Latest / Midlife Glow Up: Simplifying Fitness, Nutrition and Healthy Habits for Women over 40 / 42. The Hormone Conversation Every Woman Over 40 Needs to Hear: Interview with Dr. Stephanie Elder, Part 1

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42. The Hormone Conversation Every Woman Over 40 Needs to Hear: Interview with Dr. Stephanie Elder, Part 1 · Midlife Glow Up: Simplifying Fitness, Nutrition and Healthy Habits for Women over 40

• 0:01
  SPEAKER_00: So many women are told that feeling exhausted, anxious, foggy, or just off is simply part of getting older.
• 0:08
  SPEAKER_00: But what if it's not?
• 0:10
  SPEAKER_00: In today's episode, I am joined by menopause specialist Stephanie Elder to unpack what's actually happening during perimenopause and menopause.
• 0:18
  SPEAKER_00: We talk about why symptoms often show up long before your period stop, why so many people feel dismissed, and what you can actually do to take back control of your health.
• 0:29
  SPEAKER_00: My hope is that this conversation leaves you feeling informed, empowered, and most importantly, not alone on this journey.
• 0:36
  SPEAKER_00: Welcome back to the Midlife Glow Up Podcast, where we simplify fitness, nutrition, and healthy habits for women over 40.
• 0:43
  SPEAKER_00: I'm Joan Dandano, your midlife health and wellness coach.
• 0:46
  SPEAKER_00: And if you are ready to feel strong, consistent, and confident in this season of life, well, you are in the right place, my friend.
• 0:52
  SPEAKER_00: Let's dive right in.
• 0:54
  SPEAKER_00: All right, welcome, welcome.
• 0:56
  SPEAKER_00: Super excited.
• 0:57
  SPEAKER_00: This is my very first interview.
• 0:58
  SPEAKER_00: So over 40 podcast episodes in.
• 1:01
  SPEAKER_00: And I thought no better person to bring on than Stephanie Elder.
• 1:05
  SPEAKER_00: She's the founder of Evolve Menopause Clinic here in Issaquah, Washington.
• 1:09
  SPEAKER_00: And she's a cardiometabolic specialist and menopause society certified provider.
• 1:14
  SPEAKER_00: And also just a down-to-earth wonderful human that I love to hang out with and chat about all things menopause and girl power and women advocating for themselves together.
• 1:25
  SPEAKER_00: So welcome to the Mid Life Flow Up Podcast, Stephanie.
• 1:29
  SPEAKER_00: Thanks, John.
• 1:30
  SPEAKER_00: Thank you so much for having me.
• 1:32
  SPEAKER_00: Yeah, I'm super excited about this conversation and my community is really excited.
• 1:37
  SPEAKER_00: Let's people send in great questions.
• 1:39
  SPEAKER_00: And there's just a topic that is complicated and nuanced.
• 1:44
  SPEAKER_00: And I'm just really looking forward to breaking it all down and getting really um simplified, you know, next steps if someone is really struggling with their hormones or doesn't even understand like what is this whole perimenopause thing.
• 1:57
  SPEAKER_00: Like we're going to break it down today and really give people some good action items and maybe enlighten them a little bit about what is possibly going on underneath the surface in their bodies currently in this stage of life.
• 2:10
  SPEAKER_00: Amazing.
• 2:11
  SPEAKER_00: Sounds amazing.
• 2:12
  SPEAKER_00: Perfect.
• 2:13
  SPEAKER_00: Okay, so let's just give uh our listeners a little background.
• 2:16
  SPEAKER_00: So Stephanie and I got connected a little over a year ago.
• 2:19
  SPEAKER_00: Um, I was giving a local talk on this topic, midlife, health, and wellness.
• 2:25
  SPEAKER_00: And Stephanie came.
• 2:26
  SPEAKER_00: She and I got connected through a mutual friend who is an amazing chiropractor, who, by the way, is also gonna be a guest on my podcast someday soon.
• 2:35
  SPEAKER_00: Um anyway, so we got connected.
• 2:38
  SPEAKER_00: She came to the event.
• 2:39
  SPEAKER_00: I said, Oh my gosh, it's I'm so excited to meet you.
• 2:42
  SPEAKER_00: And um, she was opening up a new clinic in our area, and she thought, gosh, I wonder how I'm gonna get clients.
• 2:47
  SPEAKER_00: And I thought, you're not gonna have any trouble at all because this is such a need in our community and just in the world in general, in women in midlife, just a place to go to feel heard and seen and validated and also get some answers.
• 3:03
  SPEAKER_00: So, what has your experience been, Stephanie, starting this um business a year ago and you know, fast forward all the way to today, and you've got a full booming schedule and not accepting clients now until September.
• 3:15
  SPEAKER_00: So, what does that look like?
• 3:17
  SPEAKER_04: Yeah, it's it's been kind of a long journey.
• 3:20
  SPEAKER_04: You know, for for me, it really started with my own pain through my own perimetopause journey.
• 3:27
  SPEAKER_04: And I I had a pretty extreme time.
• 3:33
  SPEAKER_04: It started over eight years ago with I was working in cardiology with some of the most brilliant providers, uh, physicians, and had no idea what was going on with me.
• 3:45
  SPEAKER_04: I remember going to my primary care provider saying I something is wrong.
• 3:51
  SPEAKER_04: Like I'm I'm anemic, I have an autoimmune disorder, I am deficient, there's something, I have a virus, like there's gotta be something wrong with me because I went from doing triathlons and running to feeling like I could barely get through my day.
• 4:10
  SPEAKER_04: And I knew something was wrong.
• 4:13
  SPEAKER_04: Um, but of course, you know, she was all concerned and ran a whole bunch of labs, and I got a message.
• 4:18
  SPEAKER_04: I remember being at work and getting a message saying, everything looks great, you know, everything looks wonderful.
• 4:24
  SPEAKER_04: Um, you know, I suggest just taking a girl's weekend, getting away.
• 4:28
  SPEAKER_02: I'm like, oh girls weekend.
• 4:30
  SPEAKER_04: I remember putting my head down and I just started crying.
• 4:34
  SPEAKER_04: I'm like, what is wrong?
• 4:37
  SPEAKER_04: And then the next years after that were a series of I saw an orthopedic surgeon for all my joints aches and pains.
• 4:46
  SPEAKER_04: I had a GI specialist for GERD that just would that made me feel like I was having a heart attack.
• 4:52
  SPEAKER_04: Um, I was seeing a therapist because I thought I was going crazy and she recommended an SSRI for the first antidepressant for the first time in my life.
• 5:00
  SPEAKER_04: I was seeing a neurologist because I had random tingling in my hand, my extremities, um, a dermatologist because I was getting all these weird things on my body, skin tags and stuff I'd never had before.
• 5:12
  SPEAKER_04: Um, you know, the list goes on and on of all these weird things um until finally my husband, who had endured this for a long period of time, showed me a podcast from Mary Clay Haver way back, like right around the Galveston diet, like one of her first books.
• 5:29
  SPEAKER_04: And he's like, we should watch this.
• 5:32
  SPEAKER_04: So I I watched it and my jaw dropped.
• 5:36
  SPEAKER_04: And I mean, because this was years that I was going through this, my jaw dropped, and then I just got mad.
• 5:43
  SPEAKER_04: I was like, Are you kidding me?
• 5:45
  SPEAKER_04: I work with people that claim to be some of the best providers in the planet, and I I I've and this is hormonal.
• 5:54
  SPEAKER_04: Nobody said hormones out of all these specialists with you know, letters with a whole alphabet behind their name, nobody said hormones.
• 6:04
  SPEAKER_04: And I um it just it made me mad.
• 6:09
  SPEAKER_04: So so mad that I'm like, I'm doing this.
• 6:12
  SPEAKER_04: I'm I'm and I tried to do it through the University of Washington, and there just no, there's no place for it.
• 6:17
  SPEAKER_04: So I decided to open up my own clinic, which my husband kind of pushed me to do that.
• 6:22
  SPEAKER_04: I got mentorship and training and became certified from the Metapost Society.
• 6:28
  SPEAKER_04: But my whole fear when I was talking to you when I first met you, John, was am I the only one?
• 6:33
  SPEAKER_04: Like maybe it's just me.
• 6:35
  SPEAKER_04: You know, is this maybe, maybe I'm like, maybe I'm the only one that had it this bad.
• 6:41
  SPEAKER_04: I mean, I understand, you know, watching, you know, this was again years ago.
• 6:45
  SPEAKER_04: Like I I understand that this happened, but I'm like, I don't know how many people go through this.
• 6:51
  SPEAKER_04: I mean, like, you know, the the none of my providers even mentioned it.
• 6:57
  SPEAKER_04: How, you know, is this something that's actually going to be marketable?
• 7:00
  SPEAKER_04: Like, will people come?
• 7:02
  SPEAKER_04: And yes, the the answer is yes.
