Victoria Kleinsman (00:00.183)
Here we go. Well Robyn, I’m so excited for this conversation. So thank you for being here.

Robyn (00:06.776)
Thank you so much, Victoria. I truly appreciate your time.

Victoria Kleinsman (00:11.113)
it’s a pleasure. So before we dive in, who are you, what do you do, and why do you do what you do? Just to give our listeners a bit of a background of you.

Robyn (00:21.442)
My name is Robyn. live outside of Boston, Massachusetts, and that’s where I practice in the state of Massachusetts. I’m the first dietician to become a nurse practitioner, which dates me in terms of the combination of those degrees. And then I really focus mainly on…

eating disorders, disordered eating, and body image in terms of my work with all humans, not just women initially. And over the past six, seven years, I’ve been studying and learning more about hormone therapy. As I was looking at my patient population, I…

felt like I wasn’t able to help all of the people that I was seeing in the ways that I wanted to. And I had done some continuing education in 2019 and was really struck by the combinations or lack thereof in terms of psychopharmacology and hormone therapy and how strongly they matter to one another.

Victoria Kleinsman (01:26.328)
Bye.

Robyn (01:27.742)
at that time I was in perimenopause and I wasn’t able to get any of the help that I know that I needed then, you know, sort of now. And so I just, as I was looking at my practice, I…

just focus more on the education and for myself and learning and really wanting to help women. I still see some men, still see adolescents and through lifespan but

I truly am empowered working with highly motivated women who want and deserve to feel better in these phases of life and being able to work with them through this time.

Victoria Kleinsman (02:14.265)
Yeah, I mean, what a gift because I do coach women who all different ages from children from age like 13 to women up to age 70 has been my oldest client. And I speak, I coach and speak a lot from personal experience and I’ve not yet hit menopause or pre-menopause. Do you call it perimenopause if it’s like kind of just starting to happen or yeah, perimenopause. So this is what another reason why I would.

Robyn (02:22.242)
Yeah. Yep.

Robyn (02:28.974)
Mm-hmm.

Robyn (02:32.705)
Yeah.

Robyn (02:37.248)
Yes, Perry. Yep.

Victoria Kleinsman (02:42.613)
I’ve had you on to just talk and share about this because I haven’t experienced it and I can learn about it but it’s different when you’ve been through it yourself. what can someone, I mean, aside from eating disorder and body image, which of course we’re going to go into, what can someone who is in perimenopause expect to experience? albeit I’m sure everyone is different, but what are the signs that we might be looking for psychologically and emotionally maybe and also physically?

Robyn (03:03.384)
Thank you.

Robyn (03:11.85)
So.

These are very nuanced, right? Person to person and cycle changes can be a big one. And this is nuanced as to whether we’re using a type of birth control and birth control pills and the IUD are considered hormone therapy. This is on board for us. We may have lesser symptoms because the pill or the IUD or the next MononRiver are true symptoms.

But some of the symptoms that really jump out beyond cycle changes are the number one thing I hear is like, I’m just not feeling like myself. know, some of the things that we often hear on our devices could be close to things like…

changes cognitively, like things feel not as sharp, you know, lots of notes to oneself, right, to remember things. Sleep changes are a huge piece and the sleep changes really trickle down to everything and we’ll probably get into more of that. Some women experience increases in joint pain, but really some of the hallmarks are how are the cycle changes happening or not.

Like what’s going on with those? Because they really help us understand where in this phase we are. And that affects our sleep. And those things affect our mood. And if we’ve had histories of anxiety and depression, which we know are so significant in the populations that you and I work with, these things can resurge significantly during these phases.

Victoria Kleinsman (05:00.985)
I think that’s definitely worth sharing that whether you’re on hormonal support or not with a pill with conception, conception pills, whatever you call it. I’m a little bit distracted because those of us who know who we’ve just recorded and my little girl is now awake off my lap. So I’m just going to call my husband and edit this out to come and get her. So just one second.

Robyn (05:07.544)
Yeah.

Robyn (05:20.622)
Yeah. Yeah. No worries.

Victoria Kleinsman (05:47.161)
Okay, I can come back and edit that out. His tuck are away now, so now I can fully concentrate. So, okay, so let me just get in my mind what you said, then I’m gonna do a sign to myself where I can edit it out. Okay, well, thank you for sharing that Robin, because I’m sure those of us who, God no, wait.

Robyn (06:05.262)
Take your time. It is hard. So we just finished. Yes.

Victoria Kleinsman (06:07.511)
You just finished on signs of paramenopause, psychological signs, the sleep depra…

Robyn (06:15.598)
And how they can, in our population, how anxiety and depression can surge in these phases of life. It’s kind where we left it, I think. Yeah.

Victoria Kleinsman (06:29.529)
All right, okay, thank you. Okay, yeah. Thank you for sharing that Robyn. And if someone is struggling or they think they’re struggling, is there something that they can do? Because I’ve heard of hormone replacement therapy before. What can someone do to support themselves through this transition? I guess if we’re talking, we’re from Carl Jung’s stereotypes of…

the types of women like from maiden to mother, from mother to crone. Are you familiar with those types? Yeah, so this would be called from the doesn’t they didn’t have to be a mother, like literally with a child. But as we age, we go from maiden to mother and then mother to crone and crones this wise woman who’s after menopause, who’s no longer menstruating. So a lot of my listeners will resonate with that. So it’s a transition of like a spiritual

Robyn (07:03.318)
I’m not actually.

Robyn (07:10.254)
Yeah.

Victoria Kleinsman (07:26.265)
transition, emotional transition, a physical transition, like you’re saying. So what support can someone get through this?

Robyn (07:35.055)
I think knowing themselves as much as they can and really trying to find a clinician who’s truly educated in the process. And hormone therapy is not for everyone, right? There are certain physical, you know, there are certain, if we can edit that out, there are certain

Victoria Kleinsman (07:45.847)
Yes.

Robyn (08:04.088)
predisposing factors that would prohibit us from using hormone therapy, right?

Victoria Kleinsman (08:09.273)
Okay.

