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Restoration Is Rebellion: Dr. Kristin Markell on Hormones, Healing & Whole Person Care · A Lifetime to Learn

• {This podcast is for informational and educational purposes only and is not intended as medical advice. Please consult a qualified healthcare provider for guidance specific to your personal health needs.} Dr. Kristin Markell [00:00:00]: We are trained that rest is bad. Leslie Zanoff [00:00:05]: Right? Dr. Kristin Markell [00:00:06]: Right. That we have to earn it earned. That it's lazy, that we're not worthy of it. Right. Like we have to care for everyone else before us and rest. So as women, this is the unwritten rule. Leslie Zanoff [00:00:25]: This is a space where presence meets purpose, where we explore the moments that shape us, from entrepreneurs and change makers to women in leadership. It's about learning out loud, together with honesty and humor. Where luminaries with real stories remind us how to live by our own rules. Because progress doesn't come from having all the answers. It comes from staying open. And we've got a lifetime to learn. I'm your host, Leslie Zanoff. Let's get started. Leslie Zanoff [00:00:56]: Friends. I'm so glad that you're tuning in today. This episode is one that I've personally been looking forward to for quite some time. Not just because my guest is brilliant, but because she's one of my favorite humans on the planet. Dr. Kristin Markell is a double board certified OB GYN with over 20 years of experience. But honestly, that title doesn't scratch the surface of who she is. She's a hormonal health expert, a certified integrative and functional medicine physician, a sexual health and perimenopause specialist, a yoga trained somatic healer, and the founder of concierge and telehealth boutique right here in Northwest Arkansas. Leslie Zanoff [00:01:36]: She's built her life and her work around the belief that I think is going to really resonate with every woman listening, that restoration is rebellion, that your body holds wisdom. Whether she's coaching corporate leaders, speaking on stage, or writing for her community, her goal is always the same. To help women reclaim their wholeness, ignite their purpose, and lead lives rooted in joy, vitality, and freedom. Kristin, I'm so happy to have you on the show. Welcome to A Lifetime to Learn. Dr. Kristin Markell [00:02:08]: Thanks so much for having me. I've been looking forward to this too. Yes. Leslie Zanoff [00:02:12]: I feel, you know, for years you and I have had conversations that I feel like have been a podcast in the making and we're like all women should be having, you know, hearing these conversations. So here we are. Dr. Kristin Markell [00:02:23]: I know, right? So glad. It's time. Leslie Zanoff [00:02:25]: It is time. And really, I want to just start out because by talking to you and have you explain or tell our listeners about treating the whole person, that's what I feel like you really do well in your practice. So, will you just talk about that a little bit? Dr. Kristin Markell [00:02:43]: Yeah. Thank you. Yeah. I think being in women's health for so long, focusing on different areas I started to notice how everything is really connected. And while that can feel sometimes overwhelming to people, it also for me always helped me counsel patients that, hey, when we start working on one area here, that's going to affect these other areas that you're also looking at. And so, when you really approach women's health from a whole person perspective, you're seeing how all the areas are connected, related to your mind, your body, your spirit, your relationships, your work in the world. And so, when I meet women in my practice, I'm not looking at them as, okay, this is what I would recommend to everyone. It's, this is what I would recommend to you for this season of life. What's important to you right now. Dr. Kristin Markell [00:03:48]: And it's going to get you there with the most ease and effectiveness. Leslie Zanoff [00:03:53]: Yes. And I know that to be true because you're always saying medicine is personalized. And I think that's something that you live out in your life and work and with your patients, that medicine is personalized. Dr. Kristin Markell [00:04:06]: It really is. And with women's health, it can be a bit tricky because the study of women in research studies has not always been as robust. That's maybe putting it lightly … as robust as we would want it to be. And as someone who's worked with women for over two decades, I can tell someone, hey, this is what it says in the study. But we also have to look at that study and say, Are there people in there that look like you? Are there people in there that represent you? And for some of the studies, the answer was no. Right. And so you have to go with, you have to go with clinical experience. You have to go with understanding what symptoms mean and having a provider that has that experience to say, I think for you, this is where we're going to start. Dr. Kristin Markell [00:04:58]: And then we'll see what happens. Right? And we'll trust your symptoms. We'll trust the ones that get better. We'll trust the ones that are still saying, hey, I need more attention over here. And then we create this personalized care plan for them. And if it doesn't look exactly like their moms or sisters or cousins or best friends, it's not because they're doing it