations like this and conversations within our family members will really help people feel that what they're experiencing is normal.

I completely agree. Also, I would say that sometimes those multi-generational conversations don't go so well. So one of the misconceptions that I've come across, I am in the middle of my perimenopausal journey right now. I'm in the trenches. I've said this before on some of the other Herbal Academy, the intensive that we've recently. And so I've heard quite often from the older generation, that thing of, Well, back in my day, we just got on with it, which didn't go down so well for me. So my point to that would be, Nobody has done the menopause we are doing now. And here is the reason, because no other generation has been exposed to as many hormone-disrupting chemicals for so long. We don't know what they're doing. Anything you use that's got perfume in it, anything parfum, it says on the label, right? Your laundry liquid, your deodorants, your room diffusers, all of those things. The xenoestrogens from the plastics that we've been exposed to for most of our lives. So generations that went before, they didn't have all of this stuff for all of this time, okay? Also now in the UK, a couple of months ago, we've talked about the first time moms in their 40s were more than first-time moms in their 20s. So we're now also pushing our motherhood with young children up against a time when you're going through menopause, and you also may be of that generation where you have older people in your family to take care of. So we have this sandwich generation going on. Also, we've got more people who are going through menopause who are working at higher levels in business as well and taking on executive roles, maybe traveling for work, all of that stuff. No one's done it this way before. And I think that is a big misconception. We're not whining. We're going through a different process than any other generation has gone through before us.

So I completely agree and echo everything that Selima and Pamela have shared, because I feel like menopause is something we don't need to fix. It's something that we need support with. And I think that this is a new time period where we're going into menopause earlier than we did before. We're living longer than we have before. We've got glycophosphates and endocrine disruptors and plastics and endogenous estrogens and everything. We've got hormones in our food and our meat and our dairy. And all of this is affecting the journeys that we're all going through now. And I think this is kind of like a refresh or a new start of this conversation because it's affecting people differently than it has in the past. People are living longer, so people are not dying before everything from these menopause changes and the estrogen and progesterone fluctuations and the luteinizing hormone and all the hormones that are fluctuating. We're living longer, so we're actually seeing what the long term changes in the body are after 5, and 10, and 20 years, which is something we haven't really seen before.

Yeah. Thank you all. I am really feeling empowered by listening to you all speak to these misconceptions. I just want to share briefly that I recently heard somebody who had gone through the menopause transition was on the other side say how powerful the freedom was that they encountered in themselves afterwards. It feels like there is a light at the end of the tunnel. I also had someone tell me that as a cold person, which I very much am, cold all the time, that hot flashes actually felt really good in their body because they were like, Oh, I'm actually warm so that was a beautiful thing.

We want to talk about phytoestrogenic herbs. This is a big topic in herbalism when it comes to the hormonal conversations that we have in the various time periods of our lives. So let's hear from you all on phytoestrogenic herbs and the place that they hold within the menopausal transition.

Well, I think this is probably the most obvious place where people feel like herbalists can assist. And what we're going to go on to talk about later in this conversation is all of the other things that we can do, too. So we were like, well, let's address this one first. It's the one that we're probably most famous for. And then we can move on to all of the other ways that we can also assist. So essentially for me, phytoestrogenic herbs is one of the only times where we can say, okay, we have a situation where the body is requiring more of this chemical, and we can find it in plants and put it into the body. And by doing that, we can alleviate some of the symptoms that the body is going through not having enough of this. I can't actually think—maybe you guys, you can think of some time—but I can't think of any other situation where this is actually the case. And I think maybe this is why in the market people have cottoned onto this is because it's almost like, oh, it's a bit like it fits into that pharmaceutical model of, I'm deficit in this, I take some of this, it goes into my body. Herbs don't usually work like that. So of course, we know that our phytoestrogenic herbs are way more complicated and clever than just being that. But they do deliver phytoestrogens, which if you're not familiar with the term, it's just plant estrogens that can weakly bind to our estrogen receptors and be used by our body. And I kind of talk to—when I'm doing talks and workshops in the UK, I'm talking about some of the symptoms are happening to us because the body is yelling for more estrogen. More estrogen, please. And that is not being fulfilled. And it's almost like hot flush is the classic one is the body really yelling, Can I have more estrogen, please? And the plants can come along and they can plug those receptors and the body can be a little bit happier. And so that's the way I would explain in layperson's terms, how we reduce some of those symptoms.

Two of my absolute favorites, I'm just going to mention, and there are so many of the plants in this class, but I really like using red clover, Trifolium pratense, because it's gentle, it's reliable. We also use it for skin conditions as well. So sometimes skin can be, for some people, will be red or more inflamed or their skin issues can come along with this lack of estrogen that we're going through. And so it really helps with that. Really helps when at the beginning of your menstrual bleed is what I would call inefficient. So stop, start, stop, start. Trifolium is amazing. Red Clover is amazing at making the bleed more efficient in the early stages. Another herb I rely on very much would be something like hops, Humulus lupulus, because it is also quite sedating. So if you're in a situation where the low estrogen levels and low progesterone are making your sleep disturbed or you're anxious, then it makes a great addition to a sleep mix, for example, to try and help to bring back some of that sleep. Sleep is so important through these huge changes in our bodies to let our bodies really recuperate in the night. And sadly, that's one of the things that often becomes a bit of a challenge. Those would be my two favorite phytoestrogenic herbs at the moment.

So I have been... I guess before I go into my herbs that I wanted to talk about, one thing I did want to mention about phytoestrogens is they take a little while to work. Some of the other herbs we may talk about today, like nervines and herbs for sleep, they tend to work more quickly. Phytoestrogen herbs take between three to six months to really show that utmost change that they're going to find. And so I find that when I work with people, some people feel them very fast, and other people, you really just have to stick with it with blind faith, that they're going to work for several months before you start to see changes. And so if you're starting some phytoestrogen herbs, just hang in there a little bit longer and give it a little time before you make the decision whether they're working for you or not. So I recently have discovered kudzu for this purpose, which I've used for other things, but not as a phytoestrogen herb. And this comes to us from the Traditional Chinese Medicine tradition. And in TCM, it's considered safer long term use and beneficial for promoting overall health and longevity with a really low toxicity profile, which is great because we're talking about taking herbs long term. So we want to know that what we're taking long term as a phytoestrogen is safe. And kudzu does contain some phytosterols in the form of isoflavones, which do act upon the body's estrogen receptors and really help to lower complaints in perimenopause and menopause. Kudzu is cooling, so it's helpful for hot flashes. I found that in my practice that this herb tends to work where other phytoestrogenic herbs just are not working or are not doing quite enough. And so that's really a fascinating thing. And then kudzu has great effect on a lot of other menopausal complaints, vaginal tissue and bone density and cardiovascular regular complaints. And so it's really important to match up your phytoestrogen herbs that you're choosing with the complaints that you're having in the moment, and then knowing that you may need to shift them up a little bit as things in the body change. So the other herb I wanted to mention was black cohosh. If you're looking for black cohosh, please seek a cultivated source because it is an at-risk plant, and it's really important for us when we're using at-risk plants to find organically-grown sources so we are not contributing to any more endangering plants in the wild. So black cohosh is known and probably one of the most talked about herbs besides possibly red clover for hot flashes and night sweats. And interestingly enough, the Eclectic doctors really used it for joint pain or rheumatism, which is one of the largest complaints that people have besides hot flashes and menopause is body pain and musculoskeletal pain, joint pain, thinking it's arthritis. But is it arthritis or is it due to the estrogen drops? We're not really sure. So the black cohosh tend to be really effective. And even though it doesn't really have phytoestrogens, it does have phytosterols. So I thought it was interesting to include it in this section because phytosterols are building blocks for hormones. And the Commission E monograph board, which is a regulatory board that does tend to be a little bit conservative in Germany, does approve black cohosh use for menopausal neurovegetative ailments. And that means they are ailments that are related to the autonomic nervous system with brain functioning, which translates to things like hot flashes and cardiovascular issues, sleep problems, mood changes, cognition issues. And so these are all things that we see quite frequently during the menopausal change.

