January 31, 2023
268: A Guide to Navigating Menopause and Healthy Aging with Dr. Michelle Tollefson

Menopause symptoms can be socially and physically challenging for most women. So, Dr. Michelle Tollefson is back on the show to share how to enhance aging women's health and well-being. Learn more from her healthy expert guid...

Menopause symptoms can be socially and physically challenging for most women. So, Dr. Michelle Tollefson is back on the show to share how to enhance aging women's health and well-being. Learn more from her healthy expert guide on treating menopause symptoms through lifestyle interventions and a plant-based centered diet.

Key takeaways to listen for 

  • The role of nutrition for women facing menopausal symptoms
  • Why physical activities are essential during perimenopause and postmenopause stages
  • Stress-related menopausal symptoms and how you can manage them
  • How to effectively navigate your sexual health and well-being as you age
  • The power of social connection and having a support system 
  • What you can do to reduce the risks of breast cancer

Resources mentioned in this episode

About Dr. Michelle Tollefson

Dr. Michelle Tollefson is a physician and associate professor in the Health Professions Department at the Metropolitan State University of Denver. She teaches in the Integrative Therapies program and is the current secretary of the American College of Lifestyle Medicine.

She worked as a private practice obstetrician and gynecologist, until leaving to work with Poudre Valley Health System as a medical director and director of Women’s Wellness Education. She is a certified wellness coach, guest faculty for Harvard, and author of online continuing medical education for the Harvard Institute of Lifestyle Medicine. She is passionate about women’s healthcare, lifestyle medicine, and teaching people to lead healthier and happier lives.

Dr. Tollefson is a graduate of Creighton University, where she received her Bachelor of Science and Doctor of Medicine degrees. She completed her obstetrics and gynecology residency at the University of Missouri in Kansas City and received her board certification in this medical specialty.

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[00:00:00] Dr. Michelle Tollefson: In order for us to have the level of estrogen that we should have as healthy women, we need a healthy gut microbiome. And our gut microbiome becomes even more fragile when we go through menopause because of those hormonal changes. So it becomes even more important to nourish our gut microbiomes. 

[00:00:15] Maya Acosta: You have more power over your health than what you've been told. This is the Healthy Lifestyle Solutions Podcast. I'm Maya Acosta and I'm passionate about finding healthy lifestyle solutions. To support optimal human health. If you're willing to go with me. Together we can discover how simple lifestyle choices can help improve our quality of life and increase longevity in a big way.

[00:00:39] Maya Acosta: Let's get started. All right. Welcome back to another episode of the Healthy Lifestyle Solutions podcast. I'm your host, Maya Acosta, and we have Dr. Michelle Tollefson back on the show welcome. 

[00:00:53] Dr. Michelle Tollefson: Oh, thank you so much for inviting me back to be with you. It's a pleasure. 

[00:00:56] Maya Acosta: Yes. I'm very excited to have you back and I just wanna kind of remind our listeners that we just completed the Lifestyle Medicine Conference this past week, and you were there and I finally met you in person.

[00:01:10] Dr. Michelle Tollefson: Yes. It was great to be able to connect in person again after so long of only having virtual meetings with everyone in conferences. It was such a fun conference, wasn't it? 

[00:01:18] Maya Acosta: Yes, it really was. And I miss the Women's Health Stronger Together Workshop. That was the pre-conference workshop because we flew that day.

[00:01:27] Maya Acosta: But I was able to connect with, you know, the women's interest group did have a meeting and I was able to connect with everyone there. I wish I could have had, you know, more time. It's just these things go by so fast. They 

[00:01:38] Dr. Michelle Tollefson: do. But yeah, connected with so many like-minded people who are passionate. Lifestyle medicine.

[00:01:44] Maya Acosta: Exactly. So, Dr. Tollefson, I picked up a copy of one of the books that we'll be talking about today, and it's the Paving Path book, but this one is on menopause and you can see there that I've been going through it since I picked it up. It's one of those books, and we will be talking about this today. It's one of those books that is really intriguing when you're an individual like myself that wants to know, what can I do?

[00:02:09] Maya Acosta: To go through this phase of my life without so many complications. And so let's talk about that. How did you decide to write a book on meta? 

[00:02:18] Dr. Michelle Tollefson: Sure. So I, um, of course I was trained in how to help women who were menopausal as an obstetrician gynecologist. But then when I was diagnosed with breast cancer and went through chemotherapy, I went through menopause several years earlier than I was planning on it.

[00:02:33] Dr. Michelle Tollefson: The average age of menopause, the United States is about 51 years or so. So I went through menopause with. Chemo. And then because of my breast cancer type, I had my ovaries removed and I'm also on medication for about 10 years. That decreased the amount of estrogen in my body and because of my cancer type, I can't have any hormone replacement therapy.

[00:02:52] Dr. Michelle Tollefson: So I went through menopause in addition to being an active cancer treatment. And when I my chemotherapy, I thought that most of my symptoms would resolve and many of them did. However, I was still left with. Fatigue and with some brain fog and with hot flashes and night sweats. So I, I was already trained in lifestyle medicine, so I started to try to embrace even more of the healthy lifestyle practices that I was already doing or that I knew of.

[00:03:18] Dr. Michelle Tollefson: But as I was looking for resources for myself and then also for others who were saying, what do you recommend for hot flashes and night sweats? I. Frustrated or disappointed to realize how little there was in the public arena as far as evidence-based information on healthy lifestyle behaviors and menopausal symptoms.

[00:03:36] Dr. Michelle Tollefson: It really is an area where it was hard to find information that was. Truly evidence-based or that was recent. It was like they were either really out of date or otherwise. I felt like they were skewing the science to say that there was like a magic food that would take away all your hot flashes and night sweats forever, or they were saying it had no impact at all.

[00:03:53] Dr. Michelle Tollefson: And so I really felt like I wanted to get the information out. I was learning about it, I was looking into the research, I was digging into it. But not everybody has time to do that. And I think that as a breast cancer survivor, I feel really passionate about getting information that I am able to access out to everyone.

[00:04:10] Dr. Michelle Tollefson: I don't feel like it should be information that you should have to go digging through the literature or be a women's health lifestyle medicine expert in order to access. This should be information that I believe all physicians are taught during medical school, or OBGYN Residents are taught during training that they can pass along to their patients, and so this access issue was something I discussed with.

[00:04:29] Dr. Michelle Tollefson: Dr. Beth Frates. After I finished treatment for chemo, I did the paving path to wellness group with Dr. Amy Comander, who is leading paving the path to wellness for breast cancer survivors. Dr. Beth Frates created the program. Dr. Amy Comander modified it for breast cancer survivors, and I attended her program.

