Claudia von Boeselager (02:13)
Hello, everyone. Welcome, welcome to the masterclass.

We are so, so excited to have you here. And we're so passionate about this. We have an all-star lineup of all-female speakers. I was talking to somebody the other day complaining about there's not enough female speakers. I was like, you're looking in the wrong places, clearly. So excited to have you all here.

For those of you who don't know me yet, I'm Claudia von Braselaga, and I'm so excited to be your host today.

I'm a former Goldman Sachs investment banker and serial entrepreneur turned longevity and peak performance coach, business leader and speaker. And over the past 15 years, I've immersed myself in advanced training, research and real world testing across longevity science, biohacking, peak performance, brain optimization, you name it. But it wasn't always that way.

You see, in my 20s and 30s, I thought I could sleep when I was dead, very stupidly, and worked in very high stress environments, working on multi-billion dollar transactions, 100 plus hour work weeks. And I really burnt the candle on both ends. Well, what happens? Chronic health issues, right? So chronic fatigue, leaky gut, chronic sinusitis. And I just thought, well, I'm still okay until I wasn't.

And it all came to a pinnacle one day when I was climbing the stairs and it felt like climbing Mount Everest, that one small step in front of the other. And I looked down on my watch, realized it wasn't even lunchtime. And I thought, how is this possible? My energy was on zero. And that was in that moment that I realized something has to change. And it set me on this beautiful journey to uncovering health optimization and reversing my biological age by 17 years. So I'm 26 again, trying to get down to 20.

yours biologically and keep it there till I'm 100 years old chronologically. And I've made it my mission to unlock vibrant energy, mental health, clarity and lasting vitality, especially for high achievers. And so I'm also the host of the Longevity and Lifestyle podcast, co-founder of Lumara Collective, a global consultancy for longevity and biohacking. And as with all the speakers today, we're so passionate about sharing knowledge, particularly around women's health. It's so, so needed. So.

This masterclass was created to help you stop guessing, to start decoding your body, and finally take control of your hormones, your energy, and vitality on your terms. We're going to cover lots of juicy topics. So we have a 45-minute masterclass conversation. And then for those of you who have upgraded to the VIP, we have an additional 45 minutes for the Q &A. You'll also get access to the replay.

So for those of you who haven't yet upgraded to VIP and you're interested in doing so, you will find it in the description box.

have you ever been told something like your labs look normal?

over 80 % of women say that their health concerns have been dismissed.

by a doctor or that most women with hormonal issues go undiagnosed or misdiagnosed for over seven years. The traditional medical model was built around the male biology, not the female. And women experiencing symptoms like fatigue or mood swings or irregular cycles, brain fog or fertility are often told that it's just stress or try relaxing. And these symptoms are just dismissed as being part of just being a woman.

And so what we want to do with this masterclass is change that narrative. And our goal is to empower women with science-backed insights, and answers that many never receive. So this isn't just a webinar. It's a movement to raise the standard for women's health. You're in the right place. So without further ado, I want to introduce our incredible panelists to and have each one briefly introduce themselves so you know what a powerhouse team you have here today.

Dr. Asima Ahmed, let's start with you. Would you mind giving us a quick intro and sharing the lens through which you approach women's health?

Dr. Asima Ahmad (06:05)
Yeah, so I'm Asma Ahmad. I'm a board certified obstetrician gynecologist and a reproductive endocrinology and fertility specialist. ⁓ I've been in the women's healthcare space now for 25 years. And it's, it's, it's, I actually really appreciate you sharing your story, Claudia, because there was a point in my life also that kind of sparked my interest and my passion towards women's health. The short version is that I had a family member

who suffered through multiple stillbirths, had a baby that died within a day of life, and with the last delivery suffered through a postpartum hemorrhage and passed away. And what I learned from that was a lot of the things that she went through were preventable. And although she was in a resource-limited setting, it's not just within those settings that we see that women don't have access to the healthcare that they need. It's sometimes the environment that they're in, the culture, the biases, and so.

I have had a very strong focus on, and honestly, my lifelong passion is to increase access to high quality, affordable care for women across the world. And that's when it comes to reproductive health overall, their fertility, their hormonal health, and as you mentioned, longevity, and how it all kind of ties in together.

So it's a little bit about my background. And then I still do see patients in the clinical setting. In addition to my clinical work, I'm also chief medical officer and co-founder of Care-Ed.

Claudia von Boeselager (07:35)
Beautiful. So thank you so much and such an honor to have your global leadership in reproductive endocrinology and fertility with us. Next up, Ashley Madsen, can you please share a little bit about your background and what drives your work in functional and hormonal medicine?

Ashley Madsen (07:51)
Yes, absolutely. So my name is Ashley Madsen. I am a board certified physician associate or PA, and I've been practicing for well over 15 years. I started my journey actually in surgery and what actually drove me out of what I call probably the most reactive area medicine to the most proactive area medicine is things that we were not taught in our medical education. And I was starting to connect the dots on. So I love surgery. I loved the precision of it. I loved the art of it.

I loved the outcomes and walking people from the clinic into the OR and seeing their journey for progression and outcomes. But what we started to see more, and I saw treating congenital all the way through age, is that we started to see younger, younger populations of people coming in with inflammatory issues, low bone density concerns, multi-system failure issues, increase in diabetes and insulin resistance. ⁓ And so I started to actually do more research

research

on my own. I studied functional medicine, nutrition at Stanford. I studied cellular medicine, hormone therapy.