Robyn (08:09.382)
If we can utilize hormone therapy, if we have access to it, if we have a clinician who’s really educated and can help us through this phase, that is one piece that we can utilize as a tool, right? Because sleep changes affect mood like we just talked about a few minutes ago. so hormone therapy can help regulate sleep. It doesn’t make it all better, but it can help with that. And it’s also

really like I’m a crone so I hope with the way you lovely you know just so lovely the lovely way you described it but staying just really trying to stay attuned to yourself and being being

Victoria Kleinsman (08:42.178)
Yep.

Robyn (08:57.142)
We can’t, like, we may not be okay with our body changes in every moment. And by body changes, I mean what’s happening in our ovaries as well as what’s happening on the outside of our bodies, our pituitary, those sorts of things. But if we can stay attuned to that and know the changes can be normal also, I think that’s a great advantage.

Victoria Kleinsman (09:20.697)
Yeah, to know oneself with compassion. I’m hearing you talking about saying the word, but be gentle with yourself as you’re going through these changes. And how is this affecting women, especially with either an eating disorder history and a body image history body negative, body image history, or someone that perhaps is not fully healed their relationship with food? Do you often see it coming up more like it being accentuated in this

transition.

Robyn (09:51.135)
Absolutely, if women are in a recovered place, they may have a research of their symptoms.

If they’re not yet in a recovered place and that again I use the word nuanced a lot so nuanced. right there can be surges and the reason is because We are more predisposed to anxiety and depression in these phases because of how these pathways are Working or not or trying to work or not right because we have

axis that are showing up and trying to work harder for others, right? And one of the things that, you know, thinking about mood and menopause, there’s a hypothalmic, the HPA axis, which is the hypothalmic pituitary axis. And

in because this is trying so hard to work and surging different hormones that are trying to do things that estrogen was doing a great job at.

Victoria Kleinsman (11:02.029)
Yeah.

Robyn (11:02.494)
The HPO axis isn’t working as well, right? The hypothalamic pituitary ovarian axis. We have hormones coming up that are just trying to do this because our estrogen and progesterone and testosterone are just, they’re just not there. It’s a lot of it’s estrogen in the beginning. So the body’s looking for the estrogen and because the ovarian follicles are

just sort of retiring, they’re not finding it. And so then the body looks to other hormones and those other hormones just really aren’t able to do it all. And therefore then we have mood changes and sleep disturbances. There’s a lot where we could go into the science in terms of the HPO axis and the HPA axis, but that’s sort of some of the physiology to it.

Victoria Kleinsman (11:39.918)
Yeah.

Victoria Kleinsman (12:00.853)
I I remember being pregnant, giving birth, and obviously your hormones change a lot. The reason I’m sharing this is because I’m talking about hormones now. And I remember like after birth and breastfeeding and all sorts of, your body does amazing things and it’s all, if I’m correct, correct me if I’m wrong, it’s all hormonally led. So the hormones are like the drivers and they tell the body how to behave, how to feel, what to do, what not to do, what to focus on, what not to focus on. And I remember asking myself,

Robyn (12:09.016)
Yeah.

Victoria Kleinsman (12:30.425)
chatting to my husband at one point and being like, do you think we’re like literally controlled almost by our hormones because they have such a huge effect on how we feel? Like even with my period and my menstrual cycle coming back now, still breastfeeding but just don’t have as much milk, so my cycle’s back. Like in certain times of my cycle, I feel fantastic and do you think like, I don’t like to be…

Robyn (12:49.326)
Yeah.

Victoria Kleinsman (12:55.251)
I’m far from negative but are we almost like a slave to our hormones somehow, do you think, in our bodies?

Robyn (13:01.738)
We can’t.

Robyn (13:05.946)
Yes, because we can’t, we can’t really, you can’t change your, the way they’re surging or not in our monthly cycles or say for example in your case, right, in my case back in the day, like with breastfeeding, right? So then we’re put into this time of life and I guess you could say, yeah, we’re at their mercy.

Victoria Kleinsman (13:34.233)
Mmm.

Robyn (13:34.799)
You know, because it’s the physiologic way that our body is presenting itself and changing. And so then what can we do to support that? And this is why, you know, it’s so great, I think, to be a woman right now because we actually, so many of us, a lot of us still don’t, but many of us, and I’m thinking globally because this is, you know, your podcast is a global entity.

We have access to these things and we had access before and then science was read very incorrectly and we won’t get into that. But women are paying attention because they’re like, hey, I know I can feel better and I deserve to feel better and I deserve to be heard and I’m carrying, you know, literally babies, maybe not babies.

Victoria Kleinsman (14:22.723)
Mmm.

Robyn (14:34.357)
but parents, partners, jobs?

We need to feel our best and be able to access the tools that are potentially available to us if they’re safe for us, right? If there’s not a contraindication.

Victoria Kleinsman (14:53.753)
Yeah, I like what you said. A question you kind of was asking, what can we do to support the natural hormonal changes of our body? Because I’m a believer in nature knows best, nature does, and we are nature. There’s always a reason why, for example, when I was breastfeeding, I don’t know if you felt the same, I was just in my little bubble and I kind of didn’t want anyone to kind of, I didn’t want any sexual contact. I just was like, I’m in nurture mode completely. I don’t want to go out.

And then when that stopped, was like, I’m being drawn to be in the world again. makes sense why nature would do that. Going back to like perimenopause and after menopause, I know we live in a society that we currently live in where we do have jobs and we have responsibilities and we want to go out and we want to feel good. So definitely supporting ourselves and how we want to live our lives. But from, if nature could speak directly to us right now, and perhaps women are saying,

Why? Why the hot flushes? Why do I feel this way? Why aren’t I sleeping? I mean, you may or may not have an answer. What do you think nature would be telling us? Because there’s a reason why it’s happening, right? I don’t believe that nature’s just out to piss us off on purpose.

Robyn (16:07.469)
Although it does. That’s right. So our ovaries are getting to this place of retirement. And then and they’ve worked really hard. Like, think about it. Like they worked hard from that first menstrual period to that final menstrual period. That could be, you know, how many years is that? Right. From and I’m just using general general ages, right? Like 13 to 52. That’s a really long time.

Victoria Kleinsman (16:09.497)
Thank

Victoria Kleinsman (16:15.683)
Yes.