[00:04:47] Dr. Michelle Tollefson: And then afterwards, Dr. Frates, Dr. Comander and I wrote the Paving the Path to Wellness workbook based off of all of Dr. Frates work. And so we had finished that book and I was talking to Beth, Dr. Frates about my struggle with finding good resources for women who were going through or who had gone through menopause.

[00:05:06] Dr. Michelle Tollefson: And she said, I think we need this. And I said, I don't think I can write another book. I think you're, I don't think I can co-author another book. It takes so long. But she said, no, this information really needs to get out there. And so she said, let's co-author it together. So Dr. Amy Comander, Dr. Beth Frates and I co-authored this new book, paving a Woman's Path Through Menopause and Beyond, because it really, we often focus on menopause as if like that's it, but really it's menopause and we want women to thrive through menopause and then beyond healthy aging.

[00:05:36] Dr. Michelle Tollefson: So anyway, that's our book. It was definitely a labor of love and I get so excited when I hear that it is being embraced or people are finding it useful because it truly came outta us wanting to do this, to give back to women or to get them access. And all proceeds from both of our paving books, the Paving Impact Wellness Workbook, as well as this menopause book. All the proceeds go to the nonprofit paving wellness.org. 

[00:05:59] Maya Acosta: So, Wonderful. Well, I'm enjoying it. And uh, you know, before we started recording, I said I think every woman should have this book, sort of like the other book on breast. And there's a book you recommend in here that really talks about the female health and, uh, I can't remember the title of it, but I'm currently, I just started listening to it and I believe that physician has a podcast as well.

[00:06:22] Maya Acosta: And so I'll mention it later when I rerecord the intro, but it's a work. And I've been going through every section of it and you know, you say you can follow this however you want, however it calls you. So I jumped around immediately first to exercise. So I kind of went through various areas as well as timeouts.

[00:06:43] Maya Acosta: And stress those areas that I feel like are calling me. And usually when we think of immediately what can we do right now to reduce the menopause symptoms, we always think of nutrition. So maybe we can start with that. Like what role does nutrition have in terms of the menopause symptoms? 

[00:06:59] Dr. Michelle Tollefson: Yeah, so it definitely plays, definitely plays a role. So our gut microbiome, the bacteria that help us with so many things, but to live a really healthy life, they are in our pessin and part of the gut microbiome is what's called the estro, or they're actually the microbes that help us with metabolizing and modulating estrogen. And so in order for us to have the, the level of estrogen that we should have as healthy women, we need a healthy gut microbiome.

[00:07:26] Dr. Michelle Tollefson: And our gut microbiome becomes even more fragile when we go through menopause because of those hormonal changes. So it becomes even more important to nourish our gut microbiome. So that's fiber, fiber fire. We know that women in the United States are fiber deficient, and so women. Should be getting about 25 grams of fiber a day, and then we say after menopause, probably still about 22 grams a day.

[00:07:47] Dr. Michelle Tollefson: Some groups like the American Institute Cancer Research recommend that it's even higher, but we're fiber deficient. Hopefully your listeners probably aren't deficient, but overall, we're fiber deficient, and so we want to nourish our gut microbiome with fiber so that it can flourish. We also want to be giving.

[00:08:02] Dr. Michelle Tollefson: Enough fermented foods, so I love encouraging my patients to get in there fermented foods like Tempe or a plant-based yogurt. I do a smoothie every day that has some plant-based yogurt or miso, or finding ways to get those fermented foods in the sauerkraut or, or the pickles that you buy in the refrigerated section.

[00:08:20] Dr. Michelle Tollefson: Also, we know about the role of phytoestrogens and phytoestrogens are plant estrogens, and so we used to worry about women getting too much of this as far as their risk of breast cancer, but actually we know now that phytoestrogens are beneficial even for women like myself who have a history of estrogen.

[00:08:38] Dr. Michelle Tollefson: Breast cancer. What they do is that they almost like gently cover the estrogen receptor. So in some places, they like gently stimulate it, and in some areas they gently protect that receptor from being stimulated really hard by our body's own estrogen. And so eating phytoestrogen, so minimally processed soy or whole soy can really help vasomotor symptoms or hot flashes and night sweats for many women.

[00:09:01] Dr. Michelle Tollefson: So I recommend considering using soy. I don't like soy supplements or soy isolates. I think they can stimulate that receptor differently than whole soy foods, so I'm gonna recommend whole or minimally processed soy. It's also been shown to possibly help with vaginal blood flow and lubrication, which is an issue after going through menopause for so many women.

[00:09:21] Dr. Michelle Tollefson: It may not completely reverse it, but it's important to note that that can help with vaginal blood flow as well. There's some great research out there. Dr. Neal Barnard and his colleagues The Wave Study that looked at adding a half cup of cooked soybeans daily to one's diet, along with having a low fat vegan diet, and it was found to significantly decrease the incidence of hot flashes as well as improve overall menopause quality of life.

[00:09:45] Dr. Michelle Tollefson: Now, we don't fully understand why many women have benefit with their hot flashes and night sweats when they eat. Plant estrogens or phytoestrogens, but not all women. So we think that there's probably more, well, we know there's more that we still need to learn about the gut microbiome, so we still need some more research.

[00:10:00] Dr. Michelle Tollefson: But many women do notice a significant improvement. Also, when I'm talking to women who have hot flashes or night sweats, I tell 'em they need to be mindful of their hydration because some women have hot flashes that are triggered by even mild dehydration. They should watch their alcohol and caffeine intake.

[00:10:16] Dr. Michelle Tollefson: I recommend that people don't start drinking alcohol if they don't already drink it, and if they limit it to one glass or less a day of alcoholic beverages. But for some people, Alcohol can trigger hot flashes and night sweats. For some people it can be caffeine. Also, recommending that women get enough omega-3 fatty acids that's found to be beneficial in addressing hot flashes and night sweats.

[00:10:34] Dr. Michelle Tollefson: Many women, so nuts and seeds. And then also avoiding the sugar cycle, which is important for all of us, but that eating refined foods are refined carbohydrates that have our, our blood sugar go up and then come crashing down. So we wanna make sure that we're getting a lot. Plant fiber and making sure that that's optimized during our perimenopausal time, that transitioned through menopause and then beyond.

[00:10:55] Maya Acosta: Well, I can testify that since I stopped drinking alcohol, I no longer have hot flashes and . It's so funny that, and also, like you said, not so much the caffeine for me. If I do have a coffee in the afternoon, I can tell right away. I start to feel hot, but in the morning it doesn't affect me. But also, Eating whole foods, the less processed, the better for me.