wrong. It's because they're listening to what they need specifically. Leslie Zanoff [00:05:21]: Yes. What they need specifically. And I, you mentioned going from the symptoms, and that's something I want you to, to talk about because I've had conversations with friends so many times and they say, well, I'm 47 and my hormones are in normal range. My doctor said that I'm not really in perimenopause. And, and I, obviously, I'm not a physician, but I want to say you probably are. You probably are because we have to go by symptoms, right. And not our blood work. Will you talk about that? Dr. Kristin Markell [00:05:55]: I will, yes. So perimenopause is having a huge moment, which thankfully.Thankfully, right? Like, thank you. And we, we were not all trained well in perimenopause. Even me as a women's health provider, you know, I had training in hormones in med school and residency specifically focused on women's health. But I went back to learn more about this specific season because when I did training initially, it was wait until someone doesn't have a period anymore to talk to them about hormonal support. And when we look at perimenopause, which is the seven to ten years before that last menstrual period, that diagnosis of menopause, that is, you know, almost a whole decade. A decade. A decade of significant changes. Dr. Kristin Markell [00:06:50]: Right. And it doesn't look exactly the same at the beginning as it does right before you end your period, but it's a significant shift in women's lives, right? And like you said, it's not always diagnosed by labs. Leslie Zanoff [00:07:05]: Right. Dr. Kristin Markell [00:07:06]: Now, I mean, I will do labs with people because sometimes, I will find that people are further along than they thought. Leslie Zanoff [00:07:14]: Right. Dr. Kristin Markell [00:07:14]: But I'm also trusting their symptoms, right? I'm trusting the symptoms that they've been navigating for sometimes three to five years before they get in the door to see me. And so when people say, my doctor said that my hormones look normal, I always say, great. That means that on that specific day, the brain and the ovaries had some sort of communication that showed up in that moment when you had that lab test as normal. Leslie Zanoff [00:07:49]: Right. Dr. Kristin Markell [00:07:49]: But that does not discount your symptoms that you have come in here for. Right? And if you're telling me I'm suffering, I am dealing with this, navigating it, you know, it's affecting my quality of life. And it's been doing that for years. Years. Months to years. That doesn't mean that we can say, okay, labs look normal, keep on. Leslie Zanoff [00:08:12]: Right, keep on. And in your experience, is there a first sign or maybe what's the first signal that women tend to ignore? When their body is asking them that to downshift or that something's happening to come in and see you? Dr. Kristin Markell [00:08:32]: With perimenopause, it's typically fatigue. Right? So some of the, some of the non-specific symptoms that could be other things, right. And that's why I take a whole person approach, because we don't want to just say, oh, it's perimenopause, when maybe someone's thyroid is not functioning well or they're severely anemic. You know, we're really looking at that whole person. But the most common symptoms I hear, especially in the mid to late 30s, which can be perimenopause, is fatigue, change in mental health, symptoms like more anxiety, more depressive symptoms, or edginess, sometimes even some executive function symptoms like having issues with memory recall, overwhelm, you know, organization type things. Leslie Zanoff [00:09:23]: Right. Dr. Kristin Markell [00:09:25]: And, you know, a lot of women are trying to, maybe they notice it at a specific time of their cycle because they're still having periods. And they may say, well, it gets significantly worse in that week before they start their period. And so they may get a new diagnosis of PMS or PMDD, which is a more severe form of PMS, and what that can be telling us is that those hormones are starting to shift. Leslie Zanoff [00:09:55]: Okay. Dr. Kristin Markell [00:09:55]: And so, you know I love women because they're like, well, what can I do to help, right? And they, they start. They start telling me all the things. Dr. Kristin Markell [00:10:04]: They start like, I'm going to track it and I'm going to try these things. And, you know, many lifestyle practices can be very supportive, right? Those are going to be foundational pieces that we want to look at in this season of life. And we also have to say that sometimes some of those practices will not affect how your hormones are changing because, you know, perimenopause is the natural progression to menopause, where your ovaries stop functioning. Leslie Zanoff [00:10:36]: I mean, right. Can we just pause on that? I think sometimes we don't even realize, as women, what a big deal that is, that our ovaries stop working. Dr. Kristin Markell [00:10:48]: Yeah. Leslie Zanoff [00:10:48]: And, you know, to your point, when an organ stops functioning, right. I mean, this is a big deal. Dr. Kristin Markell [00:10:56]: It's a big deal. Leslie Zanoff [00:10:57]: We should treat it like it's a big deal. Dr. Kristin Markell [00:10:59]: It's, you know, I always say it's the only organ that stops functioning naturally. Like maybe people, you know, had their gallbladder out or other organs