Severe Period Pain Is A Medical Problem - Dr. Ann Marie

If you’ve ever been told to “just deal with it” when your periods are brutal or your energy disappears in your 40s, this conversation is for you. I’m Carlene Humphrey, and I’m joined by Dr. Anne-Marie Regina, a Greatee Toronto-area naturopathic doctor and Menopause Society certified practitioner, to get honest about what perimenopause and menopause can really look like and what you can do before things spiral.

We break down the difference between normal cramps and severe period pain that signals something deeper, including endometriosis and fibroids. Dr. Regina explains why perimenopause can feel like a “zone of chaos” with irregular cycles and shifting symptoms, and why a proper assessment matters. We also talk about overlapping conditions like PCOS, plus how personal history, family history, thyroid issues, autoimmune conditions, and past treatments can affect when symptoms show up.

Then we go practical. We connect heavy menstrual bleeding to iron deficiency and anemia, and we make lab terms like ferritin and hemoglobin finally make sense. Dr. Regina shares evidence-informed supports many women ask about, including vitamin D3, hydration, and creatine monohydrate for energy, mood, and brain fog. We also discuss hormone therapy, including why it should be on the table after surgical menopause from a full hysterectomy, and how patient-centered decision-making weighs risks and benefits.

If you want clearer answers, better questions to ask your provider, and reliable menopause resources like menopause.org, press play. Subscribe, share this with a friend who needs it, and leave a review with your biggest takeaway.

If you want to work with Dr. Ann Marie or do some research here is her contact information! 

Website link: https://www.drannmarieregina-nd.com/
Instagram: https://www.instagram.com/dr.regina_nd/
Tiktok: https://www.tiktok.com/@dr.regina_nd
Menopause society - finding a practitioner: https://menopause.org/patient-education/choosing-a-healthcare-practitioner

Transcript

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Welcome And Meet Dr Anne-Marie

0:01

You're listening to Diva Tonight with Carleen Humphrey, a relationship podcast with a focus on life, love, and friendship. Welcome to Diva Tonight. Hi, I'm Carleen, and this is Diva Tonight. I'm excited for a fellow Canadian who actually lives in uh Toronto, you know, well, greater to GTA. I have with me on Zoom Dr. Anne-Marie Regina, and she's a natural doctor, uh, naturopathic doctor and menopause society certified practitioner. And she's gonna share all the things. Well, not all the things, but some interesting things, right? That's right. Absolutely. Thank you so much, Carlene. I'm so excited to be here. Oh, I'm excited too. You know, um, we were just talking about, you know, the fact that you went to the University of Guelph and what a beautiful campus, right? I I mean yeah. Yes, I was sad to leave, but basically immediately after that, I went to the Canadian College of Naturopathic Medicine for another four years. We were talking about not having to do more schooling, and I was in school for way too long, but it was worth it in the end. Because now I'm here helping perimenopausal and menopausal women, and it's been such an amazing journey. Yeah, I can only imagine. You know, I read in in your biography how you had your own struggles with, like, you know, period pain and just the struggle with that, and maybe that might have been the motivator for here and now. I find

When Period Pain Is Abnormal

1:43

that there's this misconception with periods and pain. And can you just shine a light on that? Like, I mean, are periods supposed to be painful? This is a really, really actually great question because often women are just told to kind of suffer through things that just take pain medication, or we don't even talk about it at all. It's just this expectation that it's supposed to be terrible. And physiologically, like naturally, yes, cramping occurs. Your uterus is is cramping, but when you are experiencing severe pain to the point where it is debilitating, you cannot go to work, you are throwing up, you have to take a copious amount of pain medication, you are missing school, you have to miss things that g bring you joy. That is when we consider it to be abnormal. And that requires an assessment, a workup. That is something that I actually personally have lived through and do live through. I was diagnosed with endometriosis, and I will say diagnosed as kind of a bit of a misnomer because it's very poorly diagnosed. Women's health needs a lot more advocating for and assessments. We're getting better, but know that if you do experience significant symptoms associated with your period, if you're having a lot of pain, that is not normal and you should receive care and treatment. It shouldn't just be like it'll get better, because it probably won't if we don't know what's going on. Yeah. As someone who I I I'm open to talking about it now because I've dealt with my own pain and like, you know, when it gets worse, when your period like you you talked about endometriosis. So I have like fibroid. That's more than one. And and that's something else too that causes like debilitating pain where you're like, ugh, right? And so what I want to talk about obviously is just to remind women, like, you know, in this age of life, like between 40 and 50, like all the things that we should consider for our own health, even when we're tired, like you know what I mean? Like, I guess natural things that like, you know, the more supplements that we have to take. But when you work with your clients, what are some of the things that come up in consultation? Absolutely. So

