Perimenopause, Hormones, and Libido with Christina Valenzuela

What is perimenopause? How long does it last? What are the signs that you are in it? How can it affect your fertility and libido? Sarah talks with Christina Valenzuela, creator of the Perimenopause Prep Course, about thriving in the years before and after menopause. 

Understanding perimenopause, learning how to support your body through it, and communicating with your husband about your love life through this major change can empower you as a woman to be more positive and proactive about your hormonal and sexual well-being as the fertile years wind down. 

Check out Christina Valenzuela's wonderful Perimenopause Prep course!

Pearl and Thistle offers:

• Educational resources rooted in Theology of the Body
• Tools for building body literacy at all ages and stages
• Catholic resources that blend science and sacramental worldview

MORE RESOURCES

Free Enhancing Marital Intimacy Guide for Catholic Women: 9 Skills for Body, Mind, and Spirit (for married and engaged women)

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Transcript

Sarah Bartel: 0:50

I am so thankful to have my friend Christina Valenzuela of Pearl and Thistle joining me today to talk about hormones, libido. And she is just such an expert about hormones through the whole life cycle with her offerings, helping moms teach their girls about cycle awareness as girls get ready to have their periods all the way up through perimenopause with their perimenopause prep course. Christina, welcome and thank you for joining me.

Christina Venezuala: 1:20

Sarah, thank you so much. I'm really excited about this conversation, so I appreciate you having me on here to talk today.

Sarah Bartel: 1:27

Well, thank you. Christina, I want everyone to know also teaches Boston crosscheck an NFP method that not as many people know about. So I'm excited also to touch on that a little later in our conversation to bring it to people's awareness. And but what I really would love to dive into is this time of perimenopause. Can you tell Yes, Christina? Yeah. Just a little bit about like the origin story of your perimenopause prep course. I think this is so wonderful and wonderful. Oh, well,

Christina Venezuala: 1:56

so I have a course called Cycle Prep that I have been running for a long time now that came out of the request of some of my natural family planning clients who wanted to teach their girls about menstrual cycles, like the whole cycle. Not just periods, but do it in a way that's like really developmentally and age appropriate and sensitive to the needs of these young girls who are going through puberty. And so I've been doing this cycle prep course as a prerecorded video course. During Covid, it was like a live zoom workshop, and now I get to do it in person for various communities. Wow. And time and time again, these moms would come up to me after cycle prep and they would say, I'd say, Christina. Do you have this? But for like, perimenopause, we're so confused about our bodies and we never got a really good puberty education. And for sure we're not getting anything about perimenopause education and we are just so confused about our bodies. Mm-hmm. So I think that there's something very interesting to sit and think about the fact that like by the time our daughters are going through puberty, a lot of us are going through our transitions as well. And there's this need here at both ends of the spectrum to really lean into that educational support and help women understand what's going on in their bodies and help them to see the mirror kind of transitions that are puberty and perimenopause. So perimenopause prep really was built as a mirror course to cycle prep, which is my puberty course. So that, so that women can actually get this education for themselves.

Sarah Bartel: 3:24

That's so beautiful and that is really special, isn't it? That as we moms who have teen or pre twee teen daughters are helping them get ready to understand the, the beauty and dignity of their femininity as they begin cycling, our cycles are winding down. And I love that image you use as you teach about this with the carousel. Can you tell us about that a bit? Yeah,

Christina Venezuala: 3:48

so the reason that these two things like puberty and perimenopause are really mirror images is because they both are related to what's called the HPO axis, the hypothalmic pituitary ovarian axis. It's basically a communication channel between your brain and your pituitary glands and your ovaries. That makes the whole cycle happen. And so in puberty, that HPO axis is like. Building up communication. And so we see a lot of psycho irregularities and things that happen during that time. And it's just'cause your HPO access is immature. And then we enter our reproductive years and then we get to pay menopause. And that's actually when the communication starts breaking down. And again, we see it happens over the course of a number of years. So. The image that I like to use is that of a carousel. When you first get on a carousel, those first few revolutions are pretty slow. Mm-hmm. Right? And then the ride gets going and you're like, okay, I know what's going on with the carousel. There's a rhythm too. Right. And then Exactly. Yeah. And you get to the end though, and it starts slowing down again. And so that really is the way that kind of the lifespan of our reproductive years works out in terms of how that HPO access functions. Mm-hmm.

Sarah Bartel: 4:57

So that's really helpful to understand. It's sort of like reverse puberty is what's happening then. Mm-hmm. In perimenopause. Mm-hmm. So let's talk about libido and love life for Catholic women as we navigate this time, because I think there's a pretty common maybe myth I'll say that, that your hormones are gonna tank and your libido's gonna plummet and you're just never gonna be interested in sex again, which can be the experience, right? For some women. Yeah. But we know libido is multifaceted, but it's not always how it works out. Can you tell about some of the different ways that libido can play into all of this?

Christina Venezuala: 5:36

Yeah. So libido, as you said, is a, it's a very complicated thing, and I, I know that you work with, with women in understanding all, different types of libido, right? Mm-hmm. Spontaneous or reflexive, right? And all of that kind of stuff. So, low libido. I think there's two things at play. Like number one. Yes, it can be normal, fairly common for women to experience a decrease in their libido around the time of menopause. So that's true. But the word that you used is very telling, right? That tanking libido or those plummeting libido, like if you feel like your libido has fallen off a cliff, that is a sign that something has gone wrong. Like that's a level of severity that we don't usually experience. And so that's an indication that like maybe something needs attention and it's not just something that we should be like, oh yeah, perimenopause stinks and I'm just stuck with this for the rest of my life. Right? So that's one facet is recognizing between just what's kind of a normal decreased libido for women in our state of life in our ages and what we're going through right now. And then the other part is that recognizing that this is not. Necessarily prescriptive of every woman's experience. Some women, based on their hormones and kind of the ratios that they had before perimenopause may see a big uptick. In their libido. Sometimes we can have increased androgens during this perimenopause time and those, those can actually boost our libido a little bit. Getting a little bit of extra testosterone can help out. And then once we enter into menopause itself, a lot of women do experience a kind of relaxing and a kind of peaceful sense that comes over them that lets them let go of some of the anxieties or frustrations they may have had with libido before. So I think it is a very, very complicated thing to suss out, like. What exactly is, is going on with libido here and what should be a normative experience for women? I don't think we could say that there should be a normative experience. I think we have to enter into it and see what we've received during that time, and then also try to be aware to like the invitations or the signals that our body may be giving us to pay attention and respond to some of those things because they may need assistance.

