CEimpact Podcast

Can Pharmacists Help Manage Menopause Hot Flashes?

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Hot flashes may be the most talked-about symptom of menopause, but how much do you know about managing them for your patients? In this episode, we uncover treatment options, debunk common myths, and explore how pharmacists can offer crucial support during this transition. Tune in to empower your patients with the knowledge and care they need—don’t miss an opportunity to get the latest on this “hot” topic!

HOST
Joshua Davis Kinsey, PharmD
VP, Education
CEimpact

GUEST
Anna Garrett, PharmD, BCPS, AFMCP
CEO
Dr. Anna Garrett

Pharmacist Members, REDEEM YOUR CPE HERE!
 
Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)

CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe the physiological mechanisms behind hot flashes during menopause and their impact on a patients quality of life.
2. Identify treatment options for managing hot flashes that pharmacists can recommend to patients experiencing menopause.

0.05 CEU/0.5 Hr
UAN: 0107-0000-24-308-H01-P
Initial release date: 12/2/2024
Expiration date: 12/2/2025
Additional CPE details can be found here.

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Speaker 1:

Hey, ce Impact subscribers, welcome to the Game Changers Clinical Conversations podcast. I'm your host, josh Kinsey, and as always, I'm excited about our conversation today. Menopause is a natural transition, but for many women, hot flashes can make it a challenging one. In today's episode, we're breaking down the science of hot flashes, exploring the latest treatment options and showing how you, as a pharmacist, can be a key resource in guiding patients through this often overlooked stage of life. It is so great to have Anna Garrett back with us as our guest expert today for this episode. Welcome, anna. Thanks for joining us.

Speaker 2:

Glad to be back.

Speaker 1:

So before we jump in, in case someone has not previously listened to your couple of episodes that you've already done with us and I'll put in a plug there if you haven't go back and listen to them, because they're great. But before we jump into our content for today, anna, just tell us a little bit about yourself, maybe your current role and also your passion for this subject. Why are you so passionate about this topic?

Speaker 2:

Sure. So I started my own business doing hormone consultations in 2011. And that was a result of knowing that I wanted to work for myself that was a big part and wanting to be able to use my health coaching background and my pharmacist knowledge to create something for women who were in an underserved time of life.

Speaker 1:

And.

Speaker 2:

I don't mean financially underserved, I mean medically underserved.

Speaker 1:

Yeah, support yeah.

Speaker 2:

You know, menopause is now what everybody's talking about and but in 2011, that was actually not the case. I had done health coaching at the hospital I worked at and most of my clients were that 45 to 50 age range and they were like, well, this is happening and this is happening. So, to make a long story short, launched myself down the rabbit hole of learning about hormones because I actually was my ideal client at the time as well, so it made it really easy to be relatable because I was it. Yeah.

Speaker 1:

Well, and it also, it probably and it also motivated you to learn more, because you were actually learning for yourself. So yeah, Exactly so.

Speaker 2:

for somebody who came from a background in infectious disease, which is what I had done previously, it was like oh well, this is different. But, I love doing this. I love helping women feel better and more at home with their bodies and to see the light bulb go off when they are able to make some changes, you know, maybe even very simple ones that just make them feel a lot better and I think, pharmacists are in a perfect position to really have that same impact.

Speaker 2:

Maybe not in the same depth that I do, but there's certainly a whole scale of impact that pharmacists can have in this area.

Speaker 1:

Exactly, and that's part of our, you know, reason for this episode today is you're going to share some of those tips and tricks for pharmacists so that they can really assist and support those patients through this time. So, and you know, the overall goal I is increasing the quality of life of our patients, and so I think, from what I know, you're going to give me some great tips for our pharmacists that they can take back to their practice sites. So, all right, well, that's great. Thanks again for joining us today, anna. We're super excited to have you again. So let's jump right into our content. First of all, just as a foundational reset, just a quick overview of menopause, maybe just kind of give us a brief reminder of, you know, what our patients look like that are going through this I know that there's not a set age when this is an onset, so it could differ for patients but just maybe some general things about menopause, just to kind of reset that foundational level.

