Latest / The Body Pod / Menopause Q & A with Dr. Jessica Shepherd: Expert Advice on Symptoms, Treatments & Wellness

Transcript

Menopause Q & A with Dr. Jessica Shepherd: Expert Advice on Symptoms, Treatments & Wellness · The Body Pod

• 0:00
  Speaker 1: Hey everyone. This is Haley and I'm Lara, and welcome
• 0:03
  Speaker 1: to the body Pod. Welcome back to the Body Pod everyone.
• 0:13
  Speaker 1: Today I have the pleasure of interviewing doctor Jessica Shepherd,
• 0:17
  Speaker 1: who is a Chief Medical Officer at Hers. She is
• 0:21
  Speaker 1: a Board certified opg an, a woman's health, sexual wellness,
• 0:26
  Speaker 1: and menopausal expert, and the founder of synctom Med and Wellness,
• 0:31
  Speaker 1: as well as the author of Generation M Living Well
• 0:35
  Speaker 1: in Perimenopause and Menopause. So today you get to join
• 0:39
  Speaker 1: me while I have a quick Q and a rapid
• 0:43
  Speaker 1: fire session on all things menopause enjoy. Everyone is so
• 0:53
  Speaker 1: excited for you. I mean, we have like all of
• 0:55
  Speaker 1: these questions and we gave away the Generation M book
• 1:00
  Speaker 1: yesterday and so super excited about that. I've loved seeing
• 1:06
  Speaker 1: the progress of Generation M because you have just been
• 1:09
  Speaker 1: like killing it on the Today Show, Good Morning America,
• 1:13
  Speaker 1: like all of these all of these things, which is
• 1:15
  Speaker 1: just so incredible. So thank you, thank you, thank you
• 1:18
  Speaker 1: for joining us. You know, you're my absolute favorite of
• 1:20
  Speaker 1: all time. You're my favorite, and we absolutely like, I
• 1:25
  Speaker 1: don't know why we aren't meeting, but we're meeting this year.
• 1:29
  Speaker 2: Yes, Oh yeah, bar the end of the year.
• 1:31
  Speaker 1: Absolutely, Okay, I'm going to get started on these so
• 1:35
  Speaker 1: we can get you in and off to packing. Wherever
• 1:38
  Speaker 1: you're going tomorrow? Where are you going tomorrow?
• 1:41
  Speaker 2: I'm going to visa Spain.
• 1:45
  Speaker 1: Weren't you just in Italy too?
• 1:48
  Speaker 2: Someone's got to go to these places and talk about menopause.
• 1:51
  Speaker 2: You know, Hey, sign me up for the gig. I mean,
• 1:55
  Speaker 2: I'm all for it. So good thing that you're traveling.
• 1:59
  Speaker 2: It's like work slash really cool vacation place to go.
• 2:03
  Speaker 2: So I love it.
• 2:05
  Speaker 1: All right, we're gonna get We're going to get right
• 2:07
  Speaker 1: into it. So first question. I've heard that doctors will
• 2:10
  Speaker 1: prescribe low estrogen birth control to women in perimenopause when
• 2:14
  Speaker 1: the woman has been suffering from some of the common
• 2:18
  Speaker 1: perimenopause symptoms poor sleep, mood change, low energy, brain fog,
• 2:22
  Speaker 1: lack of libido. I also heard this is controversial because
• 2:26
  Speaker 1: the pill is not hormone therapy and women may get
• 2:28
  Speaker 1: better results from hormone therapy than just the pill. If
• 2:32
  Speaker 1: blocking the sperm is not a concern, should women and
• 2:34
  Speaker 1: perry with these symptoms be looking at hormone therapy instead
• 2:39
  Speaker 1: of the low estrogen pill?
• 2:42
  Speaker 2: Oh? I love this question. I actually answered it yesterday.
• 2:44
  Speaker 2: So I was at you'd ammonia over the weekend and
• 2:48
  Speaker 2: I did three sessions just on HRT and that was
• 2:52
  Speaker 2: exactly one of the questions that we got. So I'm
• 2:57
  Speaker 2: kind of going to back it up until the peri
• 3:00
  Speaker 2: menopausal phase and exactly what it is and why. It's
• 3:02
  Speaker 2: actually a little bit more confusing than the menopausal phase
• 3:06
  Speaker 2: because during perimenopause is where you have this rollercoaster fluctuation
• 3:11
  Speaker 2: of hormones, and with that fluctuation, you have estrogen that
• 3:16
  Speaker 2: some days are really sky high, really low, and a
• 3:19
  Speaker 2: lot of those fluctuations cause some of the symptoms that
• 3:23
  Speaker 2: people start to have that we would typically categorize as
• 3:27
  Speaker 2: menopausal symptoms, so hot flashes, night sweats, irritability, obviously if
• 3:32
  Speaker 2: you're decrease in your muscle mass that starts to occur
• 3:34
  Speaker 2: from your mid thirties, but these symptoms usually are going
• 3:38
  Speaker 2: to be infrequent or not as may be severe. The
• 3:42
  Speaker 2: problem becomes because you're still menstruating, whereas in menopause you
• 3:46
  Speaker 2: are not menstruating, you still have estrogen and progesterone, which
• 3:50
  Speaker 2: means that if you're still cycling and have a menstruation,
• 3:53
  Speaker 2: you have the ability to potentially still get pregnant. Now
• 3:57
  Speaker 2: is that likelihood high? No decreases as you go through
• 4:01
  Speaker 2: your forties, but there's still that likelihood. Now Here comes
• 4:05
  Speaker 2: the tricky part is that birth control. Yes, it does
• 4:08
  Speaker 2: have synthetic forms of estrogen and progesterone in it, but
• 4:12
  Speaker 2: what's its job to prevent pregnancy? HRT is usually going
• 4:18
  Speaker 2: to be more of a different form of estrogen and progesterone,
• 4:21
  Speaker 2: but it's on a much lower level, so it does
• 4:25
  Speaker 2: not prevent pregnancy. So that's why the perimenopausal phase, it
• 4:28
  Speaker 2: becomes a little bit confusing, as could I take OCPS?
• 4:33
  Speaker 2: Absolutely you could. Does it take care of some of
• 4:35
  Speaker 2: the symptoms that are what we call perimenopausal menopausal symptoms? Yes,
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  Speaker 2: but the tricky part becomes do I stay on it
• 4:44
  Speaker 2: throughout my forties into when I might be the least
• 4:47
  Speaker 2: likely to get pregnant or a menopausal or do I
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  Speaker 2: start HRT. So the way that I like to answer
• 4:54
  Speaker 2: that question is if you're still having symptoms and for
• 4:59
  Speaker 2: a smattering of other reasons, say you're not sexually active,
• 5:02
  Speaker 2: say you really have infrequent periods, or you're down to
• 5:08
  Speaker 2: maybe minimal periods, and you're like, my risk of getting
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  Speaker 2: pregnant is really low. I would like to switch over
• 5:15
  Speaker 2: to HRT to help with my symptoms and also booster
• 5:19
  Speaker 2: my estrogen progesterone kind of scaffolding which helps with longevity
• 5:23
  Speaker 2: and bone and all of those other great things. But
• 5:26
  Speaker 2: there are a lot of people that are relatively younger
• 5:30
  Speaker 2: maybe still have cycles regularly. I have forty seven year olds.
• 5:33
  Speaker 2: I have fifty two year olds who have cycles regularly,
• 5:36
  Speaker 2: and so to me, even though the likelihood is lower,
• 5:40
  Speaker 2: they still are ovulating enough to a level to elicit
• 5:44
  Speaker 2: a period, which means they're probably ovulating. So they are
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  Speaker 2: probably people that I'll be like, you know what, you
• 5:51
  Speaker 2: can get benefit from both, but let's prevent pregnancy should
• 5:55
  Speaker 2: maybe be prioritized than just looking at it from an
• 5:58
  Speaker 2: HRT perspective. So the hormones and both of them are
• 6:02
  Speaker 2: completely different and they do different things. So you do
• 6:05
  Speaker 2: have to weigh where you are in the process, what
• 6:08
  Speaker 2: you're looking for as an outcome, and then make a decision.
• 6:12
  Speaker 1: Oh, that was the best answer of the night right
• 6:14
  Speaker 1: at the top. Actually, I don't know. I haven't read
• 6:17
  Speaker 1: them all. I read most of them. Okay, So for
• 6:21
  Speaker 1: a perimenopausal woman who is already prone to waking up
• 6:23
  Speaker 1: around two to three am. This is me. I didn't
• 6:27
  Speaker 1: do this question, but this is me. But who definitely
• 6:29
  Speaker 1: wakes up with hunger around two to three am when
• 6:32
  Speaker 1: in a calorie deficit. Do you anticipate the adding progesterone
• 6:36
  Speaker 1: at night might be helpful for better sleep?
• 6:40
  Speaker 2: Yes, So it was the hunger part part of the
• 6:43
  Speaker 2: question or just the sleep.
• 6:45
  Speaker 1: I think they're saying that they also wake up if
• 6:48
  Speaker 1: they're in a calorie deficit, but then they're waking up
• 6:51
  Speaker 1: anyways if.
• 6:51
  Speaker 2: They're not okay, so let's address it as just a
• 6:54
  Speaker 2: pure sleep question. Then maybe if there is more clarity
• 6:57
  Speaker 2: on the hungry part than I can address that. But
• 7:02
  Speaker 2: there's multiple reasons why we have change in our sleep
• 7:06
  Speaker 2: during the perimenopausal phase into the menopausal phase, and then
• 7:09
  Speaker 2: again has to do the fluctuations. So we'll go back
• 7:12
  Speaker 2: to that rollercoaster ride that you're having where you don't
• 7:15
  Speaker 2: have this great consistency in how your your hormones are
• 7:18
  Speaker 2: starting to show up, and so it happens, namely progesterone,
• 7:22
  Speaker 2: which is I like to call it our comfy hormone.
• 7:25
  Speaker 2: It really like relaxes everything. It makes the GI relax,
• 7:29
  Speaker 2: it makes your sphincters relax, everything is just like so relaxed.
• 7:33
  Speaker 2: So in addition to that is it really does help
• 7:36
  Speaker 2: relax you from a sleep perspective. And so when we
• 7:40
  Speaker 2: start to have actually a really significant drop and progesterone
• 7:44
  Speaker 2: during the perimenopausal phase, that's when it starts to impact
• 7:49
  Speaker 2: not only from the comfy perspective of what it does,
• 7:52
  Speaker 2: but also our circadian rhythm, right, and so our circadian
• 7:55
  Speaker 2: rhythm is ever so important when we think about what
• 7:59
  Speaker 2: it provides as far as time frames of when you're
• 8:03
  Speaker 2: having certain when your brain is regulated to sleep be
• 8:07
  Speaker 2: sleep versus awake. But then you're also having now this
• 8:10
  Speaker 2: disruption in your progesterone, which is also impacting how you're
• 8:14
  Speaker 2: able to relax in that timeframe. So because of that
• 8:18
  Speaker 2: fluctuation and decrease in progesterone, it is actually a good
• 8:22
  Speaker 2: idea to consider progesterone. And when I say that, it
• 8:25
  Speaker 2: has to be not synthetic progestine because that is the
• 8:29
  Speaker 2: one that actually we don't like because it does have
• 8:32
  Speaker 2: increased risk of breast cancer in that use, but a
• 8:35
  Speaker 2: natural progesterone which you can get from a regular pharmacy,
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  Speaker 2: so that can be your micronized form of progesterone in
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  Speaker 2: either a dose of one hundred two hundred. Some people
• 8:44
  Speaker 2: take a little bit higher, maybe three hundred. But we
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  Speaker 2: do see that because of that phase or that drop
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  Speaker 2: in the hormones, you're not going to have quite as
• 8:53
  Speaker 2: much as the sleep that you like. Now. The other
• 8:56
  Speaker 2: thing that occurs too is it impacts. So now you
• 9:00
  Speaker 2: have estrogen starting to decrease, which doesn't take as much
• 9:02
  Speaker 2: as a dive is progesterone throughout the perimenopausal phase. But
• 9:06
  Speaker 2: because estrogen decreases a lot of people then have night
• 9:10
  Speaker 2: sweats because that's where we get a lot of our
• 9:13
  Speaker 2: hot flashes and night sweats is because of the decrease
• 9:15
  Speaker 2: in estrogen. But even if you don't notably have a
• 9:19
  Speaker 2: night sweat, we have a lot of good data that
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  Speaker 2: shows that even if it's not visibly waking you up
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  Speaker 2: in your sweating, that people actually do experience night sweats
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  Speaker 2: or hot flashes at night, but it's not the typical one,
• 9:33
  Speaker 2: but it's still enough to wake them out of their sleep.