Sarah Bartel: 7:43

Yes. That's so great. You know, I think it matters so much what we are expecting and set ourselves up for when we think about childbirth. And if you are in a culture that just, you know, pro promotes this idea that childbirth is so terrible and you're, you're gonna be in such pain right? Then you're kind of gonna be expecting that. Absolutely. And, you know, priming yourself to have that kind of experience. Whereas in other cultures or with, with a different mindset, childbirth can be a very manageable, and even for some women, even pleasant and enjoyable experience, some women even experience pleasure during childbirth.

Christina Venezuala: 8:18

I have heard that. And that is like beyond my comprehension, but good for them. Yes.

Sarah Bartel: 8:24

I had a great verse. I love them. And I, I was really into, I mean, it was not experience euphoria like during the contractions. Right,

Christina Venezuala: 8:32

right.

Sarah Bartel: 8:32

But I was really into like the crunchy world there and reading lots of midwives and books and, and, and the language that they used around like your power surges, you know? Yes, yes. I thought that was really helpful. And I just think it's really wonderful to be able to point out that with, with perimenopause that this is a possibility. Mm-hmm. Because I don't know that many women have even entered that, you know, that that thought has entered their heads that this could be a time of libido growing. Yeah. And you know, we're, we're more confident usually later in life. We know about more about ourselves. We've learned and we're more reflexive. So that also could be a factor, you know, in libido, growing. But I think also Christina, when we look at this time of life, when women are going through perimenopause there are a lot of demands on a woman. Yes. Like by this time she has. Gained a lot of competence and mastery in different areas, and so she's responsible for more.

9:28

Mm-hmm.

Sarah Bartel: 9:28

Your attention is a big part of libido as well. Mm-hmm,

9:31

mm-hmm.

Sarah Bartel: 9:31

But maybe could you just outline what are the years of perimenopause in general? I know it can be unique for each other. Oh, it can

Christina Venezuala: 9:37

be so different. So basically perimenopause can last anywhere from like three to even 10 years for women. Like starting the transition from like the late reproductive years to all the time to the time when you have your last menstrual period. Like it's gonna be at least three to five years usually, but for some women it's like eight to 10. And so it really is highly variable about, our experience and looking at our family history and paying attention to what our body is doing. But in general, we can say that if you are after age 35. Which people hear that and they kind of freak out a little bit. If you're after age 35 and you're starting to see some key cycle disturbances or changes that your hormones are shifting, that could be signaling that you're entering what's called the late reproductive years, which is kind of like the threshold of perimenopause. Okay. And, and so when we're talking about perimenopause, that sort of like proximate acute time around menopause, including the first couple of years after you've had your last menstrual period,'cause those are still times of shifting hormones. You know, for, for many women, that's gonna be about five to seven years, you know, that span. And we're typically looking at onset in the early to mid forties with last menstrual period by your early fifties.

Sarah Bartel: 10:55

Wow. And so can you describe or just define for us what perimenopause means? Is this the same as pre menopause? What, yeah, how do we

Christina Venezuala: 11:04

distinguish? Yeah. The terms are a little confusing. So a lot of times doctors will just talk about pre menopause or the menopausal transition. I love the term perimenopause because peri that prefix means around. And so it really is the proximate, the immediate time. So menopause is like the, the cessation of your periods, right? So you're officially in menopause one year after you've had your last. Leading episode. Mm-hmm. Okay. So perimenopause is the years leading up to that, that are marked by a lot of cycle transitions. But then also when we think about perimenopause this time around menopause, there are postmenopausal years, as I said, of kind of hormonal settling and shifting still. Mm-hmm. So when I talk about perimenopause this entire time around, like leading up to, and then including those post-menopausal years, that would not be like a strictly like medical definition, right? Perimenopause specifically would be early perimenopause, late perimenopause as defined by like, what's called the straw plus 10 criteria. So those would be the two stages right before you have your last menstrual period. I think I've probably confused a lot of people at this point, but

Sarah Bartel: 12:13

no, I, it makes sense to me that period, it's the time of round because your hormones are shifting as we lead up to the cessation of periods and cycles and then. You know, after that settling into this new phase, that there's still adjustment happening right at the hormonal level after period. Stop for a while after that.

Christina Venezuala: 12:35

Yep.

Sarah Bartel: 12:35

I love it. And so all of that can be this three to 10 year period, is that

Christina Venezuala: 12:39

mm-hmm. Yeah. And sometimes even longer. Sometimes even longer when you've hit that post-menopausal time. So it can be a long transition, ladies,

Sarah Bartel: 12:49

and that's okay. You know, change is, there's beauty to it. Let's go deeper. I love Christina that you have the theological background with your master's in theology from Boston College and can really draw that in. When I read your book, the Language of Your Body Embracing God's Design for Your Cycles. Last summer, I actually brought this with me when I traveled around France last summer and was really starting to reflect on, you know, my own season of life as I look at my own periods winding down and mm-hmm. Just, you know, I've got some young adult children now and I really appreciated how you drew in theological reflection to this. And especially I flipped to the back of the book and read what you had to say with some reflections about menopause because like a lot of women, I found like, oh gosh, these were good years of having children mm-hmm. Of having fertility and there is a sense of loss and saying goodbye to those. Mm-hmm. But you really tied it into, Christian life and the cross and resurrection and that, that we can look forward to good things ahead in menopause. Can you just share some of your thoughts there about Yeah. Just looking as Christian women with life in Christ and the, you know, in our spiritual life Yeah.