[00:11:18] Maya Acosta: And the workbook allows you to document all of this. It's a very interactive book in terms of really writing down the things that we're noticing. It's really like personal work. What about physical activity? Why is that important in the peri and postmenopausal faces? 

[00:11:34] Dr. Michelle Tollefson: Sure. So exercise is important throughout a woman's life spam, but it becomes even extra important as we go through the menopause transition and then beyond.

[00:11:43] Dr. Michelle Tollefson: When women lose that estrogen mm-hmm. , what happens? It usually tilts our balance, so it decreases muscle mass and often we see fat mass increase in metabolisms. Slow. And so even if we're eating the same amount of calories, and even if we're moving the same amount, often we'll start to lose some lean muscle mass, and that's not what we want.

[00:12:02] Dr. Michelle Tollefson: We wanna maintain our lean muscle mass. It's not that we wanna be bodybuilders necessarily, but we want to maintain our lean muscle mass. And so that's why in addition to doing aerobic activity, it's really important that we do resistance training in order to maintain our muscle mass and our muscle strength.

[00:12:17] Dr. Michelle Tollefson: It also helps to keep our metabolism where it was before or to maintain. We know that resistance training in per postmenopausal has been to increase life satisfaction, physical function. So I'm years down the road, I wanna be 90 and still able to pick up things off the floor and to get down and get up.

[00:12:34] Dr. Michelle Tollefson: It also supports positive wellbeing and. Resistance training in and of itself has also been shown to decrease hot flashes and night's when you just look at resistance training. I'm a huge proponent of resistance training, like those resistance bands. I did my resistance bands this morning in my bedroom, you know, just doing some different strengthening exercises, working on posture and pulling back, and some arm strengthening, going to the gym or working with a physical therapist or.

[00:12:57] Dr. Michelle Tollefson: Certified trainer who has expertise, that's great. But even just some bands at home or lifting some small weights can be beneficial too. And then aerobic exercise is important. We know that aerobic exercise is also, well, in some studies it looks like it's probably beneficial with helping with hot flashes and night sweats.

[00:13:14] Dr. Michelle Tollefson: But even if we take that out, it still is, is so important for so many areas, whether it's cognitive health, brain health, bone health, decreasing our risk of dementia, we really see a dose response relationship. So as somebody is more cardiovascularly fit, their risk of dementia goes down. So a huge, huge role as far as maintaining our brain health.

[00:13:33] Dr. Michelle Tollefson: We also know that it decreases the risk of some cancers as well as some types of cancer recurrence. I think one of the things that's really fascinating is that one of our most newly identified hormones is called irisin, and that's released by skeletal muscle during and after. And so Irisin is important because it helps to inhibit or delay dementia.

[00:13:54] Dr. Michelle Tollefson: It helps predict our tel length so that the end of the chromosomes that are shortened with aging. It also helps with bone strength increase our insulin sensitivity and how our body responds to sugar. It also works along with rain derived neurotrophic factor or BDNF, which John Brady calls Miracle Growth for the brain.

[00:14:13] Dr. Michelle Tollefson: So doing physical activity is so, so important for so many reasons. Huge proponent of it for women across the lifespan, but especially perimenopause. It is so important. Different things that help with balance. Training, so like yoga, great research out there on yoga, things that help you maintain your flexibility and balance. All of that is so important. 

[00:14:31] Maya Acosta: Yes. And I was actually looking at that resistance training and also the working on balance because I was thinking, you know, and you mention it, that as we get older, we wanna reduce our risk having, you know, for falling. Because once we have sort of a hip injury, Or anything like associated with that, then the complications then begin even more.

[00:14:52] Maya Acosta: And if only we knew about the importance of exercising earlier in our years, we can easily go into menopause and into our older age with this practice already in place. But I've noticed, because I'm interested in signing up for a few classes, that there are so many dynamic fun classes now that. Not the typical Pilates class, not the typical yoga class that we have thought of in the past.

[00:15:18] Maya Acosta: So I'm looking forward to signing up for more classes so that I can also be more physically active. This is great. That's great. You bring up that 

[00:15:24] Dr. Michelle Tollefson: Joy of movement, right? It's finding what you enjoy, what speaks to you. For me, I love doing Zumba in the morning. It is, it's finding what resonates with you, with your listeners, what resonates with them, what is joyful, what helps them feel alive and really focusing on.

[00:15:37] Maya Acosta: Yeah, you mentioned stress in the book and I jumped to that section as well because I have dealt with stress and I've often said that the pandemic really brought a lot of things to the surface, but also I began to transition into menopause during that time. So it's hard to say which is the one that's affected me the most.

[00:15:54] Maya Acosta: But you say that society teaches women that stress is something to be avoided and conquer. You know, it's almost like we're not supposed to feel this way and there's the good stress, but also the stress that can actually affect our health. And I was wondering if you could talk about that. And then, you know, some of us that experience stress can have something like emotional eating or excessive alcohol intake.

[00:16:17] Maya Acosta: If you could talk about that. And another thing that I wanna point out that you mentioned, because I'm in a different place in my life, I don't care for parents, I'm not raising grandchildren, but many women that are making that transition are responsible for other people, maybe adult children that are still living at home or sending a child off.

[00:16:34] Maya Acosta: To college. So these are all the different things that are affecting us. It's a time when we feel like we're losing something or we're losing a part of our lives or making this transition caring for parents. Can you talk about how we can navigate that and how does stress affect our experience in of menopause?

[00:16:52] Dr. Michelle Tollefson: That's a great and great issues that you point out. So yes, we become more sensitive to stress as our hormones change. We know that progesterone is, it has a calming effect and so we lose that progesterone or we are, the progesterone decreases and so we become more sensitive or we have like a heightened or exaggerated sensitivity to stress as we go through the menopausal change.

[00:17:15] Dr. Michelle Tollefson: And then postmenopausally, it's important to practice stress resilience or to look at how we can become more resilient to stress. Across the lifespan, but especially when we're going through the menopause transition, we need to first of all be compassionate and honored that it is harder for us to deal with stressors that were more sensitive to stress.

[00:17:34] Dr. Michelle Tollefson: So maybe things that used to happen years ago, maybe we could have like calmly sailed through it. But now some things that might before have been not a big deal, might feel like a big deal, and to become compassionate to ourselves and say, It's not that I'm crazy, I am not a bad person. It's just that because of my hormonal changes, I am more sensitive to stress, and so I have to be extra mindful at how I take care of myself and self-compassion about my health.