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  Speaker 2: So a good way to start, especially if someone's hesitant
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  Speaker 2: about going on HRT or the estrogen part of it
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  Speaker 2: is actually just to start with a progesterone compound and
• 9:46
  Speaker 2: also to start magnesium as well. Magnesium is a beautiful
• 9:50
  Speaker 2: way for you to kind of get that regulation back
• 9:52
  Speaker 2: with your sleep habits. So those are two good things
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  Speaker 2: that you can put into your routine when it comes
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  Speaker 2: to sleep.
• 10:00
  Speaker 1: On the progesterone because my sleep is not good. Yeah,
• 10:04
  Speaker 1: and I do all the right things. I try to
• 10:06
  Speaker 1: like turn off the phone, and you know, it's just
• 10:09
  Speaker 1: a doozy, and so.
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  Speaker 2: You're still getting kind of the awakening, right.
• 10:13
  Speaker 1: Yes, yeah, every time, and then I'm just like, should
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  Speaker 1: I get up and work?
• 10:18
  Speaker 2: No?
• 10:18
  Speaker 1: Two thirty three? Oh, don't do it. Eventually I go
• 10:24
  Speaker 1: back to sleep, but it's a it's a doozy. Can
• 10:27
  Speaker 1: you please give possible causes of post menopausele bleeding and
• 10:31
  Speaker 1: suggestions on how to stop it?
• 10:33
  Speaker 2: Yeah. Post menopausal bleeding is definitely one of those things
• 10:37
  Speaker 2: as an OBGYN that really concerns or alerts us. Okay,
• 10:41
  Speaker 2: it's something that when someone says that, immediately we're like,
• 10:45
  Speaker 2: but why why are they bleeding if they've experienced menopause.
• 10:48
  Speaker 2: So menopause technically means you've gone twelve months consecutively without
• 10:53
  Speaker 2: a cycle consecutively is important because some people will not
• 10:57
  Speaker 2: have a period for ten months and then they'll have
• 10:58
  Speaker 2: a cycle and I'm like, we have to start the
• 11:01
  Speaker 2: clock again. So unless it's twelve months consecutively that you
• 11:06
  Speaker 2: have not had a cycle, then that's menopause, like that
• 11:09
  Speaker 2: is the hallmark in the start and thereafter you should
• 11:13
  Speaker 2: not ever have any more bleeding. So if you do
• 11:16
  Speaker 2: have bleeding after that, it is really important that you
• 11:19
  Speaker 2: talk to your obgyn about that because we need to
• 11:22
  Speaker 2: know why is your endometria aligning causing bleeding If your
• 11:26
  Speaker 2: ovaries are not giving up enough estrogen to cause a cycle,
• 11:32
  Speaker 2: so there should be no bleeding at all, So it's
• 11:34
  Speaker 2: very important that you talk to your doctor about that.
• 11:36
  Speaker 2: The caveat to that is that there is if someone
• 11:39
  Speaker 2: is on actual HRT with a form of estrogen in it,
• 11:45
  Speaker 2: it may cause a bleed that is not a bleed
• 11:48
  Speaker 2: of your uterus, but the estrogen that you're on is
• 11:51
  Speaker 2: causing the bleed. But it's also important to still talk
• 11:54
  Speaker 2: to your doctor about it because then we can at
• 11:56
  Speaker 2: least put into the equation. While she is on HRT,
• 12:00
  Speaker 2: the estrogen component on it could it be the estrogen
• 12:03
  Speaker 2: that's eliciting this bleed, and we can figure out, you know,
• 12:06
  Speaker 2: through ultrasound, we can see if it resolves on its own,
• 12:10
  Speaker 2: we can decrease your level of estrogen if you're on HRT,
• 12:14
  Speaker 2: but if you're not, then we definitely have to look
• 12:16
  Speaker 2: into that as a reason of why. So both of
• 12:18
  Speaker 2: them are still very important, but two different reasons why
• 12:20
  Speaker 2: you might be have bleeding. End story is if you
• 12:23
  Speaker 2: have bleeding after menopause, absolutely categorically do not hesitate and
• 12:28
  Speaker 2: go see your obgyn.
• 12:30
  Speaker 1: Okay, does the next question kind of piggybacks off of that.
• 12:35
  Speaker 1: Can vaginal estrogen cause post mental puzzle bleeding?
• 12:38
  Speaker 2: Is that a reason it can? And the reason is
• 12:40
  Speaker 2: we have estrogen receptors all over our body. I think
• 12:43
  Speaker 2: we do type CASSI to just being in the pelvis
• 12:46
  Speaker 2: specifically the vagina, but we have in our bone, our brain,
• 12:49
  Speaker 2: our heart, our muscle. So because it's very sensitive obviously
• 12:54
  Speaker 2: within the pelvic region, especially the vagina, because that's what
• 12:57
  Speaker 2: allowed the vagina to have secretions when we were younger
• 13:02
  Speaker 2: in our kind of reproductive phase. You know, like think
• 13:04
  Speaker 2: about it when you have a baby and baby gets
• 13:07
  Speaker 2: all the way through the birth canal. When it comes out,
• 13:09
  Speaker 2: it goes back down to size. So that's the flexibility
• 13:12
  Speaker 2: and distensibility of the actual vagina. Estrogen has a lot
• 13:16
  Speaker 2: to do with that. So now when we lose our
• 13:18
  Speaker 2: estrogen and our vagina doesn't have the ability to be distensed,
• 13:22
  Speaker 2: it becomes more fragile, the tissue becomes more fragile. And
• 13:26
  Speaker 2: now you start vaginal estrogen, the receptors are like, thank you,
• 13:31
  Speaker 2: thank you so much for pouring this estrogen into the
• 13:34
  Speaker 2: area that we really do love and and it helps
• 13:37
  Speaker 2: the vaginal tissue thrive. So if you have vaginal bleeding
• 13:41
  Speaker 2: after still another reason to go to your obgi in
• 13:44
  Speaker 2: and get it checked out. It doesn't necessarily mean that
• 13:46
  Speaker 2: you have to come off of your HRT or your
• 13:48
  Speaker 2: vaginal source of estrogen. We just want to make sure
• 13:51
  Speaker 2: we are definitely providers or professionals that want to rule
• 13:56
  Speaker 2: out worst case scenario, so we will always be like,
• 13:59
  Speaker 2: what caused bleeding and if we can make sure that
• 14:02
  Speaker 2: it's nothing that has to do with anything that we're
• 14:04
  Speaker 2: concerned about, then we feel better and we can manage
• 14:07
  Speaker 2: it that way.
• 14:09
  Speaker 1: That's a great answer. Moving on to the bladder, how
• 14:12
  Speaker 1: does the bladder change during perimenopaus, I feel as though
• 14:16
  Speaker 1: it is smaller. I need to go to the bathroom
• 14:18
  Speaker 1: way more often and the amount isn't as much as
• 14:20
  Speaker 1: I used to be able to hold. This is me
• 14:22
  Speaker 1: all the time too, not my question, but this is me. Yes,
• 14:27
  Speaker 1: there is.
• 14:29
  Speaker 2: A lot in the pelvis that responds to estrogen, and
• 14:32
  Speaker 2: the bladder actually is a very beautiful part of the pelvis.
• 14:37
  Speaker 2: A lot of times it's forgotten because it doesn't seem
• 14:39
  Speaker 2: like it's part of the uterus, vagina and ovaries, but
• 14:42
  Speaker 2: it really does have sensitivity to both progesterone and an estrogen.
• 14:47
  Speaker 2: But the same type of thing that I talked about
• 14:49
  Speaker 2: in the vagina happens with the bladder. So as we
• 14:51
  Speaker 2: start to age, it doesn't, you know, the distensibility and
• 14:55
  Speaker 2: the capacity for it to hold urine is not as much. Obviously,
• 15:00
  Speaker 2: the sphincter, so the part that closes when you're not urinating,
• 15:03
  Speaker 2: and then that opens when you do want to urinate,
• 15:06
  Speaker 2: it gets a little bit looser, right, So now you
• 15:08
  Speaker 2: have incontinence issue with leaking because the door the stop
• 15:12
  Speaker 2: clock is not there as well. And then the other
• 15:15
  Speaker 2: thing is that estrogen really has the ability to our
• 15:19
  Speaker 2: control of the actual bladder. So it's smaller, it does
• 15:23
  Speaker 2: not hold as much. And so if you think about
• 15:25
  Speaker 2: during the night a lot of times, that's usually when
• 15:30
  Speaker 2: you know your bladder usually will capacitate a lot more
• 15:32
  Speaker 2: as you're in rest. And then when you get up,
• 15:34
  Speaker 2: usually after maybe eight hours or however long you sleep,
• 15:37
  Speaker 2: then you do have to use a bathroom. But if
• 15:39
  Speaker 2: it can't go as big as it used to and
• 15:42
  Speaker 2: hold as well as it used to, that again is
• 15:44
  Speaker 2: why we start to have more issues with our bladder
• 15:47
  Speaker 2: and having to have decrease time in the times between
• 15:52
  Speaker 2: we need to urinate as we used to before. The
• 15:55
  Speaker 2: other thing that I will say is we don't typically
• 15:58
  Speaker 2: work out our pelvis right. So when I think of
• 16:00
  Speaker 2: a pelvic physical therapist which helps us with our bladder
• 16:05
  Speaker 2: and our control of our bladder, most women have never
• 16:10
  Speaker 2: been taught how to do really good pelvic exercises to
• 16:13
  Speaker 2: strengthen their pelvic bowl. And so as we get older
• 16:16
  Speaker 2: and this starts to happen, we don't know how to
• 16:18
  Speaker 2: kind of control it and keep it to do what
• 16:21
  Speaker 2: we would like it to do. And then on top
• 16:24
  Speaker 2: of that, think of what usually happens we have pregnancies
• 16:29
  Speaker 2: then you know, even whether it's C section or vagile delivery,
• 16:33
  Speaker 2: childbirth a lot plays a lot of like trauma on
• 16:36
  Speaker 2: the bladder, and so over time it just gets a
• 16:39
  Speaker 2: little bit weaker. And it is quite frankly when when
• 16:42
  Speaker 2: I used to do a lot of surgery. It's a
• 16:45
  Speaker 2: kind of lazy organ. It just likes to forget what
• 16:48
  Speaker 2: it does. It's like, what were we doing again? I
• 16:50
  Speaker 2: don't know. So it's a little lazy, but I will
• 16:54
  Speaker 2: I will give it some slack and that the estrogen
• 16:56
  Speaker 2: makes it smaller.
• 16:59
  Speaker 1: Okay, good to know. So I'm using estrogel for twelve
• 17:04
  Speaker 1: days a month and a testosterone gel. I still get
• 17:06
  Speaker 1: mood swings despite this routine, as this something that can
• 17:09
  Speaker 1: be changed with dose increases.
• 17:13
  Speaker 2: So tell me how long they're on the estrogel twelve days? Yes, okay.
• 17:18
  Speaker 2: So when we think of hormone replacement therapy, there are
• 17:23
  Speaker 2: reasons why people can take it cyclic, which is exactly
• 17:27
  Speaker 2: what you describe taking twelve or fourteen days, depending on
• 17:30
  Speaker 2: how someone prescribes it, or you could just take it
• 17:33
  Speaker 2: all the way through. So I'm going to answer the
• 17:37
  Speaker 2: question is if they're perimenopausal and menopausal and the perimenopausal phase.
• 17:41
  Speaker 2: Because we're doing that whole kind of rollercoaster thing. Sometimes
• 17:45
  Speaker 2: it is a little bit hard to figure out where
• 17:47
  Speaker 2: your fluctuations are and if you're not on estrogen for
• 17:50
  Speaker 2: the other remaining days, what's happening during those days as well?