Speaker 2:

So the menopause just to kind of reset that foundational level. So the menopause transition actually is broken down into three stages. So there's perimenopause, and that's the five to 10 years before you actually hit the one day of menopause. Because that's what menopause is it's one day of your life that marks 12 months without a period. But perimenopause is where the hormone shifts begin and that can start in your mid to late 30s all the way into your mid 40s.

Speaker 2:

So it lasts an average of five to 10 years, and this is where all the fun begins, with the hormone rollercoaster, and so a lot of women really suffer during perimenopause, even more so than some that are in postmenopause. So, anyway, you go through that lead up phase and your hormone levels decline, and in our perfect world they would decline very nicely and neatly together and you would have no symptoms and your period would stop and you'd live happily ever after. But unfortunately that's not how it works.

Speaker 2:

So there can be a variety of symptoms and in my book that I wrote, I mentioned 34 of them. So if you've seen one woman in perimenopause, you've seen one woman in perimenopause, because everybody's experience is vastly different. So then you hit the day of menopause and then everything after that is postmenopauseause and you can still have symptoms, although they shift into a different quality of symptoms. Dries out, your vaginal tissue dries out, your eyes dry out, and it's all because you've lost all these hormones that keep everything nice and lubricated. And those symptoms tend not to be part of perimenopause but show up later down the road joint pain, that kind of stuff.

Speaker 1:

So Okay, wow, that's a that's a great refresher. Yeah, I honestly I'll have to admit I've never realized or heard it referred to as that it's basically one day, that menopause is one day, so that's fascinating. So thanks for sharing that. That's a great kind of, like I said, just foundational reset. So I think probably, and again, the major reason for our episode today is really to talk about one of the major side effects that we see, which is hot flashes, and so let's just jump into a little bit more of explaining hot flashes, what actually causes them. You know how I remember as we talked about previously before we started recording I remember my mother going through this process and I remember her hot flashes were extremely frequent, but I assume that that differs from patient to patient. So maybe let's talk a little bit about the causes of hot flashes and the frequency and just really how they impact patients' life, because I know it can be so, so difficult. So let's jump into a little bit about hot flashes particularly so difficult.

Speaker 2:

So let's jump into a little bit about hot flashes particularly so. The mechanism of hot flashes isn't fully understood, but the thinking is that the shifts in estrogen up and down through perimenopause and menopause affect the temperature regulation center of the brain, and so when you get these swings up and down, that's what's causing the hot flash, because estrogen helps regulate the body's temperature. There are some other things that can be at play. So, for instance and this is estrogen related as well if you have a hysterectomy and you have your ovaries removed, well, you've just lost your major source of estrogen. So women with hysterectomies tend to suffer with hot flashes as well, regardless of their age. You can get them in pregnancy. There are medications that cause hot flashes, so SSRIs are famous for causing sweating.

Speaker 2:

And so you know, I think, one of our jobs as pharmacists. If somebody says, well, I've started having hot flashes and you notice perhaps on their profile that they recently started an SSRI, you can kind of ask them about the correlation between the two there are some other things that will trigger hot flashes and then throw into that pot.

Speaker 2:

Stress and anxiety cause cortisol dysregulation. Cortisol spikes can also trigger a hot flash. So if your listeners, if you've ever been giving a presentation, and you start feeling yourself having this flushing sensation, that's a cortisol surge, not an estrogen surge. Those are the most common causes. Sometimes tumors can cause a hot flash. But you know, I think for the purposes of this discussion you know probably best to stick to the basics so that people don't have a hundred things to look for. They only have like five or six.