And I wanted to add vitex to this conversation, and it's not usually one we think of in terms of adding phytoestrogens, but I really love the way that it supports hormonal balance, particularly when you're perimenopausal. And as Pamela mentioned, as the progesterone is declining faster than the estrogen. So I'm this season and my period is starting to shorten for the first time ever. And I was like, what's going on? Denial, right? What's going on? It can't be what's going on. And vitex was the ally that I reached for, and it was able to lengthen the period back to around 28 days. So it really helps with that hypothalamic-pituitary-ovarian axis. So that's the feedback loop that's happening in our brain and our ovaries, and it's influencing that progesterone production, trying to keep that ratio between estrogen and progesterone more balanced. And so with that in perimenopause, it can help with mood swings, the breast tenderness, irregularity with cycles, and even mild hot flashes. And then I also wanted to add flaxseed into the conversation because it's food. I really like thinking about the ways that we can incorporate. I mean, I do it with herbs anyway, but we have food that we can incorporate into our daily routines. It's truly phytoestrogenic, so it's rich in lignins that help with our loosely bind to our estrogen receptors. And so you can sprinkle flaxseed on your breakfast yogurt. You can blend it into smoothies. I'm a big fan of elderberry and blueberry muffins. You can add flaxseed into your muffins, your baked bread even. My wife bakes bread every day, almost. It's so good and so not good, right? So fresh baked bread every day. And it's like we can add flaxseed and have that additional phytoestrogenic support.

That sounds so good, Selima. Thank you for sharing, everyone. Okay, so we've talked about phytoestrogenic herbs, and obviously, these have a place in response to hot flashes. I want to hear, though, how do you all approach hot flashes, this number one complaint for the menopausal transition, and how do you differentiate between the patterns found within individual presentations of hot flashes?

Well, that's a big question. What I would say is that I would always differentiate between the people who come for help by looking at their constitutional type. There is absolutely no way we get time to go into all of that today. But suffice to say that when I was trained, we worked with the Ayurvedic model. I am always, and anyone who's interested in that, there's lots of references on the Herbal Academy site to Ayurveda, and there's some Ayurvedic specialists out there who have taught for us. I am not one of them, but I do use this in clinic every day. So what I'm looking at is the energetics, and of course, we've got lots on energetics as well. And Lindsey, you recently did a class on energetics, which was excellent. So energetics come into all traditions. Essentially, to break it down, where are you on the hot, cold, moist, dry axis? And if you are a particularly hot person, then you are likely to have hot flushes, flushes we call them in the UK, flashes, you call them in the US. You are likely to have them. They are likely to be intense, the hotter constitutionally you are. And so like Lindsey, you were talking about being a cold constitutional type. And like some people, I actually know someone here who I've worked with in the past who was delighted with her hot flushes because she spent her life being cold. So that is a thing, right? So she didn't want to help with them. Okay, that's important. She was like, Leave my flushes alone. This is good. But if you're a hot constitutional type and your flushes are really hot and intense, you can go down the phytoestrogenic route. We've already looked at that, but I wanted to look at one of the other places where I always look, which is the liver. I think we overlook the liver a lot. I have developed and written and talked about a method with three pillars. I'm not going to talk about all of them today. One is phytoestrogens. Pillar two is the liver, because the sad news is that your liver is going to be shrinking during the battery of menopausal process. Also, it shrinks every year. And also it's got more work to do. So some people find that suddenly, if they did enjoy a glass of wine at the weekend or whatever, suddenly they cannot go near it without having a massive hangover. That would be a big red flag to me that their liver is working very hard. And in traditional medicine, we talk about the fact that congested liver causes heat in the body. So one of the key things I would do would be using bitter herbs. And one of my favorites is milk thistle because it's so straightforward and so reliable just to help support liver function. And that can take the heat and the intensity out of some hot flushes while you also do all of the other work that we're going to talk about and add in the phytoestrogenic herbs, if that's appropriate, that we've already discussed in the last question.

I wanted to talk about sage as the first herb that I'll often use for hot flashes. A lot of times when people reach out for an herb list during menopause and menopause transition, they're miserable. I mean, they're having tons of hot flashes. I've had clients who when they have a hot flash or a hot flush, they're like dripping wet from sweat, and they need to go change their clothes. And so that's really disruptive to your life, to your work, to whatever is going on for you. And so if something like that is happening to you or you're waking during the night and you're just like, you need to change your clothes, you need to change your sheets, you need to get out of the bed and wake your partner so you can change the sheets, it's huge disruptions to your life, to your rest, to everything. And so I am a great believer in using phytoestrogenic herbs, in looking at constitutional patterns, in addressing liver, in addressing stress. But while we're doing all of that work, we need to make somebody comfortable if we possibly can. And so sage seems to work really, really well for heavy sweating, whether it's daytime or nighttime or both, heavy sweating. Sage has phytoestrogens, an estrogenic effect on the body, and it tends to work very quickly, and it seems to only really work while you're taking it. So it doesn't have lasting effects when you finish taking it or you stop, but it works really well while you're taking it. So it's a really great herb to introduce very quickly at the beginning while you're working on things like phytoestrogens while you're working on adrenals and the nervous system and taking nervines and adaptogens. Because I do really find that a lot of times, thermal dysregulation and feeling hot flashes and hot flushes happen due to stress. And this is stress in the body and stress in the mind. And I don't think anybody ever has said they have a stress-free life. And while some people definitely have more stress in their lives than others, I think it's something that everybody feels. And so it can be really important to do that homework with the slower herbs, but making someone comfortable in the moment to make them comfortable so they can go on and continue on with their life. And they don't lose their job or things like that.

And this conversation is actually reminding me in this moment that my cycle shortening wasn't the first symptom. I was experiencing night sweats, and I didn't, again, denial, not making the connection. And I'm only 43, so also not thinking that this is happening right now. It will happen later. But something that I did, and it's the herb that I'm going to contribute to this conversation, was I started adding more hibiscus to my daily infusion, which is a practice that I encourage everyone to have. And I really like hibiscus for its refrigerant qualities. It has many other benefits, but I'm really focusing on the fact that it's a cooling and a moistening herb as well. Having that... It feels like an internal shower, almost most of that cooling effect that you can have throughout the day. I think that that can be really supportive to people. And in terms of patterns, I think the one that I've seen typically, or similar to Shona, is that the stress-induced hot flashes. And so if you're experiencing that, then pair your hibiscus with nervines like blue vervain or chamomile or a gentle adaptogen like tulsi. And I think that hibiscus, it also masks for people who have an aversion to bitters. That sour can mask some of the bitter flavor while you're still getting the benefits of bitters, which help our parasympathetic nervous system state. And so it tends to be one of those herbs that I add to a lot of blends. And I'm like, Oh, the night sweats went away! I think a sage hibiscus tea sounds really good as an intervention for hot flashes or those temperature dysregulations.