Robyn (16:35.98)
That’s like, they gave it a healthy effort, right? And that’s not just where estrogen is, but because of that decline, the lack of estrogen then sort of radiates throughout our bodies. And I think two things that come to mind are,

Victoria Kleinsman (16:52.279)
Yeah.

Robyn (16:57.058)
And this is, you know, aside from the physiologic pieces. And I know I shared with you a paper by Dr. Pauline Mackey, who’s wonderful. And she just does such a great job of explaining all this in terms of this HPA axis just sort of being the one to lead a lot of these changes. But I think that it’s important to remember

And I think women tend to do this, and I hear this a lot. I either hear women in perimenopause who they come to see me and they say,

I want to have a different experience than my mother. I’m hearing about all these changes that women are having and affecting them in such debilitating ways. I’m starting to have these symptoms. What can I do to prevent it? How can you help me take me through this? And we actually, we can form these clinical relationships. This is like why I did this because I want to start working with these women in the beginning and take them all the way through. And things change.

And what I really so so that’s sort of like one presentation and I think we still have a lot of women who are like, nope, I’m going to strong arm it. And some of that I think comes also from hearing that that’s what they have to do. And and being told by medical clinicians that it’s too early for you. You don’t need this until your mid 50s.

Victoria Kleinsman (18:14.253)
Hmm.

Robyn (18:35.158)
You know, those are just kind of two examples. I hope I’m not being too tangential.

Victoria Kleinsman (18:40.449)
No, what would it look like if someone came to you early on and they knew themselves, they knew their body, they were experiencing different changes and they weren’t liking it and they don’t have to endure it as we live in a world where we have so many great things that are out there to support us, natural medicines, pharmaceutical medicines, so we don’t have to, right? What would that look like if they were to work with you and they were wanting support through to the other side? And I assume, this is kind of a question on top of a question,

when their menopause is over, do you then can stop taking the support? Does it then just even out? Like, is it okay? Or is it like a lifelong thing then?

Robyn (19:18.37)
Yeah, those are… Right, well, it can be. So let’s start from the first part. the number one question is, where are their cycles? How are their cycles presenting or not? And the reason is because if we’re still cycling, we can get pregnant, right? And it’s not gonna be as easy potentially.

Victoria Kleinsman (19:30.968)
Right.

Robyn (19:43.785)
This is why, and I reference the menopause society frequently, this is why the menopause society really solidly wants us to think about birth control pills, IUDs, next one as hormone therapy. Right? Yes. And what we want to do is have this careful conversation with the patients that we’re seeing, and we use the word women, because

Victoria Kleinsman (19:59.735)
Yes, because they are hormones in the body.

Robyn (20:12.874)
we need to help them with the birth control piece or not. And that can also provide hormone. therapy, because it is providing hormone therapy. Now, every person is different. And we have different types of progestogens, and we have different methods and ways in which that we can provide estrogen to the body.

Victoria Kleinsman (20:17.41)
Yeah.

Robyn (20:40.17)
So it’s that careful assessment, including where they are in their like primarily where they are in their reproductive cycle. What are their symptoms? How are they sleeping? How is their mood? What’s their life like? Like I when I meet there’s a you know all the fun forms right you you feel that before you see a clinician and

Victoria Kleinsman (20:46.915)
Mm-hmm.

Robyn (21:01.034)
I have more of this like get to know you form because I want to know what my patients want to get out of this. And when I sit down with them that first time, which is most of the time after a 20 minute discovery, call like that we just have, I want to know what a week in their life is like because knowing that trajectory and knowing who they are can help me point.

Victoria Kleinsman (21:06.617)
Mmm.

Victoria Kleinsman (21:20.077)
Mm.

Robyn (21:29.95)
them in directions of options. Everyone has options. and I want the amazing women that I get to meet with, patients I get to meet with, to not feel like they then have to go to the pharmacy five minutes after we meet. They can go talk to their

Victoria Kleinsman (21:36.279)
Yeah.

Victoria Kleinsman (21:47.993)
Mm.

Robyn (21:51.457)
therapists, their partner, their best friends, their family, and understand, take that information and think it through. Right? And so then when we get to menopause, which is the menopause transition of a couple of years, one to two years, after that, things do kind of even out hormonally.

Victoria Kleinsman (22:00.395)
Yes. Yeah.

Robyn (22:16.632)
But women can still have hot flashes for years because we don’t have the estrogen. So again, that HPA axis is like, hey, I’m helping, I’m helping, but you know, I’m doing it in my way. And so what we know now, and this is different. So initially when we were prescribing more hormone therapy again, the recommendations were just for five years. And then it went to, actually you can use it for 10.

Victoria Kleinsman (22:19.587)
Mmm.

Victoria Kleinsman (22:41.901)
Right.

Victoria Kleinsman (22:45.977)
Mm.

Robyn (22:46.624)
And now it’s the patient clinician decision making process in what’s needed. And we also have what we know to be, and this is a clinical term, is the timing hypothesis. And that is the beginning of hormone therapy within 10 years of the final menstrual period or up into age 60.

Okay, so you have a 57 year old that’s still cycling. There’s that 10 year, 60 year old, that’s a nuanced discussion. And the other thing that’s been super popular, so ultimately, and let me backtrack a sec, we can use hormone therapy for longer periods of time. It depends when we start it because our risk factors for using it shift as we get older.

Victoria Kleinsman (23:17.176)
Mmm.

Victoria Kleinsman (23:34.923)
Yes. Yes.

Robyn (23:35.639)
right? And the number one killer of women is cardiovascular disease. And because of all the hormone changes in our body, we have shifts in that in that system. We have to be careful with that and our bone health, big ones. And I’m sure a lot of listeners have potentially heard a ton about the use or not of vaginal estrogen, which

Victoria Kleinsman (23:48.513)
Mmm.

Robyn (24:05.366)
you know, was also considered to be just something you can use for this period of time, which isn’t true. Like, we can use it forever. And one of the reasons we want to use it is because we want to protect that area of our body and have it not atrophy. And we could have a whole other podcast on that. But I hope that answered.