Speaker 1:

Sure, sure, yeah, that's super helpful and I think you know. What's also important to note is what you just shared with us is, just because someone says they have a hot flash, it doesn't it doesn't mean that we automatically start the onslaught of menopause counseling for them, because it may not be that that's what's what's causing it. So I think it's really good to just kind of remind ourselves that hot flashes or temperature regulation can happen from other things and outside sources and medications, so that's good to know. So we talked a little bit about the kind of what can trigger them and what can bring them on. If it is someone going through hot flashes as a result of the menopause phase I guess it would be mostly post-menopause, like you said when they're, or do they have some hot flashes in peri as well.

Speaker 2:

Yeah, some women do, and you know, just for the sake of correctness, we call it vasomotor symptoms.

Speaker 1:

Got it? That's great to know. We call it vasomotor symptoms. Got it, that's great to know.

Speaker 2:

Yeah, that's awesome. Or VMS, which encompasses hot flashes and night sweats. Got it Okay? But to answer your question, yes, women in perimenopause can experience hot flashes, although they tend to be more common as women move into menopause.

Speaker 1:

Okay, so how frequent are the issues once they begin? Is it something that someone's going to feel daily, or multiple times a day, or?

Speaker 2:

Well, there are some women who are having them hourly.

Speaker 2:

And so it is a very, very broad spectrum. So some people just might experience a couple of week, Some are experiencing them all day long and it really kind of depends on how much effort is made to avoid the triggers that are. I've seen a lot of women who end up getting hormone replacement just because they can't deal with the experience of having that all day long, because it can be really embarrassing. I had one client early on who? She was an art teacher and she was having to change her clothes like twice a day because she was sweating so much while she was, and for her hormone replacement was an easy choice.

Speaker 1:

Yeah, yeah.

Speaker 2:

Completely shut that down.

Speaker 1:

Yeah, no, I totally get that. I, I have a personal experience to share and it's obviously not uh and and my hot flashes are not of this reason. But I also and typically it's when I'm in a stressful or, um, when something has raised my anxiety, and mine would be probably more related to the cortisol issue I will experience one and, like you said, it can be very embarrassing, but it can also be debilitating, like I, just I kind of almost, it's almost like a full-blown panic attack and I have to shut down. My forehead will just pour sweat and just, you know, it's just, it's very I can't think of another word other than debilitating. I have to stop whatever I'm doing and try to like get myself out of that. So I can only imagine, if you know a female is going through that multiple times a day how frustrating that can be.

Speaker 2:

So Well, and it can be like the the Frank refused sweating, or it can be just a sensation of feeling like from the inside out you're just burning, getting warm and flushed. So that somewhat depends on race, potentially, and I believe, latino women start getting the sweating from the back of their neck. Some people get it from their feet up. So it's a different picture depending on the person.

Speaker 1:

Wow, well, that's interesting. So I have, in our outline, common misconceptions about these symptoms and issues. What are some of those?

Speaker 2:

Well, the first one would be that everybody's going to experience hot flashes because that really isn't true. I mean, I hardly had any. So, like I said, there's a whole realm of what people are going to experience and some people never have a single hot flash. They don't need to necessarily be severe. Like I said, they could be just that sensation of warmth. You know you'll sometimes.

Speaker 2:

sometimes women are told by their physician or their healthcare provider that they just have to deal with it that it's part of aging and that's just not true, because lifestyle changes that can help, there are medications that can help, there are supplements that can help. So I think to let yourself be dismissed like that is a mistake. And again, this is a place where pharmacists can have a conversation about what the alternatives are if the woman doesn't want to pursue HRT or for some reason can't, or her physician has said you know, no, hormones cause cancer, which you and I could go down a whole rabbit hole.

Speaker 1:

So we'll get into that later.

Speaker 1:

Yeah, but yeah, no, that's very helpful. So I think you know that is a great segue into the next kind of section that I wanted to go into, which is really focused in more on what? What is our role as a pharmacist for these patients that are experiencing hot flashes? And as we talk about that, we can also kind of segue into treatment options, whether they be non-hormonal versus hormonal treatment options, and you even mentioned some are prescriptions, some are supplements, some are lifestyle changes. So let's kind of move into the pharmacist role and then we can kind of transition into treatment options.