And eventually my passion just grew really strongly. And clearly it was a sign to shift gears and focus. So I went into precision medicine and I was able to be ⁓ mentored and work with some amazing world-class physicians from endocrinologists, reproductive endocrinologists, to ⁓ regenerative medicine specialists. I studied peptide therapy and really started to understand that sexual medicine, which is what I really focus on now, was the canary in the coal mine for so

any other system diseases that I was seeing. So we knew already from men's health that say, you know, ED or some erectile dysfunction was correlated to cardiovascular disease that came later on. And that we, these, these blood vessels were really important. And so we started to connect the dots there, but women were really left to be siloed. Women were not really part of the conversation. If you look, most of the pharmaceuticals are really procured and made for men. Look at the research.

And I was seeing more and more women, but no one was giving them help and understanding. So to me, that was such a calling to help women understand their bodies better. I certainly felt like, my goodness, all the years that I was on birth control pills and all this other stuff, nobody really educated me. And it wasn't, you know, I had amazing doctors, amazing clinicians I worked with, and this is not to be against them. But there was a missing link in our educational system and also what's getting out to our patients. ⁓

I really saw was this disconnect in our medical training, but also what's being conveyed to patients. So now I see this more we can advocate, we can learn, we can deep dive on ourselves and on our own.

And that really that perimenopause, menopause transition, which is really what my focus is on, especially for sexual wellness, is such a significant biopsychosocial model. It's not just one hormone. It's not just one cause. as Dr. Asima said, we're talking about culture, socioeconomic background, just being able to afford things and know that you have options available to you is so important for age-related disease. So cardiovascular, dementia, bone

We know hip fractures kill people almost as much as breast cancer kills women. And so all of these things are super connected. And really what my calling was to understand that, advocate for women, and also teach other clinicians.

Claudia von Boeselager (11:27)
Beautiful. Pita, last but not least, can you introduce yourself and tell us what inspired your groundbreaking work in vaginal microbiome, in the vaginal microbiome space?

Pita Navarro (11:36)
It's so happy to be here. Hi, everyone. I'm Tita. I'm the co-founder and chief science officer at EVI. By background, I'm a molecular biologist. Before EVI, I was actually building a company in the oncology space with immunotherapies and precision diagnostics while also dealing with my own autoimmune conditions and going to hundreds of doctors. And the answer was always, we don't know. Maybe you should go on birth control. Maybe you should drink more water. Maybe your job is too stressful.

And so I started doing my own research and that was when I came to the fact that in the US women weren't included in clinical research until 1993. So I immediately quit my job and decided that there was such a massive opportunity, especially in the precision medicine space, because precision medicine simply can't exist if we never include 50 % of the population and the data sets that then inform the precise tools that we're using to treat people. And so we set out to build a platform that would finally enable precision medicine.

for women by understanding and leveraging those overlooked female biomarkers. And we started with the vaginal microbiome, both because we have heard over and over again from women their experience dealing with vaginal infections, as well as from doctors and providers that don't necessarily have novel treatments or diagnostics tool to help these women. ⁓ And also there is amazing research pointing to the vaginal microbiome as a potential predictor of cervical cancer progression, IVF outcomes, risk of acquiring STIs.

So we thought it would be the perfect place to start by helping women today with their vaginal symptoms. We can also build really interesting high fidelity data sets that would then inform novel tools to ⁓ diagnose and treat conditions like infertility, PCOS and chronic infections. And at the end of the day, really what drives our urgent passion and need is replacing all of the outdated diagnostics with precision tools that actually meet the complexity of female biology.

Claudia von Boeselager (13:29)
Yeah, so everyone in the audience, your audience, can see what a rock star panel we have today. I'm super excited to dig in. And I'd love to kick off with what I call the secrets behind the symptoms, the critical things most women were never told about their bodies. We're going to pull back the curtain with each of our incredible experts. So Asma, maybe we start with you. Most people don't get a full picture when it comes to fertility or hormonal changes, especially around IVF. What's one

Dr. Asima Ahmad (13:58)
.

Claudia von Boeselager (13:58)
The truth

you wish every woman knew about her fertility or IVF prep that rarely gets talked about even in the doctor's office.

Dr. Asima Ahmad (14:06)
So I think the biggest thing is that people and clinicians themselves, they don't really think about infertility or fertility as something that you can talk about proactively, meaning that you don't have to wait until something happens to start thinking about the topic. You can learn about it. You can try to understand it. And it's never too early, in my honest opinion.

I think people should learn about this when they're learning about how their periods work and how to prevent pregnancy. They should also be talking about like, this is what happens when you're not able to get pregnant. This is how many people it affects and this is what perimenopause and menopause is. So I think that's something that should be taught early on. So in the clinical setting, I think the first thing is just like, it's never too early. If you feel like you're walking into the clinic and you're trying to learn about your fertility and you're being told like, don't worry about it, you're young, et cetera, et cetera.

then just seek a second opinion and get a little bit more information. ⁓ I think one thing that people have a misconception about when it comes to fertility is your ovarian reserve and ⁓ looking at ovarian reserve markers and thinking that just because you have a low egg count, that means you're infertile. I think there's a lot of women out there when they hear the term diminished ovarian reserve, they automatically think that that means that they're not going to be able to get pregnant. Now, the thing is, yes, as you get older,

your egg quality and quantity will decline and your ovarian reserve markers like your AMH or anti-malarion hormone, follicle stimulating hormone, estradiol, your follicle or antral follicle count, all those will shift and change as you're aging. But again, just because it's low doesn't automatically mean you're infertile. ⁓ It's again, not uncommon as you get older to have the diagnosis of a diminished ovarian reserve. But let's say you have a diminished ovarian reserve and you're 30.

and you have a diminished ovarian reserve in your 40, those mean very, very different things. The other thing is like, if someone's like, well, what's like one thing that if I could just do one thing to look at my fertility and ovarian reserve, and again, there's a lot more to it than this, like what's like the one test that I could do. I personally really like anti-malarion hormone or AMH because that can be drawn at any time of your cycle. The general trend is over time, it's going to go down.