[00:17:57] Dr. Michelle Tollefson: Talk about having a growth mindset. I do not need the perfect Thanksgiving dinner or the perfect Christmas dinner, right, or the perfect decorations. Really, it's about coming together and being together and nobody's perfect. We all feel these different things, but just that self-compassion and self-talk.

[00:18:11] Dr. Michelle Tollefson: I love that the painting. Program that Dr. Fates created has the focus on attitude cause that can often help us with our stress when we have that attitude of gratitude and of self-compassion. also with stress. I think it's important, like you mentioned, many people are going through changes during this menopausal time or that often career changes or relationship changes or kids are going off to school or empty nest or they're caring for others, maybe caring for parents, and so, so change is stressful.

[00:18:39] Dr. Michelle Tollefson: So we know that change can be good, as you mentioned, eustress or it can be distress. A certain amount of change is actually beneficial for peak performance, but it's when we have two excessive levels of stress that go on for too long. . And so we want to be mindful of our stress levels to really look to see what is causing the additional stress, and then what can you do to support your wellbeing as far as helping you manage that stress.

[00:19:02] Dr. Michelle Tollefson: So that comes back to eating a whole food plant predominant diet, getting enough physical activity. There's probably more research around physical activity and managing stress than any other area getting. Sleep, which becomes harder after menopause too, but really trying to prioritize sleep, having meaningful social connections.

[00:19:19] Dr. Michelle Tollefson: You don't need a million Facebook friends, but at least a couple people who you can call on when things get rough. and then being mindful, so the paving steps also has investigation, so is one of the 12 different themes of the book and investigation. What causes eustress because what you to cause eustress or what causes other people's stress may not be what causes eustress in this moment.

[00:19:40] Dr. Michelle Tollefson: And then also using variety and investigation to find out what works best for you for managing that stress. For some people, it might be getting out in nature, and I always recommend getting out in nature to help with decreasing some stress. Great research. To, but for some people it might be nature. For some people it might be reading a common book and you get out and go for a walk or spend time with your pet.

[00:19:58] Dr. Michelle Tollefson: So what is it that helps you manage your stress and then trying to be even more mindful and intentional about creating time for yourself. That time out is another area, the paving, 12 paving steps, but allowing ourselves to have that time to really decrease our stress and to be. Mindful of prioritizing our stress resilience practices that can often get pushed to the side when they're often needed the most.

[00:20:25] Dr. Michelle Tollefson: I'm 

[00:20:25] Maya Acosta: so glad that you talked about all of this, because since I mentioned, you know, that I've gone, I myself am going through the change. I wasn't really prepared. You're, you know, busy living your life, working, doing the things that you're responsible for, and on top of that, you begin to notice changes and mood changes and anxiety goes up, stress goes up, and so it's good to know.

[00:20:45] Maya Acosta: It's part of the process and that we can now reexamine our lives and to see where we can adjust things. And you talk about, you know, finding a passion and, and taking time out many different ways that we can manage that stress. And you're right. You know, we don't have to have the perfect Thanksgiving or the perfect anything. 

[00:21:05] Maya Acosta: I think this is a great time to sit back and say, okay, I don't have to have a control over everyth. Definitely, it's very comforting for me to read this book as well. There was something else that you mentioned in here that I was sharing with my husband. When you have a, an area devoted to sexual health, which not a lot of people talk about, especially our mothers, our grandmothers, you know, a little taboo, but you say that.

[00:21:28] Maya Acosta: Only about 50% of women over the age of 50 are sexually active. That really shocked me. I don't know. But then all the other complications that women experience as a result of, you know, losing their estrogen levels and, and you give tips in terms of what women can do to comfort themselves to feel better.

[00:21:46] Maya Acosta: As they're connecting with our partners. So if you'd like to mention any of that, that'd be great. Of course. 

[00:21:51] Dr. Michelle Tollefson: So sexual health is an important part of overall health and wellbeing and, and I do agree, I believe it's not discussed enough, but it's something that often is brought up in the gynecologist office about, about how women can support their sexual health and wellbeing.

[00:22:04] Dr. Michelle Tollefson: So it's an important area. First of all, I think it's important for women to know that they're not alone. Decreased libido or decreased sex drive is very common. However, that doesn't mean that we don't do anything about it or that we don't care about it. Just to acknowledge though that, that in our society where there's such high levels of stress, where there's problems with sleep, when there we have a lot of physical inactivity, those things all play a role in sexual health and wellbeing too.

[00:22:27] Dr. Michelle Tollefson: So first of all, know that decreased libido, decreased interest in stress in. Sexual activity is common, especially as women age or go through stressful times. This is compounded by the fact that vaginal dryness is really common or becomes more common in women after they go through menopause, because as estrogen decreases the vaginal tissues and the tissues, that tissue becomes thinner, and so that vaginal dryness often leads to discomfort or can lead to discomfort with intercourse.

[00:22:58] Dr. Michelle Tollefson: And so, . So I try to share some information about local hormone replacement therapy. So some people choose to use just like vaginal estrogen or vaginal hormones. So I try to go over, I try to give women, I believe that women deserve all the education and then trust them to make their educated decision. I try to give some information about hormone replacement therapy, but the risk associated with topical or vaginal estrogen are much lower for most women than systemic estrogen, where every cell in your body is seeing that amount.

[00:23:26] Dr. Michelle Tollefson: So that can help with vaginal dryness. For some women's soy is able to help using moisturizers, so vaginal moisturizers, uh, regularly throughout the week to help with that tissue. Just as you would kinda imagine a moisturizer for your hands. Dryness is more common everywhere. And then also vaginally with women after they go through menopause.

[00:23:43] Dr. Michelle Tollefson: So using a vaginal moisturizer. Finding one that works well for you. For some people they, it's coconut oils. I mean, there's a variety of different things they can used. Try different things and see what works best for you. And then if somebody who does want to have sexual intimacy, vaginal sexual intimacy after menopause, if they're experiencing vaginal dryness, I recommend vaginal lubricants.

[00:24:04] Dr. Michelle Tollefson: And the book has more information on that too. But there's a variety of different vaginal lubricants, so it's just experimenting and finding what works best for you and your partner. . And then I also knowing that the decreased genital blood flow that women often experience after menopause, or especially if women have any vascular disease, that that can lead to even increased vaginal dryness.

[00:24:25] Dr. Michelle Tollefson: And so for many women after menopause, they may benefit from genital vibratory stimulation, which is a vibrator, which I know is something we don't usually talk about. But I think that women deserve to have this information and know that vascular. Flow to the clitoral sensitivity. Still is maintained even after some of the vaginal sensitivity decreases.