Christina Venezuala: 14:05

Yeah, so I think there's a lot to say about that particular question. I'm gonna try to keep my comments brief, but you mentioned the part of my book, which I have a special chapter that is about transitions, about puberty and perimenopause. And so for me, when I begin to think about this, I think about that word transition. So boys and girls, they both go through puberty. We both go through that transition, but women exclusively go through this second transition, and I think that's worth pondering when we think about how. Women uniquely image God and how women uniquely participate in our, in our faith, through our bodies. And so that word transition, if we go back there's a lot of himn, there's a lot of theological reflection in our faith, in our tradition, which utilizes the term ous means Let us Passover. And I, I just, it's so lyrical sounding, trauss let us Passover. And so that has resonances obviously with the Passover in Egypt, with Christ's celebrating the Passover at the Last Supper and connecting that with his death and resurrection, and then connecting that with our own baptism, that passing over from death to new life, right? And so when I think about all of these transitions, they are all connected with rebirth. An entrance into something new and something freeing and something closer to God. Every single time. Right. Wow. A, a Passover or a transition always brings us deeper into God's mystery of salvation. And so when we think about that, right, obviously there can be a mourning, there can be a very just grieving of the good things that we are leaving behind, but we should, as Christian women recognize that the invitation is there to enter more deeply into that spiritual life through this transition. Wow. Right? So I think that's maybe where I'll start and, and leave that for us to ponder. And I see resonances of that. Kind of in the liturgical life of the church in our understanding of what the new Jerusalem will be like. And so I do have a chapter in my book about uniting our cycles and the whole span of women's reproductive lives to the life of the church in that way. But I just, I just think that there's a lot of theological richness there that sometimes is lost because as a church we do really like to focus on the distinct ways in which women are fertile. Mm-hmm. You know, and, and the, the really dignified, beautiful aspect of being able to carry children in our wombs. Right. But obviously our holiness does not depend on that one ability. Right, right. And so I think, I think there is plenty of room for more writing on, on the dignity and the beauty of postmenopausal women and what we contribute to the church through our kind of just embodied selves, you know, and our witness.

Sarah Bartel: 17:10

It's so exciting when women engage in theological reflection. I love that you apply theology, the body to reflections on women's embodied experience. It's really cool. You know, in your book you mention that it's actually rare among mammals for mammals to have, to go through menopause. Yeah. It's sort of, a big I guess biological or evolutionary. I don't know. There's a sacrifice there, right? In like mm-hmm. And so it is unique and special that we human women experience this. And there are a lot of goods that come from having women in the community who are not fertile and childbearing themselves and who are available to help care for the younger generation or, you know, I guess two generations down. And I, yeah. So maybe do you wanna kind of share a little bit about that? Yeah,

Christina Venezuala: 18:04

yeah. So from, even from an evolutionary biology perspective, right? Menopause is one of those things that makes you go, hang on, this is different. Mm-hmm. Let's think about why. Why this may happen in these very few cases, and what it seems to be, what we're kind of beginning to, to look at is the importance of maternal care, right? That, that there are some species of animals, particularly animals that require that there young require a lot of attention from mothers. Mm-hmm. Where the mothers, the, you know, the mothers of the little ones need to be mothered, right. They need to have those other women who are there in the community who are able to tend to their needs because they're so very preoccupied with the little children for such a very long amount of time. Right? Yes. And so when we look at where menopause occurs with mammals. We're really seeing it in, in humans. And then I think there's a couple species of whale, right. And maybe gorillas, right? But, but I, you know, there's a, there's a trade off, right? Because then you have a whole subset of the population that's no longer biologically available for reproduction. So what do you get out of it? You get community and you get intergenerational support and wisdom and availability. Which I think is something that, especially in our day and age when I think we are rediscovering in America, particularly, like the importance of intergenerational living. Mm-hmm. That maybe this is something that is actually built into who we are supposed to be as a community of persons. I think there's some wisdom there that we can gain despite looking at even some of the, you know, what we might consider the evolutionary benefits of that.

Sarah Bartel: 19:47

Yes, I live in the Pacific Northwest here, and we have some resident pods of orca whales that hang out in our Puget Sound. And I, I like these whales and read books about them to my kids and the grandma, the matriarch grandma whales, she's really important. Mm-hmm. And when the mom whale needs to take a nap or go find some salmon, it's the grandma whale who is helping teach the young ones, you know, how to, how to sound out where some salmon are and will take them to go play when they're too frisky to nap with the whole rest of the pod. And she really has an important role. And I think that, yeah, in our, kinda our human society and in our church at large when I go to Daily Mass and, and I'm there with my, homeschool kids who are homeschooling that year, but I see lots of women who are later in life and some men also, I. Like they are nurturing our whole church by being there, praying, receiving the sacraments. That's a strength for all of us. And they're there. I just, I think I just wanna really highlight to women and myself that there is a lot of purpose and strength in these years of menopause that, you know, I, I, he, I have just the other day I had an email from a woman who said, she's really kind of at a loss with herself now. Her kids are grown and outta the house, and she's feeling a little depressed and at loose ends. And I just think it is beautiful to see that there is so much good that you can do. Mm-hmm. And that women can thrive in this stage. Mm-hmm. And I like how in your book you point out it's a little bit like a second girlhood. You know, when you're a girl, you don't have cycles, you don't have to mm-hmm. Think about them. It's not part of your life. And then again, in menopause, it is sort of, there's a new freedom in a sense. Mm-hmm. And I know historically a lot of women who have contributed a lot of culturally did so in their menopausal years. I think some of the suffragettes did that. Anyway, it can be a time of real creativity, contribution and thriving. Mm-hmm.