Ladies, we know that as clinical herbalists, herbs are obviously a very big part of the work that we do, but so are lifestyle changes. This is looking at stress, sleep, diet, movement, all of these things. How do you feel that these lifestyle factors most influence the way that somebody experiences this menopausal transition?

I think without getting into the nitty-gritty of each area, I overall think I like to zoom out and think that when we have unsupportive habits, that that tends to make everything else worse. And yes, there are very profound changes that are happening hormonally that affect and impact how we're showing up in our day-to-day lives, how it's affecting sleep, how it's affecting our stress responses and our anxiety. That might lead to not making good food choices in the moment because we are stressed and anxious. But I think that I can encourage people to do as much as they can to support healthy habits, that it can only help. I'll leave it there.

I love that. You're so right. When you're in the moment, you make better choices when you're supported.

Yeah, absolutely. I think that for me, working more with constitutional types, again, it's about what does the body in front of you, what does the person in front of you need? If they're high vata, maybe their anxiety is off the scale, maybe they're not sleeping. Maybe everything is getting cold and dry. So we have to moisten and we have to actually warm those bodies, even though usually when we talk about menopause, we're like, oh, no, everyone wants cooling. No, that's not the case. So It's about looking at where we can reduce stressors in life, how we can incorporate, moistening things like oil massage, those things. If it's a high pitta person, it's going to be about getting them off the treadmill, getting them to realize they have actually got to rest. They're not going to be able to work their way through this. They have to rest. For the high kapha constitutional type, it's going to be more about warming and motivating and moving. So for me, it's really important to do that, but also just to get across to people, if you are going to be a person who has a tricky menopause, and those are the people who are likely to come to us for help, it cannot just be business as usual. I can't say that enough. And I spent the first so many years of this transition in complete denial. I was killing myself laughing when you were saying that. Totally flooding. Pains all over the place. Brain fog. I was like, no, that's not happening to me. I am a high pitta person and I can achieve and work my way through this. And I'm like, yeah, no, actually, that's not going to work. And it has been the biggest lesson for me in terms of walking my talk. And oh my gosh, I do not always get it right. But it's like it is going to take a lifestyle shift and you do not have... You do have to nurture yourself through it, I think is the main thing. Whatever that takes, like you said, Selima, that's big, broad picture. Like not even going into diet. Yes, there's diet, yes, there's supplements, yes, there's this and that and the other. But actually just recognizing this is going to take some change, I think is the main thing.

I love what you both have said. And your line, Pamela, of walking your talk really jives with me because I have found that, too, in my menopause journey. And I think that all of this is so important, our lifestyle, sleep, and sleep hygiene and diet and lifestyle factors and stress management. And I think it's also important to recognize here that hormones have a great effect on mood swings and emotional dysregulation and sleep. And so while those things are definitely dictated partially by lifestyle, they're also dictated by hormones. And we really need to recognize that because I can share. I had great sleep always for my whole life. My husband was always like, you get in bed and you fall asleep so quickly and you stay asleep. And it was great. And all of this shifted for me during my menopause change, where, I think, I eat pretty well and I get exercise and take a lot of supplements and take herbs and take generally pretty well care of myself, although I do work a lot. And so I've noticed that one of the things when I talk to my clients and I talk to my friends who are in there around my age now and myself, I think that self-care and self-love is really important here. And really carving out that time for yourself and taking that downtime, which I'm also not very good at. I have a farm, I have a lot of work, I make all my herbal products. I'm always doing stuff. And so some of that self-care time of really making sure that I'm planning this downtime into my schedule. And I find for me that downtime out of my home is really important because if I'm home, I'm distracted by work. And so going boating, going swimming, going to the thermal spa in Canada, spending time at museums or music or things like that, but out of my environment. Because I'm also think that one of the things that happened, I don't know if this is for both of you, but this also joined with my empty nesting time, and so my kids have moved out. I'm taking more care of my elderly mother, and I'm in menopause. And so I'm really finding it necessary to prioritize my needs, which is not something I've done in many, many, many years. And so I found that to be very important.

It sounds very important, Shona. I'm glad you're finding those ways to create joy and cultivate that in your life in this transitionary period. One of the top symptoms that I feel women complain about during the menopausal transition is the cognitive changes. Brain fog is so real. How are we working to improve cognition with herbs during menopause?

Well, before we get into herbs about that, I just want to say that I was doing some reading on some studies, and the studies report that after about two years in postmenopause, your brain cognition comes back to its free menopausal state. So hallelujah! We're all really excited about that. Yeah, I know. So I was really happy to see that in not just one study when we were working on our menopausal intensive here. And so I did want to mention that because just hang in there. Hopefully, all your brain power is going to come back. But in the meantime, I'm a really big fan of rosemary. I mean, rosemary is definitely an herb that's always talked about for memory and cognition, improving concentration, improving cognitive performance, stimulating blood flow to the brain. It has some really great results. And interestingly enough, smaller dosing has better results than larger dosing when using rosemary, which is wonderful because it really points to using this as a food herb and incorporating it into our diet. Because one of the things that I think happens during the menopausal journey is you have whatever pre-existing health conditions you may have had before you're going into menopause. And then you start menopause and you're thinking, I need phytoestrogenic herbs, and I need herbs for hot flashes, and I need herbs for this complaint, and that complaint, and this complaint. Then all of a sudden you're like, I get this whole natural pharmacy going in front of me, and I can't possibly take another tincture, or drink another cup of tea, or take another supplement or whatever it is. And so it's so great when we can incorporate food into our diet that works and helps us. And so rosemary is a great addition to your diet. And sage, which has some similar properties as rosemary, like the rosmarinic acid, is also a good food to incorporate into your diet.

I really appreciate that you mentioned the study, because I think something that frightens people with the brain fog is thinking, especially if they've witnessed people experience dementia, Alzheimer's, is thinking that this is the onset of cognitive decline. And when it feels more like a neurological, more like a brain reset, like our brain is rewiring. And the two herbs that I want to add to this conversation are two that I recently started taking. Again, those symptoms stacking up as I'm realizing this conversation. That I added lion's mane because it helps with our neuroplasticity. It helps with regeneration. It helps to improve memory, focus, and clarity. And then it also has supports like neuroinflammation, dialing that down. And then the other piece that I added recently was supporting gut health because seeing the effects of cortisol—and we know how the gut and the brain are in constant communication. And I was seeing my body shape change a little bit—like, hold up, what's happening here? And I added reishi to support the inflammation in the gut, which is also helping the communication between the brain and the gut. And I can report that I'm definitely feeling more mental clarity. And I'm drinking rosemary right now. So I'm feeling it firsthand. And I think that we know that gut and brain are tied. So I think that that's been my strategy, have that brain connection as well as have that gut connection.

I'm still doing that, too. I'm laughing because I'm taking notes going, Oh, and I could do this, too. There's always more you could do, right? You do have to get to that point where you're like, okay, I'm doing enough right now. I'm also chuckling because I could see, Shona, you lifted up your hibiscus. Selima, you're drinking rosemary, and I have a blend that's based on sage. And I promise everybody, we did not pre coordinate that. That is just what we happen to be drinking right now. I think that brain fog is the symptom, the word finding problems. Oh, my goodness. And just suddenly stopping and not being able to find the word or knowing someone and cannot recall their name. I think it's actually been the most upsetting symptom for me because I am known as an extremely organized, very together, able to talk to all of that—see I can't find the word now, right? Here it is in real time. So I think that the fear around losing my abilities... I knew enough to know it wasn't a dementia thing. I was like, okay, I get this. But I didn't understand how it really deeply can affect your confidence. I do a lot of public speaking, and the idea of being up there and suddenly I just can't. I've had to do things in a different way. For example, when I used to do videos for the Herbal Academy, I would have just a few notes and I would just speak. And I found that recently, some of the things I've done, not for all of them, like this, obviously, or some of the things I've done with Lindsey, but for some other things, I've had to use AutoQ because I'm like, I need to deliver really clear factual information right now. And I used to be able to retain that, and I currently can. So Shona, no one is happier on this panel than me to hear about those studies because I haven't heard that. I thought that it was gone forever.