• 7:05
  SPEAKER_04: Um, there are lots of women that go through this.
• 7:08
  SPEAKER_04: Um, most women go through some form of this.
• 7:11
  SPEAKER_04: And uh my business is booming.
• 7:14
  SPEAKER_04: I have such a wonderful patient uh population, and there's more providers coming in all around um the area and the state and the country.
• 7:23
  SPEAKER_04: So it is I love this menopause moment.
• 7:26
  SPEAKER_04: I love that this is happening.
• 7:28
  SPEAKER_04: My 80-year-old mother still says that menopause didn't happen for her.
• 7:32
  SPEAKER_04: She never had it.
• 7:33
  SPEAKER_04: Mine too.
• 7:34
  SPEAKER_00: Yeah, mine too.
• 7:34
  SPEAKER_00: And I'm like, but yeah, but mom, I remember you sleeping for days.
• 7:38
  SPEAKER_00: Like you just had you had to nap every afternoon.
• 7:41
  SPEAKER_00: She's like, I was just sleepy.
• 7:43
  SPEAKER_00: It was the unmentioned thing or the taboo thing or whatever.
• 7:46
  SPEAKER_00: So yeah, that's amazing.
• 7:47
  SPEAKER_00: I'm sorry that you had to struggle so much in order for so many other women to benefit from your experience and now from your expertise.
• 7:55
  SPEAKER_00: But I am really glad that there's been this huge shift that we're now talking about this.
• 8:00
  SPEAKER_00: And just imagine you and I are both girl moms, our girls are going to have a much different experience.
• 8:05
  SPEAKER_00: They're going to know what to expect and what to do about it when they come along.
• 8:10
  SPEAKER_00: And just imagine for generations to come, we have a lot of time to make up for the lack of women in, you know, clinical studies and things like that.
• 8:18
  SPEAKER_00: We have a lot.
• 8:19
  SPEAKER_00: But but that's also hopeful to think, gosh, if we have all of that still yet to back all of this up and people are finally getting certified in this, and doctors are finally taking this seriously, or the at least the next wave of doctors should be taking this pretty seriously.
• 8:33
  SPEAKER_00: Right.
• 8:34
  SPEAKER_00: That's really hopeful to me.
• 8:36
  SPEAKER_04: Yeah, no, absolutely.
• 8:37
  SPEAKER_04: I I say that I have uh, you know, I plan on keeping my clinic open for the next 10 years.
• 8:42
  SPEAKER_04: That's when I want to retire after that.
• 8:44
  SPEAKER_04: Um, so and they say that the the natural progression to bring new protocols to practice takes about 10 years.
• 8:53
  SPEAKER_04: So I'm like, all right, maybe by then, maybe, you know, specialists, you know, primary care providers, it doesn't have to be a specialist, primary care providers um will have taken this up and will be able to treat women properly.
• 9:07
  SPEAKER_00: Um I'm that's that's my goal.
• 9:09
  SPEAKER_00: Yeah, amazing.
• 9:11
  SPEAKER_00: Well, that's an amazing goal.
• 9:12
  SPEAKER_00: And I'm I'm excited that I get to personally benefit from it.
• 9:15
  SPEAKER_00: And it has been so impactful for me in my business.
• 9:18
  SPEAKER_00: So um, you and I have been referral partners for each other over the past year or so, and that's been amazing because I can help women with fitness and nutrition and the mindset aspect.
• 9:30
  SPEAKER_00: But as far as hormones go, obviously I'm not a doctor, and I know what I know in my personal experience, but it's been amazing to be able to send my clients to you and know that they're going to get this really specific personalized treatment.
• 9:44
  SPEAKER_00: And you really do take the time and effort with each patient, which I love.
• 9:48
  SPEAKER_00: So I only have wonderful things to say, and all my clients have had wonderful things to say about you, and you have sent me some really amazing clients.
• 9:55
  SPEAKER_00: So it's just, it's neat to see the collaboration that we've been able to provide together.
• 10:00
  SPEAKER_00: And I'm hoping sort of this conversation extends that even further today and allows more women to maybe have an aha moment of like, oh wait, maybe that crazy symptom that I'm having could be this.
• 10:11
  SPEAKER_00: And maybe then it's time to advocate for ourselves and really get so curious and not take that first answer that maybe we get from the primary care.
• 10:18
  SPEAKER_00: I know that was my experience.
• 10:20
  SPEAKER_00: Like, I'm sorry, wait, you just want to patronize me and tell me that's getting older, that I should just be okay with my symptoms.
• 10:26
  SPEAKER_00: No, sorry, but that's not, I'm not okay with that.
• 10:30
  SPEAKER_00: So yeah, really just encouraging women to stand up and speak up and and don't stop until it's like it's okay that you keep trying if you're not feeling good.
• 10:38
  SPEAKER_00: It's we're allowed to feel really good and we should be able to feel really good.
• 10:42
  SPEAKER_00: Like we're entitled to that.
• 10:43
  SPEAKER_00: We might just have to do some work and do some trial and error, but it's worth it.
• 10:48
  SPEAKER_00: No, absolutely.
• 10:49
  SPEAKER_04: Absolutely.
• 10:49
  SPEAKER_04: And my patients love you too.
• 10:52
  SPEAKER_04: They only have positive things to say about you.
• 10:54
  SPEAKER_00: Amazing.
• 10:55
  SPEAKER_00: It's excellent.
• 10:55
  SPEAKER_00: Yeah.
• 10:56
  SPEAKER_00: Okay.
• 10:57
  SPEAKER_00: So um, let's start with if a woman first walks into your office and she's in her 40s, 50s, and she just feels off.
• 11:07
  SPEAKER_00: What's usually going on inside that is causing that?
• 11:12
  SPEAKER_00: And like it can show up in so many different ways.
• 11:15
  SPEAKER_00: So, how would you say to someone, it's probably time, like, do you just what is it a blanket statement?
• 11:20
  SPEAKER_00: Like, if you're over 40, it's probably time to go get your hormones checked.
• 11:22
  SPEAKER_00: Or do you say, like, these are the main things to look for to know that the process is starting of this menopause transition, and now is a good time for you to go get your levels checked and things like that.
• 11:32
  SPEAKER_04: Yeah, absolutely.
• 11:33
  SPEAKER_04: And when patients come in, especially early perimetopause, um, there are some telltale signs.
• 11:41
  SPEAKER_04: The first hormone that goes in perimetopause is progesterone.
• 11:45
  SPEAKER_04: Pegesterone is our rest and relax hormone.
• 11:48
  SPEAKER_04: So in in simultaneously, what's happening with our estrogiol is it's becoming less reliable.
• 11:55
  SPEAKER_04: So the nice gentle waves that we had throughout our 20s and 30s are are now becoming jagged spikes and cliffs.
• 12:05
  SPEAKER_04: So they're just going up and down to just jagged spikes and cliffs, and um, that fluctuation of anti-estrogen causes cognitive symptoms that actually are higher in perimetopause than they are in postmenopause.
• 12:22
  SPEAKER_04: So these are the brain fog, the maybe irritability or labile personality.
• 12:28
  SPEAKER_04: You know, sometimes I feel good, sometimes I don't.
• 12:31
  SPEAKER_04: The fatigue, because your body is not your mitochondria, as we, you know, that's kind of a buzzword nowadays, but your mitochondria are not getting a reliable source of estrogen, which they have estrogen receptors.
• 12:42
  SPEAKER_04: And you so you have this this the fatigue, the brain fog, um, some of the cognitive, I'm walking into a room, I have no idea why I'm there, um, type of issues.
• 12:54
  SPEAKER_04: Um, the things that we all chalk up to getting older or stress.
• 12:58
  SPEAKER_04: Um, and then also it's usually coupled with I used to be able to sleep, but now I just I'm waking up all night long, or I'm laying in bed trying to solve the world's problems.
• 13:12
  SPEAKER_04: And that's the cycling, that's the lack of rest and relaxed hormones.
• 13:16
  SPEAKER_04: And my anxiety like is just I wake up in the morning and I I just I feel tired but wired.
• 13:22
  SPEAKER_04: Like my anxiety is higher, higher.
• 13:25
  SPEAKER_04: Um, you know, in perimetapause, I would say we are the expert self-gaslighters.
• 13:34
  SPEAKER_04: Like we gaslight ourselves more than anybody else can.
• 13:38
  SPEAKER_04: You know, the the experience of well, you know, the reason why I'm so tired is because I'm just I'm just not I'm just so stressed, I can't get to things.
• 13:49
  SPEAKER_04: And the the 10 extra pounds, that's just because, well, I don't know, maybe it's the burger I had at the ballgame the other night and it's just hanging on and I'm just not doing it.
• 13:59
  SPEAKER_04: And you know, I I get angry at my family because, well, they're they're just you know, they're kind of doing annoying things and and uh you know I'm not sleeping as well.