Christina Venezuala: 21:46

Yeah. One interesting thing. Yeah, I'll, I'll just play off of that. There's a, there's a naturopathic doctor that I love, and so she has a book called The Hormone Repair Manual. Her name is Laura Bride, and it's a great resource for anybody entering into perimenopause. I love to recommend it, but she talks about this and about how some different cultures kind of experience or express this differently. And I think in, in Japan, menopause the term translates to something like the renewal years. Oh. And, and she talks about how it's a very real trope that, women in their sixties or seventies, like, they kind of lose their filter and they kind of don't care what other people think anymore. So she talks about how, you know, when we're in our reproductive years, a lot of women, we, we tend to be conciliatory. We are community builders, we're nurturing relationships. And we're very sensitive to that. But once our reproductive cycles in the accompanying hormones kind of ebb away. We are left with something that for many women feels like this sort of raw revisiting of the wildness of childhood, right? Not, not needing to feel as conciliatory, needing, uh, having the freedom to be a little bit more yourself than maybe you've been over the past few years. Not a universal experience for sure, but definitely something to, to also think about as we enter into this time.

Sarah Bartel: 23:08

I love that. That's really great. Well, let's bring it back to a woman's love life. How, yes. What are some conditions that can just help her thrive during this perimenopause transition And yeah. Really you know, there's, there's, I mean, factors with natural family planning and spacing or avoiding, or maybe trying to conceive during these years that they've you know, she's married later in life and they're really hoping for some babies. So that's at play. But also, yeah, how to enjoy. Yeah. Feeling that confidence and maybe that yeah, the power that comes with losing the filter a bit. Yeah, yeah, yeah. Join love making more.

Christina Venezuala: 23:46

Yeah. So I wanna, I think maybe I'll start with talking about the libido aspect and then we'll, we can talk about that kind of in the context of how that plays out if you're charting with natural family planning, regardless of your, your family planning intentions. So I was kind of thinking about it and I was like, well, libido is complicated by, by three really big categories of things, right? So there's the biochemical reality of our body, and by that I mean the shifting hormones. So in perimenopause, we both have dropping estrogen that can give us like estrogen is a real feel-good hormone and can contribute to libido. So if our estrogen drops, we may experience a decrease in libido because of that, but also our ratio of estrogen to progesterone shifts. So we sometimes experience something like an estrogen dominance. And the problem there can be an interplay with cortisol and histamines and things, which makes us feel stressed and not in the mood. So estrogen can have a very complicating relationship with libido during this time. And then also we do get a little bit more insulin resistant as we head into perimenopause sometimes. And so blood sugar levels, you know, and just our energy, our available energy and things like that that can contribute as well. So if we're looking at kind of biochemical support for our libido, we can be thinking about those hormone shifts, right? We could be talking to our doctor about whether we're experiencing kind of severe symptoms where we would want some estrogen or progesterone supplementation there. We could be thinking about maybe managing our blood sugar. All of that can kind of help the biochemical state of our body to be operating a little more. Kind of, succinctly. Then there's the biophysiological, right? So all of these hormones then have actually physical effects. So our cervical crypts that produce cervical fluid, which is, and, and then also lubricated fluid, they can become less responsive and dry up during this time. So that can make it a little bit more difficult if you're feeling very dry. You can have fatigue if you're tired, right? You can sometimes with these hormones, experience more migraines or cramps or heavy bleeding, which all of these things just make us feel icky. Mm-hmm.

Sarah Bartel: 25:52

Right? The technical term. Yeah. That is the

Christina Venezuala: 25:54

technical term of I feel icky, right? And so all of these biophysiological things can contribute to low libido, not because your actual libido is low, but just because you just don't feel in the mood. Your body doesn't feel up to it. So tending to those things. And then I think stuff that we already touched on were more the psychological components that come along with perimenopause, so we can have. Decreased self-confidence because our weight tends to shift a little bit. Some of us experience hormonal acne for the first time. Our hairs are getting gray. Like we just kind of, when we start to feel unattractive, we start to act not in a way that's receptive to being attractive. Mm-hmm. Right. And then we have like all of the mood complications. We can have this worry about fertility if we're charting with NFP and we don't know what's going on with our cycles. A lot of times women are just anxious. Mm-hmm. And so that's gonna decrease your libido if you're like really not sure what's going on with your fertility, whether you're trying to conceive or trying to postpone pregnancy, you can have that anxiety or that grief or that worry either way. Right. And then the other component is, you know, the being a sandwich caregiver. Yes. Right, right. You're caring for maybe elderly parents at the same time you're caring for children. You are stuck in between those two things and the stress of that. And as you said, like even just the mental availability during this time can be so thin. So when we're thinking about our hormones and we're thinking about support through perimenopause, there's really multiple levels going on there. Right. So what I like to focus on with NFP is I like to make sure that women understand how their cycles are changing. Right now, and it's not a completely linear progression for everybody. We don't go through it the exact same way, but generally we can know what the criteria are for cycle changes in these different times. We can learn how those biomarkers may change. And I think this is a really good time. A lot of women don't realize that they should be adjusting their NFP protocols, right? Mm-hmm. And the vast majority of methods, I think billings would be the main exception there. The vast majority of me methods have very specialized protocols for transition times. They don't use the same sets of rules. And so I think sometimes women end up feeling stuck because they think like, oh, I've already learned my method. There's nothing else to learn. I just wanna say, regardless of what you've been doing, like this is a really good time to check in with somebody who has expertise in this. Mm-hmm. So that you can get the support that you need and you can talk through any of the particular things that you're going through. And sometimes even just having somebody to like send your chart to, or to talk through a frustration or to be like, Hey, can you help me troubleshoot this? Like that can decrease the anxiety sometimes so much, right? Yes. So I think women aren't aware that a lot of times they can't just reinvest in NFP instruction and get somebody who's really qualified to walk with them, like in their corner and to help them through this.