Speaker 2:

Well, I think the pharmacist role is largely educational, so educating women on what the symptoms of perimenopause and menopause might include, because, especially with perimenopause, the symptoms can look like a lot of other things. So if somebody comes to you and they're like man, I'm having a lot of anxiety and I'm just tired all the time and I'm not sleeping well, well, that could be a million things. That could be thyroid, that could be any number of things.

Speaker 1:

Stress of work, daily life.

Speaker 2:

Yeah, you know, I hate my partner, right.

Speaker 2:

Yeah, a lot of things. In that context. You can have a conversation with somebody about well, let's talk about the timeline of that, when did this start to appear? You know, how old are you that kind of thing and say, well, you know, perimenopause probably needs to be on your radar screen. We can educate people about what the different treatment options are.

Speaker 2:

There's so much misinformation out there about hormone replacement. That could be a really long conversation, but I think it's possible to sort of boil down that conversation into well, here's what the Women's Health Initiative study showed at first. Here's what reanalysis has showed us. Here's what the Women's Health Initiative study showed at first. Here's what reanalysis has showed us. And here's what we now know and what the treatment options are, because there's so many different dosage forms and some women, you know, don't want to use a cream. They want to use a patch. What are the benefits, what are the cons? And then counseling also on non-hormonal therapies, so SSRIs, gabapentin, vioza, whatever is happening to come down the pike, as well as supplement options like maca root, for instance. That's one I have a lot of success with.

Speaker 1:

Oh wow, educated I've never heard of that one.

Speaker 2:

Yep, it's a Peruvian root. It comes in three different colors.

Speaker 1:

Oh, interesting.

Speaker 2:

Good to know and the different colors do different things, just being familiar with those things, and I'm not suggesting that somebody has to be an expert, but for instance, it could be as simple as somebody comes to pick up their hormone prescription. Well, hormones are notorious for depleting B vitamins. Are you taking a B complex with your?

Speaker 1:

hormones.

Speaker 2:

That includes birth control pills, so it could be as simple as that or it could be as complex if you want to get more into it as doing what I'm doing and anything in between.

Speaker 1:

Yeah, you mentioned, patients have preferences for the hormone replacement therapy when it cream versus patch versus whatever. We could go into a whole nother discussion on the tailoring the therapy you know, the compounded hormone replacement therapy or doing the pharmacogenomics to determine what is actually bioavailable and usable for this patient and will actually work. So, yeah, I mean that could be a whole lot of opportunities and avenues for the pharmacy team to really get involved with a patient's care, just from having that initial conversation, like you said, having your ears perked up when someone shares new side effects or new experiences and just saying, okay, let's have a, let's have a bigger discussion, let's see if there's any other way I can help you.

Speaker 2:

Yeah, that's great, and one of the challenges I know is, especially if you're in retail pharmacy, is is the time component, because that conversation doesn't take like 10 seconds.

Speaker 1:

Right.

Speaker 2:

I think you need to pick what your few things might be, that you want to talk to people about, that you actually can work into your day. I have never worked retail pharmacy for more than like a nanosecond, because I knew that it was not for me, and so I don't like to say, well, pharmacists should be doing all of these things. That practical, no. So I think you have to just choose the nuggets that you want to focus on that will really impact your patient, and lifestyle changes can actually be one of those things that doesn't require a whole big, in-depth conversation.

Speaker 1:

Well, that's a great transition. So what are some of the lifestyle changes that pharmacists could recommend for patients who are experiencing some of these things?

Speaker 2:

Well, the one I have had the most success with is getting people to avoid alcohol and the presentation. How you present that to a patient is really important.

Speaker 1:

It's really important, yep.

Speaker 2:

Oh, you're such a buzzkill because you're going to tell me I can't drink I'm like no, let's do an experiment. How about if you don't drink anything three days a week and you journal about how you feel and how your sleep is and how your hot flashes or night sweats are, and just do that as an experiment for a month, because you can do anything for a month. That's a very, very impactful one anything for a month.