Perimenopause Help Before Menopause

3:59

primarily my practice is women in perimenopause, so in their 40s and in menopause in their 50s. I think we have a huge, uh really an amazing ability to help women in that early perimenopausal phase, because often when women do go to connect with their healthcare providers or their gynecologists, it's uh from what my experience is with my patients, they're told you have to wait until you don't have a period anymore, or it's just perimenopause. When a lot of the symptoms can start occurring earlier on in life in the early 40s, that it's important to be aware of, but also you should not, like we were talking about, you don't need to suffer. So as a naturopathic doctor, I have the opportunity to help my patients reduce their suffering and give them plenty of treatment options. Within my scope of practice, I can prescribe things like hormone therapy. I also have the ability to utilize evidence-based supplements. I can run blood work. So the assessment portion is just as important as treatment because there are so many things that could be changing and going on at this point in time. It's kind of like a crux of so many factors that we kind of we do want to be able to understand all of the things that are truly happening. Because, as an example, let's say we are in perimenopause, well, your periods are also changing. Maybe they're heavier, maybe we also have fibroids. If you have heavier periods and you're really tired, you may actually have an iron deficiency. So we need to be treating that too, because if we're anemic or iron deficient because of our heavy periods, that's going to make us feel really, really terrible. And so when people come in to see me and they're like, I'm really, really tired. Is it just perimenopause? It's like, yes and no, because your perimenopause is also resulting in some of these other symptoms that we need to treat. So we have to look at a woman as a whole person and not just yes, you have a period, no, you don't have a period. You know what? I think the one thing that we need to understand is like every situation is different. Every every woman is different. Like we have similar symptoms. Obviously, Paramount menopause has multiple symptoms. But what

Hormones And The Zone Of Chaos

6:21

are hormones? Let's let's start with their like absolutely. So I'll try to keep it as simple as possible. Our hormones that we produce are primarily, if we're breaking it down, is estrogen and progesterone. Pretty much the best way that we can produce them every single month is when we ovulate. So about in the middle of your of your cycle, so between both periods, that's when we release our egg and we produce estrogen and progesterone. Now, those play such a significant role in our overall health. We have receptors for all of for those hormones all over our body, our brain, our bones, our heart, everything, our muscles, every single aspect of our body is affected by hormones. So when we're transitioning into perimenopause, what can happen is while we're not we're not ovulating as frequently anymore, we're not producing those hormones as frequently. Some people may notice like missed cycles or irregular cycles, and that can be very chaotic and feel like a roller coaster ride because we can have lots of hormones come in and that still doesn't make people feel well, or we can have times where our hormones are super low and have a different array of symptoms. And so ultimately, this is kind of, and I know Dr. Mary Claire Haver calls this like the zone of chaos. It's true, it is a roller coaster ride. So ultimately, we just ideally want like the typical flow happening, but during perimenopause, it's just everywhere. Yeah. Like when you see like irregular periods, should you be worried, right? Like, I mean, do they fluctuate more in perimenopause? They absolutely can. And that's one of the first signs that perimenopause is happening. However, we want to make sure that we're ruling out other conditions too. So it can absolutely be perimenopause. It could also be other things causing irregular cycles. And so we just want to be very clear. I think right now there is a lot of talk about perimenopause. But as a naturopathic doctor, I have to make sure that I'm ruling out any other things that could be contributing because we don't want to miss something important too. Yeah.