But some other ovarian reserve markers, typically we try to do them at the start of your cycle because that's where the reference ranges are. We expect them to be within a certain range. Or at that point in your cycle, you don't have large follicles or your corpus medial cysts in your ovaries that might falsely make your follicle count look lower. So that's something that you can go at any single point in time of your cycle with your primary care physician, with whoever, and get that checked.

Again, the general trend is it declines with age, but it does go up initially and then peaks in your 20s and then it starts to go back down. So again, keep that in mind when you're checking it. The one thing to keep in mind also when you're checking your anti-malaried hormone is that there are certain things that can make it look a little bit lower than it might actually be. For example, if you're someone who's been on hormonal contraceptive pills for an extended period of time, like let's say you've been on them for 10 years and you want to check out your ovarian reserve,

Sometimes that can, for some people, make the AMH lower than it actually is. So you may want to do what's called a washout period, maybe come off the pills for a month or two, and then get that hormone check, just to give you a better sense of where it truly stands. And we don't see that with all people, but we do see that with some. And again, you don't know until you get a check to see if you're one of those people that's affected by that. And in addition to hormones or some medications, there's also vitamins and supplements that can affect

your hormone assays. As I mentioned, AMH is the one that I'm talking about right now, but follicle stimulating hormone, luteinizing hormone, even your thyroid stimulating hormone. If you're on supplements and vitamins, for example, biotin can make some of these hormone assays look higher or lower than they actually are. So when you are going in for fertility assessment, make sure your doctor knows ⁓ what hormones you're on, what other medications or vitamins or supplements you're taking.

so that they can guide you and let you know which ones you might want to come off of before you get the testing done. But I think that's one of the biggest things is just people here lower very reserved. They automatically think that means that they're infertile. It doesn't automatically mean that. But yes, when you tie that hand in hand with age, age is one of the biggest determinants of.

Claudia von Boeselager (18:29)
Thank you for sharing that. Ashley, standard lab results often say normal, right? We all have heard this, yet women feel far from it. Why do traditional hormone tests often miss the mark and what should women really be asking or testing for to get to the root cause of what's going on? What would you say?

Ashley Madsen (18:48)
Yeah, sure. So when we test labs, it's with an understanding that it's going to help direct treatment or give us some better understanding. They're also a static time and our bodies are very dynamic, especially as women. So if you are not menopausal and you are still having some sort of cycle, even in late perimenopause, traditional hormone labs aren't always giving the full picture. And so there are a little controversial, especially when you're thinking about starting perimenopausal hormone therapy treatment, because at that point we're really

going off of symptoms versus say the lab value. However, with saying that, you have to understand that the body as a whole. estrogen and progesterone are, and I'll say estrogen is like an umbrella term, but we really look at like estradiol, you know, there's E1, E2 and E3. So we typically will test E2, which is estradiol. We look at progesterone levels, but also looking at testosterone, free testosterone, dihydrotestosterone. Those are all helpful depending on what your patient is talking, what bothers them, what's going on in their body.

you also need to understand thyroid. So as women go into the perimenopause and menopause transition, we'll start to see a hypothyroid picture. some women actually even have Hashimoto's and they never knew because only a TSH was tested for them. So what I say is that...

It's really important to work with if you're not getting the right answer, right? So a lot of primary care doctors, they're doing their annual physicals and they run maybe 18 to 30 biomarkers. It's what's covered by insurance. Typically, it's the standard panels. But if you are still not getting answers, it's important to work with the clinician that is willing to maybe go a little bit further and understand that these ranges on the side of the blood draws are median ranges. They're off of population. So depending on what lab you're working with, if it's

lab core, a private one, they're looking at maybe 2,000 people and they're looking at a median value. And if you look at some of my wonderful mentors, they'll say, Ashley, when I graduated fellowship, an ALT and an AST range were 20 and below. Now we have 50 and below, 45 and below. It's not that we thought that the liver can be more abused or that it doesn't have to work as hard, but it's okay. basically it's our patients are getting sicker and sicker. We have increased metabolic dysfunction in our country.

right? And each location is going to be slightly different. So I'm using the United States because that's where I practice. But what I say is you really have to look at nutrient levels. So iron levels for women are critical. So I treat a lot of women with hair loss and hair thinning. Maybe it's postpartum. Maybe it's also a different stress. Maybe it's associated with weight loss now that women are on GLPs. But we have to look at B12, folate, magnesium levels, iron stores, ferritin levels. Look at a full thyroid panel, not just a TSH because we'll see free T3.

that's very low and that also contributes to that fatigue problem sleeping at night. So in the context of looking at the full picture, having issues in other areas can exacerbate your hormonal symptoms and the hormonal decline can also exacerbate other areas of your body. So I think it's understanding to look at the full picture and if you're not getting answers to look for a clinician that's willing to maybe add in some testing there to understand better.

Claudia von Boeselager (22:03)
Yeah, I think that's really great. I've heard that at a conference as well. It's like, if your doctor is saying this and this and this to you and it's not possible, go find another doctor. So I agree.

Ashley Madsen (22:11)
And

some people feel really good at this area of the range, other people feel really good at that area of the range. And so that's really a bio individuality and why personalized medicine or precision medicine we're talking about is so important because it's not just the lab value, it's the symptoms, it's the person in front of you and what's going on in their life and in their body.