Victoria Kleinsman (24:28.64)
Yeah, well it sounds like you really treat the person in front of you as an individual and you get to know them and you care about them, that’s very clear and then also it doesn’t have to be this set 5, 10, it can be a shorter period of time, from what hearing you say it can be a lifetime or most importantly you meet with the person and get to know them and see what they need and I guess is it trial and error? I mean that is probably a better clinician way of saying that but

Do you try something then if that doesn’t work or does it kind of always work? Like is that something that needs to happen or is it kind of like, no this is what needs to happen and it’s very plain sailing from there or is everyone really different?

Robyn (25:09.314)
That’s a great question and it has a couple of answers. So what’s worked for us in the past is helpful information. So for example, if we used an IUD in the past and that was helpful to us.

and we’re having changes in our cycles that would warrant an IUD being helpful, that would be a great way to provide the body the progestin that it needs, right? And then we can add onto that. If we were more aligned with birth control pills,

Victoria Kleinsman (25:25.235)
anyway.

Robyn (25:46.943)
we utilize that information. If getting pregnant or not is something that we are thinking about, we utilize that. So if someone is still cycling, but they are absolutely not going to get pregnant because of myriad of reasons. One of them being maybe their partner is a man and they have a vasectomy, so there’s no reason they could get pregnant. And they’re not having bigger issues with their menstrual cycle at a

Victoria Kleinsman (25:50.499)
Yeah.

Robyn (26:16.816)
like prohibitive to them in their lifestyle, we would look at potentially different options. And those options do change. So it’s not one size fits all and then not like, like think about our body changes, right? Like we’re gonna wear different sizes because our adipose tissue is moving, we’re accumulating more visceral fat naturally, normally and

As we go through these shifts, have maybe more surges of symptoms that could warrant perhaps a little more estrogen or a little more progesterone. We then get to phases where we may not need as much.

Victoria Kleinsman (26:56.526)
you

Robyn (27:06.696)
And so it’s really, you know, don’t have to see your clinician all the time. Like once you’re in a place where you’re feeling better, meaning your perimenopausal menopausal symptoms are decreased by 80%, right? Like that’s our goal. Then we want to stay there, but our body’s still changing.

Victoria Kleinsman (27:24.825)
Yeah, as it always does, including our bodies. And I want to go back to what you just said, the adipose tissue being more prominent during perimenopause and menopause. A lady once told me, Nina Mandela, something like that, she said, I’ve been on my podcast, she’s a body peace coach. And she said that we have more fat on our bellies after menopause because the estrogen is…

within the adipose tissue, it needs somewhere to go. So it’s kind of moved from the ovaries. I’m probably butchering what she said, but what I’m trying to say here is we have more fat on our bellies in this time because our body needs it in order to function with the oestrogen. Is that correct or something like that?

Robyn (28:08.404)
I think it’s similar. So we tend to, we are more predisposed to accumulating visceral fat, which is a layer of fat between, you know, it’s a layer of, we’ve got our muscle tissue, we’ve got our organs, our muscle tissue and our subcutaneous fat, but visceral fat can accumulate more because the estrogen has sort of left the building. And it can be, it can be trying to protect and it’s the most difficult to shift.

Victoria Kleinsman (28:31.01)
Yeah.

Robyn (28:38.288)
because of where it is. And a lot of that is really normal and

to the normal aging process, right? So we’re not as active because we are, you know, taking care of children in varied ages. Maybe not. Maybe we’re taking care of parents. Maybe not. Maybe we are, you know, we have a huge job. Maybe all three of these things and like a partner. So we’re just not moving as much. so tissue shifts. It does.

Victoria Kleinsman (29:15.361)
Yeah, I think that just reminds us, in my opinion, that the body changes, we’re not robots, and to trust nature and to trust and practice accepting and surrendering the seasons of life that we go through. My body is different since being pregnant and giving birth. That’s a season of life that changes you in all the ways. And when menopause comes, I’m sure it will change again. So once we have this foundation of body acceptance and just embracing who we are, self-love and all of that good stuff.

Robyn (29:31.136)
Yeah.

Victoria Kleinsman (29:44.663)
I think it’s easier or will be easier then as we move into this stage of life for us to be more accepting of it. have two, perhaps one loaded question. Second, the first question I have is how do you differentiate between women who have an eating disorder who perhaps don’t have a menstrual cycle because of the restriction, the body fat’s too low? Can someone go through perimenopause

Robyn (29:51.822)
Mm-hmm.

Robyn (29:56.471)
Yeah, go ahead.

Victoria Kleinsman (30:14.719)
if they’re not healthy enough to actually have a menstrual cycle? Do the hormones still change or does the body kind of freeze in that room?

Robyn (30:22.998)
I think they’re still going through that cycle. Yeah.

Victoria Kleinsman (30:26.137)
Okay, yeah, so if someone came to you and they were restricting and they did have an eating disorder and their period was either gone or all over the place, perhaps because of due to lack of nutrition, do you still support them in hormone therapy? Like how would you support? Yeah.

Robyn (30:38.392)
Mm-hmm.

Robyn (30:42.914)
Yes, yes. the reason is that there’s a couple of reasons here. The number one that comes to mind is really bone health. Because it shifts so rapidly during the menopause transition and…

Victoria Kleinsman (30:51.213)
Yes, very important.

Robyn (31:00.51)
If we have a history of an eating disorder, we are more predisposed, depending on the eating disorder, right? Depending on the person, it’s all individualized, but we may be more predisposed to having some osteopenia, osteoporosis, and hormone therapy is approved to prevent bone loss. Yeah.

Victoria Kleinsman (31:23.073)
Yes, okay. So that’s going to be helpful for those as well. And then the perhaps a loaded question is, but I’ve just noticed this from personal experience. The question I guess outright is, in your experience, have you seen a pattern between someone who’s considered healthy? And what I mean by that is someone who’s happy psychologically, feels safe emotionally.

is healthy physically at their own natural set point where eating unrestricted, nourishing themselves, all of that good stuff, that their menstrual cycle and then perhaps their perimenopause and menopause is less challenging because I that and I’ll let you dive in in a minute because before pregnancy, when I’ve been going through some emotional stuff or psychological stuff, I’ve had really painful periods and then when I’ve gone through stages of being really happy and content, they’ve just been not painful at all.

Robyn (32:00.718)
Yes.

Victoria Kleinsman (32:17.619)
explain all of that because that’s really interesting. We can’t force that happiness and health obviously but we can aim towards just happiness and health to have a better transition maybe.