My two favorites, just to quickly mention, so gotu kola is a stalwart for me. So my three pillars of supporting a menopause would be hormonal support, liver, and adrenal-nervous system support. It's often ashwagandha, but if there's brain fog, then my go to would definitely be gotu kola. And in the moment, if you just can't quite bring it, I would use rosemary, like a sprig in a mug of hot water in my water bottle, for example, but my other top tip that we used to do in herbal school, would be to just chew on a green cardamom pod. And just even having that in... We used to pass the little bag around when we were studying for the four o'clock lecture. So we would have a little bottle of rosemary essential oil and then we would have green cardamom pods, and we would all just stick one up in our gum and chew on it. And it really does help to just bring that awakeness because caffeine often when you're going through perimenopause, you can't use it because it makes you jittery. I used to be a complete caffeine junkie, and now I really can't touch it very well. So green cardamom would be my other top tip for an immediate kind of a wake up.

Ooo, I like that. I am going to state that I am in my early 40s, so I'm 41, and I feel like the cognition is that first symptom that I'm experiencing, where it's like the word loss is so huge. And I feel like I had a steel trap memory, and I never had to write anything down. My schedule was in my head. I never lost a meeting or a date or anything. Now it's like, Oh, wait, I need to reach for the pen. My bottle of rosemary tincture right next to me, and I do take lion's mane daily. I love the connection that occurs when we get to talk about this stuff, where it's like, oh, it almost feels nourishing and clarity-inducing to just have this conversation. So thank you all for sharing. One thing I've also noticed is mood swings are real and emotional fluctuations in this time. So this is another challenge that is experienced throughout the transition. How are you all approaching this?

Yeah, well, that piece around adrenal nervous system is really important. Two of my absolute stalwarts for mood swings are skullcap, Scutellaria lateriflora, and vervain, Verbena officinalis. I know you guys in the US, I think you probably use Verbena hastata maybe a little bit more. We don't really use that in the UK. It's Verbena officinalis, but they're very similar. And so I've renamed skullcap a good Scottish phrase I'm going to teach you all now, which is "keep the heat." So you probably understand that translates to keep your head. So it's for the people who are the pitta types, particularly, who are easy to be irritable. The other day, actually, I changed my tincture and I took mine out. I've done this to people who come to see me before and regretted it. And I regretted mine because I was like, everything my family did—and when you said earlier, Shona, about the empty nester, I did it the other way around. I have an 11-year-old. I have an 83-year-old mother who I help to look

After, and an 11-year-old, and I'm 53. So I'm in that situation. And I realized that my husband, my poor husband, just said something and I was like [growls]. Skullcap is for that. The moment you're like, you can't keep your head, and you're just like, nipping at everybody and everyone is breathing. Oh, and breathing is so annoying when they do it near you. That moment. Skullcap is absolutely brilliant for that. And I tell my patients—here in the UK, I can say patients. In the US, you guys have clients. So for the UK people, I will say to my patients, I put some keep the heat in your mix. And they quite often will say to me, Can I get more of that keep the heat, please? Can I just, because I'm snapping all over the place. So that's my number one.

My number two is for vervain. Amazing for tension in the upper shoulders and back as well as nervous system tension. I was taught it as the letting go herb. It's when you're like, I have to do all the things myself and no one does them well enough, and your body is like, I can't. My teacher told me it's like the herb comes on and peels your fingers off and goes, just let go, just let go. And it's traditionally the herb for the liminal space is between stages of life. And I really love to work with herbs in that way. And I think that just relaxing that inner tension and that mental tension as well. Those two together for me are amazing.

I found it so hard to choose herbs for this category, I have to say. We were originally talking about which herbs we were each going to talk about, and I had four listed next to my name because I just couldn't figure out what to talk about. Because I think this category, almost more than so many of the others, we need to really narrow it down to the specific indication for you and what you're experiencing in the moment. One of the things that I've noticed that comes up during menopause, and I've noticed this in a lot of my clients and myself is I've never had anxiety before in my life, and I have been experiencing anxiety during this time. And so I thought that I would talk about herbs for that. And I wanted to talk about schisandra. Schisandra is a great adaptogen herb and affects the HPA axis. And so it's great for stress, and it's really great where anxiety and menopausal changes meet. Schisandra offers support for neuroprotection and cognitive decline and all kinds of other neurodegenerative diseases and disorders. And so it's a really important herb in the menopause transition because it helps with heart palpitations, which sometimes can be from stress. It helps with hot flashes and sweating and anxiety. And it seems to really help with this body anxiety rather than anxiety in the mind. And so there's this anxiety in the mind, which I'm going to talk about in a minute, where it starts in your head or from a thought or from this flow of thinking. But there's also this other anxiety that people feel in their bodies that it has absolutely nothing to do with the situation at hand or thought process or what's going on in your head, where it's a really physical type of anxiety. And I think that's kind of that example in studies of the heart palpitation. But that isn't the only place we see body anxiety. And so I really like schisandra for that. And I've seen this work for folks where a lot of nervine herbs that are typically used for anxiety aren't touching it. And so it's a great herb to think about introducing. And positively, it seems to act pretty quickly. And that's one of the great things about all the herbs in this category, I think, that we're talking about, or most of the herbs in this category, is they often work fast.

And the other herb I just wanted to mention briefly is tulsi, where we see it used in India for hormone and neurological support and as a longevity herb and an adaptogen. Here in the Western herbalism, we use it as a nervine, particularly as an anxiolytic herb and adaptogen purposes. We see tulsi really helping with effects of stress on the body and on the nervous system. And interestingly enough, it's also good to support pain in the vulva and vaginal areas. So that also makes it a really nice herb to consider for menopause, where anxiety, tension, and vaginal discomfort is present. This is a great ideal go-to herb. And so I think it's one that we should all be considering for depression and traumatic events. And for some people, the menopausal transition fits the bill of being a traumatic event.

And I think similar to you all shared stories around the cold person who is enjoying the heat, I tend to run emotionally stoic to cheerful. I think that in this particular area, I'm enjoying some of the emotional softening. I think that that might also be an experience that other people enjoy. But I've also heard people say, I'm crying all the time, and I don't understand why, and thinking that it's a problem. And so the herbs that I chose where I'm enjoying that sensitivity that's coming in, I could not talk about mimosa enough. It is one of my favorites. Not the boozy beverage for a brunch—I had to give up alcohol— but the plant. And it grows abundantly down here in Atlanta, Georgia, and it's known as the tree of collective happiness. And it really helps to lift the melancholy. It helps to interact. It interacts with our serotonin receptors. It's a really great antidepressant, and I microdose it. I don't ever need a lot. One to five drops of the fresh tincture tends to be all I need to just have that gentle lift. I think about mimosa for this season as well, because people are having big feelings. And it's not just this transition that we're talking about. Pamela and Shona talked about how there are other life things going on. So whether it's a job that you're transitioning from or you're caring for parents, that's another transition, or you still have young children. There's so much going on. And having a plant that can support us in just moving through the emotional fluctuations of all of the transitions that we're experiencing and be able to acknowledge the grief that comes with what's happening, what we're leaving behind us, I think is really important. And mimosa is a really great ally for me in that regard, as well as just the other things. If you live a long enough life, you are going to experience losses. And so I always keep mimosa nearby.