Dr. Asima Ahmad (22:30)
Ashley, think that's a great point because that's what reference ranges are. They're a reference, right? And so you do have to look at the whole picture,

Claudia von Boeselager (22:37)
Yeah. Peter, the vaginal microbiome is still overlooked in most medical conversations, if not all medical conversations, it's so rarely talked about. It's deeply tied though to fertility, mood and even inflammation. Can you explain how this invisible ecosystem impacts women's health and what most women don't realize they should be paying attention to it? Why should they, they should be paying attention to it?

Pita Navarro (22:56)
Thank you.

Yes, definitely. Although the vaginal microbiome isn't talked about, what is talked about very frequently is bacterial vaginosis, use infections, right, STIs. And you can think 90 % of these infections are actually due to imbalances in the vaginal microbiome. And so I would say what people, what most women and providers don't realize is that the vaginal microbiome is really an amazing, intricate, dynamic ecosystem that can either protect or predispose someone to reproductive challenges, right?

We know that a healthy vaginal microbiome is typically dominated by lactobacilli species, which keep the pH low, they protect against pathogens, and they reduce inflammation. And so beyond vaginal infections, what we're starting to learn is that when the balance in the vaginal microbiome, and you can think of, I'll go into a little bit of vaginal microbiome 101.

But the vagina is pretty much the structural connection between the outside world and your most important reproductive organs, right? So you can think of the vaginal microbiome as like a local immune system. And so when the balance is disrupted, it can do many things from cause you know, the number one reason why women seek healthcare advice, which is vaginal symptoms, but it could also be linked to, you know, it could decrease sperm motility if you're trying to conceive. ⁓ It could affect embryo implantation. It can increase the risk of miscarriage and preterm birth.

⁓ And I think the most important thing that people should realize is that even without symptoms, you can still be at risk of these things, right? So, and 80 % of women have dysbiosis without having symptoms. And so usually you would test your vaginal microbiome if you have recurrent infections or even if you have vaginal symptoms or even recurrent UTIs. ⁓ But I think it's an incredibly important tool that we could use to understand

Again, actually to your point in the context of all of these other things that you're testing for, ⁓ how could it lead us to clues on maybe the vaginal microbiome is affecting your ability to naturally conceive? And the good thing is that you can modify it, right? It's something that's easily changeable. It's not like your genetics. ⁓ But I would say the vaginal microbiome is also a driver of inflammation and locally and systemically, right? Like we see a lot of our customers have IBS that have chronic vaginal infections.

We also see women, anxiety is the condition that's most noted ⁓ that people have with vaginal infections. And so I think the driver of inflammation can really trigger immune responses that also might affect someone beyond the reproductive track, Chronic inflammation has been linked to endometriosis, unexplained infertility, and poor IVF outcomes. So we are doing a lot of research in the IVF space right now in partnership with a few fertility clinics in the US to actually understand.

very specific markers. Right now we know dysbiosis is poor ⁓ outcomes and a healthy vaginal microbiome has healthy outcomes, but we really want to understand specific markers that lead to these negative outcomes so that we can then understand mechanisms and ways to treat these negative outcomes through modulation of the vaginal microbiome. Yeah, I think, despite having all of the tools like metagenomic sequencing to deeply profile this ecosystem,

Vaginal health is still very much sidelined, ⁓ you know, in most fertility and hormone workups rather than leverage and combination. So that's, we're trying to do a lot of education, not just to patients, but also to the provider ecosystem.

Claudia von Boeselager (26:26)
Amazing. Dear audience, I'm sure you've had a few aha moments. You're welcome to share some of them in the chat as well. So much incredible information here. And by the way, for those of you that are loving this, you can still upgrade to the VIP Q &A session afterwards. And we can drop into the chat where you can still sign ⁓ up for that as well. Pete, I want to continue with you and let's talk about the science that's changing everything that most women don't realize how much their vaginal microbiome reveals.

And so you were mentioning there about infection, entire hormonal and reproductive health. So can you explain a little bit more depth? Like what can women actually learn from testing their vaginal microbiome? And how is this data, how can it be used for decisions around fertility inflammation? What are you seeing patients do with this information?

Pita Navarro (27:15)
Yeah, I think at the highest level, it's really understanding is my vaginal microbiome protecting me or is it hurting me? ⁓ And then based off of what someone is going through, whether it's fertility, whether it's recurrent infections or some hormone imbalances that might be affecting their health, ⁓ it can help identify someone who might not be responding to a specific treatment or why symptoms keep recurring when normal labs, when labs are normal. ⁓

For instance, if you're navigating ⁓ fertility, we know from publications that there are specific bacteria like Gardnerella, Atropobium that have been linked to implantation failure, early miscarriage, even lower rates of IVF, right? And so knowing what's happening in this specific environment ⁓ before undergoing such a costly or emotionally taxing procedure, I think can help patients and clinicians take a much more targeted approach.

⁓ whether that is antimicrobials or understanding, like, is it affecting, for example, there was a really interesting paper that came out that affects how the vaginal microbiome is affecting whether someone is uptaking the progesterone that they're leveraging for the IVF process. So how can we actually leverage this dynamic ecosystem to help us understand how to ⁓ treat women with a much more precise approach, given that we now have the ability to test it? ⁓ But I think, ⁓ for example,

for menopause, right? We know that the vaginal microbiome is very receptive to estrogen. We know that we see higher levels of pathogenic bacteria in women who are approaching perimenopause menopause because the healthy bacteria, lactobacilli, need glycogen in order to thrive and glycogen is produced by estrogen. And so it's understanding, like, can this help me?

figure out whether I need to start hormonal therapy first or do I need to seek out a of like a screener of like what is going on in my body and is this related to the symptoms I'm experiencing? ⁓ We also know that for women experiencing recurrent UTIs ⁓ that there are certain bacteria in the vaginal microbiome that can act as a reservoir to kind of kickstart recurrent UTIs. And so it's understanding like one, is it helping me or is it protecting me? And two, what am I going through and is it potentially related to that?