Sarah Bartel: 28:54

Yeah, absolutely. I just heard from a woman, woman in my class who was on progesterone support mm-hmm. For a few years starting I think around age 47, and then she got distracted from charting and all of that as they were in a big move and then conceived a baby at age 50. Oh my, my goodness. This is so precious and very courage. Praise the Lord. Yes. For those who are hoping to conceive, you know, later than I guess you would normally think of it, that it really can be something, that that is possible. But also I really appreciated seeing the charts of declining fertility rates because as, as we approach, our late forties, because for those who are using NFP to avoid, there becomes a, there comes a certain point where maybe you don't even need to keep tracking and charting, you know, if, if you don't have a very serious reason to avoid. And because isn't it something like you go from like four, three, 2% as you head into your late forties of, of rates of fertility?

Christina Venezuala: 29:57

Oh yeah. I think I, I'm trying to remember what the exact stat is, but I think on average, by the time you hit 47, there's only like a 5% fertility rate. So does that mean

Sarah Bartel: 30:07

like if you and your husband had sex and didn't do any charting for about a year, like there's a 5% chance during that year you would

Christina Venezuala: 30:15

what it means? Usually what that means is that only 5% of women would be able to naturally conceive. So it's not a per person fertility rate, it's a kind of per capita fertility rate. Mm-hmm. So that's, that's where these stats get really complicated, right? Because if you are in the 5%, that's still fertile. You could be really, really fertile, right? You could still be really, really fertile during this time. But per capita it's, it's very, very low. So that's, that's also an a complicating thing because I feel like sometimes when we get caught up in NFP stats. Right. There's, there's like fallacies about percentages and and things that can happen. So I wanna be careful, especially as an NFP instructor on not kind of promising or delivering too much. Sure. Yes. Which is why I think even if you're in that camp where you're like, you know what, we don't have a super serious reason to avoid, we think the chances are pretty low. We're, and it would help us a lot if we didn't have the stress of charting. I think that's even, even then to like, to talk to an instructor and to be like, Hey, what do you think about this based on my cycles? Does this seem to you like we're, we're pretty well into late perimenopause and they can give you a perimenopause assessment and they can check you and be like, yeah, oh yeah, well, or they could say like, no, actually you're still in early perimenopause. You probably have a number of years to go. We might wanna rethink that. Right. Or they could say, yeah, you're pretty well in late perimenopause. Odds are pretty low. So an instructor would be able to tell you that.

Sarah Bartel: 31:45

That is great to know. And back to my story, this woman had had several children before, so mm-hmm. Probably was in that, just general more, more fertile. Yeah. Um, camp. That's great. So for the, so some advice then is just check in with an NFP instructor and, learn about protocols for your time or get an assessment. Yeah. Yeah, that is really good. Seek that support. Yeah. What about, and then we talked about support for the biochemical factors. Somewhat, maybe some hormone therapy could be helpful. Yes. Yeah. Would you recommend, what kind of medical care would be helpful? I know there are special hormone doctors. A lot of the different branches or, methods of NFP have some medical management. Associated with them. What about just your regular primary care provider? I dunno, what are your thoughts on where to seek this medical support? Oh, I have so many thoughts. Oh, sure, sure. Yeah.

Christina Venezuala: 32:35

Yeah. I mean, it kind of depends. So here's, here's a sobering stat that I just saw. So there's a physician that I like to follow. Her name is Dr. Aviva Rom. She's a Harvard trained physician. I love her on Instagram. She's got some great books. She's not Catholic. She is not Catholic. She's very secular. But she does share our value, I think, of making sure that women can progress naturally through menopause with as many cycles as possible, because we do know that there can be big, long-term payouts to keeping our cycles intact through our reproductive years, rather than overriding them with hormones. So she's big on that. Now I gotta figure out what I was gonna say about Dr. That's okay. This was about hormonal support.

Sarah Bartel: 33:17

And what doc kind? What kind of doctors? What doctors?

Christina Venezuala: 33:19

Oh, okay. All right, Nathan. Ready. So, Dr. Aviva Rom shared a stat that in the United States, there was a recent survey done of OBGYNs, and only 30% of them reported that they had menopause training in their practice.

Sarah Bartel: 33:42

Whoa. Oh my goodness.

Christina Venezuala: 33:43

30% of OBGYNs get sufficient training in straw criteria for perimenopause and menopause assessments.

Sarah Bartel: 33:53

Whoa.

Christina Venezuala: 33:54

That is way too low. So what you wanna look for in a provider, I, I say this just as a caveat, that like your ob, GYN, may not be particularly well-versed in a lot of what we're gonna talk about. Your PCP, probably not either, right? Mm-hmm. And there's a

Sarah Bartel: 34:12

UK term for your PCP. I forget what it is like here in the States. Oh, right. It's like.

Christina Venezuala: 34:18

Your general practitioner, maybe that's it. You wanna Yeah. Your gp. I'm not sure. Yeah. So, so there is an organization, gosh, they just rebranded. It used to be called the North American Menopausal Society, menopause Society, nams, NAMS. But they just literally this year rebranded, and I cannot, for the life of me remember what their name is, but you could search for nams. Mm-hmm. And that would be a provider who does have sufficient menopause training. So you could search their directory there. I just

Sarah Bartel: 34:48

looked them up for you. And they're, now their name's just more simple. The Menopause Society.

Christina Venezuala: 34:53

The Menopause Society. Okay. So they've dropped the North America, so it's the Menopause Society. They have a directory. And, and they tend to be really good. And then also in kind of the Catholic world, we tend to think of like our naro trained physicians. Mm-hmm. The medical branch of Creighton, they have a lot of great hormonal protocols. And, and then also depending on other NFP methods, there are some that do have direct medical management support. Mm-hmm. So I love looking on my Catholic doctor.com. Ah so you can find physicians who may be licensed to even do telehealth services in your state so that you don't necessarily have to travel. And a lot of times hormonal workups can be ordered just via labs and done kind of asynchronously and then done via telehealth. So definitely check into my Catholic doctor as well if you're looking for physician support.