[00:24:47] Dr. Michelle Tollefson: And so genital vibratory stimulation can help with increasing blood flow in order to help women who may be struggling with sexual arousal or vaginal lubrication. So I think that it's just important for women to have all this information to know and to destigmatize the use of it, and to think of it as a medical device that's really useful for many women.

[00:25:05] Dr. Michelle Tollefson: And once again, just getting that information out and letting people make those decisions. But it's just something like, unless you're a gynecologist who's actually looking in the literature and reading about genital vibratory stimulation, it's just something that's not talked about. And I believe women deserve to have access to this information if it is something that they want to use.

[00:25:23] Dr. Michelle Tollefson: And then also, of course, there are many women who are not in a sexually intimate relationship or who are not having vaginal intercourse. And to honor that, there are many different. To express, uh, sexuality and wellbeing and that you don't have to be vaginal intercourse is just one way, but you can also be, you know, emotional hugging and caressing and touch, and there's so many different ways too.

[00:25:44] Dr. Michelle Tollefson: So just really honoring our sexual health and wellbeing and realizing that it's a part of us that does not go away as we age, even though society might. Want to minimize women who are postmenopausal or can sure seem that way, that sexual health and wellbeing is an important part of who we're, and that if it's an issue or if somebody's struggling with it, they should go talk to their gynecologist or talk to somebody with expertise in this area because it is an important part of health and wellbeing. There are many things that can be done. Please don't suffer in silence. Reach out and get some help. Yes. 

[00:26:15] Maya Acosta: Thank you for saying that. Don't suffer in silence because even though like you're recommending, we speak with our gynecologists, many of us may be too shy to bring up all of the discomforts and and changes that we're going through, but I feel like this workbook really gives us the tools and the confidence to know how to speak about that and to say, okay, well it is sort of a medical.

[00:26:35] Maya Acosta: Situation here that we're going through, so it's okay to talk about that. Another topic that you talk about is weight gain, and I myself have noticed that change just in this time that I've been going through the changes. Is there anything that can be done 

[00:26:49] Dr. Michelle Tollefson: about that? Sure. No, that's a great point. And it's so, so common as those hormone levels change.

[00:26:55] Dr. Michelle Tollefson: We see that decrease often in lean muscle mass if we're, especially if we're not doing resistance training or maybe we need to do a little bit more. So we see a decrease in lean muscle mass and an increase in fat mass. And so even if we're eating the same amount of calories, we often notice more weight gain as those hormone levels change.

[00:27:10] Dr. Michelle Tollefson: We also know that that with sleep, often women struggle with sleep when they go through the menopausal transition. And even if they're not fully aware that. Quality of sleep is decreased. For many women, it, it is, they'll have hot flash or they'll have night sweats that prevent them from getting quality sleep.

[00:27:26] Dr. Michelle Tollefson: And we know that when someone does not get adequate sleep, that they're ghrelin. The hunger hormone increases and leptin the hormone that makes us feel full and satiated. It decreases. So ghrelin increases. I think of it like the little gr. Saying, eat that, eat that, eat that donut. And you're like, no. I know that that's not nourishing for my brain and for my body, but ghrelin increases.

[00:27:47] Dr. Michelle Tollefson: Leptin decreases as our leap is we're struggling with sleep, and then also we become more sensitive to stress, and so we're fighting that increas in. Seeking out foods that often aren't truly nourishing for our body and mine. So we eat more calories. I'm not not even aware because we're fighting that ghrelin and leptin.

[00:28:04] Dr. Michelle Tollefson: So between the change in muscle and fat mass, often the slowing of metabolism, the change that we see with our hormones and with this. Sleep. It can really feel like, oh my gosh, I'm doing all the same things I used to. I didn't just like start eating junk food. I'm doing the same things I used to, but why am I struggling more?

[00:28:20] Dr. Michelle Tollefson: So, first of all, you are not alone. Know that you're not alone, that this is, it's really common, but that doesn't mean that we have to just say it's common. And so this is the way it is. Know that we have. So much, so much power. There's just so much that we can do as far as doing some of that, like some of that resistance training and considering working with somebody, you can also ask your physician, can I have a referral to a physical therapist?

[00:28:42] Dr. Michelle Tollefson: Or connect with an, uh, personalized exercise trainer so that they can help you create a physical activity regimen that's really designed to you and where you're at. You don't wanna injure yourself. So many people. Or do resistance training where they're not doing enough, they don't see enough of a change and they think this isn't doing anything.

[00:28:57] Dr. Michelle Tollefson: Or sometimes we see the other two more people lift too much and then they get hurt, and then they're not gonna come back and do it. We don't want people to get hurt, but we also want people to be seeing change. And so that's where I love it. You can work with a physical therapist or a trainer to make sure that you're doing exercise that is safe for you, but where you're truly going to see benefit.

[00:29:13] Dr. Michelle Tollefson: I think that's really important. So addressing physical activity with some resistance training. Also addressing sleep. And prioritizing sleep, even though it becomes more challenging, we need to really prioritize and do everything that we can as far as doing sleep hygiene to help us get enough sleep, and that helps us with weight as well.

[00:29:31] Dr. Michelle Tollefson: And then to manage stress. It's just so interconnected. 

[00:29:34] Maya Acosta: Yes, it really is. That's encouraging. So definitely the secret is to have that resistance training in there and does walking helps with emotional enhancing our sense overall of overall wellness, but also reducing the stress. But it doesn't help as much with weight loss does it?

[00:29:50] Dr. Michelle Tollefson: So the, any physical activity is good. So I always say like the, you know, any physical activity is good, physical activities, walking is absolutely wonderful. I think the resistance training is so important just because of that muscle mass. So yes, walking is better than not. Walking a little bit faster, that's great cause you are, you know, you're simulating those muscles.

[00:30:08] Dr. Michelle Tollefson: But if you can do even a little bit more, Focused resistance training, you know, two to three times a week. It's not like we're saying go spend an hour in the gym every night, but if you can do two to three times a week, separated by it a day or two and do some resistance training, that can be really beneficial.

[00:30:23] Dr. Michelle Tollefson: But don't stop walking. Walking is is absolutely fabulous. Too 

[00:30:25] Maya Acosta: that, that's awesome. We're gonna resume our walks pretty soon in our area, and so my goal is to, you know, encourage people to find a group in their area that they can walk with or exercise with, especially because as we get older and we go through this menopause phase, we also find ourselves experiencing loneliness.

[00:30:44] Maya Acosta: And it's just because, you know, you may not be connected because you're maybe transitioned out of a career or like you mentioned, you know, experiencing the emptiness from having children moved out. So what are some of the things that we can do to kind of fill that void? 

