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

Transcript

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

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