• 17:54
  Speaker 2: You still may be having these fluctuations, and that can
• 17:57
  Speaker 2: be contributing to the actual let's see, it can be
• 18:01
  Speaker 2: contributing to the actual kind of frustration irritability because you
• 18:06
  Speaker 2: don't know where you're controlling. It's still just kind of
• 18:08
  Speaker 2: all over the place. Where it was a little bit
• 18:11
  Speaker 2: more predictable earlier in our teens, twenties, and thirties because
• 18:17
  Speaker 2: it followed the regiment, it followed the schedule. Now it's
• 18:19
  Speaker 2: just like a radic all over the place. And then
• 18:21
  Speaker 2: the other reason is that in a continuous fashion, sometimes
• 18:26
  Speaker 2: it is better to try and convert to continuous fashion
• 18:30
  Speaker 2: because then whatever you're on, whatever dosage you're on, can
• 18:34
  Speaker 2: really be there to kind of buffer those fluctuations and
• 18:37
  Speaker 2: keep the stability of the levels of hormones. So for
• 18:40
  Speaker 2: someone who is taking a cyclic form of the HRT
• 18:44
  Speaker 2: in the gel form, I think it's worth a try
• 18:47
  Speaker 2: or a shot to maybe just do it continuously to
• 18:50
  Speaker 2: see what the outcome is, because there's no harm in
• 18:53
  Speaker 2: taking it continuously during cyclic it's just how it was
• 18:58
  Speaker 2: prescribed that maybe that was thought it could be done
• 19:02
  Speaker 2: in that fashion. But I think a good way to test,
• 19:04
  Speaker 2: you know, if you're going to have these kind of
• 19:07
  Speaker 2: dips is just to try a continuous form, obviously with
• 19:11
  Speaker 2: the advice of your doctrine in what dose you're on
• 19:13
  Speaker 2: and figuring that out and seeing if you can actually
• 19:15
  Speaker 2: eliminate those moments and where you have the irritability.
• 19:20
  Speaker 1: I mean, all of this, there's so many different options
• 19:23
  Speaker 1: that you can use for this.
• 19:26
  Speaker 2: I would say at the end of all of this
• 19:28
  Speaker 2: is for everyone on here to realize that however they're
• 19:32
  Speaker 2: taking it, or if they're not taking it, or if
• 19:34
  Speaker 2: there's always options. I love that.
• 19:38
  Speaker 1: Yeah, for postmenopausal women wanting to use progesterone cream alone
• 19:43
  Speaker 1: no estrogen for sleep benefits, what are the FDA approved
• 19:46
  Speaker 1: options for progesterone cream that you would recommend discussing with
• 19:49
  Speaker 1: our healthcare provider.
• 19:51
  Speaker 2: Yeah, progesterone cream. So what we have in I guess
• 19:55
  Speaker 2: you could say in a pharmacy fashion and what pharmaceutical companies.
• 19:59
  Speaker 2: Usually they will be in a pill form. Now for
• 20:02
  Speaker 2: a cream, usually it is a bioidentical form, it could
• 20:06
  Speaker 2: be compounded and so that you can actually ty trait
• 20:10
  Speaker 2: the amounts differently because it is compounded. What I would
• 20:13
  Speaker 2: say is that because you're doing it in that fashion
• 20:16
  Speaker 2: versus just estrogen alone, it is much safer. So I
• 20:19
  Speaker 2: said this yesterday every woman who decides if they want
• 20:23
  Speaker 2: to take HRT, if you have a uterus, you must
• 20:28
  Speaker 2: take progesterone. If you're taking estrogen. If you don't have
• 20:32
  Speaker 2: a uterus, that's the only time you have the luxury
• 20:35
  Speaker 2: of saying I would like to take estrogen alone. And
• 20:38
  Speaker 2: the reason is because they balance each other out, and
• 20:41
  Speaker 2: if you only take estrogen and have a uterus, the
• 20:44
  Speaker 2: lining in your uters will build and build and build,
• 20:47
  Speaker 2: and it can potentially become endemetrial cancer because progesterone is
• 20:51
  Speaker 2: not there to equal it out, and so progesterone, however,
• 20:56
  Speaker 2: you can take alone without estrogen, but progesterone and an estrogen.
• 21:00
  Speaker 2: If estrogen's taken, you must take progesterone if you have
• 21:04
  Speaker 2: a uterus. So with the cream, there's usually going to
• 21:09
  Speaker 2: be in a compounded version of how you take it,
• 21:12
  Speaker 2: and it is very safe. I think it's like I
• 21:14
  Speaker 2: always say, it's like one of the best ways to
• 21:18
  Speaker 2: test HRT if you're a little bit hesitant about it.
• 21:21
  Speaker 2: It really is like the cute c type of benign
• 21:26
  Speaker 2: or front format, you know, like for people who are
• 21:29
  Speaker 2: just like, oh, I don't know if I should tell
• 21:30
  Speaker 2: her tea progesterone really is that one that you can
• 21:34
  Speaker 2: try in a cream form and get that compounded as well,
• 21:39
  Speaker 2: And there's different levels of it as well. There's different
• 21:41
  Speaker 2: dosages as well. I hope I'm answering that question in
• 21:44
  Speaker 2: the right way. The other thing, too, is that I
• 21:47
  Speaker 2: just as I'm thinking through the answer, there are a
• 21:51
  Speaker 2: lot of progesterone creams that you can get over the counter,
• 21:57
  Speaker 2: like if you go to like because it can it
• 21:59
  Speaker 2: can be made with yams, right, So in my head,
• 22:03
  Speaker 2: I'm thinking that's where this question may have come from,
• 22:06
  Speaker 2: because there's ones that actually are the biodenical forms of
• 22:09
  Speaker 2: the hormones in your body, which would be prescribed, and
• 22:13
  Speaker 2: then those that people can try and make from wild
• 22:17
  Speaker 2: yams so that it can replicate to some degree what
• 22:22
  Speaker 2: progesterone can do. But it will never be as strong
• 22:25
  Speaker 2: as what something is compounded and made in an actual
• 22:28
  Speaker 2: pharmacy or compounding pharmacy and actually made from a chemical form.
• 22:33
  Speaker 2: So you may get relief from the ones over the counter,
• 22:36
  Speaker 2: but there are some people who may try that and
• 22:39
  Speaker 2: not get the relief they're looking for and may need
• 22:41
  Speaker 2: to transition into more of a prescribed progesterone.
• 22:46
  Speaker 1: Okay, what are the most important biomarkers for an active
• 22:49
  Speaker 1: postmenopausal woman to monitor for maintaining health at the stage
• 22:53
  Speaker 1: in life? Which specific blood work markers percent muscle mass
• 23:01
  Speaker 1: or body fat percentage? Do you have any?
• 23:05
  Speaker 2: Yeah? So, yeah, when patients come into my office, you know,
• 23:09
  Speaker 2: to me, the menopause transition is much more than just
• 23:12
  Speaker 2: the reproductive hormone portion of it. That's obviously a big
• 23:15
  Speaker 2: part of it, because the ovaries that have declined in
• 23:19
  Speaker 2: their ability to do what they do. And so we
• 23:21
  Speaker 2: do have our estrogen and our progesterone that we can
• 23:24
  Speaker 2: monitor through that as well as your testosterone. But you
• 23:27
  Speaker 2: also have progesterone and testosterone that come from your adrenals,
• 23:30
  Speaker 2: but most of your estrogen does come from your ovaries.
• 23:33
  Speaker 2: So those three obviously are ones that we're going to
• 23:35
  Speaker 2: look at and then we'll look at the hormones that
• 23:37
  Speaker 2: tell those ones to release, which would be your follicle
• 23:41
  Speaker 2: stimulating hormone, which is your FSH and then your lutinizing hormone.
• 23:45
  Speaker 2: Are they as important, No, but they're good to include
• 23:47
  Speaker 2: in those to kind of see where those are as well.
• 23:50
  Speaker 2: I always look at thyroid and I look at a
• 23:53
  Speaker 2: full panel of thyroid, because hormones are chemical messengers and
• 23:57
  Speaker 2: they like to talk to each other and tell it's
• 23:59
  Speaker 2: a simple everyone's telling everyone what to do and where
• 24:02
  Speaker 2: to be and how to show up. And if you
• 24:06
  Speaker 2: basically have a portion of the symphony, you know that's
• 24:10
  Speaker 2: playing bad notes and sounds horrible. Everyone knows and everyone
• 24:14
  Speaker 2: kind of like is noticing that. So thyroid is, you know,
• 24:17
  Speaker 2: small little gland in your neck, but it really does
• 24:21
  Speaker 2: have a lot of responsibility. So full thyroid panel, in
• 24:25
  Speaker 2: addition to the other ones I just said, I also
• 24:27
  Speaker 2: love your lipid panel. So because estrogen is decreasing over
• 24:31
  Speaker 2: this timeframe, it actually triggers. Remember we said estrogen receptors
• 24:35
  Speaker 2: are all over your body, so there are a lot
• 24:38
  Speaker 2: of features that occur as you're starting to age with
• 24:42
  Speaker 2: your lipids and those start to increase and sometimes do
• 24:46
  Speaker 2: some funny things as well. So a lipid profile is
• 24:49
  Speaker 2: also very helpful to make sure you're not increasing some
• 24:52
  Speaker 2: of your triglycerides or your total cholesterol, to watch that
• 24:56
  Speaker 2: as well. Another test that's also important is your hemoglobin
• 24:59
  Speaker 2: AM one C. Your hemoglobin A one C is a
• 25:03
  Speaker 2: lab that we draw that helps us to tell if
• 25:06
  Speaker 2: you're going towards a pre diabetic or a diabetic stage.
• 25:10
  Speaker 2: We know that as we age and estrogen starts to
• 25:13
  Speaker 2: go down, our body starts to have more insulin resistance.
• 25:16
  Speaker 2: And one good way to make sure that we're not
• 25:19
  Speaker 2: becoming completely insulin resistant is to make sure that our
• 25:25
  Speaker 2: sugar is not creeping up. And that is a better
• 25:28
  Speaker 2: range than just taking a random sugar which can be
• 25:30
  Speaker 2: on a lab, and testing over the last three months
• 25:35
  Speaker 2: what it's been looking like in your system. So hemoglobin
• 25:39
  Speaker 2: A one C. I also recommend that women ask for
• 25:42
  Speaker 2: maybe EKG to just see the functionality of their heart.
• 25:44
  Speaker 2: It's such an easy way to just look at the
• 25:46
  Speaker 2: functionality of your heart and what's going on. And then
• 25:49
  Speaker 2: one more thing that I'll mention, it's called apo b APO,
• 25:53
  Speaker 2: and then a big B and that is again a
• 25:57
  Speaker 2: key factor in determining someone risk and cardiovascular disease. And
• 26:02
  Speaker 2: basically it's a protein that kind of facilitates and transports lipids.
• 26:07
  Speaker 2: So if you again have an issue with your APO B,
• 26:11
  Speaker 2: that means that your lipids may not be getting to
• 26:13
  Speaker 2: where they need to go to. It can be kind
• 26:17
  Speaker 2: of increasing the plaque that forms in your vessels, which
• 26:19
  Speaker 2: may contribute to cardiovascular disease. So again that's another one
• 26:24
  Speaker 2: that can be included in a blood test to kind
• 26:26
  Speaker 2: of help because number one killer of women is heart disease.
• 26:31
  Speaker 2: A lot of times we think it's breast cancer or
• 26:34
  Speaker 2: we think it's something else, but it's actually heart disease.
• 26:36
  Speaker 2: So we really have to take care of our hearts,
• 26:38
  Speaker 2: especially as we start to go through menopause.
• 26:43
  Speaker 1: Perfect So is it What is the difference between using
• 26:48
  Speaker 1: combined pill staying on it versus switching to MHT. Are
• 26:55
  Speaker 1: the hormones the same? Oh, we talked about this, they're different.
• 26:59
  Speaker 1: I'm fifty and have been on OCP since eighteen and
• 27:02
  Speaker 1: was planning to just stay on it until fifty five
• 27:04
  Speaker 1: then switch, but MHT is more appropriate. So really that
• 27:09
  Speaker 1: you covered that of what we should do at the first.
• 27:13
  Speaker 2: I would make a strong disclaimer for someone I For me,
• 27:17
  Speaker 2: typically it is a personal over the age of thirty
• 27:20
  Speaker 2: five birth control pills. I'm like, Okay, how much longer
• 27:24
  Speaker 2: do we have to stay on this? Can we find
• 27:26
  Speaker 2: another way, even if it's for birth control, I'll try
• 27:28
  Speaker 2: to find other modalities of birth control. We did, definitely,
• 27:33
  Speaker 2: so there's nothing wrong that was done. We definitely have
• 27:36
  Speaker 2: used birth control pills for decades as a form of MHT.