Perimenopause Versus PCOS

8:45

So even uh, what do you call it? There, there's a lot of talk about perimenopause and menopause, but let's talk about PCOS because I actually know someone with that. And I think it's important to understand that too, right? Like what that is and how if the symptoms are similar to other conditions, right? Exactly. And that's actually a very important thing that we do want to consider ruling out. I have plenty of women coming into my practice saying, I think I'm in perimenopause. And I ask them, okay, let's go through your symptoms. And I have the opportunity to spend over an hour with people in my initial appointment so I can really understand what is truly happening. The difference between PCOS and perimenopause is that PCOS typically has symptoms of higher testosterone, and this has been happening like their irregular periods or the signs of PCOS have been happening probably throughout a large majority of their life. Whereas perimenopause is very much specific to like 40s in that range. Sometimes it could be earlier, like in the 30s as well. But you're right, the symptoms do overlap, and that's why it's important that we understand the differences between them with our symptoms over the course of our lifetime, our personal history, even family history. And then blood work is also a part of that too. So we can look at hormone testing if need be. We can do testosterone testing. And then even if need be, there are options like pelvic exams to see if there are cysts on the ovaries. So to understand the difference does require additional testing. But for the most part, if we just know, if your practitioner knows what to ask, it's very clear if it's PCOS or end or uh perimenopause often. Yeah.

Family History And Other Risk Factors

10:38

I think the one thing is like with perimenopause, could there be other factors? Like, I mean, what other than like, you know, the the the body's natural things to consider, are you also considering like I guess what are certain things you should consider, like your family history, like when you're going through this stage of life? Absolutely. Family history is definitely an important component, but it's not the only thing. Um personal history, too, right? So if you've had a history of endometriosis or um maybe fibroids, surgical history, people have gone through cancer treatments, right? There are many things that could age your ovaries faster, and that can put you at risk of menopause or perimenopause earlier on in life. Thyroid conditions, autoimmune conditions, inflammatory diseases, celiac, inflammatory bowel disease, anything that has an immune or inflammatory picture can age our ovaries quicker, which means that we will go potentially go through menopause early. If you know that you have a family member, a sister, or a mother that also went through menopause or perimenopause early, for sure, like if you know that for sure, or they've had a hysterectomy early for some reason, that is something that we want to be aware of too. Yeah. I guess um for me it's hard to tell because like I don't my mom didn't, I know she had heavy periods, but like I think when you don't have all the family history, but I know it's yeah, with fibroids, my aunt had it, her daughter has it, my grandmother had it. And so I guess it's really what is it, prominent on that side on my mom's side of the family. Yeah. So it seems to be right. So sometimes it's very obvious and clear, but even if you don't know your family history, that is okay. At the end of the day, if you are suffering, that's the thing that we want to be managing most. Because often we want to know, oh, what is the cause? And sometimes we don't always know. Sometimes our bodies just change at a different pace than what is expected. So, yes, maybe you've heard that at 45, that's the time that things naturally will change. But I've seen plenty of patients that are much younger than that, and I've had plenty of patients in their late 50s that still have bleeding. So it's an average, but at the end of the day, again, as a pro healthcare provider, I always have to make sure I'm looking at the individual in front of me. So it's good to have a community of people you can bounce ideas off of for sure, but you also want to make sure that you're taking your own health into account. Diva tonight, glamour for your ears.

Heavy Bleeding And Iron Deficiency

13:22

So you mentioned being anemic, and so I'm anemic as well. So I just want to, you know, I'm just so much. It's like I'm doctor and Marie, I'm always tired. You know, when you said that, I feel like I'm always playing catch-up because uh I'm tired from my period, and and then that it's just like a bouncing act, like actually not a bouncing act, balancing act, like catching up every month because of that. And so, yeah. So, what do you say to that? Like as an example, you know, for someone who is anemic, like you know, taking the supplements and making sure you eat iron-rich foods, you know. This is definitely my bread and butter in practice because anytime any person says that they're tired, I am always making sure that we're ruling out iron deficiency because I cannot tell you how many women are iron deficient or anemic. And the number one cause of anemia across the entire world is heavy menstrual bleeding. So we have to treat anemia twofold. You should absolutely be taking higher dosages of iron, and that doesn't require a prescription, but before you take it, you should be have confirmed diagnosis of anemia or iron deficiency, of course. So take it with the care of a healthcare provider as well. But we should also be understanding and treating the cause of the deficiency. So if it is heavy menstrual bleeding, we need to be reducing the bleeding because as you mentioned, which is very true, every month you're gonna be playing catch up. And for some women in perimenopause, you could be bleeding multiple times a month, right? Like it could be more irregular at this point or just a lot heavier than what you're used to. This is not only an impact on your quality of life, but yeah, to be living with anemia is it's not worth it. And there are so many treatments. So we have options to slow down the flow. I again work more as an integrative healthcare provider. So I talk to women about utilizing things like the Mirena IUD. There are medications that you could be using as needed to slow down the flow. Even Advil slows down the flow of bleeding, right? Like anything that will help to reduce bleeding will also help to prevent further anemia and iron deficiency. So it's a two-fold treatment. Right, right. No, I mean