Robyn (32:29.44)
Yeah, and I think it’s also about working with a clinician, not for a diagnosis per se, but someone who understands the difference between, you know.

with an eating disorder, body image struggles, is there concomitant defined major depressive disorder? Is there a generalized anxiety disorder? And those diagnostic criteria are very different, vary, they’re different than mood shifts in perimenopause and menopause. And, sorry.

Victoria Kleinsman (33:04.32)
Right, how do they differ? How do they differ?

Robyn (33:08.78)
So it can be, it’s a clinical diagnosis of symptoms, right, that presents itself. Or not. And because of the hormone shifts that are affecting our mood, because they are increased irritability, sleep changes, joint pain, know, more difficult.

Victoria Kleinsman (33:12.706)
Right.

Robyn (33:36.303)
with certain, you know, cognition, those symptoms are gonna surge and feel worse. Like it’s in the literature, we know it is, and it’s been in. It’s been in studies and it doesn’t even, like, so the science is there and so I think this is why…

really all of this became so present to me in the folks that I was seeing because I felt like we were missing things. Like you can’t not look at that whole picture.

Victoria Kleinsman (34:14.019)
Yeah.

So, how would someone, where do want to go with this? So we’re looking at the whole picture of health, obviously, to help our transition through menopause and our menstrual cycle in general. It’s important to seek support, not just, this is what I’m getting from what you’re saying, not just to deal with it, because you don’t have to. The happier you are and the healthier you are, the easier, perhaps, we’ve both seen a pattern from our own experience and you working with clients.

the easier it might be. If someone with an eating disorder doesn’t have a period, it’s still worth going to get support, even if they’re not, probably more so because of the bone health and all of that. Cardiovascular, yeah, to support that. And if I’m looking at my notes here, because there’s so many places I want to go, so I’m just kind of trying to rein myself in here when we go here.

Robyn (34:56.27)
Yeah. Cardiovascular health.

Robyn (35:09.655)
Yeah, yeah.

Victoria Kleinsman (35:13.837)
Yeah, what should women advocate for if they do feel dismissed by doctors? You mentioned this perhaps a bit early, like some doctors might say, no, it’s too early for that, back later, or what can they do if they are being dismissed and they kind of know that they might need that hormonal support and they’re not getting it?

Robyn (35:32.729)
The number one thing I would try to do, and again, I’m gonna use the word nuance for reason, is look for someone that is the Menopause Society certified practitioner. Because we have learned, we have studied, are hopefully staying on the pulse, right? But where this gets tricky is in the population that you and I work with.

Victoria Kleinsman (35:43.577)
Right.

Robyn (36:02.998)
There isn’t a lot of education or support around our folks. And the education to be the MSCP and really follow some of the menopause society, which is global, is more about weight.

versus the disordered eating eating disorders and body image and this this struck me so significantly when I was starting to study for this actual certification because in their whole clinicians guide and I respect them but in their whole clinicians guide there is one paragraph and one like mention of eating disorder like on a table. So so

Victoria Kleinsman (36:30.925)
Yeah.

Victoria Kleinsman (36:52.601)
Mm. No, he knows.

Robyn (36:56.438)
you’re going to see someone, they’re finally, you know, you’re finally feeling seen and heard on your symptoms and perimenopause and menopause and then it’s not from a lens of an education around eating disorders, disordered eating or body image struggles and I, this is not like, this is not new news. This is…

One of the reasons, main reason I created my course, but also I feel like this sort of lonely voice sometimes, because how can we not look at the whole person this way? Add up the percentages, add up the statistics, which I know ranges, but it’s an issue. And it just needs more education and thoughtfulness.

I think the other thing that’s important to remember is a lot of these clinicians are in primary care. And so in primary care, we get 10 minutes, 15 minutes max for a physical. So their lens is treating the main issues that come up for women during this phase of life, cardiovascular disease, bone health, you know,

Victoria Kleinsman (38:03.054)
Wow.

Robyn (38:19.712)
just the physiologic changes that happen and is it time for it? Okay, well how old are you? It’s not time yet. And then by the way, let’s look at your BMI, which I can’t stand. yeah.

Victoria Kleinsman (38:26.529)
Yeah, they’re looking at… Yeah, they’re looking at…

Victoria Kleinsman (38:36.759)
Yeah, there’s so many problems with that. So I’m glad there’s people like you in the world. And with these women who feel misunderstood and unheard, I want to just reiterate not to give up, to go to someone like you, to just be dismissed and be like, I’ll just continue on as I am and put up with it. No, get the help you need because there are people like Robyn out there that want to support you. And with regards to

Robyn (38:51.182)
Exactly.

Victoria Kleinsman (39:06.713)
because you’re saying the hormonal changes in perimenopause and menopause perhaps heighten anxiety and depression, especially if someone’s had that in the past. With regards to psychiatrists and them medicating people to support with the depression and anxiety, my belief is to do the inner work as well, like heal the eating disorder, all the stuff underneath that, because that is going to absolutely help with depression and anxiety. But how does someone know

Robyn (39:31.982)
Absolutely.

Victoria Kleinsman (39:35.543)
I guess it might be going to you, whether they’re on the right medication psychotically, if that’s the right word to use, when actually it might be something they need hormonally instead of the medication for their mental health. Like, how do you navigate all of that stuff?

Robyn (39:52.449)
A very fine line.

Victoria Kleinsman (39:54.626)
Yeah.

Robyn (39:54.913)
And I think, and so going back to what you said a minute ago, like don’t give up. And I know that just also from personal experience, don’t give up. You know, I was told by my primary care, the breast health clinician that I’ve been seeing for years, like, no, you can’t have it. You can’t have it. You can’t have it. Finally, I was talking to a colleague, another NP, and she was like, but you can, and this is who you need to see. And this was a Menopause Society certified practitioner, right? So kind. And

So it’s not giving up. And then in terms of what medicine when, we do still want to treat the psychiatric pieces.

If medicine is indicated, we can still use that, right? And very often in the patient population, we see it can be combinations of psychopharmacology and hormone therapy. And I would be completely remiss if I didn’t leave out, and we’ve talked about this, right? Like self-care, sleep, therapy.