And then the other plant, also can't talk about enough, is milky oats, fresh milky oats tincture. It feels like—it's not clinical—it just feels like a hug. It feels like I am in a weighted blanket and it's warm because I run cold. So that's relieving to me. When I take fresh milky oats tincture, it's a trophorestorative for our nervous systems. So helping us to... Helping our nervous systems repair even from the most depleted states, which could arguably be this season in people's lives. So I tend to use those hand in hand. Again, not equal parts because I don't need a lot of mimosa, but I'll have a tincture of them hand in hand. And sometimes I will sprinkle in catnip for joy and for play and this that whimsy and fun. And I found that triplet to be really delicious.

You guys mentioned so many wonderful nervine herbs. One other herb that I feel like is very important to mention here is passionflower. So I know you all love passionflower as much as I do, but it has been one of the herbs that I have seen be most effective for my clients in reducing stress during the menopausal transition, particularly, of course, where it shines is that sleep period where it's like you can't go to sleep from the circular thinking or you wake up in the middle of the night and you can't stop thinking, passionflower is such friend here.

Let's talk about sleep disturbances. This can be one of the toughest symptoms to deal with as a person going through the transition. What are your favorite strategies for supporting deeper rest and reducing night sweats with herbs? When we talk about sleep, I think that we first have to mention sleep is partially affected by lifestyle and partially affected by hormones. And so sleep is one of those areas that we see issues happen where they haven't happened previously. And while they are going to be influenced by sleep hygiene and no screens before bed and no stimulation before bed and avoiding caffeine after a certain time of day and all of these good sleep hygiene practices, I think it's also so important to recognize and understand that sleep is affected by these hormone changes. So it may be outside of all of the sleep hygiene that you're doing, you may need some help and support. So going into the evening tired and having had exercised and not eating a large piece of chocolate cake before bed is certainly going to be helpful. But sometimes we may need some more help than that in the transition. So whether it's essential oils in the room or evening baths—if that doesn't heat you too much—or foot baths and essential oils applied to the body, and things like that are all helpful. But sometimes I think we need even more help than that where we're taking internal stronger sedative herbs.

And so hops is one of the herbs that I like to use for sleep. Hops tends to be a heavy sedative herb. A lot of people have heard of hops because it's in beer and used in beer and it's bitter and it makes you a little drowsy. They first discovered this about hops because the workers who were harvesting hops for beer were getting really tired due to the constituent content in the hops making them tired. And that's how the use of hops for sleep came about. Hops is great because while it is a heavy sedative, it doesn't seem to leave that extreme grogginess or possible morning hangover that's associated with certain heavy sedative herbs like valerian and cannabis. And hops has this extra thing going for it for sleep where it has estrogenic compounds. It's great in menopause where sleep is an issue and hot flashes and particularly night sweats are an issue. Hops is really supportive during that period of time and helpful where there's worry, anxiety, thoughts and feelings, where someone is feeling a lot of physical and emotional strain. Hops seems to be calming to large emotions, especially anger and irritability and these intense emotions that people feel. And so hops is going to be relaxing, and it's a good relaxant for those kinds of feelings. It's also antispasmodic and good for pain. So it helps where pain is interfering with sleep, and it's good for muscular tension, backaches, body pain, things like that. So hops is a great herb to consider during the menopausal transition.

Then both Selima and Pamela are going to talk about other herbs that are great for sleep. But I just wanted to mention cannabis. I think cannabis, which is another plant, and it can be really useful and instrumental in supporting sleep, anxiety, and pain, and all kinds of other issues that interfere with sleep. I find that it often works well when other herbs don't work well for sleep, and it works really well in combination with herbs for sleep. As we move into discussing some of the cannabinoids that you might possibly want to consider, which are THC, which is psychoactive and is not federally legal in the United States and is legal both medically and recreationally in some states. And then things like CBD and CBN, which are federally legal in the United States, those have sedative effects. And so you can mix and match them both with each other and as well with other herbs for sleep. And I find that they work really well. Everybody has an endocannabinoid system, which is activated by use of plants that are rich in cannabinoids. It takes three weeks to activate your endocannabinoid system if you haven't used anything with cannabinoids in it before. So what that means is for some people, if they have never taken a cannabinoid, it may work the first time they take it. For some people, you may need to take it for three weeks on the daily before you notice a change in your sleep patterns. And so in those kinds of uses, it works particularly well when using it with other sleep herbs like valerian or hops or passionflower or whatever herbs we're thinking about using for sleep. And you do want to start out with really, really low doses. I suggest if you've never tried anything like this, you use liquids because you have the most control over dose. You can start with literally one drop and work your way up because some people, while they do enjoy the feeling that it makes in your body, other people do not enjoy the feeling that it makes in your body and your mind. And when you're using cannabinoids, there's this line where you will feel the psychotropic... Sorry. You're going to feel the sedative effect of the herb without feeling the psychotropic effect of the herb, and then you know you've got the dose just right for you. And the dose has nothing to do with body size. A very small person can use a large amount. A very large person can use a small amount. And each different strain is going to affect you differently. I suggest if you're interested in this and it's legal, you live in a legal state, you go to the local dispensary and get some information from them looking for products for sleep in a liquid form or looking for CBN products or CBD products, and you can start to play with them. So keep that in mind that they're not legal everywhere.

Thank you for that, Shona. It's reminding me that I really have developed a whole sleep, herbal sleep routine at this point. And having a non-psychoactive hemp gummy is a part of that routine. In addition to chamomile has been a plant for me that has supported me for sleep since I was a child. This is actually one of my first herbal stories was my mother making chamomile tea for me to both help me settle my stomach and also to get a really restful night's sleep. And it's very gentle. I don't think of it as a sedentary sedentary, but it's gentle. I feel like it calms the spirit and it settles the gut, settles the nerves so that we can ease into sleep. And then I think if people need more sedatives of support, that valerian can be an additional support for that. Sometimes you just need a thing that's going to guarantee to knock you out so that you get the hours that you need. And I keep these tinctures by the bed. And I think about it in terms of staggering the dose, where it's like, I will have the gummy when I'm downstairs in the kitchen. And then maybe an hour later, I'm going to have some of the chamomile tincture. And then right as I'm turning in and turning off the light—I usually read before bed—turning off the light, then I'm having my valerian. And when I wake up refreshed with my eight hours like I did today, feels great.

So when I think of sleep and herbs, I immediately think of passionflower. So Lindsey, I'm right there with that. And passionflower to me is always key. And it's okay as a nervine. I don't really use it just as a nervine. I would always use it in a sleep mix. And for me, when I'm teaching students at Herbal Academy and in other places where I teach, too, I would say to them, look, if you look at something, a product on the market, the way to know whether it's just a relaxing product or it's a sleep product would be, is there passionflower in it or not? So it's absolutely key for me. I think it's amazing at resetting a sleep cycle that's just gone a bit skew, and it's so great for anxiety as well. But actually, I don't pick it as a nervine herb alone. So I wouldn't think, oh, anxiety, passionflower, only ever when it's disturbed sleep. For me personally, that's just in my practice. We were talking earlier before we came on about the fact that the great thing about herbalists is we all learn from each other because we all do things differently, because there are no hard and fast rules other than around poisonous herbs. And so therefore, it's the thing that tends to drive students at the beginning of their journey completely crazy because they can't find the rule book. And when you get more into it, it's just such a joy because that's where the creativity comes from, right? For me, I wouldn't think of passionflower unless sleep is involved.