• 14:08
  SPEAKER_04: And I mean we just gaslight ourselves for years trying to make up excuses for things that are hormonal, you know, and it's it's really it's I have patients, I have a couch in my room, like it's not like a trip to I mean, I have a you know an exam table as well, but the couch, I can't tell you how many women just sit there and cry because of the frustration.
• 14:35
  SPEAKER_04: Um, I don't know who I am anymore.
• 14:37
  SPEAKER_04: My family doesn't know who I am anymore.
• 14:40
  SPEAKER_04: I look at my body, I have no idea how this body's there.
• 14:44
  SPEAKER_04: I'm eating the same things, I'm exercising the same, I'm putting on weight, and my hair is falling out.
• 14:51
  SPEAKER_04: You know, is it it's the flex that fluctuation causes so much chaos in the body.
• 14:57
  SPEAKER_04: So that's one of the examples.
• 15:00
  SPEAKER_04: And I'm not usually the first provider they see.
• 15:03
  SPEAKER_04: They have stories like you, they have stories like me.
• 15:06
  SPEAKER_04: You know, they have that frustration, and oftentimes they come in with a I'm sure I'm not, I'm sure I'm the only one, but I I just I don't know if you're actually gonna even believe me.
• 15:17
  SPEAKER_04: I'm like, that's why I'm here.
• 15:19
  SPEAKER_04: Right.
• 15:20
  SPEAKER_04: Because because I I believe me, I believe you.
• 15:24
  SPEAKER_04: Yes.
• 15:25
  SPEAKER_04: So yes, and that's it shouldn't be that hard to find providers that will actually listen to you.
• 15:31
  SPEAKER_04: Um but it does take um it does really take a load off of patients once they feel heard.
• 15:39
  SPEAKER_00: Yes, and validated and seen and normalized and all of this.
• 15:43
  SPEAKER_00: I it just makes me think like if if men had to go through this, perimenopause, into menopause, A, they would not self-gaslight themselves as much as women do because they would just be like a more outward looking, like this got what's the problem?
• 15:57
  SPEAKER_00: I gotta find the problem and fix it.
• 15:59
  SPEAKER_00: It's not me.
• 16:00
  SPEAKER_00: Right.
• 16:00
  SPEAKER_00: And then the other thing is that if they if this did happen to men, we would have all the solutions to this already figured out.
• 16:10
  SPEAKER_00: That's why it's like this crazy dichotomy.
• 16:13
  SPEAKER_00: I don't know if that's right to say, but that's how I feel.
• 16:16
  SPEAKER_00: Um, so when the patient comes to you and she says, I don't know if you're gonna even believe me, but this is what I'm experiencing.
• 16:25
  SPEAKER_00: And then do you immediately go into hormone replacement therapy, or it's now called menopausal hormone therapy, right?
• 16:32
  SPEAKER_00: Is the next best course of action?
• 16:34
  SPEAKER_00: Like, is that what you would say?
• 16:36
  SPEAKER_00: Or if not, like what is the next step?
• 16:40
  SPEAKER_00: Like, how do you take somebody through from they first come to you, they say, I've tried these things, nothing's working, I don't know who I am anymore.
• 16:47
  SPEAKER_00: Like, then what?
• 16:48
  SPEAKER_04: Right.
• 16:49
  SPEAKER_04: It's a great question.
• 16:51
  SPEAKER_04: Well, the first thing I want to when I see patients, I especially early perimetopause patients, I need to discuss with them whether birth control is something that they need.
• 17:01
  SPEAKER_04: It it steers the conversation of hormone therapy.
• 17:05
  SPEAKER_04: It doesn't say we can't add in bioidential hormone therapy, but um knowing if a patient needs birth control is kind of important, or if they're currently on birth control, which can affect labs if we pull up labs after that.
• 17:19
  SPEAKER_04: Labs are important in perimetapause for multiple reasons because there can be a lot of things other than hormones, as we know, that can cause um some of our some of our symptoms.
• 17:30
  SPEAKER_04: Um, but actually capturing perimetopause on labs is challenging.
• 17:36
  SPEAKER_04: You can, it's like capturing lightning at a bottle.
• 17:38
  SPEAKER_04: Um, because you if we if I can catch a patient in a spike or a crash, then that's fantastic.
• 17:45
  SPEAKER_04: Anywhere in between, somewhat looks normal.
• 17:49
  SPEAKER_04: Um oftentimes in mid to late perimetopause, I can see lower progesterone.
• 17:55
  SPEAKER_04: I always measure folcal stimulating hormone, luteinizing hormone as well, so we can see how well the body is ovulating, which is important to know how close you are to late perimetopause and how hard basically the body is working to create a normal cycle, whatever that looks like for that woman, uh, which can be different.
• 18:19
  SPEAKER_04: But so it does take a little bit more of a sharper eye when you look at hormones.
• 18:23
  SPEAKER_04: And if something, if the hormones come back normal, it is definitely not an exclusion criteria.
• 18:30
  SPEAKER_04: Most of them are in within range.
• 18:33
  SPEAKER_04: Um, so it's not anything that I would ever say, your hormones are normal.
• 18:38
  SPEAKER_04: Sorry.
• 18:39
  SPEAKER_04: Yeah, your symptoms are all in your head.
• 18:41
  SPEAKER_04: So um I that that I I make sure not to say that only because I've been told that before.
• 18:49
  SPEAKER_04: Um so I it doesn't feel good.
• 18:52
  SPEAKER_04: And I I give in having patients that have somewhat normal labs, um, starting hormones and feeling considerably better after starting them um is all the justification I need.
• 19:05
  SPEAKER_04: And we have a lot of trials that show that that these that labs in general, um for the most part, uh, for hormonal labs are not necessarily all that reliable, especially in early perimetopause.
• 19:17
  SPEAKER_00: Mm-hmm.
• 19:18
  SPEAKER_00: So you're also looking at cortisol, cholesterol, like there are other markers that you're looking at.
• 19:24
  SPEAKER_00: Let's maybe outline those or details those for people.
• 19:27
  SPEAKER_00: Yeah.
• 19:27
  SPEAKER_00: And then if based on the numbers, obviously, individual by individual, then you say, okay, here's what we're gonna do.
• 19:34
  SPEAKER_00: We're gonna add this supplement, I'm gonna give you this lifestyle change, or we're gonna add in some hormones.
• 19:40
  SPEAKER_00: Is that right?
• 19:41
  SPEAKER_04: So generally, I will base it on symptoms, uh, but I, you know, it depends.
• 19:46
  SPEAKER_04: Some women want to come into the clinic with a, they want to know everything.
• 19:50
  SPEAKER_04: You know, their numbers people, they want to know everything.
• 19:53
  SPEAKER_04: If we're doing that, then I am testing their inflammation markers.
• 19:57
  SPEAKER_04: So high sensitivity reactive protein, their homocystine, their vitamin mineral markers, so their B12, their folate, their ferritin, their iron, their whole iron panel, and then magnesium, making sure that all of those are optimized.
• 20:13
  SPEAKER_04: But also looking at a not only a standard lipid panel, which everybody kind of knows those numbers, but I look at an advanced um apolipoprotein panel.
• 20:23
  SPEAKER_04: So we're looking at your Apo B, your Apo A1, the ratio between the two, and also the lipoprotein A, which is the genetic marker for heart disease or atherosclerosis.
• 20:34
  SPEAKER_04: I look at that.
• 20:35
  SPEAKER_04: I try to tell patients ahead of time about that.
• 20:38
  SPEAKER_04: That is something that we will be looking at, just so they're prepared.
• 20:42
  SPEAKER_04: It is genetic, it can pass on to your children.
• 20:44
  SPEAKER_04: You probably got it from your parents.
• 20:46
  SPEAKER_04: Um, and uh all obviously looking at all the sex hormones, all the thyroid hormones, also testing for um autoimmune thyroiditis or Hashimoto's, uh, which is really prevalent within midlife.
• 20:59
  SPEAKER_04: Basically, anything that could cause fatigue, kind of cognitive issues, brain fogs, difficulty sleeping, anything that could cause those things, I try to test.
• 21:11
  SPEAKER_04: Seems like a lot.
• 21:13
  SPEAKER_04: You know, some women don't want all those, so we do some more basic tests after that.
• 21:17
  SPEAKER_04: But I do try to always add in like a vitamin D, a high sensity C reactor protein, fasting insulin, along with an A1C, um fasting glucose to make sure that we know if there's any insulin resistance going on.
• 21:30
  SPEAKER_04: You don't want patients to even get close to pre-diabetic.
• 21:34
  SPEAKER_04: And just ensuring that generally we're optimizing everything, you know, could because adding hormones to somebody who's vitamin D deficient or has uh low ferritin, like if you know, iron low iron stores, um, or has really high inflammation due to insulin resistance or maybe another type of autoimmune disorder, is it it you get diminishing returns, like everything has to be treated in that.