And is there, ⁓ you know, fluctuations in my cycle that might be affecting it? Women with longer periods, for example, tend to have recurrent infections because the pH of menstrual blood is a lot higher than the healthy optimal pH of your vagina. And so I think it's understanding, do I have symptoms? Is this related to hormonal shift, inflammation, microbial overgrowth, like really helping women decipher, like, what is the best approach to help resolve what I'm going through right now?

Claudia von Boeselager (30:00)
So interesting, so fascinating. Until I came across Evia, I didn't even know this world existed. So thank you so much for sharing that. Asima, so many women are blindsided by perimenopause. They're told just to wait it out or get on the pill. But this phase can also be deeply empowering with the right knowledge. So what are some key shifts women can expect in perimenopause and menopause? And how can they navigate these transitions with clarity rather than confusion?

Dr. Asima Ahmad (30:29)
Well, I think that's the thing. It's that it's not the same experience for everyone and so it can be confusing. There's some people who have debilitating symptoms where they feel like they can't get through their daily tasks the way that they did before. But I also know women who said that their period stopped one day and it never came back and that's all they noticed. But that being said, most people usually fall somewhere in between. I think that there's there's two big things. One is that

it's important to just be aware of the changes happening in your body. So you might notice a change in your menstrual cycle. ⁓ For example, as you get closer, you're aging, your follicular phase, that first half of your cycle starts to shorten. And so you may notice if you're tracking ovulation, you may notice that you're ovulating sooner, or you may notice that the length of your cycles are getting shorter, especially if you have regular cycles, or even women who have polycystic ovary syndrome and have very unpredictable, really, really long cycles.

may notice that they're becoming a little bit more regular and predictable. As you get closer and closer to menopause, you may notice things like a change in the length of your cycle by about seven plus days. That could be longer, shorter, it's inconsistent, or you start missing some cycles, like you might go a couple of months without having the period. You might also notice ⁓ changes in your mood or energy levels. For example, there's some women who didn't feel anything throughout their menstrual cycle, had no symptoms, but they start noticing that as they're getting

closer to the start of their period, their energy levels start dropping or maybe they're becoming more susceptible to mood changes. They just feel like a little bit more sad or easily irritable. ⁓ I think your family history is also very important. ⁓ Knowing the age that your family members went through menopause or even like other medical conditions really helps you kind of figure out if there's a trend there because sometimes people do have ⁓

genetic makeup that makes them go through earlier ovarian aging and more early onset menopause. Your race also plays a role. example, black women can have more severe hot flashes, arabesomotor symptoms, and those may also last a longer duration of time. But there's a lot of different symptoms. know, changes in your hair, your skin, the distribution of your weight can be more abdominal obesity, your ability to concentrate or

on things or even recall things may change, your ability to fall asleep, to stay asleep. And Pete, as you mentioned, the vaginal changes, right? You do have that drop in the lactobacillus and that affects maybe your sexual functioning and then the drop in estrogen, again, in conjunction with that may make it harder for people to have intercourse. ⁓ But I think the other part is that we don't talk about...

the preparation leading up to it as much as we talk about, know, perimenopausal, menopausal, what to look out for. I think what people need to start thinking about this like a decade or two decades before is like first, like my fertility and my family forming and family building goals. when do I want to figure out where I stand? What, you know, how many kids do I want? Do I want kids? And do I want to do anything to preserve my fertility? What is the timing look like? And where do I stand right now? And where do I want to be in a decade or two decades from now?

The other thing is, for example, your bone mass and your bone health. Our peak bone mass as women is somewhere in our 20s and 30s, and that's well before for the majority of women before perimenopause or menopause. And so you should be doing things to optimize your peak bone mass well before you go through those changes in your life. ⁓ The other thing is like your risk for cardiovascular disease goes up as you get post-menopausal. And so like, what's your family history?

of cardiovascular disease, you already have a genetic predisposition to, you have an elevated risk and then on top of that, post-menopausal, it's gonna go up higher. You should already be looking at your blood pressure, your cholesterol panel, your hemoglobin A1c, all these markers. ⁓ That's not the full list, but just a sense of what to look for. And just know any, get a sense of what your health is like right now, meaning do you have any pre-existing medical conditions? Are there any reasons that you might,

Claudia von Boeselager (34:30)
Thank

Dr. Asima Ahmad (34:42)
not be a good candidate for certain treatments like hormone therapy and if not, what are other things that you can access? So I think like if you start thinking about it before you start trying to optimize your health before when you get into that point or as you're approaching that you're much more well informed and when you walk into the clinical setting you have a very different conversation than if you came in without thinking about all these things and taking these proactive approaches. Proactive as you mentioned Ashley right like more preventative versus reactive.

Claudia von Boeselager (35:10)
Yeah, and we have so many topics still to cover, we're going to try to, there's so much information. This is really gold, so I hope everyone's taking lots of notes. So we'll try to get through as much as possible here before we go into the VIP. Asha, you work with high performing women amongst others who are often exhausted or foggy or anxious, even when their labs are overlooked, or sorry, even when their labs look normal.

talking proactive medicine, right? So what are some of your go-to tools or frameworks that women can use to optimize their hormones, their mood and energy, especially when they feel off, but they don't know where to start?