Victoria Kleinsman (40:43.489)
OK, yeah.

Victoria Kleinsman (41:06.425)
Mm-hmm.

Robyn (41:08.11)
Sometimes if we can find a clinician and they are available to us virtually but also some in-person cognitive behavioral therapy for insomnia. And it’s just having a careful look at things. So for example, if you’ve got a patient who’s been cycling normally in 30s, early 40s, 20s, whatever,

Victoria Kleinsman (41:19.31)
No.

Robyn (41:36.531)
and they’ve been on psychopharmacology to help treat anxiety, depression, PTSD, these things that present themselves in our patient population. Then when they get to perimenopause or menopause, are things surging? Are they resurging? Is that picture different? We can often add hormone therapy if it’s not contraindicated, and that may essentially be able to help us perhaps tweak some of the other medications.

Victoria Kleinsman (42:05.826)
Yeah.

Robyn (42:06.45)
I think I get upset when I hear hormone therapy can treat everything. We know that when we lose estrogen, our serotonin levels can shift. So some research points us to…

SSRIs working more effectively with estrogen on board. Well, they were working well with estrogen on board in our 30s and now the estrogen’s not there. So. Yeah.

Victoria Kleinsman (42:42.105)
Oh yeah, that’s so interesting, really interesting. I mean, I’m sure you’re an advocate as well for, it’s not only the deeper healing, it’s to support us with medication like you, and hormone therapy like you described, but I’m a firm believer that when, it’s a lifelong journey, it can be, when we’ve addressed and healed the deeper trauma that is the creation of the anxiety disorder, it’s the creation of the depression. Obviously, I just, can’t go without saying that in this episode that we’re having is,

it’s so important to do that work with a therapist or a coach who knows what they’re talking about because it’s not just the symptom management we want, it’s the root healing and the general happiness and contentment from within, not just because you’re managing symptoms. I think that’s just so important just to briefly touch on.

Robyn (43:14.38)
Yeah. Yeah.

Robyn (43:28.558)
Yeah.

And it’s working with a clinician who’s gonna gonna help you dynamically. It’s not like this is working great i’ll see you in six months. It’s what’s working what isn’t working and always looking at the whole person through the lens of lowest doses fewest medications if these medications are indicated and when and is there potentially maybe there will be maybe there may never be but in all the things you just

Victoria Kleinsman (43:35.768)
Yes.

Robyn (44:00.457)
said if someone’s really doing a lot of the work, their symptoms may decrease, their symptoms may be gone. So then we need to to be working collaboratively with our patients teams as well and make shifts to make sure that you know maybe they don’t need these things anymore.

Victoria Kleinsman (44:09.539)
A hundred

Victoria Kleinsman (44:25.261)
Yeah, and again, I’m not a doctor and all of that jazz, but the amount of clients I’ve helped who have, from their own accord and with their doctor’s support, nothing to do with me advising it or anything like that or initiating it, they’ve come off the medication for anxiety, depression, even psychotic medications because they’ve healed the root. They’re actually happy in themselves. They no longer have an eating disorder. They’re nourished. They’re creating a life that they love. They’re having a job that they love. All of these things have a huge effect.

Robyn (44:54.744)
Mm-hmm.

Victoria Kleinsman (44:55.681)
on us hormonally, I believe, how we feel emotionally. So like you’re saying, it’s such a holistic way of helping. We don’t have to suffer and only do the inner work and just, you know, wait for nature to catch up. No, we can also support ourselves from all angles.

Robyn (45:11.116)
Yeah, exactly.

Victoria Kleinsman (45:13.059)
Yeah, and I think it’s worth navigating into like body image, eating disorders, menopause and aging now, because do you think that alongside of course what you’ve shared with the hormones, heightening anxiety and depression and disorders that are kind of underneath there in the surface around this time, do you think there’s also a part of the eating disorder and body image stuff as we age, we’re like grieving the loss of

the younger us, our younger bodies, grieving a loss of being a woman with a menstruation. So it’s not only hormonally, it’s perhaps psychologically as well. And we’re getting older and then ultimately we’re gonna die. I think it’s also that as well.

Robyn (45:55.811)
Hmm.

It’s definitely that and it’s definitely the messages we’re hearing, right? You know, you can have hormone therapy and it’s gonna help you feel how you did then, right? I don’t like that example. I like decreasing symptoms by 80%. And where I have trouble with the whole sort of…

Victoria Kleinsman (46:03.161)
Mmm.

Victoria Kleinsman (46:13.165)
Yeah.

Robyn (46:25.014)
some of the resurgence of the utilization of hormone therapy is, and your body can look the way it did when it was 25 too. And I can tell you that gravity’s a thing, right? And so like,

Victoria Kleinsman (46:33.726)
no, no.

Victoria Kleinsman (46:42.766)
We’re

Robyn (46:46.606)
You know, and I think also, and you know, not everyone has had children for lots of different reasons. If we have been able to have a child, and maybe if we haven’t, to be able to see what our bodies can do, what they’re capable of, and then that self-respect.

Victoria Kleinsman (47:09.857)
yeah.

Robyn (47:10.804)
you know and and just that hand on the heart, compassion, gratitude. like you have a very young child; my daughter’s 13. I am not going to look like she does. I don’t look like she does.

Victoria Kleinsman (47:25.196)
No.

But sadly, the society that we live in, the media kind of think that maybe you should be trying to look as young as possible. I remember seeing my coach, Jessie Neelan, she’s a body image coach and she knows a lot about kind of aging and body image issues that come up around that. And I’m in there for educational purposes to help kind of my audience. And one of her clients put up a story the other day; it was so funny. And she had an age correcting serum in her hand. And she said,

Robyn (47:34.179)
Yeah.

Victoria Kleinsman (47:57.407)
“age-correcting serum, my age is correct, thank you very much.” It’s in the messaging everywhere, isn’t it? Whereas again, if we’re practicing body acceptance and if we choose, because I fully am a believe that our reality is how we perceive it to be. Yes, we have emotions. Yes, we have grief. But we do have the power to see

Robyn (48:01.263)
Ha

Victoria Kleinsman (48:22.965)
our world in a way that would serve us. For example, I could look in the mirror and be like, gravity’s taking its toll. I have another wrinkle. My breasts are saggy or whatever it is. Or I could choose to focus instead on, you know what, older is such a gift because I know someone who died like a year younger that like, depending on what we’re focusing on, I think that’s the experience we get. So I do believe that growing old is a gift.