• 22:00
  SPEAKER_04: understood.
• 22:01
  SPEAKER_00: Gotcha.
• 22:02
  SPEAKER_04: Gotcha.
• 22:03
  SPEAKER_00: It seems so complicated.
• 22:05
  SPEAKER_00: And it's like and nuanced, right?
• 22:09
  SPEAKER_00: Like you must have over the past year of, you know, getting certified, having your own experience, treating yourself basically, and then shifting to treating all these clients, you must have had a huge learning curve, I'm guessing, with like reading labs and understanding, but then also asking the right questions to get them to tell you the right things about the lifestyle.
• 22:31
  SPEAKER_00: And like there's so many factors that go into this.
• 22:34
  SPEAKER_00: It seems complicated.
• 22:36
  SPEAKER_04: Well ironically, and this is what's so frustrating, Joan, that I I the more I learned about menopause and perimetopause, the more I realized I see I saw these patients every day when I was working in cardiology before when I was working in orthopedics.
• 22:51
  SPEAKER_04: Like I'm like these patients the idiopathic frozen shoulder.
• 22:54
  SPEAKER_04: I remember talking to an orthopedic surgeon about it.
• 22:57
  SPEAKER_04: And he was like well that just is what happens.
• 23:00
  SPEAKER_04: You know, women between maybe 47 and 53 they just get this weird thing that their shoulder just stops moving.
• 23:07
  SPEAKER_04: I'm like how is that a thing?
• 23:10
  SPEAKER_04: Nobody that idiopathic frozen you know adhesive capsulitis like nobody's wearing it.
• 23:18
  SPEAKER_04: Right.
• 23:18
  SPEAKER_04: Oh and heart palpitations you know heart palpitations in cardio that was just you know that my it was like a common joke that we had within the clinic that you know women in the peri I mean that we didn't say perimetopause menopausal age but those that age would come in with heart palpitations because you know we were just so stressed.
• 23:37
  SPEAKER_04: We're drinking too much coffee.
• 23:38
  SPEAKER_04: We just, you know, and we know now that those are hormone mediated.
• 23:42
  SPEAKER_04: I I had heart palpitations started hormones that went away.
• 23:45
  SPEAKER_04: So it's it you know I have been seeing these patients for years.
• 23:50
  SPEAKER_04: So going to test them for other things um was actually kind of uh it's not easy but it was it was nice to be able to pull in some of my other knowledge like yes I'm looking at hormones and that was a bit of a learning curve but everything else comes from my almost 25 years in healthcare.
• 24:11
  SPEAKER_02: Yeah.
• 24:11
  SPEAKER_04: So it was actually really validating to be able to tie it all in.
• 24:17
  SPEAKER_00: I bet.
• 24:18
  SPEAKER_00: Because I think a lot of women still think hot flashes maybe mood swings maybe weight gain those are the main things they're thinking are related to their hormones fluctuating and that if I get on hormone replacement therapy that maybe would help with those things.
• 24:38
  SPEAKER_04: But it really is much bigger and broader and deeper than just the surface level like obviously those are big things that symptoms that women have but it goes deeper in it again is much more like nuanced and and then there's bone density and all these other things that we know are also happening in this stage of life that are also related to hormones but we're not all connecting the dots I don't think no and and and as providers we live in silos and and it creates such a problem I mean especially like I remember when I first sought a mentor I'm like well I'll go see an endocrinologist.
• 25:21
  SPEAKER_04: That's what they specialize in the endocrine system.
• 25:23
  SPEAKER_04: The endocrine system are hormones they don't do they don't that menopause therapy is not part of what they do.
• 25:31
  SPEAKER_04: And but they do bone density but even though menopause hormone therapy is FDA approved for the prevention of osteoporosis they still don't fully understand hormones.
• 25:42
  SPEAKER_04: So it was it was it it can be frustrating the silos that should be connected that are not very frustrating.
• 25:51
  SPEAKER_00: It seems so obvious like when you say it I mean I'm certainly not an expert but at the same time it's like you should you would think that that is what endocrinology would be focused on in the big picture.
• 26:01
  SPEAKER_00: But one of the main themes that I find myself talking to my clients about and just women in general um which is funny because when you first said like am I the only one going through this my career path is women and specifically in the past few years is women in midlife and I do a lot of things virtually and in person um creating community around this midlife stage of life.
• 26:28
  SPEAKER_00: And I would say the majority of our conversations every time we gather we talk about these symptoms we talk about the frustration all the nuances that go on with perimenopause.
• 26:37
  SPEAKER_00: And so when you said am I the only one it's like what really but I do think that some women if you're not talking about this with your community you might also think like maybe I'm alone maybe it's just me.
• 26:46
  SPEAKER_00: So one of the big themes that I talk about with my clients and keeps coming up over and over again is this sense of like advocating for yourself.
• 26:54
  SPEAKER_00: And if you don't feel right in some area, be a squeaky wheel and ask for the test.
• 27:01
  SPEAKER_00: Get the test done so that you have the data that you can then do something with.
• 27:05
  SPEAKER_00: And if you don't like the answer from one doctor, go get a second opinion and things like that.
• 27:09
  SPEAKER_00: What would you say to someone who is scared of menopause hormone therapy because of the bad rap it got 20 years ago or so and what it might look like for her to just go gather some information and stand up for herself and say it's not okay to feel crappy every day.
• 27:29
  SPEAKER_00: I want to feel better like what what would you tell that person?
• 27:32
  SPEAKER_04: Yeah no absolutely and I I always when I meet my do free 15 minute consults with patients so they can just kind of meet and greet and ask me questions.
• 27:42
  SPEAKER_04: And especially if I'm meeting a postmetopausal woman or somebody in late perimetopause I'll tell them try your primary care first.
• 27:51
  SPEAKER_04: We we spend an arm and a leg on our insurance try to do the the allopathic route.
• 27:58
  SPEAKER_04: See if you can get then tell them your symptoms hopefully they can help if they can't I'm here my my clinic I have extended hours I have long visits with my patients but it's cash based and it's not everybody can do that and I know that.
• 28:15
  SPEAKER_04: So I always advocate to try to talk to the primary care but that's a tough conversation because we even though um we can say be your own advocate some women don't necessarily know what that means because because I said even if the labs come back or they come back even slightly showing perimetopause the provider might not know how to read that properly whatever whether it's a OBGYN or primary care they might not really know and really understand what that means and women usually leave with their form of validation is well I have a gabapentin because of the fact I have muscle pain.
• 28:57
  SPEAKER_04: I have terazodone you know these are medications because of my sleep I have a Lexapro because of my depression you know they come up they have every the the doctor hears their symptoms but doesn't always equate it to hormones or doesn't necessarily know how.
• 29:13
  SPEAKER_04: So you know I stand on the shoulder of giants.
• 29:16
  SPEAKER_04: So I usually I usually recommend read some books go you know start with you know Dr.
• 29:22
  SPEAKER_04: Mary Clay Haver Dr.
• 29:24
  SPEAKER_04: Heather Hirsch you know um Dr.
• 29:27
  SPEAKER_04: Kelly Kasperson Dr.
• 29:28
  SPEAKER_04: Vonda Wright there's some fantastic providers that have written books for the patient how to advocate for themselves you know say you know I want an estradyl transdomal patch I think I should start at zero three seven five and a hundred milligrams of progesterone at night and that's it.
• 29:50
  SPEAKER_04: And a lot of times you know providers will be like okay sounds like a plan as long as they can advocate and understand what you're asking for.
• 29:59
  SPEAKER_04: You know we do it all the time you know if somebody feels like they need a pain medicine or they need something for you know their cholesterol usually we we know how to do research on stuff like that.
• 30:12
  SPEAKER_04: Hormones are no different.
• 30:14
  SPEAKER_04: So I just strongly recommend being trying to be as molecular about it as possible.
• 30:20
  SPEAKER_04: Because if you get stonewalled by your doctor it's not usually because you're wrong it's because they don't have the education behind it.
• 30:30
  SPEAKER_04: They don't really know what the next step is so if you know what the next step should be or what you want to try that's usually you know that that sometimes can work.
• 30:43
  SPEAKER_04: I can't I I obviously I'm not not giving out medical advice by any means.
• 30:48
  SPEAKER_04: I'm giving broad examples um but you know being being kind of more precise about the medication that you know you want or the type the dose the method um is really important and that is in all those books that that are written so many you know Mary Clay Havert has some great the new metopause is one of the like a really groundbreak breaking book um somebody that has a lot of fears behind um estrogen and breast cancer um sorry that was the second part of your question and that's though those fears are real you know when when patients come to me just kind of curious about you know what's the safety I've been told for years especially women that say um I have a family history of breast cancer I've been told I can't take HRT what are my options and I I tell them you know being the provider I'm like I you can take hormones um that's antiquated data data that's not that we know is not is not current um especially with the types of menopause hormone therapy we prescribe today it's still challenging for those patients to hear and I usually recommend them reading there's a book called Estrogen Matters that goes through um goes through cancer and estrogen and it's a little dense so I I recommend just reading it section by section.