Sarah Bartel: 35:44

Wonderful. Yeah. I think the fem method has medical management and billings has their own billings. Trained doctors as well.

Christina Venezuala: 35:52

Yeah, so I mean, basically any NFP method can train, like can have doctors who are trained in their method. Right. This is what we're seeing more and more of, which I'm really excited by, is that, you know, providers are actually getting trained and doing support with their methods. I hope that eventually we'll kind of have universal support in that. That'd be wonderful.

Sarah Bartel: 36:11

Yes. Wonderful. So, so getting hormone support through medical management. You mentioned earlier on when you were outlining biochemical factors. That insulin resistance increases. So looking at our blood sugar can be really important as well. Right. And like yeah, flattening our glucose spikes, rounding out the glucose spikes can help our symptoms.

Christina Venezuala: 36:33

Mm-hmm.

36:33

Better.

Sarah Bartel: 36:34

What, can you say a bit more about that and how that might help our menopause experience?

Christina Venezuala: 36:40

Yeah, I mean it's, so basically as we kind of. As our hormone ratios change, right? Our insulin resistance levels can change, and over time what that can do is that can contribute to an elevated A1C. So if your doctor has ever run an A1C test, it's basically a a 90 day survey of kind of your historical blood glucose levels. Right. And so if you have consistently high A1C levels, which means that you could have consistently high blood glucose for a prolonged amount of time, you, you're at risk for developing type two diabetes. And so one of the things that we can do as we notice these hormonal shifts is pay a little bit more attention to our blood sugars. So for most women, that can be as simple as just making sure that we're getting plenty of protein. Yes. I feel like protein is the perimenopause buzzword in a lot of health circles. Like Right, get your protein, make sure you're doing your protein. But there's also plenty of ways, I mean, I think like blood glucose management is a pretty popular thing these days, right? You can get an over-the-counter continuous glucose monitor to wear. And to check your blood pre the blood sugar levels if you want to. Or you can just kind of enact some strategies that would be, making sure that you're doing healthy, balanced meals and not starting eating with carbohydrates. Like start eating your starchy things or your proteins first and finish with your carbohydrates. That can be a very easy way. Or like 15 minutes of walking after a meal Yeah. Can be a very easy way to manage those blood sugar spikes. So just being kind of like little changes like that, you don't have to change your whole diet, but just maybe changing up some of your. Your eating habits can go a really long way towards keeping that A1C low and decreasing your overall chance of type two diabetes later on.

Sarah Bartel: 38:26

Yes. And then you mentioned the drying up with a cervical Crips not necessarily producing as much mucus. And I just wanna make sure any woman listening this conversation knows she can, she can talk to her provider about getting some cream, some, is it estradiol? I'm not sure I'm saying that right, but like a Oh, estradiol. Yep. Mm-hmm. Here we go. Thank you. Yeah. To help with vaginal dryness during intercourse, that that can be really an asset to helping you thrive in your love life through these years.

Christina Venezuala: 38:56

Mm-hmm.

Sarah Bartel: 38:57

Okay. And then, then you mentioned thirdly, psychological factors, worrying about fertility being in that sandwich caregiving generation, and then also just your relationship with your husband as well, which I think is such a strength in your perimenopause prep course that you designed some exercises in there for the wife to do with her husband, and, and they reflect on what changes have they been through together in the past. Mm-hmm. How did that go? How did each of them react to those changes? And then let's think ahead, how would we like this change to go? Let's create a vision for, how we can see ourselves really thriving through this. So, I know Christina with your also your strength from being a lay Dominican, you mentioned when we chat about this inside my delight, you were like, happy that reflection exercises can be valued and, you know, drawing in our intellectual abilities as well, right?

Christina Venezuala: 39:50

Yeah. Yeah. And that can increase your emotional bonding as well.'cause the head and the heart go together, so.

Sarah Bartel: 39:56

Absolutely. And I think just having those conversations with your husband, you can really help you feel like you're in it together. Mm-hmm. And then when you feel more emotionally connected, guess what? That is a big factor in libido as well. Mm-hmm. So even if you have these psychological, or I mean biochemical and biophysical physiological factors, you, have a lot of control over what's going on. With the, your, your emotional intimacy with your husband. Mm-hmm.

Christina Venezuala: 40:21

Well, and I think a lot of what we've talked about too with women kind of in our, in our mental approach, right, that we wanna have a positive approach and a positive framing for perimenopause and menopause because so, so often we do not get that, right. The only thing we hear about menopause are hot flashes and how everybody gets cranky to put it mildly, right? Like that's all we hear. And everybody and men are like, oh, don't talk about it. Don't talk about that menopause, whatever. And they, it's the very taboo sort of thing. So we have internalized all of those negative stereotypes about menopausal women. And of course that's gonna impact our self perception and that's gonna negatively impact our experience with our body as we go through this. But we're not the only ones who have internalized that like our husbands. Even if our, our great, wonderful husbands, like if they've never heard anything positive about perimenopause or menopause, then they're gonna be dreading it too. And so I think this element of shared education and a shared experience where we invite our husbands in to like, rethink this with us. Let's approach this as a team and let's see this as an opportunity to deepen our relationship. Because I think there's so much fear about what the relationship will look like when that fertility status changes sometimes. Right? There can be a lot of unknowns about that. And so I, I, I tend to find that men. When we tell them we really want them to like, do something with us, are usually very receptive. Right? Yes. And so, I wanna explain this to you, right? So we're not gonna sit down and we're not gonna talk about our feelings the whole time. We're gonna make a plan, right? Yes. And guys will be like, yeah, I like to do that. You know? So, so inviting them into that and making them a part of the learning process and a part of the planning and implementation phases of how we navigate perimenopause, I think is just a smart thing to do and can be so beneficial for your relationship long term.