Speaker 1:

So that's a very, very impactful one. And are we talking? Is it? Is it wine, liquor, beer, or is it just in general? It's in general. Got it Okay, Understood? Yeah, Bad news on that one.

Speaker 2:

Well, here's the why because alcohol increases estrogen levels. So if you're already having swings with your estrogen anyway and you put that in there into the mix, then you're just going to make things worse and then it affects your sleep, and how well you sleep can also affect what you experience the next day. So, for somebody who's really struggling.

Speaker 1:

There's really not an upside to alcohol other than you can just kind of zone out and not worry about the deal until Right, but we all already know that alcohol is a drug, and so if you're taking something or consuming something that is complicating other things in your life, you should get rid of that. You know so, or or limited at the very least. So yeah, that's good feedback. What any other lifestyle changes that you've seen that work?

Speaker 2:

Maintaining a healthy weight is important because fat cells make their own estrogen, and so women who are overweight tend to struggle more with hot flashes because of that. So if you can maintain a healthy weight, that's going to help your experience. And then there are the things like dressing in layers and you know, I think this is so patronizing, but keeping a fan at your desk which is just sort of like well duh.

Speaker 1:

I actually because of my issues I talked about earlier. I actually have a portable fan that always is sitting in my desk and sometimes it's on right here at my face.

Speaker 2:

Yeah, spicy foods are another thing that will kick off hot flashes for some women. So those are the big ones, you know, staying out of really hot temperatures, of course. I mean, those are the things that are sort of like no brainers.

Speaker 1:

Sure.

Speaker 2:

Sometimes people don't think about them.

Speaker 1:

Well, I was going to say, you know, it seems like a no brainer when we're talking about it, but it also could be important for just to reiterate to someone or just to remind them of something.

Speaker 1:

So, yeah, that's very helpful. So let's go into a little bit of again. As we said earlier, let's don't go down an entire rabbit hole, but let's go into a little small baby rabbit hole of the hormone therapy and I'll tell you what obviously is. Something that patients are always saying is oh well, I hear that that causes cancer, and so that is a deterrent for some people to go on hormone replacement therapy. So just briefly touch on that and we'll whet people's appetite so that they have to come back, so that you have to come back for another episode and talk about that.

Speaker 2:

So Okay, so the most effective treatment for hot flashes is hormone replacement therapy, also now referred to as MHRT, menopausal hormone replacement therapy, also referred to as BHRT bioidentical hormone replacement therapy and they're all actually the same thing for the most part.

Speaker 2:

Bioidentical hormones don't include synthetics like synthetic progestins, but that's neither here nor there for the purposes of this discussion. They all work, so what they do is they replace the hormones that you have lost as you've gone through the hormone transition. Now I will say for people women in perimenopause who are struggling with hot flashes, sometimes progesterone alone is enough to knock those out. Progesterone is the first hormone to disappear because you're not ovulating as frequently and if you replace that, it helps so many things anxiety, sleep, hot flashes. But as you get older, further into menopause or post-menopause, you really need some estrogen replacement. So if you have a uterus, you need the combination estrogen and progesterone. If you have had a hysterectomy, technically you don't need progesterone, but I tell women they should advocate for that because it has so many benefits beyond uterine infection, because it has so many benefits beyond uterine infection, like anxiety and sleep and bone health and nerve health.

Speaker 2:

So it's old school thinking, in my personal opinion, to just put somebody on estrogen alone, but it'll work. So that is the most effective treatment that there is and it works really well and it works fast. So the cancer concern came up from the Women's Health Initiative study in 2002. They did a study where they put women on just estrogen, or estrogen and a synthetic progestin, so basically PremPro is what they used and they looked at the rates of breast cancer, heart attacks, blood clots and strokes and I think they did dementia, but don't quote me on that. Anyway, the study was stopped early because the women who were in the combination group started having more cases of breast cancer compared to the estrogen alone group and the media just like picked up on this. It was like estrogen causes cancer. Well hello, the women in the estrogen alone group had a reduced incidence of breast cancer. It was the women in the combination group who had a higher incidence and what they did, what they discovered on sub-analysis, was that the synthetic progestin was the bad actor in the combination, not the estrogen.