that weren't working anymore for some reason. But the ovaries, every woman that lives to a certain age, their ovaries will stop working. Leslie Zanoff [00:11:21]: Will stop working. Dr. Kristin Markell [00:11:22]: And so, you know, and I always say, I wish that it was like a predictable stair step. Like, if it would just, you know, every few years, just take it down a notch. Take it down a notch and take until it went out right then I think we would be able to support a little bit easier because we'd say, well, this is the new normal. Here's what we do to. But sadly, you know, while the progesterone may be declining, the estrogen during perimenopause can be very erratic. Okay, sometimes it's high and sometimes it's low. And that is where it's hard to use some of these cyclical practices that we may have been using throughout our life because we had a cycle that was happening predictably, right. Dr. Kristin Markell [00:12:11]: You know, I always say women are very good at working with change because your cycle, if you look at your hormonal cycle, it's not the same throughout the 28, 30 days, but women have learned how to work with it. Hopefully that is my goal for them, to learn that on some days, you know, your one hundred percent is going to look different than your one hundred percent on another day, right? Leslie Zanoff [00:12:36]: I know this is true. Yes. Dr. Kristin Markell [00:12:39]: And so that perimenopause time-period, that seven to ten years, which that beginning may look, you know, just like things are coming in that feel a bit different. Maybe it's just I'm tired, maybe this month was hard. Da, da, da, da versus the end. You know, my periods are spacing out. I can see some changes related to the decline in estrogen and progesterone. You know, those are going to be very different time periods. Leslie Zanoff [00:13:07]: Well, and then you mentioned, right, it's not a, I guess, stair step. It's, I feel like, I mean, is this true? Is this normal? Where it's like you go a few months and you're like, I've got it figured out, and then bam, something changes again. It's not, there's not a consistent cycle to your point anymore. Is that, is that right? Dr. Kristin Markell [00:13:25]: Well, and women in perimenopause are still having periods many times. Right. In that seven to ten year period, the beginning part, most women are still having regular periods, meaning they have a bleeding typically consistent with their past history of that. But it's the hormonal changes within that cycle that may look different one cycle than it does to the next. And again, if it was predictable, if it was, if it was like, hey, I'm going have two cycles that feel normal and then one that is like, whoa, what's happening? Even if we had that right, I think we could say, okay, I'm going to plan for this cycle to be like this and so I'll support myself in a different way. But I really believe it's the erratic changes that make this season so tricky. Leslie Zanoff [00:14:19]: The up and down. Absolutely. And speaking of that. Because you were saying the hormones, and that is something that there's so much noise, I guess, around the hormone therapy. Fear, misinformation, just really conflicting advice in general. Can you kind of cut through that and. tell us what the evidence actually says about who should consider it and why? Dr. Kristin Markell [00:14:48]: Yeah. So the evidence is still forthcoming, right? We're learning more and more and more because now we're including women in studies, we're including perimenopausal women in studies. And so we're understanding what is happening during this time-period and what may be beneficial for women. We do have some excellent studies that even if they were, some of them were misinterpreted a bit. We still get some good data from some studies in the past. And, you know, what I have found and what I recommend is that every woman has some sort of discussion about what hormone therapy could do for them either in perimenopause or even before to consider for them personally, what would this be helpful for? Because, you know, obviously, when we look at symptoms, in my clinical experience, providing people with hormonal therapy, even during perimenopause, which, again, the old paradigm was you wait until people don't have a period anymore. Leslie Zanoff [00:15:59]: Right. Dr. Kristin Markell [00:16:00]: But providing people with hormone therapy during perimenopause can sometimes stabilize some of the symptoms that they're experiencing. Yeah. And this is … it's going to be so specific for each person because maybe someone's coming in saying, I have a really strong family history of osteoporosis. My mom, my grandma, everybody's broken bones. And their quality of life in this, in the season that they're in or before they passed, was horrible. And I don't want that to happen to me, right? Dr. Kristin Markell [00:16:36]: And so talking about, okay, what is going to be beneficial to protect your bones from now moving forward, right? For the second half of your life, or people coming in talking about, I have a strong family history of dementia, like, what are the things that I can do? What are the studies showing for dementia? Bone health, cardiovascular health? And so then you get to have that personalized discussion with that person and say, here's what we know, here's what we don't know. Probably in the next 10 years, we're going to know