A Wake-Up Call From Lab Results

15:49

it's it's it's always the thing. And and I and what I want to say too is that do not ignore your body. I did this and I ended up in the emergency because um I like my family doctor, like I finally went and did a physical, and when I got a call from my doctor, it was I'll never forget it because it was so early in the morning. Dr. uh Anne Marie, I was like, who's calling me at this time? I'm like sleeping. It's like 4 a.m. And my doctor called me. And he said, Yeah. No, he said the lab called him because my results were like really bad. Like, I mean, my levels were super low. And he was like, I don't even know how you made it down here to get the blood work done. Women can do lots of things, yeah. Like they say the threshold is 70. From your own personal experience with working with women in the years that you work as a doctor, what is the threshold? Like, I mean, what should you be worried about when you hear, oh, your iron is at this number? Like, you know? So now the labs are doing a fairly good job of showing the differences between like where is where your level of iron is at, your hemoglobin, if that is if that is low, that is indicative of anemia. So I don't know if that's what the number the C that you're talking about. Yeah, if it's at 70, like that's a time. It was below that blood transfusion. Yeah. Um I had a blood transfusion. Yeah, yes. I begged the nurse, I'm like, please, please, please, I don't absolutely. Oh, yeah, you would you would be qual you would qualify for it. I find it challenging to get people to get iron transfusions though, unless it's at that point. Hopefully it doesn't get to that point for most people. Yeah, um, right. And the other markers of iron though that they look at outside of just like your hemoglobin status, that's like end stage iron deficiency when you're when your hemoglobin is really low. Ideally, we just don't want it to be below 120. That's the cutoff. But you have a ferritin, and then you also have an iron panel that is being looked at as well that can be looked at. For the most part, I don't see iron panels being tested as often as I would like to see. But the ferritin level, if that is below 30, that is considered iron deficient.

Ferritin Versus Hemoglobin

18:14

So with ferritin and hemoglobin, can you just make me understand the two? Because I was like, I know it's like the ferritin levels were I check my iron every three months because of what happened to me two years ago. I don't want to repeat that. No. Yeah. No, absolutely. So ferritin is the stored form of iron. And so what we want is our storage to be higher because our hemoglobin is what carries iron in our red blood cells. So it's a marker of iron as well. But when our hemoglobin, when the iron is depleted in our hemoglobin, then we can't make red blood cells. And that's the that's when you need, you know, a blood transfusion when it's really, really low. For the most part, if it's at like a little bit less than 120, that's not going to be a big issue in terms of needing significant transfusions. But you're right, when it becomes below 70, that's a big problem. Ferritin, on the other hand, is just basically it's a marker of iron deficiency. So this is why we have to look at both because technically you don't, if you have normal hemoglobin but low ferritin, you're iron deficient, but not anemic. If both are low, then you're just anemic. That's why we want to still look at both. Either way, the treatment is going to be the same, just one may be more aggressive than the other. Right. I guess I I went down a different rabbit hole by asking you those questions, but I think it's important because already perimenopausal women are at risk of this issue because of heavy bleeding. Wow. Okay. No, I I I I I honestly feel like bringing this up is so important. If I can help one person not get to where I got, because I I I was I was winded. I would walk up a flight of stairs, doctor, and be like, oh, I'm I'm probably out of shape, but it wasn't that I was out of shape. It's because like I'm anemic and it's it's it's really bad at that point. So I mean, that was a wake-up call for me. So another thing, like you said, though those are things that have to do with perimenopause. So the patients that you help, you have both women with perimenopause and menopause. And