Speaker 2:

Well, of course, by that time the damage was done, right?

Speaker 1:

So women were ripped off the replacement, and you know so women were ripped off of the replacement and you know, all hell broke loose.

Speaker 2:

Well guess what? 2002 thinking has not gone away and there have not been any studies that have shown that estrogen causes breast cancer. Because think about this.

Speaker 1:

If we're running around for 51 years with a good level of estrogen, wouldn't we all have breast cancer? You would all get it right, exactly, exactly. If that logic of thinking, you would all be diagnosed with it at some point. Yeah.

Speaker 2:

And subsequently they've studied birth control pills, low-dose birth control pills and progestin-containing IUDs, and they also have an increased risk of breast cancer, even though it's very small. So again, that just supports the problematic that those synthetic progestin is problematic. And progesterone was not studied in the 2002 study, so we can't say, oh well, they all cause breast cancer, because that's not true. Progesterone has been shown to have a protective effect as well, so that's the skinny on that.

Speaker 1:

Yeah, well, and I think that it's fascinating because, I mean, I remember that was about the time that I would have been in pharmacy school and working in the pharmacy as a student, and that's what I remember. I remember that firestorm of nope causes breast cancer. Everybody get off of them. Nobody gets to take them anymore. Sorry, I helped you. You don't get to do it. Those issues you know, because they weren't allowed to take them or they didn't want to take them because of the fear. So right yeah.

Speaker 2:

Well, unfortunately, the pendulum went way this way. It started to come back this way now because there's a lot more publicity around this and when you're making a lot of noise about. Okay, we need something to take care of this, because it's not okay to have our quality of life impacted so negatively, so negatively, yeah, yeah, for sure.

Speaker 1:

Well, so in our just a few minutes left I want to just touch on what are some of the challenges. So we talked about what are some of the ways that pharmacists can plug in and kind of really pay attention to comments and remarks from our patients and learning a little bit more about them and where they are in their stage of life, and we've learned about some treatment options and some good information to give them, in the sense that hormone replacement therapy is totally fine and it might be an option for you. Let's talk about it. But what are some? We've talked about patient hesitancy, obviously, to some of the hormone replacement. But what are any other side effects or misconceptions that we should consider when talking about the therapy options for patients? Like, obviously, push back on weight loss that you said. Maintaining a healthy weight like that can be a challenge as well for some patients. So what anything else like that where we can be on the lookout as pharmacists?

Speaker 2:

Well, one of the big challenges is what do you do with women who have had breast cancer and are being impacted by symptoms especially like hot flashes or whatever.

Speaker 2:

But I've been really digging into this one. I think kind of what the data is showing me is that there's we're really just not sure what to do with women after breast cancer. There are some studies that show that estrogen does not fuel recurrences of breast cancer, but then there are some studies who kind of call that into question. So I think that's a conversation that you know, a woman really needs to have with her doctor. If her quality of life is so severely impacted by symptoms.

Speaker 2:

I would say that the risk may be worth the benefit if there is a risk, so we don't really know that fully at this point.

Speaker 2:

So, that's an area that's being studied quite a bit. Other challenges one of the things that drives me nuts is physicians. A lot of physicians now say, oh well, we just, we don't do any testing, we just treat by symptoms and put somebody on this dose that's not optimized for them, necessarily because they don't know what they need. If somebody's hormones are out of balance because their doses aren't right, then you can get weight gain and bloating and actually make it worse. So that's a situation where I think testing can be very beneficial.

Speaker 2:

But I have some different opinions than some other people.