Ashley Madsen (35:52)
you

I'm so glad that I am keying up after a similar cause I, this is perfect because you have to be proactive and know yourself. So when things start to go off in a ride, you're like, Hmm, something's not right with me because you know more than your clinician does when you are going into their office and saying my sleep's off my mood. I'm, I'm forgetting words. I just, I feel like my afternoon, I need a nap. And it's, instead of it being put under the umbrella of, you're getting older or you're really stressed. Well, let's figure it out.

because the human body is incredibly resilient. And so we are meant to overcompensate and sometimes to our own detriment. And we are in a society right now where people are expecting instantaneous gratification. A text message comes through. You may have other challenges with work, with family, right? And women, we are known to be the ones that kind of are the catch-alls. We are the ones that are kind of putting the lids on every single pot and keeping it together until you start to run yourself into the ground. So absolutely,

we start to notice that some symptoms come up and women will start to say, you know what, my sleep's not so great. I'm having a hard time. I'm ruminating. So for a lot of my patients that I see, they come in with increased anxiety and mood changes. And they said, you know, I went to my PCP. They wanted to put me on Lexapro and something else, but I don't know. I just, feel like something's just not right. And we start to notice, maybe having a decline in their progesterone, maybe, you know, their nutrition has really been suffering and they're eating a lot of processed foods. not eating enough.

and healthy fats and fiber in their diet. They're starting to sacrifice in these other areas to help, you know, continue on with their journey. So for me, I'm really about a foundation's first model. I can absolutely prescribe, I can, you know, help you with any hormones, any other prescriptions when necessary to triage the situation. So we obviously want to help our patients sitting in front of us. But then how do you rebuild the foundation that has been cracked? Sometimes, yes, it's with bioidentical hormone therapies, it's with medication.

with certain supplements, but we have to tackle sleep because even in the best situation we can prescribe, we can do the things that we can do in the medical community, but if someone's sleep is disrupted, it's affecting everything in their life. Insulin resistance, it's putting them at risk for cardiovascular disease. They're not obviously have that glymphatic drainage at night for their brain. There's so many different areas. Stress resilience, we have to talk about how do we manage stress, creating outlets, movement in your day, getting up from your desk and doing exercise snacks.

We talk about the loss of bone density and loss of muscle mass as women age above 35. We start to lose that muscle mass which is 80 % of where our glucose is stored. So we start to see these issues that happen and muscle is really our organ of longevity which is going to keep us strong and stable when we take these tumbles along the way which potentially can harm us, a hip fracture, a twisted ankle, et cetera. And then using strategic testing. So I don't test just willy-nilly.

test with a purpose and we want to make sure that we are using this testing with our patient in front of us and if you know and looking for optimal values and seeing where there might be another disconnect in the downstream and upstream areas of the body.

Claudia von Boeselager (39:07)
Excellent. So we're going to transition into one of my favorite topics as well, amongst others, what we're hearing here, but it's the female biorhythm and how to unleash your superpowers as women. And for years, I pushed myself to function like a man, the same routine every day until I burnt out. And most productivity systems are built on that male testosterone 24 hour cycle, but women's biology follows an approximate 28 day rhythm with four powerful phases, each with its own unique strengths.

And so what I really love to empower women is to realize that you have superpowers at different phases of the month. And the reason why women are typically burning out is because we're trying to compete with men and their 24 hour testosterone cycle. And so just so you know, ladies, like the menstruation cycle is great for reflection and intuition. It's when it's your body's reset button, right? So both brain hemispheres are sinking. You're more intuitive and have more analytical reasoning.

So this is a great time of the month, how you can apply it for incorporating things like planning or downtime to think, listening, evaluating and reflecting, be it a short walk, Epsom salt bath, et cetera. The second phase, the follicular phase, right? So day, approximately day seven to 13 is great for creativity and strategy. So the rising estrogen and testosterone will bring a boost of energy, a spring in your step and improved mood. You'll feel more motivated.

full of optimism and ideas and more assertive and willing to take risks. It's a great phase to get curious, get creative, think big, mastermind potentially how to conquer the world, whatever it is you feel like doing. And some cool biohacks to do in this phase are the cold showers and nootropics like Lion's Mane, the HIIT workouts and brainstorming sessions. In the ovulation phase, this is your charisma and confidence. This is the phase where you can really shine.

When the estrogen and testosterone are their peak levels, it makes you feel and look your best. Your brain chemistry will give you the confidence boost and make it easier to verbalize thoughts and feelings. So it's a great time, for example, for planning public speaking or networking events or even job interviews, working with your suppliers as well as your sex drive being at the highest.

And real cool biohacks for this phase are things like the Maca root or nitric oxide boosters, red light facials, social events and partner time. And the final luteal phase, so approximately 17 to 28. This is a phase when you are sharp and focused. So it's a great time for planning to get things done and make decisions. And this is great for the task orientated tasks and getting things, you know, that to do list done.

and the increasing progesterone will likely find yourself that you'll be wanting to slow down. So it's also very great to practice more self-care during this time, healthy meals, restorative things like yoga, have a massage and acupuncture. And you can do this by tackling your to-do lists, leverage your attention to detail during this time. And some cool biohacks for this are using Ashwagandha. I'm a huge fan for mood, magnesium, L-theanine.

for sleep, strength training and journaling. And the thing is that, as I mentioned before, that we're really burning out because we're trying to be the same every single day. And we have to appreciate that women are much more complex and we're not little men. We can't repeat what men do. So if you can set yourself up and your schedule up to go flow in this way and to unleash your superpowers for each of the phases of the month, you will be a superpower for sure. And by the way, this is even for postmenopausal women.

that still feel a rhythm as well, because it's encoded in our biology. So the future of women's health is obviously not one size fits all. It's cyclical, personalized, and powerful. And typically, we've just been following the wrong map. So dear audience, we are moving on to our last round. I know that it's time typically for our master class, but we'll go on for a few more minutes, because we want to get to some amazing topics like sexual wellness, symptoms, misdiagnosis, et cetera.