• 27:42
  Speaker 2: We now are much better educated and understanding of the
• 27:45
  Speaker 2: different types, why it's needed, what levels are needed for
• 27:49
  Speaker 2: us to I think get more women off of birth control.
• 27:55
  Speaker 2: To me, typically the latest maybe mid forties, early forty
• 28:00
  Speaker 2: for me, even if I if I can get them
• 28:01
  Speaker 2: on another kind of birth control, but at that age,
• 28:04
  Speaker 2: at fifty to fifty two, fifty five, I would not
• 28:08
  Speaker 2: wait till fifty five to switch and just get off
• 28:10
  Speaker 2: of it now and switch to MHT.
• 28:13
  Speaker 1: Okay, perfect, do you ever recommend hormone replacement for women?
• 28:18
  Speaker 2: Oh?
• 28:18
  Speaker 1: In perimetopause? So at what age my testosterone is super
• 28:21
  Speaker 1: low and my doctor recommended a testosterone supplement? Something had
• 28:28
  Speaker 1: never something had never I'd never heard of before.
• 28:33
  Speaker 2: A trope? Oh, yeah, so it's a trophy troshy. It's
• 28:38
  Speaker 2: basically like it looks like a pill, but you put
• 28:41
  Speaker 2: it in your your gum and it dissolved, so you
• 28:45
  Speaker 2: get what we call like sublingual release of whatever it is.
• 28:48
  Speaker 2: I mean, anything can be in a trochh It can
• 28:50
  Speaker 2: be a medication, it can be a hormone. So ask
• 28:53
  Speaker 2: the question again, because now I forgot I.
• 28:55
  Speaker 1: Oh, so they do you Okay, well, one, do you
• 29:00
  Speaker 1: recommend HRT in perimenopause and if so, what age? And
• 29:04
  Speaker 1: then her testoscerin is super low, but her doctor recommended
• 29:08
  Speaker 1: a testosteron trosh something that she had never heard before.
• 29:13
  Speaker 2: Okay, so back to the question about when to start.
• 29:15
  Speaker 2: It kind of goes back to the question of the
• 29:17
  Speaker 2: birth control control pill in when is that time that
• 29:23
  Speaker 2: your perimenopause, which is usually your forties early pies for
• 29:27
  Speaker 2: some because they still may be menstruating. Is I need
• 29:31
  Speaker 2: to sit and think about if I would like to
• 29:34
  Speaker 2: stay on birth control if I am very sexually active
• 29:38
  Speaker 2: and there's a good possibility I could have a baby, right,
• 29:42
  Speaker 2: because then that makes to me it prioritizes birth control
• 29:46
  Speaker 2: over MHT. I have frequent cycles, in frequent cycles, which
• 29:51
  Speaker 2: again is going to go to is it likely for
• 29:53
  Speaker 2: me to get pregnant or very very unlikely for me
• 29:56
  Speaker 2: to get pregnant and I can transition over to h
• 30:00
  Speaker 2: on replacement therapy. So those are like everyone's gonna have
• 30:03
  Speaker 2: a different answer choking. So it's important to know who
• 30:12
  Speaker 2: you are and what you're looking for. Mm hmm. I'm
• 30:18
  Speaker 2: gonna drink water.
• 30:19
  Speaker 1: Yes, drink drink some water. I'll get to our next question.
• 30:24
  Speaker 2: We didn't do the troshy one.
• 30:25
  Speaker 1: Oh okay, let's get let's hit that first.
• 30:29
  Speaker 2: So testosterone is buying to take his HRT. I don't
• 30:34
  Speaker 2: have a problem with taking it that way. There there's
• 30:36
  Speaker 2: various ways to take it. You could take it that way,
• 30:39
  Speaker 2: some injection, I'm not a fan of the injection. You
• 30:42
  Speaker 2: can do testosterone creams and then also testosterone pellette, so
• 30:46
  Speaker 2: there's various ways. Yeah, there's nothing wrong with that modality.
• 30:52
  Speaker 1: Okay, great, moving on to what are your thoughts on
• 30:56
  Speaker 1: maridine live vibration plate for US steal porosis and or
• 31:01
  Speaker 1: overall health.
• 31:04
  Speaker 2: Can you spell that.
• 31:06
  Speaker 1: M A R O D Y N E l I
• 31:11
  Speaker 1: V vibration plate.
• 31:14
  Speaker 2: Maybe just a vibration Yes, the vibration h I'm doing
• 31:20
  Speaker 2: really good on this, so that really really what it
• 31:24
  Speaker 2: is is to create low density vibration to help with stability,
• 31:30
  Speaker 2: to help with flexibility. Would I say I wouldn't say
• 31:35
  Speaker 2: it's bad, but is it evidence based as a form
• 31:39
  Speaker 2: in a way to improve osteoporosis. I would put it
• 31:42
  Speaker 2: more in the in the category of a supplementary A
• 31:45
  Speaker 2: supplementary way to improve bone mineral density. Ways that you're
• 31:50
  Speaker 2: going to improve your bone health from a bone mineral
• 31:53
  Speaker 2: density is resistance training, so weight training and also increasing
• 31:59
  Speaker 2: your protein intake, and also HRT hormone replacement therapy has
• 32:04
  Speaker 2: been proven from the estrogen portion to improve bone mineral density.
• 32:09
  Speaker 2: So it's not like it's a bad thing, but maybe
• 32:12
  Speaker 2: put it on the list of things in addition to
• 32:15
  Speaker 2: the other thing that I mentioned, than making it maybe
• 32:17
  Speaker 2: the only thing that you're doing, thinking it's going to
• 32:20
  Speaker 2: just magnify your bone mineral density to the level of
• 32:24
  Speaker 2: what you could get if you were doing those other things.
• 32:27
  Speaker 1: Okay, I have hashimotos and wonder about all the conflicting
• 32:31
  Speaker 1: information I read about whether or not to do high
• 32:34
  Speaker 1: intensity exercises. I always think working at my best level
• 32:37
  Speaker 1: is best. For example, lifting the heaviest I can go
• 32:41
  Speaker 1: with good form. What is optimal for people with autoimmune issues?
• 32:45
  Speaker 2: Do you have a take on that? So that's a
• 32:48
  Speaker 2: multi layer question, I think when we think of hashimotos, right,
• 32:53
  Speaker 2: so a lot of that has to do with it's
• 32:55
  Speaker 2: an autoimmune disease, meaning that your actual thyroid is attacking
• 32:59
  Speaker 2: its own or again right, So the goal with that
• 33:02
  Speaker 2: is to manage how to get the thyroid levels back
• 33:06
  Speaker 2: into a normal range, which sometimes may need medication, which
• 33:11
  Speaker 2: is okay, but there are other ways that you can
• 33:14
  Speaker 2: I guess facilitate the hashimotives and a lot of that
• 33:18
  Speaker 2: actually can be with diet. And then if you think
• 33:21
  Speaker 2: about it, most women will have thyroid issues after the
• 33:25
  Speaker 2: age of forty and a lot of that has to
• 33:28
  Speaker 2: do with starting with the fluctuations in their reproductive hormones,
• 33:34
  Speaker 2: namely estrogen and testosterone. Remember you're talking about the symphony
• 33:38
  Speaker 2: and one is out of place, and so it causes
• 33:41
  Speaker 2: a lot of other things to be out of place
• 33:44
  Speaker 2: as well. So that's why when we look at thyroid,
• 33:47
  Speaker 2: that's why I draw thyroid on the panel when I'm
• 33:51
  Speaker 2: consulting women about perimenopause and menopause. So a lot of
• 33:55
  Speaker 2: times you can be correcting one and the other one
• 34:00
  Speaker 2: starts to fall back into place. Does that make sense?
• 34:03
  Speaker 2: And so a lot of women have had Hashi motives
• 34:07
  Speaker 2: or Graves disease or whatever it is. And yes it's
• 34:09
  Speaker 2: an auto a chronic autoimmune disease, but a lot of
• 34:12
  Speaker 2: times it's missed by Maybe if I start correcting the
• 34:16
  Speaker 2: hormones of estrogen and progesterone slowly, we can start to
• 34:20
  Speaker 2: see them equal out and not have as much of
• 34:23
  Speaker 2: an issue. So when it now comes to working out,
• 34:27
  Speaker 2: I'm trying to answer the question as how I'm hearing it,
• 34:31
  Speaker 2: is that going overboard, will that impact that the hashimotive
• 34:35
  Speaker 2: thyroiditis or if that could be done? Yes, I think
• 34:39
  Speaker 2: working out always is going to decrease inflammation, and when
• 34:44
  Speaker 2: you think about a chronic autoimmune disease, it has a
• 34:47
  Speaker 2: lot to do with inflammation as well. So I don't
• 34:51
  Speaker 2: quite know where in the question where it meant like
• 34:55
  Speaker 2: working out too hard versus at your level. I think
• 34:58
  Speaker 2: obviously the best to start is at your level. Another
• 35:02
  Speaker 2: thing to do it to being like let me do
• 35:04
  Speaker 2: a full review of my hormone panel and seeing if
• 35:07
  Speaker 2: there's anything that we could do from the reproductive phase
• 35:10
  Speaker 2: of the HRT that might help with a thyroid function,
• 35:16
  Speaker 2: and then also with your food as well. I do
• 35:19
  Speaker 2: think that there are very holistic ways in which people
• 35:22
  Speaker 2: can have their food or their nutrition support an autoimmune
• 35:25
  Speaker 2: or anti inflammatory through diet our gut. Our gut is
• 35:29
  Speaker 2: a big part as well as what lets things in
• 35:33
  Speaker 2: and out and what things may be contributing to this
• 35:35
  Speaker 2: autoimmune type of disease. And so I think that there
• 35:38
  Speaker 2: are a wonderful functional nutritionists out there that kind of
• 35:41
  Speaker 2: help look at the big picture and then help from
• 35:44
  Speaker 2: a nutritional standpoint figure out what's going to help that
• 35:47
  Speaker 2: issue the most. That's great.
• 35:51
  Speaker 1: So for someone that is on HRT, they're fifty five,
• 35:54
  Speaker 1: how many years, if not for my lifetime, would you
• 35:57
  Speaker 1: recommend staying on.
• 36:00
  Speaker 2: Yes, this is a very controversial question because of where
• 36:02
  Speaker 2: we are currently in hormone literature. Have been for the
• 36:10
  Speaker 2: last twenty years fixated on a study that really had
• 36:14
  Speaker 2: us running away from hormones and thinking that they're bad,
• 36:17
  Speaker 2: and we're now just on the other side of it
• 36:20
  Speaker 2: in the sense of hormones are not that bad. They're
• 36:24
  Speaker 2: not bad at all, they're actually very beneficial. So There
• 36:28
  Speaker 2: were a lot of recommendations that were made with that
• 36:30
  Speaker 2: study twenty years ago, and one of them was stop
• 36:33
  Speaker 2: taking HRT at ten years at the time your menopausal.
• 36:37
  Speaker 2: So if you stopped having periods of fifty two to
• 36:39
  Speaker 2: fifty five, then you just add ten that's when you stop,
• 36:43
  Speaker 2: or no longer than sixty years old, right, whichever is
• 36:48
  Speaker 2: whichever pertains to your issue or your age. The problem
• 36:52
  Speaker 2: with that is that we know from literature the moment
• 36:57
  Speaker 2: you remove estrogen protesterone into stosterone body that have been
• 37:01
  Speaker 2: there your entire life, then your organs are also going
• 37:04
  Speaker 2: to take a hit because they're not being substantiated by
• 37:08
  Speaker 2: the hormones. So we're just at this early state of
• 37:13
  Speaker 2: research to say how long should women go on. There
• 37:17
  Speaker 2: are a very big body of doctors that are like,
• 37:20
  Speaker 2: from a longevity standpoint, why would I go off hormones
• 37:24
  Speaker 2: because it helps bone mineral density, decreasing rate of Alzheimer's,
• 37:29
  Speaker 2: decreasing rate of breaking your bone, improving your muscle mass,
• 37:34
  Speaker 2: and so it's more now as we start to age,
• 37:37
  Speaker 2: how can I thrive while I'm aging? And hormones have
• 37:39
  Speaker 2: a lot to do with that. But also we have
• 37:43
  Speaker 2: strict recommendations based on studies that are like, well, we
• 37:46
  Speaker 2: really shouldn't go past this point where do we think
• 37:49
  Speaker 2: that we're going with researchers more towards I'm going to
• 37:53
  Speaker 2: be on hormones until you desire to or until you die.