And the other herb that I would use there would be ashwagandha, Withania somnifera. And I'm always saying the clue is in the name. Somnifera helps with sleep. And I think particularly around menopause, when the nervous system is often under immense pressure, the adrenals, therefore, they have a new job to do. They're involved now in estrogen production going forward. They've not had that job before, but they are doing that now. They have something else to deal with. And being a great adaptogen, particularly with a positive effect on the adrenals and helping with sleep, is really useful.

And one very last thing I just wanted to add, Shona, to your tale about hops and the hop pickers. So one of my teachers, Christopher Hedley, who's sadly no longer with us, he came from down that way in England, in Kent, where they grow hops. And the thing about the hop pickers was that they used to come in just for the picking season. And so not only is hops make you very calm, but it's also a female aphrodisiac and a male anaphrodisiac. So if you've heard of brewer's drip before when someone had too much beer, right? That's the hops male anaphrodisiac part working. And so what would happen, though, is that the hop pickers would come into town. All the local men were used to it, so it didn't make them sleepy. It made all the visiting men really sleepy, but all the visiting women had this aphrodisiac effect. And so it was known that that's what widened the gene pool in these tiny little Kent villages where the hop picker is coming to join in every summertime. So there's a little bit more to that story as well. But what's not to love about hops, right? Oh, I love that addition. Thank you for sharing that with me. Welcome.

Let's talk about bone and joint health? This comes up during menopause. We know it. It's definitely a part of the aging process, right? What herbs and nutritional support are we using or even exercise to build strength and resilience? Well, I think one of the first things to recognize that a lot of people don't know is that your bone and joint health is affected by the level of estrogen in your body. And so part of what we're going to have to think about doing is putting in estrogen in some form. And that can really help with the joint pain that can come up, with the lubrication of the joints, with the healing from injury, all of those things. One of the things I would always do would be to put phytoestrogenic herbs in there if there's any sign of joint issues during menopause, or if we just want to help to improve musculoskeletal system status. And so we've mentioned so many. It could be sage, it could be hops, it could be any of them. But I think they're an important part of what we need to do.

And then to piggyback off of that, I think I'd like to add Solomon's seal. I love Solomon's seal. It grows in our backyard. It's a slow-growing rhizome, but it's really supportive for connective tissue health and for joint restoration. It helps to lubricate the tissues. It helps with supporting synovial fluid. It has this, it's an amphoteric effect where it helps to loosen—or tighten loose tissues and loosen tight tissues. I have to make sure I said that right with the brain fog, right? It supports the communication as well between the bone and the muscle and the fascia, and it helps to support the regeneration of collagen, which is our most abundant protein. But I think people can take it as a tonic herb as an ally for support for these types of syndromes as well, especially if you're not actually arthritic, just having, feeling that stiffness and feeling that rigidity and having this tonic herb can support you in addition to some weight training.

So I think when we're thinking about bone loss, we want to think about herbs that are high in nutrient value. We're thinking about things like nettle and oat straw and horsetail and alfalfa, and we're thinking about deep nutrient-rich long infusions with these herbs. One of the superstars of this is nettles, which contains calcium and potassium and silica, magnesium, lots of different vitamins and minerals that help with calcium absorption. And nettles also helps with inflammation and things like that. But I also wanted to mention incorporating foods like deep leafy greens and soy foods, which have some phytoestrogens as a good modality to think about in bone loss. And there's a really good supplement out there called AlgaeCal, which has some really good clinical research on bone loss and osteopenia and osteoporosis, which is also something for folks to consider. I'll do a plug for vitamin D3 as well, being a huge part of the nutritional support to get those bones built up.

Ladies, let's talk about vaginal changes that are experienced with menopause. This can look different for each individual, but we definitely have herbs that can be supportive here. This was a tough question for me because there are a lot of symptom changes just in this particular area. And so I was thinking about how to narrow it down. And I came back to probably the herb we've all used at some point is red raspberry leaf. At how much it supports us when we have our first period and throughout to providing that tissue tone, that strengthening in the pelvic region and for the vaginal tissues and thinking how supportive that can be during this season as well. Improving our receptivity, the estrogen binding is what red raspberry leaf can help with in addition to its other benefits on tissue toning. And you can drink it as a tonic herb. So going back to that daily infusion and that daily washing. And I was really thinking about vaginal atrophy with this particular area and how red raspberry leaf can be supportive to toning the area during this time. The vaginal tissue state can be super problematic for some people.

I think the other thing to consider not only is the discomfort physically, but there's a lot of emotional discomfort in discussing vaginal discomfort. I think it's one of the harder areas to go to your provider and say, I'm in pain in my vagina. I have a very dry vagina. I'm not having an orgasm. And all of these things which can be a little bit more difficult for some people to be willing to talk about. And I think that that makes this area one of the most important to talk about in menopause because it's so embarrassing for folks. And I don't think... Or maybe there's a stigma with it. Maybe embarrassed isn't the right word. Feel free to jump in if you want to here. But it's just one of the hardest things to go to your practitioner. It's a lot easier to go and say, I'm having hot flashes. I can't sleep. But it's really hard to go and talk about the vaginal changes because they're private. And let's face it, a lot of people feel like sex is private and intimate, and they don't even want to talk about it with a partner who they're having sex with. So forget about going and talking to some stranger. And here we are talking to thousands of people about it today. So I just feel like this is a really important subject to broach. And if you're having trouble with your vagina, please do not feel like you can't talk to your practitioner about it. You want to be able to talk to your partner about it. You want to be able to have a conversation about this with others because you may need support and you may need things to go a little bit differently in the bedroom than they have before. And I think it's really important that we feel confident and empowered to have these discussions. And so before I even talk about herbs, I really wanted to give each and every one of you permission if you need it, or encouragement if you need it, or whatever support that you need in coming forward to discuss this with whoever you need to discuss it with, including yourself, during this time.

And then I just wanted to also say before I get into the herb I wanted to talk about is that when you're doing homework and reading about herbs for vaginal health, using phytoestrogenic herbs internally while you're using phytoestrogenic or moisturizing herbs vaginally, there's a synergistic effect of the two being taken together, where one plus one is much greater than the sum of the parts and equals a lot higher of a number than two. And so that is something that we want to consider as we think about vaginal health. So after all my general information, about vaginal health, I wanted to talk about maca. Maca is a fairly new herb to Western herbalism. It comes from us from food use in Peru. It is a balancing female adaptogen, and it has a lot of affinity for reproductive and sexual health. Some of this may come from being such a nutrient dense food. It's high-end protein. Protein needs change as folks go through menopause. But it also is traditionally used, and we're seeing science and studies and seeing a clinical practice where it improves sexual function, and it's used for hormonal regulation. It has positive effect on libido. So we're seeing in studies, and I'm seeing in my practice, where maca is going to help with having sexual interest, raise your libido, improve orgasm rates, where you're able to achieve orgasm, where that's possibly interrupted from the hormonal changes, and also where it seems to bring some help to vaginal atrophy, vaginal moisture, and some change to the tissues in that area. And so it does take a little while for it to work, and you do need to take fairly high doses of it because it is a food herb. And so we're talking about, usually somewhere between three to five grams, about a day to see these types of changes. But I think it's a really important herb to think about.

