Episode 173: Genitourinary Syndrome of Menopause with Pharmacist Teresa Isabel Dias

In this re-released episode from 2022, Dr. Lisa talks to pharmacist and Certified Menopause Practitioner (NCMP) Teresa Isabel Dias about how to support vaginal and urinary health in perimenopause and menopause. Genitourinary Syndrome of Menopause (GSM) impacts up to 80% of women and can be an embarrassing result of the hormone fluctuations. It can start in perimenopause causing: vaginal dryness, pain with or without sexual intercourse, burning, irritation, frequent urinary tract infections, urinary urgency and discomfort. Learn how you can address and reverse symptoms of GSM; you don’t have to suffer! 

“Do not let your vagina ruin your marriage” – Teresa Isabel Dias

Teresa Isabel Dias is a registered pharmacist with over 25 years of professional experience in community pharmacy and drug information in Toronto.

In 2013 she became a Certified Menopause Practitioner (NCMP) through the North American Menopause Society (NAMS) and founded MenopausED to help women navigate the change.

Teresa raises awareness about menopause, provides education, and supports women in midlife (40+). She helps women understand what’s going on in their bodies and minds during the menopause transition to decrease fear and anxiety about this natural but sometimes challenging phase of life. She educates women about healthy lifestyles and symptom management options so women can make informed decisions about their care to improve quality of life, relationships, and work.

Teresa has delivered education and training to the Royal Bank of Canada, Maple Leaf Foods, the University of Waterloo, University of Toronto, Brock University, Stantec, Women in Government, and other major employers and associations. I have also written and presented to several pharmacy associations and the Pharmacy Practice + Business magazine.

In this episode, Dr. Lisa and Teresa cover:

  • The importance of awareness and education around symptoms you may experience in perimenopause and menopause
  • How lower levels of estrogen in perimenopause and menopause can change the cells of your vagina and vulva 
  • The role of lubricants and moisturizers to deal with vaginal dryness and pain with sex
  • Why Teresa recommends silicone based lubricants and doesn’t recommend using cooking oil as a lubricant
  • The role of hyaluronic acid and vaginal estrogen to address vaginal estrogen
  • What to look for in a compounding pharmacy when looking for vaginal estrogen products
  • How seeing a pelvic floor physiotherapist can help with vaginal pain and reduce urinary symptoms
  • Why you should not douche!

You can connect with Teresa at https://menopaused.org/ and find the Please Yourself – Six Tips For An Easier Menopause guide. Her IG handle is: @menopausedtid

Today’s Mama Must Have:

Dr. Lisa is a big fan of using red light bulbs and night lights. 

Teresa loves doing at least 5 minutes of stretching before bed to improve sleep.

What else we’re up to:

Join Dr. Lisa’s new Facebook group Wild Woman Adventures Toronto if you want to get out in nature, connect with other women and push yourself out of your comfort zone. Activities include: sunrise/sunset SUP, tree-top trekking, a new moon workshop and more!

Dr. Toni’s next HypnoBirthing class series starting in April – for more info on a free online masterclass to reduce fear and anxiety around birth, go HERE.

Thank you for joining us today!

Email us or connect with us on Facebook and Instagram. We’d love you to subscribe, leave us a review and a 5-star rating if you enjoyed this episode. You can also support us by visiting our Patreon page.

Please tell your perimenopausal mama friends about us, too!

Stay safe and healthy everyone!

Episode 133: Is It Hot in Here?! What You Need To Know About Hot Flashes

In this re-released episode from 2020, Dr. Lisa and Dr. Toni are talking about a hot topic: hot flashes! Whether you call it a hot flash or hot flush, they can be an annoying and uncomfortable symptom that you may start to experience in perimenopause. We discuss: what hot flashes are and why they happen; the potential causes and triggers for your hot flashes and night sweats; and what you can do about them so you don’t have to suffer.

According to research, anywhere from 35%–50% of perimenopausal women suffer sudden waves of body heat with sweating and flushing that last 5–10 minutes.