Simple Energy Tips That Add Up

20:25

the one thing I found very interesting, and I hope you can repeat it, is the five things that you can do to help some of those symptoms. And I thought it was very interesting because you're like talking about water. And I'm not a big fan of drinking water, doctor, but I know you know. Yes, yes. So, in terms of energy, I would say, of course, there are some things that you can do without doing blood work. Now, in Ontario, the recommendation is that everybody take 2,500 international units of vitamin D3. So definitely something you want to do. I would still recommend you have it tested, but I recommend all of my patients to take vitamin D3 every single day. When you wake up, have a glass of water, drink, take your vitamin D3 with it as well, for sure. I can't remember all the other five things. Yeah, because you said it wasn't um, there's this other chemical to add, yeah, to add to the water, which I thought was interesting. The other one that I recommend is creatine monohydrate. Yes, creatine monohydrate. Yes. Who's gonna remember that? I know. Creatine, if you look at look up creatine, it's everywhere. It's so widely available. Oh, okay. It is cost effective. You'll probably think of it more if you've heard of it as like a weightlifting supplement. But actually, they've done a lot of studies for perimenopausal women specifically. So, so often in perimenopause, because of the changes to hormones, we have poorer sleep. What I call creatine is like the fatigue buffer because it's been studied in perimenopausal women to improve energy and even mood, despite not sleeping well. So we do see a loss of creatine in the brain and just like in the in the body when we're in perimenopause. And it also helps with exercise performance too. But they've even studied it alongside antidepressant medications, seen an improvement in mood and response to antidepressants. So it does have a significant impact on energy and mood and even cognitive function like reduction in brain fog. And it's like cost effective. It's so cheap. I get mine at Costco. Um, it's it's useless. It's just uh a little bit of um a five gram gram powder that you can add to water and mix it. I usually just put it in a smoothie every single day. Yeah. No, I mean you've made some um interesting points there, and I definitely gotta go back to that video.

Hormone Therapy After Hysterectomy

22:54

Um, you know, I find there's another thing though, like that I think is important to remember is understanding what hormone therapy is and how that can help. Because I think, you know, with perimenopause and menopause, if you have like a hysterectomy, that puts you into early menopause. And you know, those symptoms hit on hard. I had someone on my show, she was talking about how she wasn't aware of like what would happen after she got the procedure done and like knowing. And so, what does hormone therapy help with, especially with those symptoms after something like that, you know? Yeah, absolutely. And I mean, for women that have gone through a full hysterectomy, so when they remove the ovaries, you as well as the uterus and potentially cervixes, um, you have been put into medical menopause. Sometimes they do preserve the ovaries, so it's a partial hysterectomy, and then you can still create your own hormones. But there are plenty of women. I actually had a patient today who had met was placed in medical menopause because they had to remove her ovaries. And in that case, adding back estrogen therapy and or progesterone is life-saving for a lot of reasons because when you lose your hormones literally overnight, it like I said, you have receptors for hormones all over your body. It will put you at risk of osteoporosis, of early um cognitive issues, of heart disease early, like everything is impacted, especially if you have a hysterectomy earlier on in life. So if this is quite early, then yes, you should absolutely be given hormone therapy as a treatment option, because it's personally, I think it's unethical to not even discuss that if someone is less than the age of 50 and they had a full hysterectomy. Right. Because you are, yeah, you're just losing all of your hormones in one day in one shot if you go through a full hysterectomy. If you have a partial, you still technically have likely some impairment in hormone production because anytime we touch the ovaries in a surgery, and by any means, you are going to be affecting their ability to produce hormones. However, you don't technically need the hormone therapy unless we know that you're fully in menopause. But hormone therapy is one of the treatment options for many women. It's not for everybody either. We can't just say as a catch-all, like everybody should be on hormone therapy or nobody should be on hormone therapy. And this is what I actually do in my practice almost every single day because I'm a prescriber of it. We go through the risks and benefits, we talk about individual health history, and then we make a decision together. This is what patient-centered informed decision making is. And together we decide whether we want to start hormone therapy or not. And we just make sure that I always make sure the patient doesn't have any more questions. And if they do, they're welcome to ask. But it is a it's a it's a decision as well. There's always risks, just like there's always benefits. Yeah. That is