a lot more. Leslie Zanoff [00:17:12]: Right. Dr. Kristin Markell [00:17:12]: Which is fantastic. Leslie Zanoff [00:17:13]: Yes. Dr. Kristin Markell [00:17:14]: And is starting hormonal therapy going to be harmful for you? Leslie Zanoff [00:17:21]: Yeah, that's… Dr. Kristin Markell [00:17:21]: Most people, you know most people … it won't be harmful. Will we find out what gets better when we start you on it? Yes, we will. And you'll get to say, oh, okay, when I started this, these symptoms got better and went away. Now we know. Okay, those are those symptoms. Let's follow those. Dr. Kristin Markell [00:17:39]: Right. Even for people who, you know, are contraindicated to take hormones, vaginal estrogen is safe for everybody. Leslie Zanoff [00:17:49]: Right. Dr. Kristin Markell [00:17:50]: Everybody can have vaginal estrogen. Leslie Zanoff [00:17:52]: And just to clarify, when you say contraindicated, we're talking people who are scared or worried, have a family history of. Or have a history themselves of breast cancer. Right? Dr. Kristin Markell [00:18:02]: Typically, people with a personal history. Leslie Zanoff [00:18:04]: Personal. Yes. Dr. Kristin Markell [00:18:05]: Yeah. And even ..even then. Leslie Zanoff [00:18:08]: Yes. Dr. Kristin Markell [00:18:09]: You know, there is more discussion happening around that, and I think we will see … see that conversation expand over the next decade, for sure. But everyone can use vaginal estrogen. And I think when we talk about vaginal estrogen, sometimes the efficacy of what it supports gets downplayed. People think like, oh, it's just the vagina. Right. We're giving some estrogen to the vagina. Leslie Zanoff [00:18:35]: Right. Dr. Kristin Markell [00:18:36]: But really, that whole pelvic floor. Pelvic health. Leslie Zanoff [00:18:41]: Yes. Dr. Kristin Markell [00:18:41]: That estrogen helps support with the bladder, the pelvic floor muscles. Yes. The vagina. Yes. The clitoris, you know, all the things that make up this whole area. And how it could change symptoms in the right now? But it can also help prevent urinary tract infections down the road, which is a big deal as we age. Leslie Zanoff [00:19:04]: Huge deal. Dr. Kristin Markell [00:19:04]: Right. So, you know, even if we're able to say everyone can use vaginal estrogen, and then I think everybody deserves an appointment with a specialist to talk about, what are my risks and benefits of using hormonal therapy? Leslie Zanoff [00:19:24]: Yes. Dr. Kristin Markell [00:19:25]: What is the risks and benefit if I don't start it now and I wait until after menopause? And these are the discussions that are so personalized to women. Leslie Zanoff [00:19:37]: And what … How long should someone … If you start hormone replacement therapy, when should they see a difference or notice some, some maybe relief? Is that like a few weeks, a month, or? Dr. Kristin Markell [00:19:54]: Yeah. Leslie Zanoff [00:19:54]: When would we see Dr. Kristin Markell [00:19:55]: It's a great question. Leslie Zanoff [00:19:56]: something? Dr. Kristin Markell [00:19:56]: Yeah. And, you know, I know people hate it when I'm like, it depends, right? Leslie Zanoff [00:20:03]: Medicine is personalized. We're just going to go after that. Dr. Kristin Markell [00:20:07]: The nuance is where it's at, you know? But it really depends. Some people will see a benefit within that first week, right? Depending on what we are supporting. Leslie Zanoff [00:20:19]: Right. Dr. Kristin Markell [00:20:20]: Some people at the end of that first month are like, okay, yes. Right. They're noting what has changed from when they started. And then … And I always tell people that usually at month three. We're really … we can look back and see the progression from when we started and where we are now. And if we're not seeing a benefit on certain symptoms that brought you in, certain concerns that have really been impacting quality of life, then we need to look. Dr. Kristin Markell [00:20:51]: You need to look at. Is the dose right? Is the formulation right? Is this the right hormone for you? Is there anything else that's playing into this, right? And so that's why that whole person care is so important. Because I think sometimes people will start certain things. It's not exactly right. And then they stop it and say, oh, I, I failed that. Right? And it may be that it just wasn't the dose they needed. Dr. Kristin Markell [00:21:20]: It may have been that it wasn't the combination that they needed and maybe it wasn't getting their levels where they needed them. So, you want to have someone that's, that's really following that up closely. Leslie Zanoff [00:21:31]: Yeah. Someone that's following that and is maybe certified like you, right? Through the menopause society who's taken the extra steps to understand what's happening. Dr. Kristin Markell [00:21:46]: Yeah, I agree. Right. You know, the people that, that go the extra step in the perimenopause and menopause space are typically very passionate about this time-period, right? They want to know more and they want to support women in this season because it's such a significant transition time, not just health wise, but, you know, women in the workforce, relationships. You know, it's just a huge transformation that to go into that area basically is saying like, yep, we need to help support women in this transition. Leslie Zanoff [00:22:27]: Yes. And something you mentioned