Speaker 1:

Sure. Well, one thing I want to point out too if anybody heard the little teaser that Anna gave, talking about additional content so that is something that we'll be dropping soon in the catalog is a deeper dive into treatment for perimenopause, menopause, postmenopause and understanding it better from the pharmacy pharmacist perspective, and also a deeper dive in a sense of like six to eight hours, as opposed to our 25 minute discussion here. So so that's something to keep on your radar If this is something that interests you or if you're looking to bring this further into your practice site. Be on the lookout for that to hit the catalog soon by the end of 2024, we're going to have that available to you as a learner. So that was what she hinted to, and it was a good way for me to give it a plug as well. So we're almost out of time Again.

Speaker 1:

I feel like we could talk for so much longer and go down a lot of different rabbit holes, because everything is so enlightening to me. I feel like there's a lot of things that are misconceptions, misinformation and just you know. Really, I think the biggest one that you mentioned was telling patients oh well, it's just a way of life You're just going to have to deal with it. You just got to go through it. You know there's nothing that really treats it and that's just not true, and so I'm so glad that you brought to light some options for our pharmacists who can really get in there. So, as a kind of a finish up here, before we finish up the episode completely, reiterate some of those tips and tricks, anna, that our pharmacists can really integrate into their everyday practice. I know you mentioned timing is an issue sometimes and workflow, but what are some of those small things that we can do and really see the benefits and just keep growing it from there?

Speaker 2:

So I think some of the biggest ones are looking for the drug nutrient interactions, helping people identify side effects and how to manage that, and also to help them identify where they may be in the hormone transition, because you know it really isn't rocket science. I mean, if somebody comes to you and they're like you know I was fine until I was 35. And then all hell broke loose.

Speaker 1:

Well, you know the culprit. You pretty much, yeah. And then all hell broke loose.

Speaker 2:

Well, you know the culprit you pretty much, yeah, and then giving them some, some tips. You know lifestyle tips. You know we hear about diet a lot and the diet advice for people going through hormone changes is not different than for everybody else. Process foods, you know, organic when you can, because pesticides act like hormones in your body. They sit in the estrogen receptors and can make things worse. Telling people to look through their cosmetics, or even having a one pager of ingredients to look for in beauty and cleaning products that can act like hormone disruptors. So there's a whole range of educational things that can be done.

Speaker 1:

We just went down a whole nother rabbit hole with the cosmetics and the cleaning supplies. I have never heard that Well, environmentalworkinggroupcom.

Speaker 2:

Ewg oh no, it's. Ewgorg is a site that has all of the endocrine disrupting chemicals. You can even type in the brand name of your cosmetic and it'll tell you what it's got in it. So we don't need to go down that rabbit hole because somebody already did that for us, thankfully, but that is very, very interesting.

Speaker 1:

I'm going to be checking that out. That's great information, thank you, Okay, so again, we could spend a lot more time, but we are out of time for today.

Speaker 2:

So, as I always do with my guests, before we finish up the episode, let's circle back to what's the easiest thing to start with is probably the drug nutrient depletions, because that's something that you can get a lot of information on it's already out there and just talk to people as they're getting their prescriptions filled, and you may find that there's an area you want to move into further.

Speaker 2:

But you know, until you take that first little bite, you really, you really don't know. It's too much to go all the way into the deep dive unless you, you know, want to do what I do and create a whole business, and I'm happy to talk to people about that too. But you know, you don't have to be an expert, you just need to to take that first step.

Speaker 1:

Yeah, yeah, and I think also just understanding that we do have a role as far as this patient's journey and our patient's journey down this path, and so it is something that you know. I know I hate to use the word obligated, but we are. We're their healthcare provider. We're obligated to help them through this process and to make sure that their quality of life is is improved. So this is great, anna. Thank you so much. It's all we have time for today, but thank you again for joining us.

Speaker 2:

Welcome. I'm happy to be back.

Speaker 1:

Thank you. If you're a CE plan subscriber, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpactcom. And, as always, have a great week and keep learning. I can't wait to dig into another game-changing topic with you all next week.