• 32:15
  SPEAKER_04: But it is something that I I really have to have an in-depth conversation with patients regarding um the cancer, the fears behind breast cancer um and cancers in general uh when it comes to menopause hormone therapy letting them understand if I was to prescribe hormones for them, it is not the same as the hormones that were prescribed in the women's health initiative in back in 1994 when they started this it was a great trial.
• 32:46
  SPEAKER_04: I mean it was a huge trial over 1600 women were studied in this trial and it was uh you know a pivotal trial for a lot of reasons but the medications they use quadrupedid quinestrogen and methoroxy pedresterone acetate we simply do not use anymore we don't we we don't those are the especially um the form of pedestin that was used in there is is synthetic and we don't use that anymore um and the quadrupedid quinestrogen or CEE we also I've never ever prescribed it and neither had any of my peers so we just don't use those anymore.
• 33:29
  SPEAKER_00: And the women as I understand were in their 60s.
• 33:32
  SPEAKER_00: Yeah so they just started much beyond yeah it was too late.
• 33:37
  SPEAKER_00: So had they done the study with the bioidentical hormone therapy that we use today on women in their 40s and 50s, can you imagine like what that would be where we would be today right we're I mean I understand that medicine has progressed since then and things are different too but not only did the trial not really work because of those things that we understand today, but then it went and did the opposite all the major news channels were saying estrogen causes cancer.
• 34:08
  SPEAKER_00: If you're on hormone replacement therapy stop right away you're gonna get breast cancer and it was like this crazy you know everybody freaked out and then here we are 20 years later trying to like pick up the pieces and beg people to just learn about it, understand the knowledge and realize that we've we've done better, we understand it better now and like let's give it another chance because it could really help you feel better and not pull it.
• 34:34
  SPEAKER_04: Absolutely and the the little asterisk on the bottom that hardly ever gets talked about in that trial is the arm of patients that were only on conjugated equine estrogen and were not on the synthetic pagestin actually had a reduced rate of breast cancer.
• 34:52
  SPEAKER_04: So and colorepto cancer and fractures so I mean they it actually helped decrease the risk of breast cancer.
• 35:01
  SPEAKER_04: Of course they don't talk about that you know it was only the combo um that we don't ever use.
• 35:08
  SPEAKER_04: So you know I don't think that trial could ever be replicated today.
• 35:12
  SPEAKER_04: It's it's too much like it's almost like we had our chance and unfortunately we got a lot of great data out of it.
• 35:20
  SPEAKER_04: But we have some smaller trials um that do should that do show not only the efficacy but the safety of estradiol specifically transdermal estradiol um and bioidentical progesterone not a synthetic pagestin.
• 35:38
  SPEAKER_04: So that's where I try to gear that but I also have the discussion with women that you know if if a woman has seen their mother their sister their aunts you know suffer or even pass away from breast cancer, it doesn't matter.
• 35:55
  SPEAKER_04: I can throw trials in front of them all day long.
• 35:58
  SPEAKER_04: They're not going to want to take hormone replacement therapy.
• 36:02
  SPEAKER_04: So we have the conversation of how can we manage your symptoms um without introducing um estradiol.
• 36:10
  SPEAKER_04: So there and when there are there are a lot of great medications now uh that can help there's limited data on supplements uh we have some testosterone data there are alternatives for women that are just like absolutely not I don't care what you tell me it's not gonna happen.
• 36:26
  SPEAKER_00: Yeah it is a nuanced conversation yeah absolutely um I think it'd be interesting also to explain vaginal estrogen and how that is different from systemic estrogen because I think that is also a common misconception.
• 36:43
  SPEAKER_00: So as I understand it vaginal estrogen is helpful and therapeutic for women of all ages even into the nursing home in order to help with urinary frequency and urinary tract infections and sexual health and all of those things, which is totally different.
• 36:58
  SPEAKER_00: And that does not, as I understand correct me if I'm wrong, but that doesn't even enter the conversation like someone who cannot take estrogen because they have had either breast cancer or they have a family history, they can still do vaginal estrogen.
• 37:10
  SPEAKER_00: They can still see effects right and and improvements overall am I right on that?
• 37:16
  SPEAKER_00: Well 100% 100% you got it vaginal estrogen um is fantastic.
• 37:23
  SPEAKER_04: It should be used I tell everybody 18 to 108 you know it it is a blanket for I'm I would love to get it into every skill nursing facility every nursing home for women they've studied the serum estradiol levels in women that are taking it and it does not get above the threshold of 30.
• 37:44
  SPEAKER_04: It basically affects the skin it touches for that reason you know some women put it on the back of their hands they dab it under their eyes it's meant to treat this as I said the skin that it touches it does not generally go systemic.
• 37:57
  SPEAKER_04: Ironically some pharmacies actually send me a like a revision saying you have your patient on two different estradiols like choose one and I have to call them and be like are you dumb?
• 38:11
  SPEAKER_04: Like like who is this like do you not know that these are totally different?
• 38:18
  SPEAKER_04: So this is 2026 and these are I'm not gonna name the pharmacies but major pharmacies that are sending me like I don't know if this was just auto generated but uh this happens probably once a week where I get a refusal from a pharmacy because they say that it's a duplicate prescription.
• 38:37
  SPEAKER_04: So that is it it is crazy.
• 38:42
  SPEAKER_04: So vaginal estrogen has been around for decades.
• 38:45
  SPEAKER_04: In the UK it's over the counter uh we don't need it you don't need a prescription for it.
• 38:51
  SPEAKER_04: So um why we're so reserved about it here I just I just I simply don't understand.
• 38:58
  SPEAKER_04: But yes it decreases your issue yeah it decreases your risk of urinary tract infections by 40 to 50% um decreases your risk of incontinence um increases the blood supply to the vaginal canal the vulva the labia the clitoris like it's it is a fantastic cream for women I mean even postpartum like there's all sorts of um times in our lives as women that vaginal estrogen would really be helpful.
• 39:29
  SPEAKER_00: Mm-hmm I just wish more people knew that so yeah I'm glad we talked about that one um okay I have a few questions from that my audience sent in the first one that I got and I got this from a few people is how long should you stay on menopause replacement therapy?
• 39:45
  SPEAKER_00: Is this something that you're on indefinitely or once you hit menopause which is a full calendar year without having a period, having a cycle then do you get off?
• 39:55
  SPEAKER_00: Are there some that you should stay on long term like what does that look like this is a great question.
• 40:01
  SPEAKER_04: And I know I keep saying that but it I love that I'm really passionate about this.
• 40:06
  SPEAKER_04: There is an old school of thought that was called the timing hypothesis that I mean when I say old school it's not that they just changed this as in 2025.
• 40:16
  SPEAKER_04: So it's not really that old um but it said that after the age of 60 or 10 years post menopause you were to taper off your hormones.
• 40:29
  SPEAKER_04: And what we know now what the Metapause Society has released a statement is that this is an individual conversation that women are safe to stay on hormone therapy um for long term and because we know that symptoms this that over 50% of women that stop hormone therapy their symptoms come back.
• 40:49
  SPEAKER_04: So for not only quality of life um but for continued protection bone heart brain it becomes a very individual conversation with your provider to make sure you stay on that if you want to stay on that you can stay on your hormone therapy.
• 41:08
  SPEAKER_04: There is no set age got it interesting.
• 41:11
  SPEAKER_00: And once you are in menopause do your labs then from then on for the rest of your life look pretty similar when it comes to testing your estrogen, your progesterone, your testosterone or do you still see dips and valleys after menopause?
• 41:30
  SPEAKER_04: Well if you're on menopause hormone therapy it is a little controversial but checking your estradiol numbers to make sure that you're absorbing whatever especially if you're taking your estrodiol transdermal if you're taking it orally there's a pretty good chance you're absorbing I mean you're taking a pill if you're taking it orally if you're taking your estradiol transdermally this would be through a patch through a gel through a cream or pellets or some other way then making sure you know seeing what your levels are at um is kind of important especially if you're at a what would be considered an average dose but you still feel feel terrible you still are having symptoms it's nice to know if you're absorbing your um estradiol.
• 42:16
  SPEAKER_04: And also there's some older data that shows that having your estradiol numbers above 60 around 80 you know that actually is more bone protective but we have some other data that shows that even at low dose estradiol you still have some bone protection.
• 42:33
  SPEAKER_04: There's a little bit of a dispute between whether we're actually looking for a number or you're just making sure that estradiol is in the system postmenopaus got it got it so that yeah that's to protect your bones.
• 42:46
  SPEAKER_00: Speaking of your bones then what does that look like?