[00:31:00] Dr. Michelle Tollefson: Great point. So yes. First of all, the listeners should know that they are not alone. That loneliness is really, really common, that it's felt by many people. Often women feel like we should be the social butterflies that we're expected to have a million friends, but Covid really shown a bright light on isolation and loneliness, and that even though we are a very connected. Like via social media, we might have like thousands of friends or likes that it's really those like deep or those strong relationships, people we can call on when we're going through a rough time.

[00:31:32] Dr. Michelle Tollefson: Those are the ones that really support our emotional health and wellbeing the most. And so first of all, know that it's not rare to feel lonely or to experience loneliness, even if you do have others around you. Uh, that it's important to connect with others who are going through similar things, and so that's where like the paving the path to wellness groups where people are in a group where they can talk with others, who are going through some of these different same things and connect with, connect with others.

[00:31:55] Dr. Michelle Tollefson: That can be really powerful. We know that we see a decrease in dementia incidents as contact frequency increases, and so it's important for our brain to. Those connections. And then we also see that people who are more lonely and socially isolated have an increased risk of heart attack, stroke, and cardiovascular related death.

[00:32:15] Dr. Michelle Tollefson: So I say connection isn't, you know, it's not just, oh, well, it's nice if we have time, that it really is an important part of our physical and mental and overall health. And so it's important to prioritize that, especially when we get busy. Everything. Seem to come before that, but marking time on our schedules to meet with those friends or to reach out and call people.

[00:32:34] Dr. Michelle Tollefson: But I think so many times women think, well, if I just don't automatically have a million friends, then something's wrong with me. But it's, there is nothing wrong. Reach out and try to connect with others. Reach out and join, you know, a different group. Maybe it's a neighborhood group or you mentioned like they're gonna resume walking community groups.

[00:32:49] Dr. Michelle Tollefson: Reach out and join and stay connected because know that others will benefit from being connected with you. Like even our connection. Right now, I'm receiving the gift of being able to connect with you today. I know we're not in person, but I'm receiving the gift of your connection and it strengthens both of us.

[00:33:05] Dr. Michelle Tollefson: I want your listeners to know that when they reach out and connect with others, that they're also helping that other person too, that they'll receive, but they're also giving to that person. Cause we all need that social connection and support in order to flourish. 

[00:33:18] Maya Acosta: I agree, and I feel really blessed as a podcaster.

[00:33:21] Maya Acosta: I get to speak to so many people from all walks of life, and I'm always having fun with these conversations. So even though I'm here by myself, it's like connecting with people. It doesn't have to necessarily be in person and you. Briefly talked about the paving the Path Wellness Program group. So is this for anyone who has read the book and is familiar with the steps or how do people join?

[00:33:45] Dr. Michelle Tollefson: Sure. Great. So paving the path to wellness was started by DR, and it's been, initially she did the program for stroke survivors and their caregivers outta Spalding Rehabilitation Hospital, one of the Harvard hospitals. It was unmodified. Cancer survivors by Dr. Amy Comander and has since been modified for other patient populations, for healthcare providers, for work site wellness.

[00:34:07] Dr. Michelle Tollefson: So it's been modified for many different, many different groups and offered in a variety of formats with the pandemic. It used to be, I believe, mostly or all in person, but then with the pandemic, it switched to being offered virtual. In some groups, so the paving wellness.org is the nonprofit organization's website.

[00:34:26] Dr. Michelle Tollefson: So if any of your listeners are interested in learning more, they can go to paving wellness.org and they can reach out. If they're interested in learning more, they can share their contact information. We are about ready to start launching groups. Through the paving wellness.org website, and so we'll be doing groups that are the general paving steps, the 12 paving steps, physical activity, A as attitude, B as variety I as investigations, N as nutrition, G as goal setting, then steps sleep.

[00:34:54] Dr. Michelle Tollefson: Timeouts energy because that's a big issue for so many women, especially going through menopause, is decrease energy or increase fatigue purpose. You mentioned that before. Connecting all of this with your purpose of why do I care about engaging in healthy lifestyle behaviors? How can I connect this with my purpose and social connection and stress management?

[00:35:11] Dr. Michelle Tollefson: So those are the 12 paving steps, and they really are meant to help people flourish with a healthier body, a more peaceful mind, and a more joyful heart. And to get everybody access to that, that everybody deserves evidence-based information on how to flourish with regard to these 12 steps. And then to be in an environment where they're supported and so people can just read the books.

[00:35:32] Dr. Michelle Tollefson: Which is totally fine. Um, but then if other people want to join the 12 week program that it was when it was originally designed by Dr. Frates, they can actually join a group of typically like eight to 25 or so, people who have, um, maybe who are all perimenopausal or postmenopausal or who working on a certain area of health and wellbeing, and then gather together for 12 weeks, or it's sometimes offered in other arrangements.

[00:35:56] Dr. Michelle Tollefson: So, Six weeks where they do two of the themes a week, but a variety of sessions. So if you're interested, if your listeners are interested in learning more, reach us through the nonprofit organizations website. Let us know that you're interested in connecting with us, and we'll send you information about the groups and other ways to get involved with feeding wellness.

[00:36:14] Maya Acosta: Wonderful. I'll make sure to include that link as well. And this is wonderful, you said, to be in an environment that's supportive. I wish that I had had this book just a couple of years ago, cause , I would've probably had seen the symptoms like I'm going into menopause and now I'm, I'm so thankful for the Women's health group because I'm learning so much about how to understand what is happening with me and also not being shy about it.

[00:36:37] Maya Acosta: And, you know, I wish I could have said like, you know, as I'm going through this, To my husband. You might notice some changes in me , and it might be because of this and that. So to be comfortable with what we're going through as part of the process of the blessing of living beyond 45, 50 years old or however long.

[00:36:55] Maya Acosta: It just seems like this wonderful experience is. Just on the other side of all of this. I mean, I'm going through it, doing the work, and I have a life coach as a result of my anxiety, but I'm already finding that I'm coming to a nice place. So, because I'm understanding things better, so I'm loving it. So, Dr.

[00:37:13] Maya Acosta: Tollefson, you're a breast cancer survivor. You've been on the show to, you know, sharing your story. I was wondering if. Can just briefly, if you'd like to, we just talked about breast cancer awareness in October, but if you'd like to give us some tips in terms of how my listeners can decrease some of those risks for breast cancer, please feel free.

[00:37:31] Dr. Michelle Tollefson: Oh, great. Thank you. Yes. I always appreciate an opportunity to talk to women about decreasing their risk, uh, breast cancer. So I love the American Institute for Cancer Research, A I C R. They have some amazing resources and so they go along with a lot of what we've already talked about today about trying to eat a lot of whole foods.