• 37:58
  Speaker 2: And I think when you have a really good conversation
• 38:00
  Speaker 2: some who truly understands hormones, people should be able to
• 38:04
  Speaker 2: make the decisions that they want to based on the
• 38:06
  Speaker 2: information that they get m H. Nowadays, we're still in
• 38:10
  Speaker 2: that phase where they're going to be like, oh my gosh,
• 38:12
  Speaker 2: you are sixty two and you're still on MHT. We've
• 38:16
  Speaker 2: got to get you off. I have Patians who are
• 38:18
  Speaker 2: seventy and they're like, I feel great, I'm not coming
• 38:21
  Speaker 2: off my hormones, and I'm like rock on. So again,
• 38:24
  Speaker 2: you're gonna people really need to get to the point
• 38:27
  Speaker 2: where they're like, of all this stuff with risk and benefit,
• 38:31
  Speaker 2: And what I'm looking for is I'm looking at my
• 38:34
  Speaker 2: life in my sixties, seventies and eighties, nineties, what I
• 38:37
  Speaker 2: want that to look like? How is this helping how
• 38:40
  Speaker 2: many I want? As we age, age is probably the
• 38:43
  Speaker 2: risk factor for most diseases, breast cancer, heart disease alzheimer.
• 38:48
  Speaker 2: So as we age anyway, things can start to not
• 38:51
  Speaker 2: function as properly. Disease goes up. But if you were
• 38:55
  Speaker 2: to think of it in a way that says, I
• 38:57
  Speaker 2: want to be able to be exposed to hormone to
• 39:00
  Speaker 2: give me the best benefit as I age in quality
• 39:03
  Speaker 2: of life, that's all another way to look at it.
• 39:06
  Speaker 2: But no one's wrong, right. You get to determine which
• 39:09
  Speaker 2: one of those works best for you. And I think
• 39:12
  Speaker 2: that we're going to start to see that it is
• 39:15
  Speaker 2: more personalized as far as a medicine form to sing.
• 39:20
  Speaker 2: There's going to be a risk at every point, which
• 39:23
  Speaker 2: are you willing to take personally?
• 39:26
  Speaker 1: I love that? Okay, So what do you recommend to
• 39:29
  Speaker 1: your patients with osteopenia estrogen HRT as a prevention for
• 39:35
  Speaker 1: further bone protection or bone loss? And what about creating.
• 39:40
  Speaker 2: Back up on that question again, start with the first part.
• 39:43
  Speaker 1: What do you recommend to your patients with osteopenia? Would
• 39:47
  Speaker 1: you do HRT therapy as well to prevent further bone
• 39:54
  Speaker 1: loss or for bone protection both?
• 39:58
  Speaker 2: You can see consider amount of improvement in bone mineral density,
• 40:05
  Speaker 2: levels of scores. If you're to look at it from
• 40:08
  Speaker 2: a DEXA scan perspective when people are on estrogen. That
• 40:11
  Speaker 2: has been stated clearly in the literature. So if you
• 40:14
  Speaker 2: have osteopenia, which is a deficiency, not a deficit, then
• 40:19
  Speaker 2: I would I would love if someone was like, you
• 40:22
  Speaker 2: know what, let me give it my best shot of
• 40:24
  Speaker 2: not becoming osteoporotic and go on MHT, do my strength
• 40:30
  Speaker 2: training so I can be more preventative and actually improve
• 40:35
  Speaker 2: my bone mineral density.
• 40:36
  Speaker 1: Yes, and also with which A with HRT for all
• 40:42
  Speaker 1: of these like that doesn't that's never going to replace
• 40:45
  Speaker 1: strength training, like we have to do those hand in hand.
• 40:51
  Speaker 2: Yes, because there are by different different mechanisms in which
• 40:54
  Speaker 2: they're improving the bone. So, for example, with MHT, the
• 41:01
  Speaker 2: estrogen is improving the bone mineral density by improving the osteoclass,
• 41:07
  Speaker 2: which is the cells that make our bone stronger. Resistance training,
• 41:12
  Speaker 2: what you're actually doing is it's kind of like a
• 41:15
  Speaker 2: domino effect. You're triggering your muscles through its fibers as
• 41:20
  Speaker 2: it's kind of doing its twitch to then tell the
• 41:24
  Speaker 2: cells on the bone to improve or to become more
• 41:29
  Speaker 2: or to build more. Right, So they're both different mechanisms,
• 41:33
  Speaker 2: So you're going to get the best benefit from doing both.
• 41:37
  Speaker 2: But you know, I have patients who have never weight
• 41:39
  Speaker 2: trained or they're scared to weight train. I'm like, well,
• 41:41
  Speaker 2: let's at least start with some estrogen or vice versa. Right,
• 41:44
  Speaker 2: So it's never to say that everyone's always going to
• 41:48
  Speaker 2: have the perfect template of what they're doing, but at
• 41:51
  Speaker 2: least being able to do one, if not both, is
• 41:55
  Speaker 2: the best way to improve your bone.
• 41:58
  Speaker 1: Yes, I love that. Okay, what is the best non
• 42:02
  Speaker 1: pharmaceutical intervention to protect and build bone for post metopausal
• 42:05
  Speaker 1: women diagnosed with osteopina?
• 42:09
  Speaker 2: Weight training? It's not a medicine. I mean, it's not
• 42:12
  Speaker 2: a prescription ex go exercises medicine, but that one's not
• 42:16
  Speaker 2: a drug. Are the best way to do it.
• 42:21
  Speaker 1: So, if someone was a little bit weird about X rays,
• 42:27
  Speaker 1: how safe for DEXA scans in regard to radiation exposure
• 42:30
  Speaker 1: and how often is it appropriate to get them done?
• 42:35
  Speaker 2: So? And this is a good question too that I
• 42:37
  Speaker 2: had yesterday. So when we look at radiation radiation, when
• 42:40
  Speaker 2: we look at it from a rad's perspective, that's how
• 42:42
  Speaker 2: we monitor the amount that you're getting exposed to. DEXA
• 42:46
  Speaker 2: scan is really low on that list and even X rays.
• 42:50
  Speaker 2: And when we think about like exposure to radiation and
• 42:54
  Speaker 2: like the likelihood of cancer, it really is for people
• 42:58
  Speaker 2: who are getting like significant amounts of radiation like every
• 43:02
  Speaker 2: day for like two years, you know what I mean.
• 43:04
  Speaker 2: A lot of the data that came out on radiation
• 43:07
  Speaker 2: and cancer when it was done on mice, which obviously
• 43:12
  Speaker 2: were not big mice, but that's a good indication of
• 43:16
  Speaker 2: what can happen. But when you actually look at the studies,
• 43:20
  Speaker 2: it was a significant amount of radiation. So an everyday
• 43:24
  Speaker 2: person's life who's like, I'm just doing this imaging occasionally
• 43:29
  Speaker 2: with which a DEXAS scan, I'll actually let me go
• 43:32
  Speaker 2: back to let me finish my scenements. I'll go back
• 43:34
  Speaker 2: to recommendations for DEXA and how often to do it.
• 43:37
  Speaker 2: But it really requires a lot of exposure to radiation
• 43:42
  Speaker 2: for someone to say, oh my gosh, I got a
• 43:44
  Speaker 2: cancer from actual right, Okay, So I want to reassure
• 43:49
  Speaker 2: everyone with that. The other thing about DEXA scans, currently
• 43:53
  Speaker 2: the recommendations for a DEXA scan by insurance is not
• 43:58
  Speaker 2: until the age of sixty five, which I completely hate
• 44:01
  Speaker 2: because what do you think has happened by the age
• 44:03
  Speaker 2: of sixty five, our bones are like we were already
• 44:07
  Speaker 2: on our way out, and so it's not a very
• 44:10
  Speaker 2: preventive way in the way the recommendations are written about
• 44:14
  Speaker 2: dexas scan, the way that we use it, so amount
• 44:18
  Speaker 2: of radiation is very low currently the recommendations at the
• 44:22
  Speaker 2: age of sixty five. To me, I'm just like, of
• 44:24
  Speaker 2: course women are going to be They've been usually menopausal
• 44:27
  Speaker 2: for at that point, like fifteen years without any estrogen,
• 44:31
  Speaker 2: and most of them are not taught to weight train,
• 44:32
  Speaker 2: so of course their bones are not doing great. So
• 44:37
  Speaker 2: when you think of physicians, there are again a circle
• 44:40
  Speaker 2: of physicians, not to say that it's little, but outside
• 44:43
  Speaker 2: of the traditional setting who use dexis scan not only
• 44:48
  Speaker 2: to look at your bones earlier, so they might recommend
• 44:50
  Speaker 2: someone to go get it like in their latter forties
• 44:53
  Speaker 2: early fifties, is they're going through that transition into menopause
• 44:56
  Speaker 2: because now they're losing estrogen. But also dexis scans are
• 45:00
  Speaker 2: beautiful way to look at your lean muscle mass and
• 45:02
  Speaker 2: your actual fat capacity as well. And the reason why
• 45:06
  Speaker 2: that is also important is because your muscle mass too
• 45:09
  Speaker 2: is significantly decreasing over that menopausal that perimenopause menopauseal timeframe.
• 45:16
  Speaker 2: So now your estrogen's going down, That's what I'm saying.
• 45:19
  Speaker 2: Estrogen receptors are all over impacts your bone mineral density,
• 45:22
  Speaker 2: your muscle mass is starting to go down as well,
• 45:25
  Speaker 2: but your fat cells as well. How they respond to
• 45:28
  Speaker 2: estrogen is they just they're not as agile and shrink
• 45:32
  Speaker 2: as well as they used to before, which is why
• 45:33
  Speaker 2: we start to change our body composition as we start
• 45:37
  Speaker 2: to age. So Dexa scan is actually a beautiful way
• 45:41
  Speaker 2: to look at multiple things and to help people being
• 45:44
  Speaker 2: a little bit more visual to what's going on internally
• 45:47
  Speaker 2: in their body so they can start to make that
• 45:50
  Speaker 2: the changes and the connections in their head and being like,
• 45:54
  Speaker 2: oh my gosh, look at my muscle mass. And so
• 45:57
  Speaker 2: they're actually if you go find Dexa scanned facilities, they're
• 46:02
  Speaker 2: actually not that expensive. They're like one hundred and twenty
• 46:04
  Speaker 2: five to one hundred and fifty dollars. And if someone
• 46:07
  Speaker 2: wanted to get a good baseline on what their body
• 46:09
  Speaker 2: is doing internally from a muscle perspective, a bone perspective,
• 46:13
  Speaker 2: and kind of like a fat mat or a muscle
• 46:15
  Speaker 2: fat ratio DEXA scans a beautiful way to see that.
• 46:19
  Speaker 2: It also can be preventative because now you know your
• 46:21
  Speaker 2: bone mineral density is at a younger age and if
• 46:24
  Speaker 2: you wanted to, you could do it every year, you
• 46:26
  Speaker 2: could do it every two years. But it's a great
• 46:29
  Speaker 2: way to see so much more than what we used
• 46:31
  Speaker 2: it for, and much earlier is better.
• 46:34
  Speaker 1: Yes, okay, would you recommend somebody going on our HRT
• 46:42
  Speaker 1: that's not having any symptoms, still has a period in perimenopause,
• 46:47
  Speaker 1: but like doesn't have any headaches, no, no, nothing, Yes,
• 46:51
  Speaker 1: you would recommend it.
• 46:53
  Speaker 2: The reason why is this is a very controversial question
• 46:57
  Speaker 2: right now because typically we used to wait for women
• 47:01
  Speaker 2: to be menopausal before we would give you MHT. We
• 47:05
  Speaker 2: are moving away from that and still a lot of
• 47:07
  Speaker 2: providers and again not to say that they're wrong, but
• 47:10
  Speaker 2: this is how we were trained. We would say, well,
• 47:12
  Speaker 2: we'll only put you on MHT if you have a symptom.