Dr. Asima Ahmad (43:01)
you

Claudia von Boeselager (43:16)
Then we will be going into the VIP. So in case you are interested to still jump in and be a part of the Q &A, in the text box, you will see the link. can still upgrade before we jump over. Ashley, sexual wellness. I know you love this topic and you've become known as empowering women and men around sexual wellness. And it's so under discussed, especially in clinical settings. What do you wish more women knew when it came?

Dr. Asima Ahmad (43:21)
you

you

Claudia von Boeselager (43:43)
or when it comes to optimizing sexual health, pleasure and libido, especially through hormonal shifts.

Ashley Madsen (43:50)
Right, I want women to feel encouraged that there are treatments and ways to help you. So libido is very different than arousal, and yet we kind of put it under one umbrella. Responsive desire versus spontaneous desire, which most men will experience, spontaneous desire versus women, is a little bit different. Our neurocognitive system is a little bit different, right? So we can't put ourselves in the same box as men and think that, gosh, there's something wrong with me.

We

are super dynamic beings and sometimes it's not just about age. Sometimes it's like you're going on a medication, maybe you're going on a birth control pill or maybe that you're starting to get a little bit over 35, you start to see a decline in testosterone, but maybe you're not having overt perimenopausal symptoms. Testosterone is a really important hormone that doesn't get enough attention and yet we have more testosterone in our body than estrogen. It is incredibly vital for women, especially for

food, cognition, motivation, but also for libido and arousal. So there's a lot to be said. Also the decline of estrogen with the microbiome in the vagina. see increase in urinary tract infections. see increase in BV, is bacterial vaginosis, yeast infections. So there's also different treatments. It doesn't always have to rely on hormones. So we even have amazing FDA approved medications like Addi, which is flavancerin. We also have Vilece, which is also a peptide called PT-141 or Bromel.

These are non hormonal options for women that also can help improve your desire and your libido. And then we also have other options. So if you are having pelvic pain, can investigate that. There are different devices available. We have photobiomodulation, is red light. We have ⁓ rings. So if you have a male partner and they're a little large, we have an O nut. We have so much in our arsenal that I don't think gets out there to women. And I just want women to understand that if you are experiencing

something that's bothersome to you. There is help out there and you just keep searching for a clinician out there and you'll find someone that will be able to give you that information.

Claudia von Boeselager (46:00)
I see how many women are told their symptoms are just hormonal, but these signals often point to deeper imbalances. Which symptoms do you see most commonly ignored or misdiagnosed? And what should women watch for as red flags?

Dr. Asima Ahmad (46:05)
you

I think along the lines of Ashley, what you just mentioned is that I think that a lot of times pain is dismissed by clinicians, but also by the patient in the person in the sense that they're like, well, it's that time of the cycle and maybe that's why it's happening. But pain, whether it's pelvic, vaginal, vulvar, whether it's during intercourse or in other situations, I think that in itself is a red flag and it's not normal. ⁓

Again, most of the times when people have pain, think that maybe it's because they have periods and they have cramps, or if it's not during the setting of their menstrual cycle or menses, they think it might be lubrication or might be something positional. But I think there's questions that you should ask yourself if you start feeling pain and as a clinician that you should be thinking out. One is why? So is it related to a medical condition? Could it be endometriosis, which again, it takes about seven

plus years on average for women to get that diagnosis because that symptom is not always taken as seriously, could the person have had a history of sexual trauma? Is it something that's physical or is it something that's more ⁓ mental or emotionally related and it happens only in certain situations or with certain people? ⁓ When does it happen? Is it during sex? Is it a time of your cycle? Is it something that lingers after it starts or it goes away immediately?

⁓ And again, is it only in certain situations or with certain people? Where is the pain located? Is ⁓ it a deep pain, ⁓ which again can be more associated with like endometriosis or other anatomical changes? ⁓ Is it in the vagina? Is it at the the atriotus or the vaginal opening? Where on the opening does it happen? What's the type of pain? Is it a sharp pain? Is it throbbing? Is it a burning sensation?

And is there anything that's made it better or worse that you've tried? And the other thing is just timelines on onset, because sometimes these things can be an abrupt onset, meaning it was never there and suddenly it's the worst experience and the worst pain that I've had. Or was it more gradual and it's gotten worse over time? And as a clinician, when you're getting the history, which is very, very important, the other thing is also the physical exam. Is it something that can be reproduced on the physical exam or is, again, something that just happens in a different setting for the person?

But again, I think this is something that's quite often dismissed in a way or that is not ⁓ resolved. ⁓ It takes several years to get a diagnosis. So I think as a person, again, an eye on how your body is changing, what symptoms you're experiencing, and all those like why, what, how, when, that's going to be very important when you walk into the clinical setting to be able to share that with the doctor. ⁓

And ⁓ as a clinician, again, like if someone's bringing up the topic of pelvic pain, there's usually a reason for it. It's important to learn what that reason is sooner rather than later because certain things can progress and worsen over time. can affect other parts of your system. I'm using endometriosis as an example because it's something that's quite often ⁓ diagnosed after extended periods of time, but that can also affect your fertility. So being able to understand what you have diagnosed and addressed early on can actually help prevent it from.

progressing and getting worse and causing other issues later on as well.