earlier about knowing your family history of heart health and osteoporosis and maybe even when your mother or grandmother entered into menopause. Man, if we, if your family members are still alive and you have the ability to ask them, I think it's so important. Right? To know and question because it might give us some indicators for ourselves. Right. What our health might look like. Dr. Kristin Markell [00:22:55]: So I always encourage patients to visit with their family members if, if they're still alive about their experience. Now, there also is a caveat there of that generation was not really encouraged to talk. Leslie Zanoff [00:23:09]: Right. Dr. Kristin Markell [00:23:09]: About menopause, perimenopause. Leslie Zanoff [00:23:14]: And so, they were like we just dealt with it. Right. We don’t even know. Dr. Kristin Markell [00:23:15]: Right. They're like, oh, it was fine, I just got through it. Right. Leslie Zanoff [00:23:18]: Yes. Dr. Kristin Markell [00:23:18]: And so sometimes people will tell me that, but then they'll also tell me stories of… I remember there was a time when, you know, my mom wasn't feeling well or was very sad. Or, you know, left for a while or… And so you have to dig a little bit sometimes to find this information for that generation, because they weren't encouraged to talk about it. They weren't encouraged to know more about what was going on with their body. They were told, this is just aging. This is how it's going to be, and you just need to deal with it. Leslie Zanoff [00:24:02]: And not looking at the signs that something actually might be happening hormonally. Dr. Kristin Markell [00:24:06]: Right. Leslie Zanoff [00:24:06]: Just This is aging and stress or whatever. Dr. Kristin Markell [00:24:09]: And isn't it interesting when. When a majority of women will say, oh, I turned 40 and my body fell apart. Leslie Zanoff [00:24:17]: Yes. Dr. Kristin Markell [00:24:18]: I mean, if it's something that abrupt, you know, why have we not been asking these questions before? Leslie Zanoff [00:24:26]: Why are we not asking the questions Dr. Kristin Markell [00:24:27]: Like, what happens at 40? What's happening in that decade? Leslie Zanoff [00:24:32]: Yes. Dr. Kristin Markell [00:24:33]: That would increase your symptoms throughout your whole body? Leslie Zanoff [00:24:40]: Yes. Dr. Kristin Markell [00:24:40]: Right. Because a lot of times people think like, oh, it's just my ovary. It's just going to affect my periods. Right. And what we need to talk about is that we have hormone receptors on every area of our body. Leslie Zanoff [00:25:00]: Yes. Dr. Kristin Markell [00:25:00]: And so this is why perimenopausal symptoms are so not random, I would say. But why they can be pretty much everywhere. Everywhere. Leslie Zanoff [00:25:10]: Right. Dr. Kristin Markell [00:25:10]: Your skin and your ears and your eyes and your heart and your brain and your teeth. Leslie Zanoff [00:25:15]: Teeth, Gums. Dr. Kristin Markell [00:25:16]: Teeth. Which are bones, and your gums. And so, you know, you name an area, and we can say, oh, here's a perimenopause symptom that's associated with it, because there are hormone receptors there. Leslie Zanoff [00:25:29]: Yes. Dr. Kristin Markell [00:25:29]: And so if a lot of women are saying, wow, I turn 40 and everything, just … what's been happening for the last few years? What's been shifting that would make them have a lot of different symptoms that make them think their body is falling apart. Leslie Zanoff [00:25:48]: Right. Things we need to talk about. Dr. Kristin Markell [00:25:50]: Right. Leslie Zanoff [00:25:51]: One. One thing that I love you say, you talk about restoration as rebellion, and I love that phrase, especially as someone who is certified to teach meditation. Dr. Kristin Markell [00:26:03]: Right. Leslie Zanoff [00:26:03]: But what does that actually look like in a woman's daily life? Like, why. Why do so many of us have to be convinced, I guess, that we're worth that kind of care? What does that mean? Why do you say that? Dr. Kristin Markell [00:26:15]: Well, I call it rebellion because we are trained that rest is bad. Leslie Zanoff [00:26:23]: Right. Dr. Kristin Markell [00:26:23]: Right. That we have to earn it earned. That it's lazy, that we're not worthy of it. Right. Like, we have to care for everyone else before us and rest. So as women, this is the unwritten rule and this is what people tell me. I've experienced this myself. Right. Dr. Kristin Markell [00:26:42]: And so when I talk about restoration as rebellion, I'm like, okay, get your rebellious side out. I don't know what she looks like, right? Maybe she's your inner teenager. And she's like, I'm not doing that. But she's coming out to say, I'm bringing rest into my life. Now, some people think rest is just physical rest, like sleep. But you and I know that it's not just sleep. Dr. Kristin Markell [00:27:09]: It can be mental rest, it can be emotional rest, you know, sensory rest for some of my ADHD neurodivergent people, I'm like, you need to get yourself to a place that your senses get a break. Leslie Zanoff [00:27:22]: Right. Dr. Kristin Markell [00:27:23]: And it could be creative rest, like getting our. Our brain into something that is not like checking all the boxes, doing all the things. It's like such an exhale, such a pause. And, I mean, your work is exactly what we're talking about here is providing that space for your