Her Path Into Naturopathic Medicine

26:04

that is well said, as someone who's been practicing for some time now. We didn't talk a little bit about who you are. I like to ask the question. My signature question is you know, it's not where you're going, it's where you came from. And so the parents. I know it's my go-to. Um were the parents doctors? No, but it's actually a very interesting story, too. I was exposed to naturopathic medicine as a basically a toddler. I was always sick, as I'm sick now. She's sick. Okay, go on. And we're just kind of at a loss because they didn't understand why. They were we were always eating so healthy. They ended up taking me to a naturopathic doctor, and I had been on so many antibiotics, so many puffers, like changing everything they possibly could on so many different medications. Nothing was helping. I was sick for over a year. Um, and after seeing a naturopath, it was like, yeah, I was just not sick after that for so long. And my parents had their life back. My dad was even thinking about like changing his job and opening a health food store. He was so invested. But since then, you know, I just grew up being in that my family was always just in that mindset. And then I had my own personal hormonal struggles too. And so it just kind of together, I just knew that was the path I wanted to take. Wow. Very interesting story there. Yeah. Well, I mean, I that's it's it's always it's always our journey that helps us get to where we are here and now. And so I appreciate you sharing the information for whoever's listening that might have to use your resources and have a consultation with you. So

Trusted Menopause Resources And Booking

27:55

if anyone is here and do you are most of your patients here, do they do online versus in person? Yeah. So both as a naturopath and on like licensed and registered in Ontario, I can only treat patients that reside in Ontario, Canada, but that's a pretty wide range. Um I do have virtual and in person. And I'm also a menopause certified practitioner too. So you can find me on menopause.org, uh, which is always a great resource for so many patients. If you are wanting to understand more about menopause, perimenopause, this is a great website, the menopause society. Um, and you can actually find a menopause certified practitioner in your area. I'll be on that directory as well. You'll see me there. But it's just people, practitioners that have gone through additional training to manage women in menopause and peripheral. That is so amazing. It's kind of like you knew I was gonna ask that. I'm like, do you have any suggestions on where we can get information about menopause? Because I mean, knowledge is always power, right? Any suggestions for a book to read as well? Like, you know, like you know, yeah, there's I know Mary Claire Haver just came out with her book. She has two now. Estrogen matters is another one. Oh, I like that. Although it's a good one. Yeah, I would say you always want to take things with a grain of salt, but it gives a nice basis and resource. But yes, menopause.org is a really, really great website. And there is the Canadian Menopause Society as well, menopause, Canadian Menopause Foundations. So there's so many different resources online. I would avoid using ChatGPT. Like it's a great resource too, if you have questions, but there are so many other like truly reliable places. I yes, the menopause society is a great place to start. I think um knowing is good, but I mean obviously going to your doctor, speaking to them about your symptoms too, and just knowing, getting the test results and and those kind of things, right? Like are important too, right? So, but yeah, so you are online, your website is dr Ann Marie Regina.com, or you're on TikTok and I'm on TikTok, I'm on the Instagram, I'm on all the social medias. That's right. So um you are a very young doctor. How long have you been practicing? Um, it's been it'll be seven years this coming November. So it's six over six years. Yeah. Yeah. Yeah. Well, it's amazing what you're doing, and I want to thank you because you know, I usually I've interviewed American doctors, so it's nice to have someone here in Ontario. And then you know other other Ontarians, Canadians can, you know, get advice from you and help them in their journey because you know, this this stage of life is difficult, it has its ups and downs, right? And so, yeah, that's why we call it the window of vulnerability. There's just so many factors, things that are happening at this point. Yeah, definitely. Well, I'm Carlene, and this is Diva Tonight with Dr. Anne Marie Regina, and I want to thank you for sharing your knowledge. It's appreciated. Thank you. Thank you for having me. I love this. So good, so good. Thank you. Thanks

How To Follow And Send Messages

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