Sarah Bartel: 42:19

That's true. It's not just the wife going through menopause. I like how in your book that's, you talk about how men who are married to women, live a cyclical life as well. Mm-hmm. Because they're married to a woman who is cycling or, end cycling with menopause. So it is something that through that one flesh union and through your, your marriage bond, you are doing this together. That is really wonderful. Well, Christina I just love everything you create and one thing though that I don't know that much about is Boston Crosscheck, and I think it would be really helpful for Yeah. For our audience to hear more about what this type of natural family planning, what makes it unique, what it's especially great at. Yeah. Yeah. Just enlighten us.

Christina Venezuala: 43:01

Yeah. So Boston Crosscheck, to give a very clunky intro definition, right. We would call it Athermal hormonal method. Wow. So yeah. Yeah. So Boston Crosscheck in our standard protocols, everybody learns how to observe cervical fluid. Very simplified categories, not complicated like Creighton, but simplified categories of cervical fluid basal body tracking, either with oral thermometers, oral wearable called the temp drop. Mm-hmm. And then hormone tracking with the clear blue fertility monitor. So everybody learns all three. You're not required to use all three, but you learn how to use them so you have them in your toolkit. Okay. Wow. And then what we do is we help our clients work through what's called a crosscheck to identify the end of fertility. And so they use any two, any combination of at least two of those or three, to chart their cycles and to track their cycles. So a similar method, actually a similar approach would be the Marquette method. They also have fluid and monitor and temps. Oh yeah. A lot of people won't know about the temps. I thought just monitor. Yeah, yeah. No, no, no. So Marquette has fluid and monitor and temps. So people are like, well, what's the difference? The difference is Boston Crosscheck started out as Athermal method way back in the 1970s, and for many, many years was the kind of in-house method with the Archdiocese of Boston when their NFP office closed the method, then gained independent status from the archdiocese and is now owned by lay people. And so it's a very small method, but it really retains in a lot of the ways that we approach calculations for the start and the end of fertility. A very strong symptothermal core. For anybody who's familiar with the Symptothermal approach with fluid and BBT. Marquette. Ba I just wanna il body temperature. Yes.

Sarah Bartel: 44:53

Say what? The acronym standpoint? Yes. Make sure I don't

Christina Venezuala: 44:55

use the buzzwords. Sarah. Yes. So Marquette, I think four ease of use is really built around the hormone monitor, right? And so there are some things that they do with their fluid and with their temperatures that kind of reflect that centrality of the hormone monitor. So they'll, they'll do things a little bit differently than we do in terms of working around some of the quirks of the monitor, incorporating the fluid in the temps in different ways. I tend to find that Boston crosscheck, it's built for simplicity and to be a little bit conservative. Mm-hmm. So by that I mean that if you were using the same three biomarkers with Boston Crosscheck and Marquette, your fertile window with Boston Crosscheck in a regular cycle might be anywhere from like 12 to 36 hours longer. Possibly, depending on how your biomarkers line up. And so people who like Boston crosscheck, they like the initial investment in learning all three of the biomarkers because you'll learn all of them. You don't have to use all of them, but you learn how to do all of them so that you can switch up your method basically anytime you want to without having to retake a course without or without having to, you know. Mm-hmm. Um, so you have the autonomy and the flexibility to do that on your own.

Sarah Bartel: 46:11

You would, and

Christina Venezuala: 46:12

then

Sarah Bartel: 46:12

choose like a two di, like a different combination of two methods depending on

Christina Venezuala: 46:17

what, so for example, I, I had a client one time, she, yeah. She was working with her her monitor and cervical fluid and her toddler threw her monitor in the toilet.

Sarah Bartel: 46:32

This is real life. I can totally see that happening. This

Christina Venezuala: 46:34

is real life. And she was like, I just, I cannot afford a replacement. I just dunno what to do. And so the next cycle, she was like, well, I know how to use temperatures. Like I can st, I can do fluid in temperatures. And she just switched it up for a while until she felt like she could invest in a monitor. Then she did all three and then her temp drop went through the wash. And so she just went back to the fluid and the monitor. But it's like very, very flexible and adaptable. Is, and even when your situation changes. So, I have one client that chooses her different biomarkers. She's a, a flight attendant. And so based on, which, which shifts she's doing, she'll switch up her biomarkers to make it easier to either track in the morning or in the evening. Like it's super flexible. And then I think that other people, they tend to like the, the fact that it is a little bit more conservative, it just makes people feel sometimes if they have any, any anxieties about identifying that fertile window, or they feel like they, they got pregnant kind of right on the cusp of a fertile window with a different sort of method. Having that little bit of an extra buffer helps them feel a little bit more confident as they're easing back into an NFP method use. So we find that a lot of people who may have had, unexpected pregnancies and other methods, sometimes feel very comfortable coming to this method.

Sarah Bartel: 47:50

That is really wonderful. It's so great to know that this is available and that flexibility sounds really great as well as the reassurance you've, you've got, you're literally cross checking, you're getting additional information. It's so important to be able to create a culture, I think, in our church where we can normalize NFP, where it's more familiar. And I love that you have contributed a really valuable resource to doing this with your NFP Ambassador Resources. Oh, yes, we close. Can you just, I just wanna highlight that a little bit. Can you tell about what you've created here? Yeah, so