body, your mind, your spirit to take a break. Leslie Zanoff [00:27:45]: Yes. Dr. Kristin Markell [00:27:46]: And, you know, and then addressing the stories of, like, this is lazy, or this is counterproductive, when we know that if you have restoration, whatever that looks like for a woman, then they come back rejuvenated, and then they put that energy towards the work that they love to do in the world, whether that's their people, their community, their passions. Like, this is what we see. Leslie Zanoff [00:28:17]: Yes. It's so important. Dr. Kristin Markell [00:28:18]: And so, you know, this rest will look different for each woman. If I've got someone who's, you know, got small children and they're really touched out and they, you know, are in that time of life where it's a lot of physical and doing, then maybe their rest is a nap or maybe it's getting in the bathtub and, you know, having a little alone time. Leslie Zanoff [00:28:40]: A moment of peace. Yes. Dr. Kristin Markell [00:28:41]: For people who are managing, a lot of people, whether that's at work or home, maybe their rest would look different than that. And so this is where I invite women to listen to what they need. They know. They tell me, like, I just want to run away to an island and, like, on a beach, or I want to go to a pottery class, or I want to, you know, go to a nice dinner with friends, or I want to, you know, like, they'll tell me. Dr. Kristin Markell [00:29:10]: And it's like, oh, okay, so this is what you're craving as your fill your cup up time. Leslie Zanoff [00:29:16]: Yes. And can I just say. And then sometimes, too, it's like we inherently know what's best for ourselves, but sometimes it takes going to our doctor, our physician, or a friend to validate 100%. Yeah, I hear you. And what I hear you saying is, you need this. Dr. Kristin Markell [00:29:36]: Yeah. Leslie Zanoff [00:29:37]: And then doing it. Dr. Kristin Markell [00:29:38]: And those stories that we talked about at the beginning of, like, rest is lazy and you're not worthy. Those are the stories that I think block people from doing it and having someone to say, we already know, like, yeah, go do it. Full permission. Like, give yourself permission to do it because you know what you need. And that is one of the things I love about having women in community in this time period is having people say, oh, I see you. You know what you need, and it's going to allow you to do whatever you want. Leslie Zanoff [00:30:16]: Yes. Dr. Kristin Markell [00:30:17]: I mean, there's no pressure. You don't have to come out of it ready to, like, you know, start a new business or something. But, like, you're going to have that space to then decide, oh, what do I want to do with this energy? Leslie Zanoff [00:30:33]: You are working with a lot of different women, including corporate leaders, women who are managing their homes. And is there a common thread that you see in women who truly transform their health? And is there a mindset shift that people who are able to do that? Dr. Kristin Markell [00:30:54]: Yeah. What I see, especially in this time period in perimenopause, is that the women that are most successful at supporting themselves are prioritizing themselves. Right. Maybe for a long time. They've been very far down on the list and they're noticing that that doesn't work anymore for various reasons, whether it's physical, mental, emotional, quality of life. And so they are like, I'm here for me to be on this list. Leslie Zanoff [00:31:30]: Yes. Dr. Kristin Markell [00:31:31]: And sadly, that is a bit countercultural in, you know, the way that women show up in the world and are encouraged to show up in the world. Leslie Zanoff [00:31:45]: Right. Dr. Kristin Markell [00:31:45]: And so it is a reminder of, like, I'm doing this so that I can show up in the world the way that I want to. Leslie Zanoff [00:31:57]: Right. Dr. Kristin Markell [00:31:57]: With myself, with others, with my community. You know, so sometimes it is a mindset shift of, this is not selfish. This is, you know, I'm not taking from others. Like, this actually allows me to show up full, wholeheartedly. Leslie Zanoff [00:32:18]: Yes. Dr. Kristin Markell [00:32:19]: With others instead of resentful, instead of depleted and saying, like, oh, this is what I'm supposed to do. Leslie Zanoff [00:32:26]: Supposed to do. Yes, that's right. We women are the caretakers. But it has to start with taking care of ourselves. Dr. Kristin Markell [00:32:36]: Right. Leslie Zanoff [00:32:36]: It just has to. Dr. Kristin Markell [00:32:37]: And caretaking is such a lovely … It's life giving. As a lifelong caregiver, it really gives back to people in so many ways. And there's a point, right. There's a point. Leslie Zanoff [00:32:52]: Yes. Where you've reached the point, you can Dr. Kristin Markell [00:32:54]: feel it right in your body of like, oh, okay, I've got nothing left to give here. Leslie Zanoff [00:32:59]: Yes. Dr. Kristin Markell [00:33:00]: And I feel like women are encouraged to push past. Past that and to not trust that. Leslie Zanoff [00:33:06]: That's right. Dr. Kristin Markell [00:33:07]: And to say, oh, I should. Should give more. I should. Instead of saying, okay, I've. I've got to the point where this doesn't feel good anymore. Now it's time to go, you know, restore and yes. Pour back into myself, and then I can come back and. And do that. Dr. Kristin Markell [00:33:28]: What I want with that again. Leslie Zanoff [00:33:30]: Well, and you have talked about some common ways that we ignore or override our bodies. Maybe in the name of success or just pushing through what you see women coming in. And you have said that women apologize. Will you just talk about that for a minute? Dr. Kristin Markell [00:33:50]: Meaning tell me a little bit more about that. Leslie Zanoff [00:33:52]: Like, women are coming in, they're apologizing for coming in. Maybe it's seen as complaining. Oh, I don't want to complain. But these are the things that are happening. Dr. Kristin Markell [00:34:05]: Yes, yes. So very common for women to come in and say, well, you know, I hate to complain. I hate to. Maybe I don't even know if I should be here. Leslie Zanoff [00:34:17]: Right. Dr. Kristin Markell [00:34:18]: When literally all they're doing is stating what they're concerned about. Leslie Zanoff [00:34:23]: Right. Dr. Kristin Markell [00:34:24]: And sadly, they'll tell me. I've really never had anyone listen to me and explore what these concerns could be. Leslie Zanoff [00:34:35]: Right. Dr. Kristin Markell [00:34:36]: I always say, these aren't complaints. These are your concerns. Leslie Zanoff [00:34:39]: That's right. Dr. Kristin Markell [00:34:39]: Right. You don't have to apologize for being here. You don't have to apologize for, you know, having an emotion related to how long you've experienced this. Like, it makes sense you would be sad or upset about having to carry this for so long. And so there is an understanding of kind of a retraining, reframing of, hey, these are just concerns. Leslie Zanoff [00:35:08]: Just concerns. Dr. Kristin Markell [00:35:09]: And we're bringing them to someone who can say, okay, let's check it out. Let's check these other things to see how big of a concern this is. If we need to use certain tools to, like, turn this around, or is there something else that we need to look into? Leslie Zanoff [00:35:27]: Well, and probably too, by the time women finally get to you, they've seen sometimes many doctors where it's like tears because finally someone is listening to me. Dr. Kristin Markell [00:35:40]: I've seen women that have seen eight to 10 different doctors, different specialties. And, you know, when you put all the pieces together, you start to see, oh, all of these symptoms work your body like telling you, hey, hormones are shifting, hormones are changing. And you know, when other people are not trained in this right, then they may not be thinking that. They may be thinking like, oh, you're a patient that's here to see me for your ear, nose and throat, and I'm going to address what I can for you. Leslie Zanoff [00:36:15]: Right. Dr. Kristin Markell [00:36:15]: And so we need more providers to be educated in what is happening to women in this time period so that they can say, hey, from an anatomical standpoint, everything looks great. You know, I know you're maybe not wanting to hear that, but like, I can tell you as an expert that this looks great, but you are having these symptoms. So I think your next step would be to see a specialist in hormonal therapy who sometimes these symptoms can be caused by those changes. Especially in this season of life. Leslie Zanoff [00:36:49]: Yes. Dr. Kristin Markell [00:36:49]: I mean, what would it feel like for a woman to hear that? Leslie Zanoff [00:36:53]: Well, right? First it would feel so validating and also just relieve a little fear, I think, for me, of being, you know, thinking, oh, you might have an autoimmune disease, you might have this, that, whatever, when actually, no, it's just your hormones shifting. Dr. Kristin Markell [00:37:10]: Yes. And there's things we can do, right? Leslie Zanoff [00:37:12]: And there's things we can do. Dr. Kristin Markell [00:37:13]: There's things we can do, right? Yes, I know with, with medicine and health, sometimes we can go all the way to the, you know, worst case scenario. Right. Like, and we always say there's like, there's like zebras, right? And then there's horses. And, you know, most people, most people are in the horses, but there are occasionally zebras. And that's why we, we do the workup that we do. But sometimes my job is to kind of like pull people back from the zebra, right? And be like, let's not go there yet. I mean, obviously I understand why you're there, but let's, let's do some more exploration. Let's, let's check some things out to see, hey, is that really what we're dealing with or is it more over here? And we've got options for either of those. Dr. Kristin Markell [00:38:03]: I know, okay. Leslie Zanoff [00:38:04]: And this is something that you and I have talked about, but you are taking care of other people all day. Is there something that you would consider. I don't even know if it's a radical thing you've done to care for yourself, but just something that you do to take care of yourself as you're taking care of so many others. Dr. Kristin Markell [00:38:24]: Yeah. I mean, I don't think of it as radical, but some people might … is that I schedule my like movement practices. They are an appointment. Leslie Zanoff [00:38:36]: Yes. Dr. Kristin Markell [00:38:36]: And so, you know, I have a dance class that I go to once a week and it is like literally my life's joy to go to this dance class. I've danced for many, many decades, so it is on the schedule. And sometimes my kids have, you know, things