What is a hot flash?

A hot flash or vasomotor flush can vary from feeling slightly warm to more like a fire from the inside out. They can come on rapidly and last anywhere from 1-10 minutes. 

You may get them anywhere from a few times per week to more than 10 times during the day and night. They can be combined with visible flushing with your chest, neck and face turning red, with a little bit or a lot of sweat.

Hot flashes often continue for a year or two after menopause, but in up to 10% of women, they persist for years beyond that. They can disrupt your sleep, which can worsen: fatigue, irritability, anxiety, metabolism, weight control and immune system function.

Why do you get hot flashes?

Although hot flashes have been studied for more than 30 years, no one is absolutely certain why or how they occur. The Centre for Menstrual Cycle and Ovulation Research (CeMCOR) at UBC attributes hot flashes to “estrogen withdrawal”, as their research has found that hot flashes closely resemble an addict’s drug withdrawal due to the hormonal associations and brain effects seen.

Your level of estrogen while in perimenopause is fluctuating and can be unpredictable. When your estrogen level drops from normal to low or high to normal, it can trigger a hot flash in your body.

Estrogen drops can trigger the release of your stress hormone norepinephrine, as well as other stress hormones and brain neurotransmitters. Norepinephrine narrows the range of body temperature where you feel comfortable (also called your thermoneutral zone) so you’re more sensitive to both heat and cold. 

A hot flash is a vasomotor symptom where your blood vessels dilate to release more heat because of the narrowing of your thermoneutral zone.

Causes of hot flashes can include:

  • Blood sugar imbalances that can trigger your stress hormones, resulting in you feeling hot and wired
  • High stress and cortisol levels that can worsen night sweats
  • Inadequate detoxification through your organs of elimination or emunctories. Things that can make your hot flashes worse by negatively affecting your body’s ability to detox include:
    • smoking, constipation, being overweight, not exercising and not sweating (via exercise and sauan usage)
  • Triggers are different for each women. It is useful to keep a hot flash journal, tracking your potential triggers such as:
    • Hot drinks, caffeine, alcohol
    • Sugar, spicy foods, garlic
    • Nightshades like tomatoes, eggplant, peppers
    • Perceived stress or stressful situations

What can you do about your hot flashes?

  • Avoid your known triggers
  • Manage your temperature
    • Turn your thermostat down, put on a fan or A/C 
    • Sleep naked or in loose-fitting breathable cotton
    • Under-dress during the day and wear layers
    • Use a breathable weighted blanket like ZonLi, Chilipad or gel pillow
    • Drink cool or ice water
    • Use an essential oil spray with peppermint, clary sage, geranium
  • Manage your stress
    • Have stress-releasing time EVERY DAY! Be proactive to improve your response to stress
      • Meditation, yoga, deep breathing, singing, humming
  • Get a sweat going during the day with exercise, sauna or a hot bath
  • Eat nutritious food to:
    • Balance blood sugar levels – see Episode 10: What to Eat? Nutrition Tips for Hormone Balance
    • Include liver-detoxifyng and phyto-estrogenic foods
      • Ground flaxseeds (can add to chia pudding, smoothies, cereal, yogurt)
      • Organic fermented soy like miso soup or tempeh
      • Brassica vegetables like broccoli, cabbage, cauliflower, kale, Brussels sprouts
  • See a Naturopathic Doctor for hormone testing and individualized treatment including:
    • Herbs like maca, vitex, black cohosh, sage, red clover, pueraria (Thai kudzu), hops, milk thistle, dandelion, artichoke
    • Nutrients like berberine, plant sterols, N-acetyl cysteine, magnesium, vitamin E, L-glycine
    • Acupuncture
    • Homeopathy
    • Bio-identical hormone creams
      • Natural progesterone has been shown in recent research to be safe and effective for hot flashes and night sweats, avoiding some of the adverse effects of classic estrogen therapy or synthetic estrogen with synthetic progesterone (progestin)

Today’s Mama Must Have:

Dr. Toni has a favourite oat and fruit bar recipe for a quick and easy breakfast or snack that Frankie loves:

Dr. Toni’s Banana and Fruit Breakfast Bars

  • 3 ripe bananas
  • 1 cup chopped apricots, cranberries, dates and/or prunes
  • 2 cups rolled oats
  • 1 cup sunflower and/or pumpkin seeds
  • 1 cup milled flax seed
  • ⅓ cup olive oil
  • 1 tsp vanilla

Mash bananas and combine with fruit and oil. Add remaining ingredients and mix well. Spread onto a pan or cookie sheet and flattened with a fork. Bake at 375oF for 10-15 minutes until slightly browned.

Dr. Lisa found a tasty gluten-free beer called Glutenberg to enjoy in moderation on hot summer days.

Thank you for joining us today! 

Email us or connect with us on Facebook and Instagram. We’d love you to subscribe, leave us a review and a 5-star rating if you enjoyed this episode.

Please tell your perimenopausal mama friends about us, too!

You can also support us by visiting our Patreon page.

Stay safe and healthy everyone!

Disclaimer: The information provided in this presentation is not meant to replace treatment with a licensed health care practitioner. It is for informational purposes only. Consult with a Naturopathic Doctor or other licensed health care professional to determine which treatments are safe for you.

Episode 6: Healthy Hormone Hacks Challenge Summary: 10 Simple Tips to Balance Hormones and Boost Energy

In today’s episode, we are reviewing all the tips from our recent 10 Day Healthy Hormone Challenge. These simple tips help to support your hormone balance, increase your energy and support your overall health.

Tip #1: Aim to drink 2 litres of water daily, including herbal tea

Benefits of drinking water include:

  • Avoid dehydration symptoms like headaches and low energy
  • Keeping hunger at bay
  • Helping with weight management and metabolism

Recommended strategies you can use to get the most out of your water intake:

  • Use a filter like Santevia or Berkey to reduce contaminants like lead and other heavy metals, as well as prescription medications that can unfortunately be found in your water supply
  • Drink warm water first thing in the morning to support your digestion
  • Use an app like Water Minder to remind you to drink your water
  • Always keep a glass or mug by your desk at home or work to refill throughout the day
  • Bring a reusable water bottle with you everywhere 

Tip #2: Reduce stress with deep breathing

Benefits of deep breathing exercises include:

  • Better stress management and lower stress hormone cortisol
  • Increased mental clarity, concentration, memory and focus
  • Decreased anxiety
  • Improved sleep
  • Lower blood pressure

Box Breathing: inhale for a count of 4, hold for a count of 4, exhale for a count of 4

Get in deep breathing throughout the day by taking a few deep breaths:

  • When you link it to the colour red, for example, at a stop sign or red light
  • When you hear your phone ring or beep from a notification

Tip #3: Increase your fibre intake to at least 25 grams daily

Fibre helps binding up your used hormones and other garbage to support toxin elimination and proper hormone balance. Different types of fibre are found in vegetables, fruit, legumes, beans, nuts and seeds

Easy ways to add in more fibre daily include:

Tip #4: Ditch the plastic to avoid hormone-disrupting BPA and BPS

BPA and BPS can act like estrogen and worsen:

  • Breast tenderness
  • Weight gain
  • PMS mood swings

Start to swap out your plastic:

  • Alternative to plastic food bags: silicone food bags by Stasher
  • Instead of plastic wrap: beeswax wraps by Abeego
  • Switch out plastic bottles with glass or stainless steel bottles like Klean Kanteen
  • Use stainless steel mug like Contigo instead of takeout coffee cups
  • Reusable silicone or stainless steel straws instead of plastic straws

Tip #5: Eat organic when you can to reduce your exposure to pesticide residues

Check out the Dirty Dozen and Clean 15 lists by Environmental Working Group (EWG) to see what veggies and fruit have the highest levels of pesticide residues.  