• 42:50
  SPEAKER_00: So um I know there's a direct correlation between the loss of estrogen and the increase of potential osteopenia osteoporosis.
• 42:57
  SPEAKER_00: So what is the correlation between your hormones and your bone density and is that something postmenopausal we see a big drop in bone specifically right after the menopause transition is like complete and you're in menopause.
• 43:13
  SPEAKER_00: So that's a really important time for women to get their numbers and get a DEXA scan, which I'm surprised we're not even supposed to do that till 65.
• 43:22
  SPEAKER_00: So um for someone like myself who has osteoporosis in my DNA in my genetics, right?
• 43:28
  SPEAKER_00: What do you recommend from a hormone standpoint and just like what can women do to advocate for themselves as when it comes to bone health, I guess.
• 43:39
  SPEAKER_04: So Stexascan screenings getting a referral from a provider like myself provide referrals to radiology all the time for patients to get screening DEX as most of the time insurance will cover it and it is a really great baseline.
• 43:57
  SPEAKER_04: I do not have this 65 or older criteria Um, I have your perimetopausal in a woman, and we need to watch this criteria.
• 44:07
  SPEAKER_04: And I am always shocked at the amount of women, especially the women that tell me that they're I don't think I need that.
• 44:15
  SPEAKER_04: My PCP told me I don't have to do this for another 15 years.
• 44:17
  SPEAKER_04: Why do I even bother?
• 44:19
  SPEAKER_04: And I'm like, just let's just get a scan.
• 44:21
  SPEAKER_04: And then they come back positive, either with osteopenia, osteoporosis, and they come back positive.
• 44:25
  SPEAKER_04: And it's um it what that does for me is I will monitor their labs to make sure that they are absorbing their patch.
• 44:36
  SPEAKER_04: I want, I I I personally try to get women above 60.
• 44:41
  SPEAKER_04: Um, it would be and in their numbers, it's um, you know, depending on your lab, I'm looking at that as kind of a baseline.
• 44:50
  SPEAKER_04: But again, I'm also just trying to base it off their symptoms and make sure that they are absorbing something.
• 44:54
  SPEAKER_04: If you get a basic estradiol or sensitive estradiol lab, um, it'll show whether you're below 30.
• 45:01
  SPEAKER_04: And that that is tends to be a number that has been shown to not be as beneficial for bone health, for bone density to help increase bone density, help decrease bone reabsorption.
• 45:13
  SPEAKER_00: Gotcha.
• 45:14
  SPEAKER_00: Yeah, I mean, the the bone density conversation is is tricky because you don't feel symptoms until you break a bone.
• 45:20
  SPEAKER_00: And then you're like, oh, I wonder if maybe I have low bone density because I broke a bone, you know?
• 45:26
  SPEAKER_00: So it's a lot of what I do with my clients is fall prevention.
• 45:30
  SPEAKER_00: So inside of our workouts, we're balancing on one leg, we're working on proprioception, like where's your body in space?
• 45:36
  SPEAKER_00: And then we're really strengthening our muscles, which helps strengthen the bones.
• 45:40
  SPEAKER_00: And then in the nutrition, I'm talking about we have to get this protein, we have to be eating our green leafy vegetables to make sure we're, you know, like all of this stuff.
• 45:46
  SPEAKER_00: Take your vitamin D, especially if you live in Seattle.
• 45:48
  SPEAKER_00: Like we need it.
• 45:49
  SPEAKER_00: These are also such important things.
• 45:51
  SPEAKER_00: And I wish I could just stand on a mountaintop and scream at make sure every woman understands this.
• 45:55
  SPEAKER_00: But it's not the kind of thing where you're gonna feel like your bones are weak.
• 46:00
  SPEAKER_00: It just you don't do that.
• 46:01
  SPEAKER_00: You you have to go and get a DEXA scan and then find out where you are and then see what you could do, not just lifestyle-wise, but also um hormone replacement-wise, to make sure that you're giving your body the best option it has in order to build the bone so you can stay young and do all the things you want to do for the rest of your life.
• 46:22
  SPEAKER_04: No, absolutely.
• 46:23
  SPEAKER_04: And it and it's frustrating to me because providers have been so focused with women with what's called bikini medicine.
• 46:31
  SPEAKER_04: So anything that's under me is a bikini, breasts and reproductive organs.
• 46:35
  SPEAKER_04: Like that's everything, that's it.
• 46:36
  SPEAKER_04: Like that's that's all we care about.
• 46:38
  SPEAKER_04: As long as you know, you start mammograms when you're young, um, you know, you make sure you get your pap smear.
• 46:44
  SPEAKER_04: It's like that's all that we were screened for is the bikini medicine.
• 46:49
  SPEAKER_04: And that's the reason why heart cardiovascular disease is the number one killer of women, which still a lot of women don't know that.
• 46:56
  SPEAKER_04: Yeah, osteoporosis, by the time women get screened other 65, it's too late.
• 47:01
  SPEAKER_04: Yeah, it's just it they need to be screened.
• 47:04
  SPEAKER_04: We need to be doing this like we're doing like we're doing preventative with mammograms and PAPs.
• 47:09
  SPEAKER_04: Like this should not be something that's starting, and they're not real expensive tests.
• 47:14
  SPEAKER_04: So I don't really understand the rationale behind that number, why they chose that number.
• 47:19
  SPEAKER_04: Because it's interesting.
• 47:20
  SPEAKER_04: Yeah, because the fall prevention, hip replacements, just just in general, fractures and the decreased quality of life that can come from severe osteoporosis, you'd think that that would be something that would be on the top of the list of things to prevent.
• 47:36
  SPEAKER_00: You would think so.
• 47:38
  SPEAKER_00: Yeah, but we've been so focused on bikini medicine that it just doesn't that is so interesting to me.
• 47:43
  SPEAKER_00: So I'm curious, are do you know, are other countries being more proactive with DEXA scans?
• 47:50
  SPEAKER_04: You know, honestly, I don't know the answer to that.
• 47:52
  SPEAKER_04: Yeah, I don't know what their guidelines are.
• 47:54
  SPEAKER_04: That you're right.
• 47:55
  SPEAKER_04: That's a good that would be a good thing to learn.
• 47:58
  SPEAKER_00: Hmm.
• 47:58
  SPEAKER_00: And then on the cardiovascular side, what are you looking for?
• 48:02
  SPEAKER_00: What are the main markers that you're looking for when patients come in and get their regular blood work done?
• 48:07
  SPEAKER_00: Is it cholesterol mainly?
• 48:08
  SPEAKER_00: And because I know that is also impacted by loss of estrogen in our body.
• 48:13
  SPEAKER_00: And that was a surprising one for me when I got my numbers done.
• 48:17
  SPEAKER_00: Like, wait, what?
• 48:18
  SPEAKER_00: I've never had anything off with cholesterol at all.
• 48:21
  SPEAKER_00: Well, that you told me, like, that makes sense.
• 48:23
  SPEAKER_00: Your your estrogen's down, so you're gonna, you know, have a higher chance of um, so is that the main thing, or what else are you looking for from a cardiometabolic standpoint to help women stave off cardiovascular disease?
• 48:36
  SPEAKER_04: Insulin resistance, aka being pre-diabetic, your blood sugar is going up.
• 48:42
  SPEAKER_04: And the new guidelines that just came out about cholesterol have shown that cholesterol itself isn't as much of a problem as insulin resistance.
• 48:54
  SPEAKER_04: You know, the combo of the two increased bad cholesterol, LDL or APOB, um, plus an elevated blood glucose, um, really can be athrogenic, really can cause, you know, really can increase your risk for cardiovascular diseases for women.
• 49:13
  SPEAKER_04: Um, so I I highly recommend women check their, you know, keep on top of their A1C.
• 49:23
  SPEAKER_04: Don't just be happy with borderline.
• 49:26
  SPEAKER_04: You know, as healthy, healthy menopause, premenopause, perimetapause women, we should not be borderline pre-diabetic.
• 49:34
  SPEAKER_04: I don't like there's there's like a black and white cutoff.
• 49:37
  SPEAKER_04: Uh, you know, if you're 5.6, you're fine.
• 49:40
  SPEAKER_04: If you're 5.7, you're pre-diabetic.
• 49:42
  SPEAKER_04: Like if you're 5.6, you're you're you're peering over the edge of diabetes and you need to do something about it.
• 49:50
  SPEAKER_04: So understanding your fasting insulin, um, which is how hard your body is working in order to regulate your blood glucose, um, that starts creeping up in when you're becoming pre-diabetic, but also understanding your cholesterol and your genetic, you know, understanding your LP little A, the lipoprotein A, your genetic predisposition to heart disease, and seeing if any of those are causing systemic inflammation.