[00:37:48] Dr. Michelle Tollefson: So minimizing our processed foods, not drinking sugar sweetened beverages like soda or, um, eating a lot of that ultra processed food. Really trying to eat a lot of whole Foods, foods where we can, what it was when it came from the ground. Um, eating a lot of. Plants eating the rainbow. All the different phytonutrients are the plant nutrients that come.

[00:38:06] Dr. Michelle Tollefson: They're what give plants their smell and their taste and their color. And we just keep learning more and more about all the benefits of the phytonutrients for reducing the risk of some cancers and including breast cancer, as well as doing, um, other amazing things for our health. So try to eat the rainbow, get in those fruits and vegetables.

[00:38:22] Dr. Michelle Tollefson: I recommend if people are struggling at all with getting in lots of servings of fruits and vegetables that they think about doing a smoothie. I do a smoothie every day that has some kale and some mango and some soy milk and some flax seeds. Think about ways to increase fruits and vegetables, getting berries in, so just a variety of abundance of plant foods.

[00:38:39] Dr. Michelle Tollefson: Also, physical activity decreases the chances of somebody getting breast cancer and maintaining, obtaining, or maintaining a healthy. After menopause also decreases the risk of getting breast cancer. But know that even if you do all of these things, oh, and sleep as well, we know we're learning more and more about sleep and about the importance of trying to get adequate sleep, at least seven hours a night of restorative sleep.

[00:39:03] Dr. Michelle Tollefson: But even if you do all of these things, And, and not drinking alcohol can also increase the chances of breast cancer. So even if you're doing all these things, still get your mammogram. I had no symptoms. I'd done clinical breast exams for years and I couldn't feel anything even before my biopsy. I said, lemme just see if I could feel this.

[00:39:19] Dr. Michelle Tollefson: But it was hiding behind my nipple, this, and it was growing into my chest wall. So I had a normal mammogram. One year and one week later, I had a two centimeter mask that was invading my chest wall, that I as a doctor who'd done thousands of breast exams with these fingers that I could not feel, I had no symptoms.

[00:39:35] Dr. Michelle Tollefson: I did not have a strong family history. I breastfed my kids even if you're doing all these things. So yes, please do all the different things you can to eat healthy foods and to be physically active. And all of those are, are so important for so many reasons, including decreasing the risk of getting breast cancer, but also, Do your screening, um, do your mammograms, do your screening, talk with your doctor.

[00:39:55] Dr. Michelle Tollefson: There's some different, uh, schedules as far as like how well frequently to get them and when do you start and stop. But I recommend talking with your doctor and doing your screen. Don't put it off. I don't know that I would be here if I had waited, you know? An extra year. Don't know that I would be here.

[00:40:09] Dr. Michelle Tollefson: So the, my mammogram screening probably saved my life and caught it. It was really aggressive, so caught it when it did so 16 rounds of chemo and Devin surgeries later, and I'm doing really well. I still get nervous. I still have neuropathy, and I still get nervous when I have tumor markers drawn every three months.

[00:40:25] Dr. Michelle Tollefson: I would like to tell you that I'm perfect with all of this lifestyle and stuff that I have everything figured out, but life is a journey for all of us. We're all on on this journey together, and I still get super stressed every three months, no matter how much I tell. Okay, you're doing everything. But it helps me to know that I'm doing everything that I can to decrease my risk of a recurrence.

[00:40:42] Dr. Michelle Tollefson: So yes. So please get your mammograms. Please eat lots of plants, please move more stress less, love more, all of those fabulous things, and take care of yourself and take care of one another. We need to, you know, community of women, we need to be advocates for each other. We need to. Speak out and let our voices be heard as we age.

[00:41:01] Dr. Michelle Tollefson: I believe as men go through menopause, if we look at the media, if we look at what is often highlighted as being most important in society with youth, and I, you know, I, when I see those commercials about like, oh, I look so much younger or, Like as if that's all that we should all be aiming for in our life is just to look young and that's where our true value lies.

[00:41:21] Dr. Michelle Tollefson: No, it's in our wisdom. It's in our beauty, it's in our experiences and what we share. And so I think that our voices are important, of course, throughout our lifespan, but I think that using our voice as passionate women becomes even more important as we go through menopause and beyond. Speaking out on behalf of those who don't have access to the lifestyle medicine, knowledge and pillars.

[00:41:43] Dr. Michelle Tollefson: I think often it's easy for those of us who are in this kinda wellness world or more cognizant of it, it's easy to think, well, maybe everyone already knows this or is doing this, but we still deal with a lot of health disparities, people who don't have access. To healthy food people who don't have access to safe places to walk.

[00:41:57] Dr. Michelle Tollefson: And I just think we need to keep addressing that as well. And speaking for those who don't have a voice and getting access and this knowledge to everyone. That's really paving wellness.org and my mission is to get this evidence-based lifestyle medicine information to everyone and then also to help support them with the tools and resources to make these healthy behavior changes.

[00:42:16] Dr. Michelle Tollefson: Because everyone deserves to thrive, not just those of us who know to go looking for some literature here and there. Really, everybody deserves this information. Everybody deserves a nourishing environment where 

[00:42:26] Maya Acosta: they're able to thrive. Absolutely. And I thank you for saying that. Thank you for just mentioning that there are those women that probably cannot afford to do these kind of things, you know, to take a yoga class, to eat healthy food.

[00:42:38] Maya Acosta: But we're, that's part of what lifestyle medicine does, is we're working hard to get this information out to everyone. Dr. Tollefson, as we're closing, I don't know if you'd have, uh, time to do some rapid fire questions just to get to know you a little bit better. I know that you're, Now and the children are around.

[00:42:54] Maya Acosta: This is actually Thanksgiving week, . We're recording on a Monday, so lots of things to do right before, uh, Thanksgiving, so, okay. So a couple of questions. Are you ready? All right. Awesome. What is the best thing that happened to you this year? 

[00:43:07] Dr. Michelle Tollefson: The publication of the Menopause book, and I was so excited, came out in color, our publisher.

[00:43:11] Dr. Michelle Tollefson: He was, I was like, please do it in color. Yes. And so anyway, so being able to be the co-author, yes. The co-author of this book with Dr. Beth Frates and Dr. Amy Comander is I think is my highlight of the year. Oh 

[00:43:24] Maya Acosta: wow. Yes, it really is. I didn't realize that at the conference. All three of you were available to sign the book, and so I missed that opportunity.