• 47:16
  Speaker 2: But what do we know happens when you're just declining
• 47:19
  Speaker 2: from estrogen anyway, so many things in your body, it's
• 47:22
  Speaker 2: not always a symptom. So I think that there are
• 47:26
  Speaker 2: providers who will do it. I think that women need
• 47:29
  Speaker 2: to think about those decisions when they sit down and think,
• 47:33
  Speaker 2: am I having a symptom versus am I improving quality
• 47:36
  Speaker 2: of life and longevity? Those are two different things and
• 47:40
  Speaker 2: actually get the benefit of both when you use MHT,
• 47:44
  Speaker 2: and so approaching it from that way rather than I'm
• 47:46
  Speaker 2: only going to go on MHT when I have symptoms
• 47:49
  Speaker 2: as much, and I really want to make a disclaimer
• 47:51
  Speaker 2: that i'm you know, as much as an HRT advocate
• 47:54
  Speaker 2: that I am. It does not mean that if you're
• 47:57
  Speaker 2: not on it then you should be shamed because you
• 47:59
  Speaker 2: didn't go on it. I just want everyone to have
• 48:01
  Speaker 2: the ability to know really good fundamental information so when
• 48:05
  Speaker 2: they make the decision that they would like to or not,
• 48:08
  Speaker 2: as much as I could be, like, I think it's
• 48:10
  Speaker 2: the best thing for you. If you choose not to,
• 48:12
  Speaker 2: then you choose not to.
• 48:14
  Speaker 1: Yeah, this is why I love you because I feel
• 48:18
  Speaker 1: like your your energy and your candor is just so
• 48:22
  Speaker 1: spot on, Like it's not harsh either way, Like it's
• 48:27
  Speaker 1: just here's the information.
• 48:28
  Speaker 2: As a physician, say you get to make the choice,
• 48:32
  Speaker 2: Say you change your mind in three years just because
• 48:34
  Speaker 2: of the information you heard, and you just gave it
• 48:36
  Speaker 2: more thought and you had more conversations, right, All of
• 48:40
  Speaker 2: this is really now to get people to then go
• 48:42
  Speaker 2: and being like, hmm, I didn't know that about. Let
• 48:44
  Speaker 2: me talk more about to my friends, let me bring
• 48:47
  Speaker 2: it up to my doctor. And that's how we change
• 48:50
  Speaker 2: the ability for us to make decisions is because we're
• 48:52
  Speaker 2: changing our conversation.
• 48:54
  Speaker 1: Yeah one, Oh, okay, I love it. So I'm someone
• 48:59
  Speaker 1: who was in the age range of perimenopause forty two
• 49:03
  Speaker 1: but hasn't experienced any trouble except for a bit of
• 49:07
  Speaker 1: the let's talk about the visceral fact because there's a
• 49:09
  Speaker 1: few questions here with that, but no other symptoms. And
• 49:14
  Speaker 1: have heard that women should do hormone testing before menopause
• 49:18
  Speaker 1: so that they have baseline levels of hormones to aim
• 49:20
  Speaker 1: with HRT if they choose that route in the future.
• 49:24
  Speaker 1: Should I check Should I consider checking my hormones at
• 49:27
  Speaker 1: this point anyway? If I or wait until I have
• 49:30
  Speaker 1: further symptoms. If hormone testing is recommended, do you have
• 49:34
  Speaker 1: a recommendation for the test? You went over the test
• 49:37
  Speaker 1: so well cover.
• 49:38
  Speaker 2: Those Yeah, So what your hormones are doing today at
• 49:43
  Speaker 2: what time, Well, at my time at six fifty seven
• 49:46
  Speaker 2: will be different than if I tested them today at
• 49:48
  Speaker 2: two am or tomorrow morning, right, And so it's not
• 49:52
  Speaker 2: so much a matter if I draw it now, will
• 49:55
  Speaker 2: it help me later. It's good to have a baseline
• 49:57
  Speaker 2: to see where you were, but it should not dictate
• 50:00
  Speaker 2: what your dosage of MHT is going to be now
• 50:03
  Speaker 2: or in the future. So it's not so much for
• 50:07
  Speaker 2: I have to do it now so I know my
• 50:08
  Speaker 2: dosage will be later. I think that it is good
• 50:12
  Speaker 2: for people to get a baseline, just to have a baseline,
• 50:14
  Speaker 2: and if we decide if you have symptoms in two
• 50:17
  Speaker 2: years or if you're like, let me see what my
• 50:19
  Speaker 2: hormones are in two years, you can kind of see
• 50:21
  Speaker 2: what that difference would be. But it doesn't necessarily mean
• 50:24
  Speaker 2: that it should dictate your dosage. Yeah, I want to
• 50:27
  Speaker 2: make sure that people understand that. Then the other thing
• 50:30
  Speaker 2: is you asked a second part of the question. It
• 50:33
  Speaker 2: was about the we went over that what should be
• 50:35
  Speaker 2: drawn on the labs, and you said something about visceral fat.
• 50:38
  Speaker 1: Yeah, does the visceral fat so this is the only
• 50:40
  Speaker 1: symptom that they're having. But then someone else had mentioned,
• 50:43
  Speaker 1: you know, the weight gain with visceral fat, and how
• 50:46
  Speaker 1: realistic is it for perimetal puzzle woman to achieve fat loss.
• 50:50
  Speaker 1: Weight loss is their hope and does HRT help with that.
• 50:55
  Speaker 2: Yes, So I'll answer the first question first about visceral fat.
• 50:58
  Speaker 2: So you have your and subcutaneous fat, which is the
• 51:02
  Speaker 2: fat that we see, right, So it's the fact that migrates.
• 51:06
  Speaker 2: It used to be on your hips and your button.
• 51:07
  Speaker 2: Now it moves to you your abdomen, even though you
• 51:09
  Speaker 2: didn't ask it to go there. And then you have
• 51:13
  Speaker 2: visceral fat. Visceral fat we can't see. I have seen
• 51:16
  Speaker 2: vistral fat because I went into someone's organs and looked
• 51:19
  Speaker 2: at it with a laparoscope where I cut them open
• 51:22
  Speaker 2: and was doing a surgery. It's the fat that you
• 51:25
  Speaker 2: see around an organ, and the fat that's around an
• 51:29
  Speaker 2: organ is for protective reasons. But what happens as we
• 51:32
  Speaker 2: start to get older is that our visceral fat starts
• 51:36
  Speaker 2: to increase. Okay, so that and therein becomes a problem.
• 51:41
  Speaker 2: And that's also what you can see on a dex
• 51:43
  Speaker 2: of scan as well, your visceral fat, which we are
• 51:46
  Speaker 2: we can't see just looking at someone externally. So the
• 51:49
  Speaker 2: reason why visceral fat is important because you won't feel
• 51:52
  Speaker 2: when it's increasing. You won't see when it's increasing, but
• 51:56
  Speaker 2: it does impact your organ systems, okay, and so that's
• 51:58
  Speaker 2: why people start to make we have like liver issues
• 52:01
  Speaker 2: or heart issues or whatever. That's the reason why weight
• 52:05
  Speaker 2: loss in general will always be one of those biological
• 52:10
  Speaker 2: features that for some people maybe more than others, but
• 52:13
  Speaker 2: in general everyone will start to have fat weight rather
• 52:18
  Speaker 2: increase as they age because of insulin resistance. The main
• 52:23
  Speaker 2: bulk of why we start to see that happen is
• 52:27
  Speaker 2: because estrogen decreases and we start to have a shift
• 52:30
  Speaker 2: in our muscle mass.
• 52:31
  Speaker 1: Right.
• 52:31
  Speaker 2: So if you think of a pie chart and for
• 52:35
  Speaker 2: your twenties and thirties, and when you're an adolescent, really active,
• 52:38
  Speaker 2: and your muscles are very very they're thriving, they may
• 52:42
  Speaker 2: take up sixty five percent of the pie, and then
• 52:45
  Speaker 2: you have organs and water weight and fat which take
• 52:47
  Speaker 2: up the other portion. As we start to get older,
• 52:50
  Speaker 2: that sixty five percent of that pie starts to decrease
• 52:53
  Speaker 2: slowly over time. So what does that allow more space
• 52:56
  Speaker 2: for more fat? Right? And so now we have decrease
• 53:01
  Speaker 2: in estrogen, which is also not helping our muscles, We
• 53:05
  Speaker 2: have a decrease in testosterone, which is also not helping
• 53:08
  Speaker 2: us build more muscle. So hormone replacement therapy in essence,
• 53:13
  Speaker 2: is not directly making you lose weight. It's helping all
• 53:17
  Speaker 2: of the things that we're there part of that symphony
• 53:19
  Speaker 2: to kind of keep everything in check. Increase your muscle
• 53:22
  Speaker 2: mass through testosterone. But then the work comes with bulking
• 53:27
  Speaker 2: up your muscle because you're already losing it, so you
• 53:29
  Speaker 2: need to bulk up to get that pie chart back
• 53:32
  Speaker 2: to what it used to be. And that's why when
• 53:35
  Speaker 2: I see your program, it's so phenomenal, because weight training
• 53:39
  Speaker 2: is really saving lives because muscle is the organ of longevity.
• 53:43
  Speaker 2: It's the thing that keeps us stable, it's the thing
• 53:46
  Speaker 2: that keeps us strong, It's the thing that protects a
• 53:49
  Speaker 2: lot of our bones and also our heart. And that
• 53:53
  Speaker 2: is why it's important to switch to more of a
• 53:55
  Speaker 2: weight training workout than ever when you're going through that
• 53:59
  Speaker 2: phase trying to get that sixty five percent back right
• 54:04
  Speaker 2: And I'm just using cotrary numbers, but I'm just trying
• 54:06
  Speaker 2: to give you a like a kind of visual of
• 54:08
  Speaker 2: what's happening with your body. The insistence part is also
• 54:12
  Speaker 2: crucial because it's not anything that you can see. It's
• 54:16
  Speaker 2: really just this thing that's happening internally. And when you
• 54:19
  Speaker 2: start to have increase in insulin resistance, that means it's
• 54:23
  Speaker 2: like a mailman. I always say this. The insulin's like
• 54:25
  Speaker 2: the mailman. It distributes the sugar where it needs to go,
• 54:28
  Speaker 2: and it's like you are fuel. You're going to the brain,
• 54:31
  Speaker 2: so the brain can use you, the liver needs you,
• 54:33
  Speaker 2: the muscle needs you, all of these things. But as
• 54:36
  Speaker 2: more insulin resistant, as we start to age, the mailman's like, yeah,
• 54:40
  Speaker 2: I'm not doing the mail today. And then the male's
• 54:43
  Speaker 2: just sitting around and the sugar is like, we have
• 54:45
  Speaker 2: nowhere to go, and so it just sits in our
• 54:48
  Speaker 2: blood and then we become more diabetic in a more
• 54:51
  Speaker 2: diabetic phase. But the reason why I love your program
• 54:55
  Speaker 2: again is because the biggest utilizer of glucose is muscle.
• 55:00
  Speaker 2: So if we're building muscle and it's already on its
• 55:02
  Speaker 2: way down biologically, the sugar is just going to be like, well,
• 55:05
  Speaker 2: won't just sit here too, because we're having fun, and
• 55:08
  Speaker 2: then it converts to fat. Yes.
• 55:11
  Speaker 1: Oh, and and to answer the rest of this question, yes,
• 55:15
  Speaker 1: you can absolutely lose fat in menopause and perimenopause.
• 55:21
  Speaker 2: Yeah, and I know you have time. I will, I
• 55:25
  Speaker 2: will go on on on brand and say is it easy?
• 55:28
  Speaker 1: No?
• 55:28
  Speaker 2: Can it be done? Yes?
• 55:30
  Speaker 1: Yes, absolutely, Okay, we're going to rapid fire these questions
• 55:33
  Speaker 1: because you got to get off. You got you gotta
• 55:36
  Speaker 1: a trip to pack for.
• 55:37
  Speaker 2: I mean, it's only a beza. Well you play.
• 55:41
  Speaker 1: I can't wait to watch all of your stories. Okay.
• 55:44
  Speaker 1: As menopausal women not on HRT are, libido decreases and
• 55:48
  Speaker 1: orgasms may take longer to achieve. Considering a happy, healthy
• 55:51
  Speaker 1: sexual relationship exists. What natural supplements or adaptogens can you
• 55:56
  Speaker 1: recommend for this that isn't HRT?
• 56:00
  Speaker 2: Yes, Vitamin B twelve. There's a medication called ad e E,
• 56:04
  Speaker 2: a D d ye that's helpful. Vio LESSI is also
• 56:08
  Speaker 2: a helpful medication that helps with it. I definitely am.
• 56:13
  Speaker 2: There's gosh, it's a niacin. It's a little, it's over
• 56:18
  Speaker 2: the counter, but it's a little. All that you can
• 56:21
  Speaker 2: put on your clitteris increasing and enhancing PRP injections O shots.