• 50:15
  SPEAKER_04: So looking at your high-sensity C reactive protein to see if there's any inflammation being caused by insulin resistance and the maybe more orthogenic uh cholesterol particles that could be causing inflammation within the body that puts you at greater risk for heart disease.
• 50:33
  SPEAKER_04: Wow.
• 50:34
  SPEAKER_00: So do you often then go to so they get their numbers done, you analyze the lab work, then is it do you go to a continuous glucose monitor for them to really understand how their their individual body is processing insulin and and glucose?
• 50:50
  SPEAKER_00: I would love for all my patients to do that.
• 50:54
  SPEAKER_04: Um, but not not a lot of them want to do that.
• 50:58
  SPEAKER_04: I eventually to try to convince maybe 50% of my patients to do it.
• 51:03
  SPEAKER_04: Um, the ones that I'd feel could really could really benefit from it.
• 51:09
  SPEAKER_04: Um continuous glucose monitors are great tools.
• 51:12
  SPEAKER_04: They give you numbers.
• 51:13
  SPEAKER_04: You know, it's funny.
• 51:14
  SPEAKER_04: We, you know, we all we wear our aura, or I didn't mean to give you anything.
• 51:18
  SPEAKER_04: We wear our aura rings, we have aura rings.
• 51:22
  SPEAKER_04: Um we have um, you know, we have our our special watches or you know, our fancy stuff, you know, all the fancy stuff, but we still don't um but when it comes to continuous glucose monitors, some people are just um feel like that's too much of a you know, a bridge too far.
• 51:39
  SPEAKER_04: But I do them not only for people that feel that they go hyper, but I like too high of a blood glucose, but I also do it for people that um maybe feel that they go too low.
• 51:52
  SPEAKER_04: Like the women that are like, I can't go more than two hours without eating.
• 51:56
  SPEAKER_04: I get shaky and I can't do it.
• 51:58
  SPEAKER_04: We should be able to fast.
• 52:00
  SPEAKER_04: As human beings, as as mammals, we should be able to go a prolonged period of time without eating and not crashing or passing out.
• 52:10
  SPEAKER_04: If if that's happening, then something's unstable with the blood glucose.
• 52:15
  SPEAKER_04: So I mean, maybe you're not comfortable for those 24 hours.
• 52:19
  SPEAKER_04: It's not fun, but you know, you shouldn't be, you know, you shouldn't be on that uh you shouldn't be suffering, you know.
• 52:26
  SPEAKER_04: As I said, you shouldn't be passing out or anything.
• 52:28
  SPEAKER_04: So um it'll be in it's interesting to know if patients spike and crash, because spiking and crashing can all with their blood glucose can lead to kind of a normal-ish A1C, um which can be deceiving.
• 52:43
  SPEAKER_04: So you know, I'm I try to educate patients on that.
• 52:47
  SPEAKER_04: That needing to eat all the time or feeling hangry or how however it comes is not is really showing that there's some sort of dysregulation with your blood glucose.
• 52:59
  SPEAKER_00: So a lot of times when my clients come to me, they are not eating enough.
• 53:02
  SPEAKER_00: And so a lot of the education that I do is around the fact that your metabolism is probably decreased because you're not fueling your system.
• 53:09
  SPEAKER_00: You might not be feeling hunger because over time you stop listening to your hunger cues, yada, yada.
• 53:13
  SPEAKER_03: Right.
• 53:14
  SPEAKER_00: So we talk about, I want you to eat every three hours or so throughout the day so that you can regulate your blood sugar so that you're not having these huge spikes and these crashes.
• 53:24
  SPEAKER_01: Yeah.
• 53:24
  SPEAKER_00: Um, and I talk about I get hangry, but I also think it's I've kind of conditioned my body to expect fuel every few hours.
• 53:32
  SPEAKER_00: And if I don't, then that's where I get the hangries.
• 53:35
  SPEAKER_00: But I'm not shaky.
• 53:36
  SPEAKER_00: I could go if I needed to go without food for hours and hours.
• 53:39
  SPEAKER_00: They actually got for Christmas or my birthday or something.
• 53:42
  SPEAKER_00: My husband bought me and him and for the girls CGMs, and we haven't used them yet.
• 53:46
  SPEAKER_00: And I'm actually just very curious to put them on and just go about our normal life and just see how our individual bodies are reacting to different things.
• 53:54
  SPEAKER_00: Because it seems very interesting to me that my husband could have a meal and his blood sugar wouldn't really spike or crash at all.
• 54:00
  SPEAKER_00: And I could have the same thing, but mine could react in a totally different way.
• 54:03
  SPEAKER_00: And that's just information.
• 54:05
  SPEAKER_00: It's just gathering data that we know about our bodies.
• 54:08
  SPEAKER_00: And I think the more that we know about our individual systems and how it works, then the better we can understand the impact that we have on how we feel and how we perform and our energy and our sleep and all these things, and they're all interconnected, right?
• 54:23
  SPEAKER_04: Yeah.
• 54:24
  SPEAKER_04: No, absolutely.
• 54:25
  SPEAKER_04: And I agree with you.
• 54:26
  SPEAKER_04: If you condition yourself, it's it is about what you eat.
• 54:30
  SPEAKER_04: Like I had a patient who would said she had reactive hypoglycemia, which is a diagnosis, but it's also very treatable if you are doing all the things that you tell your patients to do.
• 54:45
  SPEAKER_04: Eat fiber, eat protein.
• 54:47
  SPEAKER_04: Do not eat your carbohydrate first.
• 54:49
  SPEAKER_04: Try not to eat a simple carbohydrate on an empty stomach.
• 54:53
  SPEAKER_04: So she would have like a um a croissant for breakfast and then crash and get shaky.
• 54:59
  SPEAKER_04: And then she's like, I keep my purse full of marshmallows so I can raise my blood glucose.
• 55:03
  SPEAKER_04: I'm like, don't tell me this.
• 55:06
  SPEAKER_04: I know.
• 55:07
  SPEAKER_04: So I'm like, I hope she's not listening to this podcast.
• 55:12
  SPEAKER_04: We you are.
• 55:13
  SPEAKER_04: Um, and so we changed the way she ate.
• 55:17
  SPEAKER_04: Um and it went away.
• 55:19
  SPEAKER_04: You know, we it was a diagnosis she had had almost her entire life, and it's just amazing.
• 55:26
  SPEAKER_04: I'm like, you don't have to get rid of the croissant, but eat it after you've eaten some fiber and some protein and some fat.
• 55:33
  SPEAKER_04: And you know, and just make sure that you're not eating this on an empty stomach and you're not eating it alone.
• 55:40
  SPEAKER_04: Um my husband first started doing intermittent fasting, you know, the doing like a six-hour window, and I'm like, I can't.
• 55:47
  SPEAKER_04: This was years ago.
• 55:48
  SPEAKER_04: I'm like, I can't do it.
• 55:49
  SPEAKER_04: I can't, I'll I'll die.
• 55:50
  SPEAKER_04: Like I'll pass out.
• 55:52
  SPEAKER_04: And so I got a continuous glucose monitor.
• 55:56
  SPEAKER_04: And sure enough, when I felt like I had to eat because I was just not gonna make it, my blood glucose was like 85.
• 56:04
  SPEAKER_04: Like I was fine.
• 56:05
  SPEAKER_04: I was fine.
• 56:06
  SPEAKER_04: Yeah.
• 56:06
  SPEAKER_04: So I just had to, and it was a validating, honestly, for me to see that number on my phone and for me to be like, you're fine stuff.
• 56:14
  SPEAKER_04: You're fine.
• 56:15
  SPEAKER_04: Yeah, keep going.
• 56:17
  SPEAKER_04: So I I tell patients to use it as a tool.
• 56:20
  SPEAKER_04: Continuous glucose monitors that we use for non-diabetics are having an error range, so about 15 points, you know, plus or minus.
• 56:31
  SPEAKER_04: So this is more looking for trends rather than saying this is absolutely where my blood glucose is.
• 56:36
  SPEAKER_04: And it's also there's a delay.
• 56:38
  SPEAKER_04: So the patients have a bit of there's a delay with the numbers about 15-minute delay because they're not getting the number from the blood, it's getting the number from your extracellular fluid.
• 56:49
  SPEAKER_04: So it's kind of a little bit of a delay in how you get your numbers.
• 56:53
  SPEAKER_04: So use it as a uh tool, but not a diagnostic test.
• 56:58
  SPEAKER_00: If that makes sense.
• 56:58
  SPEAKER_04: Gotcha.
• 56:59
  SPEAKER_04: That does make sense.
• 57:00
  SPEAKER_00: I feel like we could talk forever.
• 57:02
  SPEAKER_00: And I haven't only gotten to have like half of the stuff that I wanted to, but good news is uh Stephanie and I do have something coming in the fall that we're super excited about.
• 57:11
  SPEAKER_00: So if you're local and potentially we might be able to offer something um virtual as well.