Always aim to buy organic “Dirty Dozen” fruit and veggies: strawberries, spinach, kale, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery, potatoes

Can’t buy organic? Focus on the Clean 15: avocado, sweet corn, pineapple, sweet peas (frozen), onion, papaya, eggplant, asparagus, kiwi, cabbage, cauliflower, cantaloupe, broccoli, mushrooms, honeydew melon

To remove pesticide residues from conventional non-organic produce, consider soaking all fruit and veggies in 10% vinegar and washing with baking soda.

Tip #6: Balance hormones by supporting estrogen detoxification

Symptoms of perimenopause can often be linked to relative estrogen excess and progesterone deficiency. These can include:

  • Hot flashes
  • Night sweats
  • Trouble losing weight
  • PMS
  • Breast tenderness

Cruciferous vegetables can support your liver’s ability to detoxify excess estrogens. Eat lightly steamed or sauteed veggies for easier digestion, especially during the winter. These can include broccoli, cauliflower, Brussel sprouts, cabbage, kale, rutabaga, bok choy, collard greens and turnip.

Quick tip: Buy frozen and organic cauliflower, broccoli or vegetable medley mix, then lightly steam or serve sauteed.

One of our favourite cruciferous veggie recipes is this Roasted Cauliflower Dip (paleo, gluten-free and dairy-free).

Tip #7: Eat more detoxifying herbs

Herbs that support liver and kidney function with extra antioxidants include: cilantro, parsley, coriander, turmeric, ginger, garlic

An easy recipe to add to chicken, fish, pasta to get in more detoxifying herbs is this Vegan Nut-Free Avocado Pesto Sauce.

Enjoy detoxifying herbs like milk thistle, dandelion root, schizandra and burdock root daily in tea form by buying a blend like Traditional Medicinals or make your own blend with this recipe for Herb and Fruit Infused Water.

Tip #8: Get your sleep

Between hot flashes and not being able to turn your brain off, sleep can be a challenge in perimenopause. Get your body ready for a deep and restful sleep with proper sleep etiquette. 

Simple tips for a good night’s sleep:

  • Turn off screens at least one hour before bed
  • Use blue blocker glasses like Cyxus
  • Lower your thermostat or wear minimal clothing to bed
  • Try hot shower or bath before bed to cool your core temperature 
  • Consider using a weighted blanket
  • Wind down with meditation, yoga nidra or journaling

Want more sleep hygiene tips? Check out our Sleep Solutions Episode!

Tip #9: Move your body

Benefits of physical activity and movement include:

  • Decreasing stress hormones
  • Supporting circulation
  • Improving mental health
  • Decreasing Liver Qi stagnation symptoms like PMS

How do you fit more movement into your day?

  • Exercise snacks: get up from desk every hour – plank, squats, jumping jacks or walk down the hall
  • Play with the kids outside: bundle up and walk to the park or enjoy the snow by making snow angels or snowman
  • Walk your kids to and from school or daycare
  • Park at the far end of the parking lot to get in more steps
  • Have a dance party at home
  • Ask yourself: Is it time to join a gym, yoga studio or sports team?

Tip #10: Green your personal care products

The chemicals in your body care products will be absorbed through your skin, so be mindful of the products you use. Avoid chemicals that can interfere with your hormone balance and possibly increase your cancer risk.

Avoid parabens, fragrance and other Suzuki Foundation Dirty Dozen in personal care products.

Use EWG’s Skin Deep Database at to see if the products you are using right now pass the test. Start to switch out the products that get a questionable rating.

Try out one new tip every week and do your best to support your hormone balance. 

Mama Must Have:

Dr. Lisa recommends dry skin brushing to support lymphatic circulation for eliminating toxins and exfoliating your skin. 

Find a natural bristle brush HERE.

As an Amazon Associate Dr. Toni earns from qualifying purchases, which helps to keep this podcast up and running! 

Thank you for joining us today! 

Have any comments, suggestions or burning questions? Email us or connect with us on Facebook and Instagram. We’d love you to subscribe, leave us a review and a 5 star rating if you enjoyed this episode.

Please tell your perimenopausal mama friends about us, too!