[00:43:33] Maya Acosta: We'll do it later. So where do you go when you need to relax? 

[00:43:36] Dr. Michelle Tollefson: So if I'm at home, sometimes I just go into my bedroom to be away from my six year old and nine year old boys who I love deeply. However, sometimes I need to just have my own time in order to relax, and then I love traveling. I love, love traveling.

[00:43:47] Dr. Michelle Tollefson: So Costa Rica's my favorite destination to get away and relax. But if I'm at home, sneaking away to my bedroom. 

[00:43:53] Maya Acosta: Oh, that's great to have that little time out. And we will, I will mention and put some links down that you do have some upcoming Costa Rican trips retreats that you've scheduled for next year where you will basically guide people into the blue zone because that is one of the places of the world where people live the longest and they're.

[00:44:13] Maya Acosta: Predominantly plant-based. Yes, 

[00:44:14] Dr. Michelle Tollefson: for sure. I'll doing the education there a couple weeks this July. So yeah, I'd be happy to talk to any of your listeners about that. 

[00:44:20] Maya Acosta: All right, awesome. What was the best present that you've ever received? 

[00:44:24] Dr. Michelle Tollefson: That's a hard one, but. Think it's probably the connection. After I went through chemo, I joined a survivorship group and it was incredibly depressing, and so I thought, this is not for me.

[00:44:35] Dr. Michelle Tollefson: I dropped out. I'm never coming back. It just was not right. And Dr. Beth Frates said, you need to join Dr. Amy Comanders. Breast cancer survivorship group. So it was one of those like blessings and disguise because of the pandemic. Amy's group had just transitioned from being in person, which they're in Boston, I'm in Colorado.

[00:44:52] Dr. Michelle Tollefson: They just transitioned from being in person to being online and they let me join partway through and I thought, I don't need, you know, a peer group with others. I thought like, I know this, I know about nutrition and exercise and stress and sleep. So I thought like, I can do the research. But I learned about attitude and about variety and investigations and about energy and about purpose.

[00:45:11] Dr. Michelle Tollefson: And there are things that I knew about. But to really spend time going deeper and reflecting and looking at how I could use those pillars in order to enhance my wellbeing and to deal with energy. Cause I was experiencing a lot of fatigue still with menopause and also being after chemo. So the best gift was probably Beth Brady saying that I should join Dr.

[00:45:28] Dr. Michelle Tollefson: Amy Comander's group. And then, like I said, I fell in love with. When I, like the last day, we were saying our goodbyes to that group on the last of the 12 sessions, and I remember feeling teary and being like, I did not think I, you know, even really wanted to be part of a, a group of people who come together to discuss this, but it was so meaningful.

[00:45:45] Dr. Michelle Tollefson: So that's probably the best gift I've ever been given. 

[00:45:48] Maya Acosta: Well that's even encouraging because you know, now you're talking about other, how other people can be part of that paving the path to wellness program. What upcoming life event are you excited about? 

[00:45:59] Dr. Michelle Tollefson: Oh, my daughter graduates really soon. She's going to graduate from high school, so that's exciting that we have that coming up.

[00:46:05] Dr. Michelle Tollefson: And then we'll be doing some traveling this summer. And I always loved traveling with family, so with my extended family and with my immediate family. Those are the life events that I love that are coming up. And of course just the holidays are amazing to celebrate. My kids' birthdays are on December 13th, 18th, and 21st, so we have a lot of celebrating around the holidays,

[00:46:24] Maya Acosta: Oh, that's all cool. And your daughter was the one that went with you to Costa Rica and was sampling, was doing some of the meal prepping out there? I think I saw on social. That's so cool. Okay, one last question. Is there something that most people are afraid of that doesn't scare you? 

[00:46:40] Dr. Michelle Tollefson: Sure. So I used to feel really nervous presenting in front of groups.

[00:46:44] Dr. Michelle Tollefson: And now after being a professor and after talking to so many different groups, that doesn't scare me like it used to. I think that I, um, I still maybe felt some anxiety around it. Being a breast cancer survivor, but now being a breast cancer survivor, I feel so strongly that women deserve to have information, evidence-based information on lifestyle medicine, and I just see the need for what we're doing as so strongly that it's almost like that's taken over and I don't really feel an anxiety to.

[00:47:13] Dr. Michelle Tollefson: To talk, to speak out or do public speaking anymore. I mean, it's just this information needs to be known. We need to get it out there. So I used to get nervous before podcasts or, or you know, like talking to group or doing conferences. And now I just feel like it's a blessing, a joy to be able to share this message with others and to help.

[00:47:30] Dr. Michelle Tollefson: Spread the message in any way. Any way that I can. So thank 

[00:47:34] Maya Acosta: you. Yeah. And we're very lucky that you have your training as a gynecologist and that you have the ability to deliver this message the way you do. And you lead the Women's Health Interest Group, and there's so much that you're involved in to empower women.

[00:47:47] Maya Acosta: So even though we may not have you as our personal gynecologist, you definitely are helping to give us the tools that we need to take care of our health. And what's the best way for women to find this book, the Paving the Path. So 

[00:48:01] Dr. Michelle Tollefson: Paving Woman's Path Through Menopause and beyond. You can find it on Amazon along with the original paving workbook.

[00:48:07] Dr. Michelle Tollefson: They're both available on Amazon, or you can go to our publisher Healthy Learning and get them that way as well. You can also go to our website, the paving wellness.org. You can go there and it'll direct you the different ways you can purchase them as well. Once again, all of the authors proceeds, Dr.

[00:48:24] Dr. Michelle Tollefson: Comander, Dr. Frates and I were co-authors for both of those. And all of the proceeds go to the nonprofit organization so that we can get this information out to others. It truly is our desire just to help others. And then I should mention too, even though she's not one of our co-authors, the other member of the board of directors board Impact Wellness is Valman. And so the four of us just feel really passionate. We're feel really strong about the need to get this information out there and the word.

[00:48:46] Maya Acosta: Thank you so much, Dr. Tollefson. It's been wonderful having you again. Thank you for sharing this information on menopause. And you know, ladies, go out and get your breast exams, you know, they're easy to do.

[00:48:58] Maya Acosta: Grab yourself a copy of this book if you can. It's on Amazon and thank you again, Dr. Tollefson. 

[00:49:03] Dr. Michelle Tollefson: Oh, thank you for the opportunity. You have a beautiful rest of your day. 

[00:49:06] Maya Acosta: Thank you. You've been listening to the Healthy Lifestyle Solutions Podcast with your host, Maya Acosta. If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave us an honest review on Apple Podcast that helps us to spread our message. Thanks for listening.