• 57:15
  SPEAKER_00: So stay tuned.
• 57:16
  SPEAKER_00: We we do have some stuff in the works.
• 57:17
  SPEAKER_00: But um I guess what I would love to end on is just if if a woman listening today takes just one or two nuggets away from this conversation to protect her long-term health, what would you want those couple of things to be?
• 57:34
  SPEAKER_00: Maybe it's a habit, maybe it's just an understanding, a mindset shift, maybe around the stage of life, midlife, and hormones and all the things.
• 57:43
  SPEAKER_00: But what would you say to the women listening?
• 57:45
  SPEAKER_00: Like, what is it that you really want them to remember from this conversation?
• 57:50
  SPEAKER_04: Well, first off, that there are over 50 different metapausal symptoms.
• 57:55
  SPEAKER_04: And if you were listening to the beginning of the podcast, when I was listing all my symptoms, the one I didn't list was hot flashes.
• 58:02
  SPEAKER_04: I had very few, if any, of hot flashes.
• 58:05
  SPEAKER_04: And my mother's the same way.
• 58:06
  SPEAKER_04: It's the reason why she still states that she never went through menopause.
• 58:10
  SPEAKER_04: So try to look past the hot flashes and try not to let your provider say, well, you're not having hot flashes, therefore you're not in menopause.
• 58:22
  SPEAKER_04: Because about 85% of people have hot flashes and they usually come on late perimetopause, early menopause.
• 58:28
  SPEAKER_04: So there's a lot of years where they either might not happen or will never happen.
• 58:34
  SPEAKER_04: So then you know, look beyond that.
• 58:36
  SPEAKER_04: That's one of my pearls.
• 58:38
  SPEAKER_04: Um and another pearl that I have is definitely try not to gasolite yourself.
• 58:49
  SPEAKER_04: Try not to blame what's happening on yourself, your life, your job, your work, your exercise routine, the couple times that you ate something that you shouldn't have eaten over the weekend.
• 59:04
  SPEAKER_04: These are things um that we we are just raised to blame ourselves before we blame anything or anybody else.
• 59:13
  SPEAKER_04: So please examine the fact that this could be hormonal and your life is actually doing really well.
• 59:19
  SPEAKER_04: And the other thing is don't let perfection be the enemy of good enough.
• 59:24
  SPEAKER_04: You know, it's it's I mean, you preach this all the time, John, in your podcast.
• 59:29
  SPEAKER_04: You know, don't get caught up with everything has to be perfect.
• 59:33
  SPEAKER_04: I have patients that think very black and white about hormones.
• 59:38
  SPEAKER_04: Like, like they either will be dangerous and they all cause cancer and cardiovascular disease, or they're perfect and I, you know, they're the magic pill, patch, gel, whatever we do, it's going to cure everything.
• 59:52
  SPEAKER_04: This is a process.
• 59:53
  SPEAKER_04: Uh, we can hormones help, but they help along with exercise, nutrition, stress, sleep, the things that we still have to do as midlife women.
• 1:00:05
  SPEAKER_04: We have to understand all the other important aspects of life just beyond the magic HRT.
• 1:00:12
  SPEAKER_04: Right.
• 1:00:12
  SPEAKER_04: Um, that a lot of people are preaching right now.
• 1:00:15
  SPEAKER_04: So that's Yeah, absolutely.
• 1:00:18
  SPEAKER_00: I love that.
• 1:00:18
  SPEAKER_00: Yeah.
• 1:00:19
  SPEAKER_00: I mean, it's an exciting time for us because the conversation has started.
• 1:00:23
  SPEAKER_00: We feel more comfortable talking about this in our communities and bringing up symptoms instead of just like burying them and hush-hush and oh, what are people gonna think or worried about being judged?
• 1:00:34
  SPEAKER_00: I really encourage like the more open you are with your friends, your family, your providers, the more open you can be.
• 1:00:40
  SPEAKER_00: That opens the conversation then for more people to say, oh my gosh, me too.
• 1:00:44
  SPEAKER_00: And then you don't so alone.
• 1:00:46
  SPEAKER_00: And that there are people like you, Stephanie, who are dedicating their careers to helping women feel more in control of this whole craziness that happens to us in this stage of.
• 1:01:00
  SPEAKER_00: And so if you can gather your community, you have your people you can go to with questions, you know that you're not alone in all of this.
• 1:01:07
  SPEAKER_00: And then realizing that you really do have so much control around the lifestyle piece.
• 1:01:12
  SPEAKER_00: And then if you can get in the workouts and focus on the nutrition and try to prioritize sleep and all these things, and you add menopause cormone therapy onto what you're already doing, that might just be the recipe that you need to feel like yourself again, to have energy and to be able to feel your best so that you can then give your best to everybody who is depending on you.
• 1:01:34
  SPEAKER_00: Like we just we always think about everybody else.
• 1:01:36
  SPEAKER_00: And a lot of times we put ourselves at the bottom of the list.
• 1:01:40
  SPEAKER_00: And it's like, no, we have to make sure that we are optimized and working at our capacity so that we can then be able to give and serve and and just show up as our best selves.
• 1:01:49
  SPEAKER_00: I'm pretty excited about this conversation and I'm just really grateful that you were willing to come on and spend your time with me.
• 1:01:55
  SPEAKER_04: Oh, I know.
• 1:01:56
  SPEAKER_04: This was great.
• 1:01:57
  SPEAKER_04: I I mean, I I love talking about it.
• 1:01:59
  SPEAKER_04: It's my passion, and I love what you do, Joan.
• 1:02:02
  SPEAKER_04: I love your last podcast, by the way.
• 1:02:03
  SPEAKER_04: Um introducing hormones.
• 1:02:06
  SPEAKER_04: That was great.
• 1:02:07
  SPEAKER_04: And uh this was this was fantastic.
• 1:02:10
  SPEAKER_04: Um, I encourage women, if they have any questions, to reach out and uh go on the menopause society, see if you have a menopause society certified provider in your area that may be able to answer questions for you.
• 1:02:25
  SPEAKER_04: And if you live in the state of Washington, I'm I'm here for you.
• 1:02:28
  SPEAKER_00: Yeah, so we'll link everything in the show notes.
• 1:02:31
  SPEAKER_00: And Stephanie, if you wouldn't mind giving me the list of the books that you had recommended.
• 1:02:36
  SPEAKER_00: Um, so I'll put those in the show notes as well.
• 1:02:38
  SPEAKER_00: Um, a link to your clinic if people are local and want to check you out, knowing that you're on a wait list now until the end of September.
• 1:02:45
  SPEAKER_00: But that's a good problem.
• 1:02:46
  SPEAKER_00: And then dangling a carrot that we do have something exciting coming in the fall for those of you who are local, and we're excited to share more about that in the coming months.
• 1:02:54
  SPEAKER_00: But um, for now, I just want to say a big giant thank you, Stephanie, for coming on, being willing, and being my first podcast guest.
• 1:03:00
  SPEAKER_00: Hopefully, not the last.
• 1:03:02
  SPEAKER_00: And hopefully you'll want to come back another time.
• 1:03:04
  SPEAKER_00: And because I feel like we just kind of scratched the surface today, and there's a lot more we could talk about in the future.
• 1:03:08
  SPEAKER_04: Yeah, I agree.
• 1:03:10
  SPEAKER_04: I agree.
• 1:03:10
  SPEAKER_04: Thank you.
• 1:03:11
  SPEAKER_04: I feel honored.
• 1:03:12
  SPEAKER_04: Yes.
• 1:03:13
  SPEAKER_00: All right.
• 1:03:13
  SPEAKER_00: Thanks so much.
• 1:03:14
  SPEAKER_00: Thanks.
• 1:03:15
  SPEAKER_00: I hope this conversation gave you some clarity, some hope, maybe even some permission to keep asking different questions if you know something just doesn't feel right.
• 1:03:25
  SPEAKER_00: I would love to hear what resonated with you most from today's episode.
• 1:03:28
  SPEAKER_00: Come find me on Instagram at Jones FitzZone and send me a message and let me know.
• 1:03:32
  SPEAKER_00: And if you enjoyed this episode, would you just take a moment to subscribe, maybe leave a review, or share it with a friend?
• 1:03:39
  SPEAKER_00: I truly hope that this podcast reaches more women who need to hear these types of conversations.
• 1:03:45
  SPEAKER_00: And I'd especially love your feedback because this is my very first guest interview.
• 1:03:49
  SPEAKER_00: So if you enjoyed this format, let me know.
• 1:03:51
  SPEAKER_00: I have a feeling there may be some more expert conversations in our future.
• 1:03:56
  SPEAKER_00: Thanks for listening, my friend.
• 1:03:57
  SPEAKER_00: Remember, progress over perfection and consistency over intensity.
• 1:04:01
  SPEAKER_00: Until next time, keep growing, keep glowing, and bye for now.