• 56:27
  Speaker 2: They do help. I really do like those. There's so
• 56:30
  Speaker 2: many other ways than taking testosterone, but when it comes
• 56:33
  Speaker 2: to libido, all I would say is women, do not
• 56:36
  Speaker 2: let that go. We are entitled to pleasure. We are
• 56:39
  Speaker 2: entitled to having really fulfilling lives as we grow older.
• 56:43
  Speaker 2: Do not let that go.
• 56:45
  Speaker 1: Yes, agree, Mike drop Okay, would you suggest? Okay, so
• 56:50
  Speaker 1: we talked about if somebody was just having hot flashes,
• 56:55
  Speaker 1: would you suggest to stay on HRT after six I
• 57:01
  Speaker 1: guess that goes back to quality of life, of what
• 57:02
  Speaker 1: you want quality of life.
• 57:03
  Speaker 2: But I'm going to give a very big nod to yes,
• 57:06
  Speaker 2: because I have patients who are in seventeen having hot flashes,
• 57:09
  Speaker 2: Like I can't tell your hot flashes to stop right,
• 57:12
  Speaker 2: I would love there, But if they're still there, you
• 57:15
  Speaker 2: need estrogen.
• 57:17
  Speaker 1: Yeah. And progestine yes, yes, I learned that from tonight,
• 57:23
  Speaker 1: so that was new to me. Okay, what do we
• 57:29
  Speaker 1: know about safety of oral micronized progesterone compared to progestin?
• 57:34
  Speaker 1: Is it associated to breast cancer or cardiovascular diseases or
• 57:37
  Speaker 1: any other risks?
• 57:39
  Speaker 2: Very easy answer, progestins. Please just don't take those. Those
• 57:43
  Speaker 2: are what in that study twenty years ago increased risk
• 57:46
  Speaker 2: of breast cancer. So those are synthetic. Really, look at
• 57:52
  Speaker 2: your micronized progesterone and stick with that. Yeah, okay, awesome.
• 57:58
  Speaker 1: What are your thoughts on estrogenducts for the face. Do
• 58:01
  Speaker 1: they work to improve the skin and are they safe?
• 58:04
  Speaker 2: Yeah, so they are safe. It's estriol, which is a
• 58:07
  Speaker 2: weaker form of estrogen, so it's not like it's getting
• 58:10
  Speaker 2: absorbed in your face and it's in small amounts. It's
• 58:12
  Speaker 2: not be getting absorbed and it's going to course, they're
• 58:14
  Speaker 2: all throughout your body. It does work because you have
• 58:17
  Speaker 2: estrogen receptors on your skin as well, and so they
• 58:20
  Speaker 2: respond to it. They make it more plump, increase vascularity
• 58:23
  Speaker 2: to the area. Is it the fix all for everything? No?
• 58:27
  Speaker 2: What I would say is using that, consider your your botox,
• 58:32
  Speaker 2: your lasers, your micro needling. Really, like really pay attention
• 58:36
  Speaker 2: to your skin because that's like the thing that we
• 58:38
  Speaker 2: see and is impacted by menopause. So start to invest
• 58:43
  Speaker 2: more in that area. So you just you feel great
• 58:45
  Speaker 2: about yourself. But estradie or estriol or estrogen creams in
• 58:50
  Speaker 2: her face are good and they are safe.
• 58:53
  Speaker 1: Yes, I'm getting some that's been on my list, but
• 58:56
  Speaker 1: I just don't have two seconds to actually even go
• 58:58
  Speaker 1: to the dentist.
• 59:00
  Speaker 2: Oh right, that's me. That is me okay?
• 59:05
  Speaker 1: Any thoughts on taking adaptagens like a Goonda while also
• 59:10
  Speaker 1: on estragel, prometrium and testosterone feel as though the HRT
• 59:16
  Speaker 1: doesn't help so much for mood related symptoms.
• 59:21
  Speaker 2: Say that one more time you put a lot in there.
• 59:24
  Speaker 1: And yeah this I'm just reading this, how how they
• 59:28
  Speaker 1: wrote it? And any thoughts on taking adaptagens, particularly Asha
• 59:32
  Speaker 1: Gwanda while also on estrogel, prometrium and testosterone, but she
• 59:38
  Speaker 1: feels like HRT doesn't help so much for the mood
• 59:41
  Speaker 1: related symptoms.
• 59:42
  Speaker 2: Great, okay, so now I get the question. So, Yes,
• 59:44
  Speaker 2: astragonda is an aptogen. I think aptigens are wonderful as
• 59:47
  Speaker 2: natural substances, and they really help balance some of the
• 59:50
  Speaker 2: other things that are going on in life. As much again,
• 59:53
  Speaker 2: as much as a hormone advocate that I'm that I am,
• 59:55
  Speaker 2: there are other things that we can be taking that
• 59:57
  Speaker 2: can also subtle or help them rather, so Yes, as
• 1:00:02
  Speaker 2: an aptogen, that's completely fine to take. The one thing
• 1:00:05
  Speaker 2: that I would say about if you feel your hormone
• 1:00:07
  Speaker 2: replacement therapy isn't working for you, then you need to
• 1:00:10
  Speaker 2: find someone. And if someone's not adjusting it for you
• 1:00:14
  Speaker 2: in the manner in which you need it, because it's personalized.
• 1:00:17
  Speaker 2: It should never just be everyone's on the same dose,
• 1:00:19
  Speaker 2: so someone may need to adjust that for you. But
• 1:00:22
  Speaker 2: aptogens are a great way to kind of balance and
• 1:00:25
  Speaker 2: use natural ways to create more of the substances in
• 1:00:28
  Speaker 2: your body and the hormones to respond better. So yes,
• 1:00:31
  Speaker 2: you can take that. At the same time, there's one
• 1:00:33
  Speaker 2: the one on here that I want to answer, how
• 1:00:35
  Speaker 2: do you know if you're insulin resistant? When you get
• 1:00:38
  Speaker 2: those labs that I talked about earlier. Hemoglobin A one
• 1:00:42
  Speaker 2: C is a good way to tell where your body is,
• 1:00:45
  Speaker 2: how it's processing sugar. I guess you could say, or glucose.
• 1:00:49
  Speaker 2: Get a fasting insulin and a fasting glucose, because then
• 1:00:51
  Speaker 2: you can do insulin glucose ratio and see how your
• 1:00:55
  Speaker 2: body is actually absorbing utilizing glucose. That can give you
• 1:00:58
  Speaker 2: a good idea if you're going more towards insulin resistance
• 1:01:02
  Speaker 2: than not. But just in general, everyone their body biologically
• 1:01:05
  Speaker 2: just starts to get more.
• 1:01:06
  Speaker 1: So yeah, okay, fabulous. Is there a minimum known estrogen
• 1:01:14
  Speaker 1: dose estrogel or estra estro dot for osteoporosis prevention?
• 1:01:21
  Speaker 2: Oh, that's a good question. There's no minimal dose. The
• 1:01:26
  Speaker 2: goal really is to get you started on it. And
• 1:01:28
  Speaker 2: the reason why I say that is how we measure
• 1:01:30
  Speaker 2: bone mineral density is through like a T scorn DIZ score,
• 1:01:34
  Speaker 2: which is arbitrary. I don't need to know about that,
• 1:01:36
  Speaker 2: but everyone kind of has a score of where they are.
• 1:01:40
  Speaker 2: So a lot of factors into where you are, your age,
• 1:01:42
  Speaker 2: your ethnicity if you're a smoker, and also like your
• 1:01:47
  Speaker 2: your DNA, like you know, your your family history of
• 1:01:50
  Speaker 2: what your bone structure is made up of. So there's
• 1:01:52
  Speaker 2: no minimal dose. We're really just trying to improve who
• 1:01:55
  Speaker 2: that person is and where they are based on all
• 1:01:57
  Speaker 2: those things that I mentioned. So going to help, but
• 1:02:01
  Speaker 2: there's no minimum dose.
• 1:02:03
  Speaker 1: Okay, we are almost done. How does being overweight affect
• 1:02:06
  Speaker 1: symptoms of perimetapause. I'm on HRT for improved sleep, joint relief,
• 1:02:10
  Speaker 1: and minimizing hot flashes and night sweats. It works, but
• 1:02:13
  Speaker 1: I've gained five to seven pounds since starting HRT a
• 1:02:16
  Speaker 1: few months ago. Is there a correlation between weight gain
• 1:02:19
  Speaker 1: and worsening perimetalpausal symptoms?
• 1:02:22
  Speaker 2: Yes, so there are some people who when they start
• 1:02:25
  Speaker 2: HRT can start to have this like slight little bump
• 1:02:27
  Speaker 2: with that five and seven five to ten pounds some
• 1:02:30
  Speaker 2: at most times it is transient, transient meaning that it
• 1:02:34
  Speaker 2: will even out. The other part of that is progesterone. Again,
• 1:02:38
  Speaker 2: the comfy hormone does sometimes like to absorb water, right,
• 1:02:43
  Speaker 2: and so you may you may be more water retaining
• 1:02:47
  Speaker 2: because of the progesterone. So things or to offset that
• 1:02:51
  Speaker 2: would be again with weight training, it's going to build
• 1:02:54
  Speaker 2: your your muscle, increase your protein intake because that is,
• 1:02:58
  Speaker 2: and your fiber intake. If there are probably three things
• 1:03:01
  Speaker 2: that I would mention in dietary to focus on. Obviously
• 1:03:04
  Speaker 2: there's a lot more vitamin D, making sure sometimes you
• 1:03:08
  Speaker 2: mix it with ADK so that it's absorbed in the intestine.
• 1:03:12
  Speaker 2: Vitamin D, protein intake, and fiber. Right. Remember we talked
• 1:03:16
  Speaker 2: a little bit about gut health, so again making sure
• 1:03:20
  Speaker 2: that we're keeping our gut in the most healthy way
• 1:03:22
  Speaker 2: so that we're not again losing things that we want
• 1:03:25
  Speaker 2: to keep in and things are coming in that we
• 1:03:27
  Speaker 2: don't want to come in.
• 1:03:29
  Speaker 1: Yes, okay, great information. Is there a chance of inflammation
• 1:03:34
  Speaker 1: and joints increasing significantly as women approach post metopause, In particular,
• 1:03:39
  Speaker 1: the hand and finger joints.
• 1:03:41
  Speaker 2: Yes, inflammation. There's a great company if you wanted to
• 1:03:44
  Speaker 2: look it up. It's called Glycanage gly c a n age.
• 1:03:50
  Speaker 2: What they're and they're not the only one who does this,
• 1:03:52
  Speaker 2: but what they actually look at is from your biomarkets.
• 1:03:55
  Speaker 2: So they take your blood and look at your inflammation
• 1:03:59
  Speaker 2: factors because there is such great data. As we start
• 1:04:02
  Speaker 2: to decrease an estrogen, inflammation increases. So two things cause inflammation.
• 1:04:07
  Speaker 2: One well, actually a lot does our diet our age.
• 1:04:11
  Speaker 2: As we start to age, we just become more inflamed.
• 1:04:13
  Speaker 2: And then also menopause contributes to that as well, so
• 1:04:16
  Speaker 2: many women start to have joint issues. I have a
• 1:04:18
  Speaker 2: lot of women who that's their presenting symptom of menopause.
• 1:04:22
  Speaker 2: We get them on HRT and their joints are not
• 1:04:25
  Speaker 2: as achy. Muscular skeletal syndrome of menopause is real. Most
• 1:04:30
  Speaker 2: people might complain of a frozen shoulder, but joints are
• 1:04:33
  Speaker 2: also part of that as well, as well as lower
• 1:04:36
  Speaker 2: back pain too.
• 1:04:37
  Speaker 1: Okay, what would you recommend for vaginal dryness HRT or
• 1:04:42
  Speaker 1: another natural way?
• 1:04:43
  Speaker 2: Oh? I love this because I do all of them
• 1:04:45
  Speaker 2: in my office. So vaginal estrogen, so it would be
• 1:04:49
  Speaker 2: you're not going to get as much bang for your
• 1:04:52
  Speaker 2: Bucklet's say if you take systemic HRT like a pill,
• 1:04:54
  Speaker 2: a patch, a cream vaginally, but a vaginal estrogen cream. Yes,
• 1:05:00
  Speaker 2: there also is the laser is CO two laser that
• 1:05:03
  Speaker 2: can really help restore a lot of the vaginal tissue.