Christina Venezuala: 48:26

I have a training program that's really, it's it's a discernment program really for anybody who feels called to share about NFP, but you're not quite sure how, because I've met a lot of women who are like, I wanna be like an NFP support person, but I do not wanna be teaching clients Uhhuh. Uh, I, I think that those two things, they don't have to go together. And so a lot of times, you can sit and you can think about, okay, well how could I support NFP in my unique community? What are our needs? What are our challenges? What is our unique demographic makeup? Where are the resources that I can contribute? So the NFP Ambassador Training course is helps you sort through why you may be feeling this call and what to do about it. Because I think that there's a big difference between kind of NFP evangelization uhhuh, which is bringing more people into NFP versus NFP support, and I think that, that people feel differently about those aspects, right? So that's one thing, like discerning where am I called to serve in this? And then how do I actually make a plan? And then it gives you a whole big catalog of teaching on, okay, what is the church teaching on NFP? We'll, make sure that you're really well equipped to understand that what are the different biomarkers and the different methods? Not that you need to help people find a method, but just be aware of what they are. And then what are some common pastoral situations that we should be sensitive to when we are promoting natural family planning or, if we're working with any other parish staff people, like how can we help them become more sensitive to some of these issues?'cause I think we just don't talk about it all that much. And so there's a lot of assumptions, especially sometimes on the part of the clergy, that like, this information is readily accessible to anybody who wants it Totally. That it's totally free, right? And, and so clearing up, even just clearing up some of those misconceptions can go a big way towards making sure that you can pave the way for NFP support in your community. So that's what the NFP Ambassador training is about. So individuals can go through it, or I do have diocese that actually sponsor people to go through it for the diocese and they make them like their point people for NFP throughout the diocese.

Sarah Bartel: 50:32

Wow. And I know a woman at our parish went through and was able to really kinda look at how are we as a parish supporting NFP, making it known to our marriage prep team. So now we have a couple that meets with every engaged couple who comes through our parish for marriage prep. Nice. Yes. And yeah, just make sure that materials are around that the different part, you know, people and parish staff are equipped to to be able to Yeah. It literally

Christina Venezuala: 51:02

can be that simple sometimes and make a big difference. Yes. So

Sarah Bartel: 51:06

wonderful. Okay. All of this, the. Cycle prep course, perimenopause prep, NFP Ambassador Training, I think even the connection to your NFP instruction through Boston Crosscheck. Is that also available on your website, Pearl and Oh, on my

Christina Venezuala: 51:21

website? Yes. Yeah, Pearl and thistle.com all spelled, spelled out. Yeah.

Sarah Bartel: 51:26

Can you tell us about the Pearl and Thistle? How did you choose this?

Christina Venezuala: 51:29

I know this is your favorite topic, doesn't it? I love it. Yes. So I am a direct descendant of St. Margaret of Scotland and King Malcolm Canmore. And so when I was reflecting on a business name, Margaret just kept knocking on my door. You know how sometimes they do that, you know, or, yes, I sure do. And, and so I really thought, you know what? I, I am just really feeling called that, like the business should reflect where I come from. And reflect my ancestry. And so Margaret was known as the Pearl of Scotland. Mm-hmm. And the Purple Thistle is the Scottish national emblem and the symbol of the royal family in Scotland. And so the Pearl and Thistle stand for both Margaret and Malcolm, respectively.

Sarah Bartel: 52:12

Oh, that's so wonderful. Yes. Margaret means pearl, doesn't it? It's a Greek word for Pearl. Yeah. One of our daughters, her middle name is Margaret. And when my oldest daughter, I, went to visit her in Scotland, I saw actual thistle flowers growing, in the fields all around, but also the symbol of thistle just everywhere. Really, really cool. And the the Catholic student group there meets at Canmore Hall that they've named their whole Canmore Hall. Oh, I love it so much. Yes. It's really neat. So it's really wonderful to be able to see. Mm-hmm. The, the tower there, there's the remnants of the foundation of the tower where St. Margaret. And Malcolm Canmore made their, their first home. Mm-hmm. Just wonderful. And I was praying for you and all these Oh, I know. That was so sweet. Thank

Christina Venezuala: 52:57

you.

Sarah Bartel: 52:57

Yeah. All those were blessed by your ministry, so I think that's really special. And who knows among us, you know, who else might be walking around not knowing that they're descended from saints.'cause wasn't this something, you know, discovered later in life or, I mean, not as a child, but as an adult, right?

Christina Venezuala: 53:12

No, as an adult. Yeah. And, and there's even like a whole big backstory to that. Like, so you mentioned that I'm a lay Dominican and so in the lay fraternities we're allowed to take a religious name. And so my name is Zelly Margaret for Zel Martin, theres's mom, and then Margaret. And I wanted moms. I was like, if I'm gonna do this vocation right, I need two really holy moms on my side. And I had been really inspired by Margaret, like, and I, and just to sidetrack a little bit as I think about her patronage of my business, I see. How it really was her relationship with her husband and then their relationship with their children, like this whole family community, which is incredibly inspiring to me. So if you've never read about their family, please, if you're listening, go look them up. They're amazing. Yes. But I had taken this name Zelle Margaret, and then it was like three years later when my mom was going through a backlog of family genealogy stuff that she was like, wait a minute, like we can trace our ancestry back even further than this particular lineage says, and we can get back to Margaret. She's like, did you know we're descended from Margaret? I was like, get. You already

Sarah Bartel: 54:22

chosen? I had already already chosen.

Christina Venezuala: 54:24

Well, I guess we could say she chose me, right? Yeah, because she was really, she, again, just like she knocks on my door a lot, like she's there for a lot of things in my life. So that's a really special connection to have. That's, I know

Sarah Bartel: 54:35

just what you mean, st Theres does that with me. She's everywhere I go. You know, we, when traveled to France we had trouble finding, I mean, there's lots of French churches everywhere, right? But not all of them are open for mass. But it would happen that we would find like, oh, let's go to this church. And it's named after the saint there. I'm like, oh, thank you St. Theres, she's just, she's my gals a Wonderful. Well, thank you so much, Christina, for sharing about all these great resources that you've created. Thank you for everything you do to support women and the church and couples. It's been a real joy talking with you.

Christina Venezuala: 55:11

Thank you, Sarah, for the opportunity. I love chatting with you too.

Sarah Bartel: 55:13

Alright, well catch us next time. On my delight. God bless.