I think that one of the things that quite often gets overlooked in terms of vaginal health is the microbiome. One of the things I would say is, you don't just have a microbiome in your gut. We also now are learning more about microbiome in your mouth and that related to your health. But you also have a vaginal microbiome as well. And so there are products out there where there are specifically put together strains in order to support the microbiome there. I think that is important. One of the other ways that I help to support vaginal health would be in terms of helping with lubrication. So using pessaries, there's a really great one you can get here in the UK. It is a coconut oil base. It has garlic powder in there for a lot of the times you can get thrush. Maybe you don't even realize it's there, but that's helping support the microbiome as well. And rose oil, because rose oil is just like, well, rose is just the queen of herbs, the most feminine, helping to reconnect with the female reproductive system in a time when maybe it's causing you some trouble. That feeling around your ability to have sex, your ability to orgasm, all of those things going on. Rose is so helpful, both physically for the tissues and also mentally and emotionally, I think. Those would be my two things that I would do. Thank you both. Thank you all, ladies, for sharing. I think this is an important topic to discuss. And I love that pairing of the rose with the oil because the rose is an astringent herb, but with the oil, you can see it lubricating in that way. I love my favorite herb that I've used in practice for dry atrophy in the vaginal area is shatavari, Asparagus racemosus, which in my opinion is the juiciest.

Let's move into hormone replacement therapy and bioidentical hormones. This is a big topic for women in this transition period. What do you all think? What do you have to say? All right, so I'm going to go first on this one. This is a huge topic. The first thing I guess I wanted to say is everyone's different, and everybody's journey is different. And some people have a lot of a smoother journey, and some people have a really large roller coaster ride. And so whatever you thought you were going to do going into this time, you may be able to do, and you may not be able to do, because you might decide that standing in your convictions and your beliefs about not using hormones may actually not be the best choice for you, depending on what's going on in your body. And so I just really first wanted to say, try the herbs first, if that's what you're moved to do, and do it with professional support because a lot of people say they try herbs, but they do it alone. And while a lot of people know a lot about herbs, and there's certainly a lot of great information on the internet, there's also a lot of poor information on the internet. And as you've heard each of us bring up in our conversation today is constitution and who you are makes a really big difference in what herbs work for you. And so you may not have ever used a professional herbalist or naturopath or medical herbalist in your past. But this might be a good time if you're really struggling with menopause to think about having some help with that where somebody helps you match up your herbs to your needs and your constitution.

But I also want to say that sometimes the herbs are not enough during this period, depending on what's going on with you. Maybe you have been experiencing a lot of trouble and you've been told that you need a hysterectomy. And so maybe you've decided that trying hormones is going to help circumvent the need for a hysterectomy. Maybe you're just, or not just, but maybe you're miserable, right? You're having a lot of trouble with your mental cognition. Maybe you're in your 40s and you now have osteopenia. Maybe your vagina is on fire. And not only do you not even want to have sex, but you don't even want to go to the bathroom. And so maybe these are the things that you've decided, maybe I need to think about hormone replacement therapy. And so we're in a really interesting period of time where the Women's Health Initiative, which is a study that came out on hormone replacement, and they followed thousands of women for many, many, many years. And so it was some really great results came out of that showing that when hormones used in the proper balance, in the proper administration, within the certain amount of time of stopping bleeding, cessation by a certain age, using the right application, we're really seeing good changes for some people where they're able to move through the menopause transition more comfortably and possibly without a lot a lot of these bigger, scarier health problems looming in the future with bone density changes and cardiovascular changes and endocrine dysfunction. And so I think that it's really important to do what's right for you at this time and don't suffer because of your beliefs and convictions. And I really had to go within for myself to think about this because for my whole life, I've been interested in herbs, and I've used very little prescription medication and over-the-counter medication in my life. And this menopausal transition has been a really large upheaval for me. And I had to really decide what is the most important thing for me. Is my conviction of using only herbs for health and wellness the most important? Or is my physical, emotional, and mental well-being the most important? And having the ability and evenness and happiness through this time of my life rather than just getting through it. And so I think that I'm just going to encourage you guys all to do what's right for you in the moment and do what's right for your body in the moment. We've all met people who didn't want to use herbs because they're like, I don't use herbs. I just use conventional medicine. And we've encouraged them, try herbs. This could really make a difference for you. And so I think that this is that time where we need to walk our own talk, and we may need to decide that suffering isn't worth it. And we're going to try some modalities that we haven't been open to before in order not only to get through this period, but I want to thrive through this period of time. I want to feel good through this period of time. I want my mind to work well. And so I think that's a really important distinction and a place that we need to think about as we're giving thought to whether or not we want to use hormones. And I just wanted to mention that there's not as much science on bioidentical hormones. And when I went into looking at the definition of bioidentical hormones for teaching this class, I found that there was a lot of different definitions, and they didn't all line up from each source that I looked at. And so I feel like there's a lot of confusion around what bioidentical means and what hormone therapy is and what's considered to be approved and what's not approved. And so I think we're just learning a lot more about this period of time than we ever have before, because people are going to be into this postmenopausal period of time for longer than they have been in the past. And that herbs work really well with hormones, and you don't necessarily have to use one or the other. You can use both together, and you can really give yourself permission to thrive and do what's best for you in the moment.

Thank you, Shona. I don't have a huge amount to add to that other than to echo the fact that a lot of people are conflicted about taking HRT, hormone replacement therapy. But for me, when I'm supporting people and also in my own life, it's about the best treatment for people at that time, the person in front of me at that time. For some, they're not even going to think about menopause. They're going to be off enjoying life. They're not here thinking about the stuff. For some, herbs are going to be enough. For some, it's not going to be enough. And we need to take any stigma away from that. Now, the bioidentical hormone replacement therapy is causing confusion. So we originally came into this thinking, Okay, we're clear. So standard HRT that has been on the market for years is synthetic, and bioidentical is not synthetic. And then actually Shona came across a place where it said that it could be synthetic. And so there's also in the UK, we talk about body identical, and body identical is non-regulated, and that is not the same as bioidentical. And so I'm not going to try and give a clear answer here. I don't think any of us have one to say that there's a lot of confusion out there to speak to a trusted health provider. And I, personally, I'm really looking forward to a few years down the line when we have a lot more evidence around body identical. I mean, automatically, I feel more pro that because it's supposedly not synthetic. But then we find this other site that says it could be synthetic. So I think it feels better the more natural it is. And I think most people who would be here listening to our conversation would feel similarly to that. But I think we just need to keep our eyes and ears open and to know that we're all learning at this stage about what this means and what body identical, bioidentical could be, and how that may be an improvement on HRT that we've had up to them.

I don't have much to add either. I echo all the sentiments from Shona and Pamela. I think that people need to do what's best for them and to find what your body is most responsive to, and that's both herbally and pharmaceutically. I have had clients in my practice have great success with a short-term intervention. You just need to get through right now for a short period with the HRT and then implementing herbs on top of it and seeing shifts happen. I mean, it really is about what is best for the person at this time.