And if we allow ourselves to focus on the positives in that and see all our lines on our faces as lines of like living, face we lived in and smiled in and crying.

Robyn (48:59.983)
Body well lived in. Yeah.

And I think what gets hard is when we are feeling so terrible because a lot of these symptoms can feel like they have just come on like that, right? Like all of a sudden, a lot of that’s true, right? Because though they’ve been sort of coming up a little bit here and there, it can really feel like this big swoop of shifts. There’s this looking for something to feel better. I want to feel better. I want to feel better. And I totally get that. I really do.

Victoria Kleinsman (49:21.93)
and we’ll

Robyn (49:33.345)
And I think that, you know, at the same time, we can utilize the tools that we have around us and, you know, find some grace in it. But it can be really tough when it does feel like all of a sudden, and I say this to a lot of women, like, you know, the fortunate and unfortunate part is this.

Victoria Kleinsman (49:53.442)
Mm.

Robyn (50:00.705)
It’s almost this, like we have a finer line in terms of a little less sleep or, you know, kind of a work project that takes up too much time. A parent that needs more support, a child that needs more support. We just, it’s the toughest time I think to try to…

find more time to devote to our self-care and yet really noticing what we need because those shifts, just, we don’t have as much grace in the shifts that are just sort of hitting us. We can give ourselves the grace.

Victoria Kleinsman (50:37.859)
Mm-hmm.

Victoria Kleinsman (50:49.497)
Yeah, and like you said, because of our conditioning and all those things, when it hits us like that, whether it’s perimenopause or not, I mean, again, I’ve not experienced that. I can only imagine how hard that would be. But when life hits us and we grasp, we’re grasping at control and we’re grasping at a way to feel better, sadly, we still have a belief, unless we’ve worked on it, that if I’m just thinner, I’ll be happier. If I’m thinner…

everything will be better in my life. If I can just get myself under control, I’ll feel better. And whereas that may be true initially, it’s not the ultimate truth. So people use their bodies as the greatest scapegoat. It’s something to focus on and obsess over when actually their attention might be needed on their marriage or their job or their hormones that needs support. So the body can be a great distraction to try and feel better and be happier without really realizing that.

That’s what we’re doing, perhaps, as well.

Robyn (51:48.801)
I like women to, because I’ll often hear, as I’m sure you do all the time, I hate that picture of myself. That picture was awful. Our first glance is not necessarily our kindest glance. So go back to it a different day, you know, and yeah, you’re going to look different.

Victoria Kleinsman (51:54.445)
between.

Victoria Kleinsman (52:00.697)
Mm.

Victoria Kleinsman (52:10.649)
Mm-hmm. And that’s when grief comes in. Like, I put up a post in my private group the other day, and on Instagram actually, a similar photo, of my now soft stomach. And I’ve been praised to high heaven my entire life for having a flat stomach. Even my midwife, after giving birth, said, “oh my God, that’s the flattest stomach I’ve ever seen after literally having a baby.” I mean…

Robyn (52:13.825)
Mm-hmm.

Robyn (52:23.374)
Mm.

Victoria Kleinsman (52:35.757)
They think they’re complimenting us, but actually it’s not a compliment. I couldn’t have cared less. I just birthed baby. But I love this stomach now because I don’t like the way it looks necessarily, but I love everything, what it means. I’ve been gifted enough to be a mother and give birth and, you know, I’m still waking up twice to feed milk in the middle of the night. I’m chronically sleep deprived. I’m emotionally eating sometimes and that’s okay because I’m a human.

and I’m trying to cope and this is the body that I have that enables me to be this version of me. I love this version of me but it’s took a bloody long time to get to this stage and that’s why we should never give up on ourselves because we’re so worthy of our own love more than anybody else.

Robyn (53:11.852)
Mm-hmm.

Robyn (53:15.875)
Yeah.

Robyn (53:22.67)
Right. Right. And hopefully through, you know, women working with people like you, right, we can practice that even if we’ve heard differently. Right. And so we can change that inner voice and that inner critic. And it may not be 100 % gone. Sometimes it may come up now and then. And yeah.

Victoria Kleinsman (53:46.745)
Yeah, and that’s okay. Do you have an extra 10 minutes or so Robyn?

Victoria Kleinsman (53:58.635)
Okay, that’s good. I’ll make sure we get to before then. Because there’s a few, there’s two more things and I’d like to open it up for you. So are we missing a liberation piece? So we’ve talked a lot about the challenges, of course, of perimenopause and eating disorders and all that happens hormonally. Are we missing a liberation piece that might be available to us at the time of perimenopause and as the archetype goes of entering the crone, that wise old woman, you know, who everyone turns to perhaps?

Robyn (54:24.331)
and

I think we’re in it. I really do. Now I’m older than you and so I’m 53 and I feel like so and I don’t know where my phone is and it’s off. Different things we say then show up to us, right? So the things in my feed are very symbolic of where I am in my life and my work, right? Things like that. So maybe that’s why I’m saying some of that, but I really think we’re in it.

Victoria Kleinsman (54:29.901)
Mmm.

Victoria Kleinsman (54:57.08)
Yeah.

Robyn (54:57.594)
And I think we’re in it also from another concrete example is I don’t know about in the UK, but in the US there’s a shortage of the estrogen patch. Why is that? We’re prescribing it more because and potentially by clinicians that are using it safely and for women who do not have contraindications, but.

Victoria Kleinsman (55:11.8)
Mm.

Robyn (55:20.632)
We’re using it more to help us feel better, but we don’t have enough of it and women are angry. And so we as clinicians then are literally like, where can we get it? And really have to be on the pulse of this because local pharmacies don’t have it. Or a lot of the lower doses are…

Victoria Kleinsman (55:27.917)
Good for them, they should be.

Victoria Kleinsman (55:44.121)
Mm.

Robyn (55:49.748)
stock and that’s because the lower doses potentially are being used more in the perimenopausal phase. And so I think we’re in it and that’s just an example of that.