• 1:05:07
  Speaker 2: And then there's also radio frequency which can also help
• 1:05:10
  Speaker 2: get to the deep layers of the tissue the vagina
• 1:05:13
  Speaker 2: to help restore the vascularity and also secretions. And then
• 1:05:18
  Speaker 2: PRP injections can be we can do that for hair,
• 1:05:21
  Speaker 2: we do it in phase, but we can also do
• 1:05:22
  Speaker 2: it vaginally as well to kind of help restore that.
• 1:05:25
  Speaker 2: So that's like four great different ways that you can
• 1:05:28
  Speaker 2: do it. If someone wanted to do HRT and a
• 1:05:30
  Speaker 2: blend of some of the other things or non hormonal
• 1:05:33
  Speaker 2: and do investigate the other three.
• 1:05:36
  Speaker 1: I mean, thank goodness for this day and age right right,
• 1:05:38
  Speaker 1: I know, okay, almost done. I'm fifty one and for
• 1:05:44
  Speaker 1: the last year I've been on birth control to help
• 1:05:46
  Speaker 1: me with perimetopause and have very heavy periods. I had
• 1:05:49
  Speaker 1: an ultrasound prior to rule out other causes of excessive bleeding.
• 1:05:53
  Speaker 1: I've been fine on birth control and the pills are
• 1:05:56
  Speaker 1: controlling my periods, but I'm wondering if I should switch
• 1:05:58
  Speaker 1: to HRT. What are the oh? Okay, so that's another
• 1:06:02
  Speaker 1: oh over the counter. So probably time to talk to
• 1:06:05
  Speaker 1: her physician about possibly switching.
• 1:06:08
  Speaker 2: Switching to HRT from what though?
• 1:06:13
  Speaker 1: From nothing birth control pill?
• 1:06:16
  Speaker 2: Yes? Yes, yes, so she wants to, but she's unsure
• 1:06:18
  Speaker 2: of what.
• 1:06:20
  Speaker 1: Yeah, she has very heavy periods, so I think that's
• 1:06:23
  Speaker 1: why she's been on the pill. She's been doing fine
• 1:06:27
  Speaker 1: on the pill, but then wondering if she should switch
• 1:06:30
  Speaker 1: to HRT instead.
• 1:06:31
  Speaker 2: If she has heavy bleeding, I would navigate another form
• 1:06:36
  Speaker 2: of birth control because she's not going to get the
• 1:06:38
  Speaker 2: control of bleeding with the HRT. So really, I say
• 1:06:42
  Speaker 2: this because I have one myself, But an IUD is
• 1:06:44
  Speaker 2: a great way to control bleeding, and then you could
• 1:06:47
  Speaker 2: still go on HRT. You could also there's also medications
• 1:06:51
  Speaker 2: for heavy bleeding that are just for the heavy bleeding
• 1:06:53
  Speaker 2: and then you can kind of do the other stuff,
• 1:06:55
  Speaker 2: which would be HRT. So I think that or a
• 1:06:59
  Speaker 2: small per so it's not a surgery, but there are
• 1:07:02
  Speaker 2: small things that can actually help with heavy bleeding as well,
• 1:07:04
  Speaker 2: So that one actually has like a longer cascade. I
• 1:07:08
  Speaker 2: guess of lists that can be done for that part
• 1:07:11
  Speaker 2: while considering do I switch over to MHE team. So
• 1:07:14
  Speaker 2: it's just separate categories. The bleeding is a category that
• 1:07:17
  Speaker 2: needs to be addressed with medications, non medication or non
• 1:07:21
  Speaker 2: hormonal medications or procedures. And then the other side would
• 1:07:24
  Speaker 2: be do I stay on birth control or do I
• 1:07:27
  Speaker 2: switch to MH team? Two separate things.
• 1:07:29
  Speaker 1: Yeah, okay, what effect on menopause does an IUD have
• 1:07:33
  Speaker 1: for women? And for a woman in her mid forties?
• 1:07:38
  Speaker 2: Say that one again.
• 1:07:40
  Speaker 1: What effect on menopause does an IUD have on a
• 1:07:44
  Speaker 1: woman in her mid forties?
• 1:07:47
  Speaker 2: Great birth control and no bleeding. That's coming from a
• 1:07:50
  Speaker 2: personal experience. It really was designed to be like this
• 1:07:54
  Speaker 2: really great local way to decrease bleeding and provide birth
• 1:07:57
  Speaker 2: control that's low maintenance because you don't have to take
• 1:07:59
  Speaker 2: something out every day, change something out. But it doesn't
• 1:08:03
  Speaker 2: have an impact on menopause. It helps with the bleeding
• 1:08:06
  Speaker 2: portion of someone who's perimenopausal and also provides birth control
• 1:08:10
  Speaker 2: while you can still address considering MHT in the perimenopausal
• 1:08:14
  Speaker 2: phase if you wanted to.
• 1:08:16
  Speaker 1: Okay, okay, we're wrapping it up. What what are your
• 1:08:21
  Speaker 1: thoughts about when this person entered menopause, she started experiencing
• 1:08:26
  Speaker 1: recurring UTIs and urgency and continence. Do you recommend a
• 1:08:30
  Speaker 1: hormone therapy for women in similar situations?
• 1:08:34
  Speaker 2: Yes, because the bladder that remember we're talking about the sphincter,
• 1:08:38
  Speaker 2: and it doesn't control it's not as tight as it
• 1:08:41
  Speaker 2: needs to be. So in the moments when we're trying
• 1:08:42
  Speaker 2: to hold our year and it's still a little open,
• 1:08:44
  Speaker 2: so urine can come out. HRT can definitely help restore
• 1:08:48
  Speaker 2: some of the tissue in the in the sphincter and
• 1:08:52
  Speaker 2: in the urethra. The other good thing. And why even
• 1:08:55
  Speaker 2: if it doesn't correct it, even if you needed a
• 1:08:57
  Speaker 2: procedure or a laser or some else, you're now being
• 1:09:01
  Speaker 2: preventative by using HRT, namely vaginal estrogen in this instance,
• 1:09:07
  Speaker 2: because as you start to get older, it's only going
• 1:09:10
  Speaker 2: to become more of a problem. And quick statistic when
• 1:09:16
  Speaker 2: you look at actual old age homes, most of the
• 1:09:22
  Speaker 2: women a lot of times there usually are having issues
• 1:09:26
  Speaker 2: with chronic UTIs because of either losing urine or their
• 1:09:33
  Speaker 2: bladders not working to the best capacity that it can
• 1:09:36
  Speaker 2: because of the microbiome in the bladder because it's no
• 1:09:39
  Speaker 2: estrogen is being provided, and that can lead to so
• 1:09:43
  Speaker 2: many other mortalities and diseases and issues in older age
• 1:09:48
  Speaker 2: for women. So protect your urethra. Consider vaginal estrogen as
• 1:09:53
  Speaker 2: both helping with symptoms and also being preventative for later
• 1:09:57
  Speaker 2: on in life.
• 1:09:59
  Speaker 1: Okay, fabulous. Two more quick questions. If a woman went
• 1:10:02
  Speaker 1: through metapaus five years ago, is it possible to start
• 1:10:05
  Speaker 1: HRT to treat lack of libido? Is it too late
• 1:10:08
  Speaker 1: or is it too late to start?
• 1:10:10
  Speaker 2: I always say it is never too late to try anything,
• 1:10:12
  Speaker 2: because at the end of the day, if it works
• 1:10:15
  Speaker 2: for one but doesn't work for another, like we still tried,
• 1:10:19
  Speaker 2: I think that test fosterone is a beautiful way to
• 1:10:22
  Speaker 2: restore a hormone that was already there. Women have sposterone.
• 1:10:26
  Speaker 2: We just we're just put in this category where you know,
• 1:10:29
  Speaker 2: everyone thinks that we don't have and only men have it.
• 1:10:32
  Speaker 2: But we should be just as happy to be the
• 1:10:36
  Speaker 2: sexual beings that we are and that should not decrease
• 1:10:39
  Speaker 2: with age, And so I think it is always worthy
• 1:10:42
  Speaker 2: of someone to consider starting testosterone therapy and in considering
• 1:10:46
  Speaker 2: to increase dosage until they might feel that they do
• 1:10:49
  Speaker 2: have their libido restored and not to give up on that.
• 1:10:52
  Speaker 1: Oh, I love that. I hope this is considered general enough.
• 1:10:56
  Speaker 1: I wanted if I wondered if you could touch on
• 1:10:58
  Speaker 1: how fibroids affect active women, what lifestyle changes should be
• 1:11:03
  Speaker 1: we be making if we develop them.
• 1:11:05
  Speaker 2: Yeah, fibroids are actually up to seventy percent in Black
• 1:11:10
  Speaker 2: women and fifty percent in women of all ethnicities have fibroids, right,
• 1:11:14
  Speaker 2: So a lot of it has to do with when
• 1:11:16
  Speaker 2: we think of firewery as we think of size, amount
• 1:11:19
  Speaker 2: and where they're located. So most women, if you listen
• 1:11:24
  Speaker 2: to those statistics, either half or most women will have fibroids,
• 1:11:27
  Speaker 2: but most of us don't even know. Right, But twenty
• 1:11:31
  Speaker 2: five to thirty percent of women are symptomatic, meaning they're
• 1:11:35
  Speaker 2: big and they take up size or they have heavy bleeding.
• 1:11:38
  Speaker 2: So there are really a lot of modalities that are
• 1:11:40
  Speaker 2: out there to help with the symptom. If you do
• 1:11:43
  Speaker 2: have a symptom, If you don't have any symptoms and
• 1:11:46
  Speaker 2: maybe on ultrasound saw that you had fibroids, typically we
• 1:11:52
  Speaker 2: can be like, Okay, if they're not bothering, you can
• 1:11:54
  Speaker 2: kind of just monitor them are causing an issue, so
• 1:11:59
  Speaker 2: many different modes that can help with the symptom that
• 1:12:02
  Speaker 2: it's causing, because there are multiple symptoms that can cause.
• 1:12:05
  Speaker 2: But throughout the pyramid apausal phase, I would say that
• 1:12:08
  Speaker 2: fibroids sometimes can start to wreak havoc because our hormones
• 1:12:12
  Speaker 2: are doing that roller coaster, remember how we started the
• 1:12:15
  Speaker 2: roller coaster ride, and that can actually create heavy periods
• 1:12:19
  Speaker 2: for people who are like I never used to have
• 1:12:21
  Speaker 2: heavy periods, and all of a sudden they start to
• 1:12:23
  Speaker 2: have heavy periods. Could be a cause of the five
• 1:12:25
  Speaker 2: voids that are being responsive to these hormone fluctuations. But
• 1:12:29
  Speaker 2: a lot of women have fibroids, they just don't have symptoms.
• 1:12:34
  Speaker 1: Jessica, I adore you, and I'm so grateful and I'm
• 1:12:38
  Speaker 1: so sorry we kept you a few minutes over. Thank
• 1:12:41
  Speaker 1: you so much. I mean so many of these questions,
• 1:12:44
  Speaker 1: not only I mean I didn't have time to really
• 1:12:46
  Speaker 1: read the thank you for all you do, doctor Shepherd,
• 1:12:48
  Speaker 1: doctor Shepherd, so I was just like trying to get
• 1:12:51
  Speaker 1: to them. But so much love from this group of women,
• 1:12:54
  Speaker 1: and so much love for what you're doing and just
• 1:12:56
  Speaker 1: who you are as a person. And a physician. So
• 1:12:59
  Speaker 1: thank you, think you, thank you. I can't wait to
• 1:13:01
  Speaker 1: track you while you're experiencing Biza and have fun while
• 1:13:10
  Speaker 1: you're there along with work.
• 1:13:13
  Speaker 2: I can't wait for us to get together. I hope
• 1:13:15
  Speaker 2: everyone who's on here thank you for investing in your
• 1:13:17
  Speaker 2: health and being here. But when you see Hayley and
• 1:13:20
  Speaker 2: I together next time, she will be busting my butt
• 1:13:24
  Speaker 2: And then you guys can be like, wow, she's really
• 1:13:27
  Speaker 2: kicking her ass. I'll be like, yeah, that's what she does.
• 1:13:31
  Speaker 1: Exactly. We're making it happen. Yes, we are, okay, I
• 1:13:35
  Speaker 1: adore you, take care and thank you so much.
• 1:13:38
  Speaker 2: All right, having a safe bye.
• 1:13:41
  Speaker 1: Thanks for listening.
• 1:13:43
  Speaker 2: If you enjoyed this episode.
• 1:13:44
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