Let's talk about that shift in identity that occurs in this transitionary period. We move from one stage of life to another over the years that include this transition. How can this be empowering rather than stigmatizing? Well, I feel like an awful lot that's written out there is based around symptoms, and a lot of what we've spoken today has been based around symptoms. Actually, in truth, it is a massive life change, and I think people are beginning to wake up to that, but I think there's much less spoken about around that. And one thing I have noticed, I noticed in practice from when I began 20 years ago, was that conversations around your relationship to your fertility or children in your life comes up right now to be looked at. And don't be surprised because it blindsides a lot of people when this happens. So whether you have children, don't have children, choose not to have them, couldn't have them, miscarried, lost children, adopted children, it doesn't matter what your personal relationship is with that. I feel strongly it comes up at this time because it's about the end of the possibility of fertility. I would also say all other things working properly because some people get to this point and fertility has not been possible for them. Anything around that conversation, whatever it looks like in your life, I feel it comes up.

One person that literally has inspired me so much is Alexandra Pope, and she is working in the UK along with her business partner, Sjanie Hugo Wurlitzer. And they started the Red School. The Red School is about menstrualities. It's about living in a menstrually aware way. I didn't come across them when I was having regular bleeds. Where I came across them was around their work around menopause and what they have created, I actually heard Alexandra Pope speak, and I had tears streaming down my face. I never heard anyone speak in this empowering way before. She talks about menopause as a cycle spiritual journey, and they have mapped out stages along that journey that you can grab onto and go, Oh, my gosh, that's why that's happening. They have loads of resources on their website. They have a book. They have a course. Once you're in the course, you can revisit it every year. They've pulled me out so many times. They really have, including talking about the burn the house down moment, which she talks about everyone having, where they literally just are like, I can't do my life anymore. And they wanted to light the match and throw it over their shoulders, set fire to everything and walk off. My best friend actually, well, she didn't set fire to the house, but she literally did that. She literally walked out of her life and created a new one. And they're like, Yeah, but most people don't probably want to do that. So let us help you through that stage. So I would say that turning around to inspiring people like that would be really helpful at this point. Certainly has been for me.

So I feel like one of the things that's really important at this time is redefining yourself, but who you are based on you and not in relationship with others, if that's possible. So there's a lot of time where people spend a lot of people or parents who come into menopause, and a lot of people are caring for their parents, and you're caring for your work or your partner or your animals, your home, all these things. And so I feel like one of the things that I think is really helpful during this period is really taking that time for yourself and redefining you, whether you're looking at new hobbies or interests that you've maybe been interested in but have put off or didn't have time for, whether it's making foods that are good for you rather than the family in mind, whether it's small routines of being able to have time for a bath before bed that you didn't have time for before because you're busy putting your kids down for bed and things like that. But really valuing yourself, valuing your own needs and desires and boundaries and allowing your individual self and your individual identity to shine. So I'm not all the way there yet, but I'm actually looking forward to it. I'm looking forward to what other types of ways I'll channel my creative energy. I'm looking forward to not having a period, even. Typically, we'll see. We'll see in a couple of years, we should come back and circle back as to how my full transition goes. But I tend to, or this isn't my identity, I tend to think of myself as someone who can flow through changes easily. And I'm hoping that this will be the same with this change as well. But I'm really looking forward to not having a period and to just having that area be generative in a new way. And what ideas are going to emerge? What new adventures can I pursue? What else can I learn? What else can I do besides bleed? And I don't want more children. And so I think that we can choose our perspective. And so that's my invitation, is to choose your perspective about it. We are going through it, and we want to be on the other side of it. So let's choose our perspective while we're in it.

I love these positive spins, ladies. Thank you. That feels really supportive to not only myself, but I'm sure the listeners out there. Let's offer one final piece of advice, just a quick offer to folks entering this stage of life. This is a big one because it's hard to do one, but it makes me think about how we tend to be the lowest priority for health care and policy changes. We're the lowest priority when it comes to workplace environment changes. We put ourselves perhaps in the lowest priority when it comes to caring for other people, whether that's children, loved ones, even showing up for friends and the folks in our community. And now is the perfect time for you to not be the lowest priority in your own life because you fully are required to show up for yourself in a different way and how you show up, I think that will have an impact on your experience of this transition. People can extend grace to themselves. Sometimes we say that we don't put ourselves on the burner. Again, that lowest priority, we're not considering ourselves. I think that if we continue that pattern, it's not going to feel great. And that's one thing that we can control. We may not be able to fully control how our hormones fluctuate while they're erratically declining, but we can control how we show up for ourselves. And we can be on the burner. We can be a priority and extend compassion and grace to ourselves while we're doing that.

Absolutely. I think that also it's really important to say, pace yourself. So this is not a sprint. This is going to take a time. There are changes. You're not going back to where you were. You're going to be someone new. So pace yourself. Really important to listen to yourself as much as you can. I don't want to sound condescending here because if you are just miserable right now, you're not going to want to hear, embrace it. But okay, once you're less miserable, maybe try to just don't fight it because actually you can't stop this. And there is a deep empowerment that comes with it. My BS filter just doesn't exist anymore. And I hear so many people saying that. I am not putting up with stuff that I put up with in the past. There is real empowerment that comes with it. You're just like, actually, no, I'm not doing it that way anymore. I'm not putting up with that anymore. There is real power comes from it. Don't fight it. Embrace it when you can. But I get that if you're feeling miserable, that might not be possible right now. So baby steps.

Oh, that's so funny, Pamela. I found this quote. I can't remember where I found it, but it was having to do with menopause. You're entering into a phase of fewer apologies and a deeper truth. Just like, sums up exactly what you just shared. I agree so much with everything that both Selima and Pamela said. The one thing I guess I will add to this is don't have any self-blame during this period if you're not able to move through menopause the way you wanted to or the way you thought you would. If it isn't flowing well, if you do need to take conventional medicine, if you need support that you didn't need, if you need a therapist, whatever it is that you need, you're not failing. And if you need help outside of herbs, you should really just give yourself permission to get it. Don't blame yourself. Don't put yourself in a martyr situation do the best possible thing for yourself. And remember that whatever it is that you're going through during this time, you're absolutely not alone because there's a lot of people going through it together. And in fact, I was reading that as of 2025, there are 1.2 billion women in menopause on the planet right now, which is the largest number of menopausal people that ever been on the planet before. And so you are not alone in this journey. A lot of us are in it together.

Thank you, ladies. That was some really powerful advice you have offered. I'm so appreciative for all the wisdom you had shared throughout this conversation. I want to make sure before we sign off, you all take a moment to tell our listeners where they can find you out in the world? Of course, Herbal Academy is one of those places as we are all educators with the Herbal Academy, and you'll see our faces and our teachings pop up throughout many of the courses in our website. So please definitely come see us there. But ladies, please take it from there on your own worlds.

Yes, you can find me at iwillaremedy. com. So it's Iwilla, it's my middle name, and it means I will rise. So iwillaremedy. com. Iwilla Remedy at all the social platforms. You can find me on my website, which is pamilaspense. co. uk. You can also find me on Facebook and on Instagram. My handle there is @pamilaspenseherbalist, and I look forward to connecting with you there.

And you can find me online. I have a website, Earth Rhythm Herbal. Where I offer remedies or I offer herbs that I grow and I make on my herb farm here in central Vermont, and I offer some apprenticeship opportunities on my farm. If you happen to be in the near central Vermont or you want to move here for a season and have a farm experience, and you can find me also on Instagram and Facebook under Official Earth Rhythm Herbal. I also teach at another herb school called Ace of Cups, if you want to do in-person learning.

Wonderful. Thank you all so very much. It's been such a potent conversation that you have shared, and I really appreciate you offering all this to our listeners. Thank you.