Claudia von Boeselager (49:38)
Pita, we've discussed also the vaginal microbiome is not only in terms of infections, but can also show broader hormonal and systemic imbalances. What are some, let's dig a little bit deeper into this, what are some things that women should really be paying more attention to and how can testing with EVI or testing the vaginal microbiome help to identify it and then what should they do with this information with their clinician, have those conversations? What would you encourage women to know?

Pita Navarro (50:06)
Yeah, I think two things that I just want to start with, ⁓ which has led to the lack of research and knowledge around it, is one, we're taught to normalize a lot of vaginal symptoms, like maybe this is normal at the time of my period, or maybe this is normal in menopause. And I think that there is no really definition of normal, it's so unique to each person, what they're going through.

⁓ And then two, think we just haven't really talked about it because it has been viewed as gross and it has been viewed as And if we don't talk about it, then we can't bring awareness to it. And I think ⁓ then there's no research behind it. And so I think a lot of what we have invested in it is just normalizing talking about it ⁓ and going to these social platforms and talking about discharge and smell. And so would say it's very important to not completely ignore vaginal symptoms.

⁓ especially itching, discharge, and irritation. These are signals that our body is giving that I think are often dismissed as just an infection. And in the medical system, they're viewed as binary, right? It's black and white. There's an infection, let's throw a grenade at it, let's throw antibiotics, and then pretend that that's gonna solve everything. ⁓ But I think it's important to note that they're frequently downstream indicators of broader imbalances, right? ⁓

We've been talking a lot about estrogen, how it plays a crucial role in supporting a healthy vaginal microbiome. And when you see hormonal shifts, like during paramenopause, postpartum, on certain birth controls, the loss of estrogen can actually really lead to physiological changes that can lead to these reproductive outcomes that we talked about, like miscarriage and preterm birth. So I think the most important thing is just not dismissing the itching that you're feeling to just really seeking out answers and understanding

that these symptoms might not just be local, right? They can signal broader systemic issues ⁓ like some form of hormonal dysregulation or chronic low grade inflammation. And all of these things as Ashley pointed can then affect your sleep, your libido, your mood. And so if you don't have like a very clear vaginal infection ⁓ but you do test your vaginal microbiome and you do see surprising results like a lot of pathogens, maybe seek care with the provider and say like,

What can this be signaling about overall hormonal health or overall fatigue and inflammation? And so I would almost view it as like a very accessible, almost thermometer that can tell you so much more information that we're not leveraging right now.

Claudia von Boeselager (52:33)
Fascinating. So let's do a quick lightning round before we head to the giveaway. I'd love to invite each of our amazing speakers to share one closing thought. So what's one thing you wish every woman knew? Perhaps a truth about her body, hormones, or health. So Asma, do you want to start?

Dr. Asima Ahmad (52:53)
Sure, think in many.

cultures or families. It's not uncommon to be told to deal with the symptoms or with the changes. And I don't think there should be that stigma. There shouldn't be that guilt or shame. You should learn about your body. Ask questions. We said this so many times during our sessions today. Pay attention. Learn about your body. Learn about your family history, because again, you may have a genetic predisposition to certain things. And yeah, ask the questions. Don't shy away from them. And if you don't find somebody

who's helping you address them, you can get a second opinion.

Claudia von Boeselager (53:29)
Beautiful. Ashley, what would you say?

Ashley Madsen (53:31)
Yeah, I want to reiterate the fact is that we're not broken. You know, we are, we have rhythms and life is very dynamic. I said this already and that many times it comes down to the fact is that we're just under resourced and that when you give your body the right signals, the right nutrients, you know, give it the support it needs. It's going to heal. It's going to come back on board. And I think every woman deserves to know her options and it's not up to the clinical

It's not up to society or culture to dictate that. It's women should be able to decide for themselves and they should know the risks of starting a treatment, but also the risks of not starting a treatment. They should understand the full gamut and use shared decision making with their clinical team to find out what's best for them. And I love the tools like Evvy, because to be honest, I think back how many women come in with recurrent urinary tract infections were being over treated with fluoroquinolones and all these medications. ⁓

And

we know that every single thing has an effect, although it's a beauty. We love conventional medicine. We love allopathic medicine. It's there for a reason, but is there a better way? Is there a way to be more personalized, more bio individual, and really help women from that biopsychosocial approach?

Claudia von Boeselager (54:46)
Beautiful. Peter, what would you say?

Pita Navarro (54:48)
I think it's just important to understate, once you start tracking and understanding your health, it becomes a source of power. Even knowing, think providers are very uncomfortable saying the words like, don't know. But I think when women have information, once they start tracking and relating what they're seeing in a lab results to what they're feeling, I think it just becomes very powerful. have seen

Thousands and thousands of women go from years of misdiagnosis to finally getting answers. And that shift from being misdiagnosed to being understood is completely life-changing. So don't give up on your health and just seek answers and providers that are willing to put in the work for you.

Claudia von Boeselager (55:27)
So beautifully said, that's why we're here to raise the standard for women's health.

thank you so much for joining.

Remember to follow each of our incredible speakers and subscribe to the Longevity and Lifestyle podcast to keep this movement going. And we see you, we hear you, and we created this for you.

This is what happens when women are given real knowledge. So let's keep rising together. It's just the beginning of truly empowering women through knowledge.