Victoria Kleinsman (56:00.151)
Yeah, and that’s again going back to self-advocacy and not giving up and asking for what you want. And I know it’s hard, especially when women, you know, don’t have a lot of worth or they’re not connected to their inner power, but you, we, me, they, we deserve to get this support. So the more that people ask for it, people have got to listen at some point, you would have thought.

Robyn (56:25.016)
Potentially.

Victoria Kleinsman (56:26.253)
Yes, and finally a practitioner like yourself. Do you work with women online or is it only

Robyn (56:32.334)
I’m only licensed in the state of Massachusetts. So I can only dispense medications to folks in the state of Massachusetts. I have at my fingertips, I think, I know I have at my fingertips, but it’s more about.

Victoria Kleinsman (56:35.522)
Okay.

Robyn (56:57.386)
If someone needs a clinician and they’re not in my state or not in my country, there are ways to help them find clinicians who can hear and see them. And that’s easier than we think.

Victoria Kleinsman (57:09.783)
And how would so someone, say if someone’s in the Netherlands and they want someone like you in the Netherlands, where do they start?

Robyn (57:13.166)
Yeah.

Robyn (57:18.072)
So the number one thing I would think about would be.

Is there a menopause society certified practitioner there? And to come to one of us who is this and we can go to our networks and I do this all the time to say who’s practicing here? Right and so in our world we have international organizations right who have different members right in various places and if I get a request I can go to one of my networks

Victoria Kleinsman (57:37.709)
Mmm, yeah, yeah.

Robyn (57:52.592)
and find someone.

for this individual and give them choices. Now countries are different in terms of what’s available and what isn’t. I think other countries have been much more at the forefront of hormone therapy than we have here in the United States for a number of years. But I think that has very much evened out.

Victoria Kleinsman (58:02.755)
That’s correct.

Victoria Kleinsman (58:26.393)
Good. And then lastly, is there anything that I haven’t asked you that you want to chat about? Of course, there’s your training that please, please share that because that’s a gap that’s in, you know, in a lot of professionals and dietitians and things or anything else that you want to talk about or share.

Robyn (58:44.822)
I think it’s really about, and we’ve talked about this, you know, don’t give up. Don’t, you know, try to leave space for compassion and not feeling like you have to strong arm this process and knowing that the process is dynamic, right? Our bodies change purposefully.

Victoria Kleinsman (59:06.979)
Mm-hmm.

Robyn (59:12.99)
so we can find solutions for us that are helping us and that’s going to shift and that’s normal and surround yourself with like-minded people you know like people who are going to support you in this process and not dispense of your symptoms

Victoria Kleinsman (59:21.038)
Yeah.

Victoria Kleinsman (59:30.295)
Yeah.

Robyn (59:43.288)
You’re not laughing at your symptoms. You know?

Victoria Kleinsman (59:46.595)
Yeah. And could someone go into somewhere to ask for support and ask not to be weighed? A bit of a random question, but okay, yes. We don’t want to be looking at VMI.

Robyn (59:54.863)
Yeah, I have patients that… And the tricky part is then that, you know, if you have access to your medical records, which legally then we do, then there that number can be. Now there are ways around this, but I have a lot of patients that don’t get weighed. You know, my own daughter, when we went for her physical, you know, she didn’t want to know the number.

Victoria Kleinsman (01:00:13.945)
Good.

Robyn (01:00:23.534)
When you go to get, I rent skis for her every winter and she was like, I don’t wanna know the number. Like, what is that gonna do for me? Yeah.

Victoria Kleinsman (01:00:33.645)
Smart girl. And lastly, talk about your training. am I right in saying you have a training for clinicians?

Robyn (01:00:41.152)
I do. yes, I do. So I created a course. It’s got CPEs for dieticians and I’m contemplating it having CPEs for other disciplines. But it is beyond nutrition integrating psychopharmacology and hormone therapy during eating disorder treatment and perimenopause and menopause. And Victoria, please pardon me for the very long name, but it’s really beyond the nutrition part. And it has

Two plus hours of audio so you can take a walk and listen to it, right? You can listen to it in the car if you want, whatever. And then it has the slides that you don’t have to go through with it, but you can, but that’s a separate piece.

the resources that are on my website, which you know about in terms of these pieces being more significant in our population. And it includes a 30 minute call with me. And the reason I have that call is because I want to talk through specific cases with people. I want to have that be an option for them. And what I’ve learned is that

many of the people who take the course may be taking it for themselves to just learn more about these phases of life and what’s available to them.

Victoria Kleinsman (01:02:02.605)
Yeah. Well, anything else that you want to share Robyn before we say goodbye to our listeners?

Robyn (01:02:09.56)
Think onward, right? Like let’s keep helping one another, staying strong, being heard.

Victoria Kleinsman (01:02:17.347)
Yeah. And what I’ve taken from your wisdom today is just a beautiful reminder that our bodies change, we’re supposed to change, hormonally, emotionally, physically, spiritually, mentally, and just to go with the flow and enjoy the ride as much as we can because growing old is a gift. And we also get to ask for help. We don’t have to struggle alone.

Robyn (01:02:32.248)
Yeah.

Mm-hmm.

Robyn (01:02:39.254)
Yeah, and then we get to offer that wisdom and experience to our younger ones, right? Raising strong daughters, strong, confident daughters.

Victoria Kleinsman (01:02:49.165)
Yes. I think there’s a quote that my mum has on a mantelpiece and I think it says, strong women, may we raise them, may we be them or something like it’s about strong, it’s like that quote about strong women and it’s just like, hell yeah, women come together not to be in competition but to come as sisterhoods and to support and to share. That’s what we’re needing in the world right now. Yeah.

Robyn (01:03:03.16)
Yep. Yep.

Robyn (01:03:15.02)
Yeah, more than ever.

Victoria Kleinsman (01:03:17.655)
Well, thank you so much, Robyn, for your time and for your wisdom. Obviously, I’ll get all the links from you to put underneath wherever anyone’s watching or listening so they can contact you and see our listeners next week. Much love to the listeners. Thank you, Robyn.

Robyn (01:03:19.32)
Thank you.

Robyn (01:03:26.144)
Yeah.

Robyn (01:03:32.129)
Okay.

Take care, Victoria, thank you.