around it and I will go there and then go to dance or dance and then go to there. And it's just like this is, this is important. Yeah. And it helps me. I learned a long time ago that it helps me show up better for everyone in my life if I'm moving my body, if I'm, you know, finding some joy. And I love to move my body, you know, that, that is thankfully something I've always enjoyed. Dr. Kristin Markell [00:39:25]: And I show up better as myself and show up better with others, which makes me feel more effective and connected with people. And so that’s it. Leslie Zanoff [00:39:37]: Okay. Dr. Kristin Markell [00:39:38]: It's on the schedule. Right. Leslie Zanoff [00:39:40]: I love it. Dr. Kristin Markell [00:39:40]: Yeah. That's important. Leslie Zanoff [00:39:43]: Okay. I want you to talk about, I know you have done so much over the years shifting from a group practice, and I'm not sure if I'm wording that right, but shifting from a group practice into your private practice, being self-employed. And I know all the, the extra hours you spend keeping up with your, your credentials. I want you to talk about what just becoming a doctor gave you. And then is there anything that maybe it quietly took from you you've had to kind of reclaim? Dr. Kristin Markell [00:40:16]: That's a great question. Yeah. So when I went into medicine, you know, I didn't have any family members who were in medicine. It was just something that I was drawn to. And love of learning is one of my values. Like I love to learn. And the way that I give back is to, you know, do this with my patients, educate and support them and educate in the community. Because it just feels so good to like, learn new things and share that with people. Dr. Kristin Markell [00:40:48]: So maybe if they find something there that they want to explore, works for them, then that feels worth it. And so I think what medicine gave to me was that opportunity to continue to learn and to continue to support women throughout their all seasons of life. Right. When I went into medical school and you're going to classes and da, da. And then, then you start doing rotations. And I remember going to certain rotations and being like, oh, I like pieces of these. But it wasn't until I did my OBGYN residency or OBGYN rotation that I was like, oh, yeah, this has all the pieces. Dr. Kristin Markell [00:41:37]: I get to support women throughout all seasons of life. I get to have a little bit of this and a little bit of that. And it really was my sweet spot. And then I worked for, you know, 15 years in a traditional OBGYN group practice and that was amazing. I mean, to be there when people have their babies is life changing. Like, you just, it never gets old, even at two in the morning, right. It's just like, wow, I get to be present for something like this. Leslie Zanoff [00:42:10]: Yes. I love when I'm with you and somebody's like, you probably don't remember me, but you delivered my baby. It happens all the time. Dr. Kristin Markell [00:42:18]: And now they're just like walking around in the world with like, you know, up to here, it's such a treat. And then also my life started shifting. Right. And those hours, that lifestyle was just not, it wasn't sustainable for me anymore. And you know, and then that's where I think that love of learning really came back. Right. And I, for a while there, there was, you know, growing my family and, you know, things that took my attention that way. But then that love of learning really came back and said, hey, this is something you value. Dr. Kristin Markell [00:42:59]: This is something important. And that threw me back into, you know, doing more. Leslie Zanoff [00:43:05]: Yeah. Dr. Kristin Markell [00:43:05]: Learning on hormonal medicine and, and sexual health and, and the areas that I focus on now. And you know, I think. What was the last part about something Leslie Zanoff [00:43:17]: that, oh, is there something that maybe you've had to just reclaim that being a doctor took from you? Dr. Kristin Markell [00:43:28]: And you know, I think there was a point there where, you know, like we talked about earlier that got to a point of like giving, giving, giving and it didn't feel right anymore. There was a shift in me that I needed to explore something different so that I could show up, you know, well, for myself and my family and. But I wouldn't say that it really took that. For me, it just was a learning experience of that. Life evolves, seasons evolve and to really trust it. You know, I think, as a baby doctor, if someone had said, oh, in 20 years you're going to be, um, you know, just focused on hormonal health and well-being for women, I would been like, oh, really? That because at that point when I first started, it was, you know, I loved everything about where I was. But your life just changes. Dr. Kristin Markell [00:44:29]: And I think that's what, that's what I learned throughout the last few decades of trust that change. Trust what your body is telling you. You're not doing it wrong, it's just that you need something different. Leslie Zanoff [00:44:45]: Well, and of course we need this education, midlife and what's happening. Because some people and so many women that I've talked to, probably myself included, we never even got an advanced sexual health class or no one was really talking to us about these are the things that you're are going to happen with your body, your hormones, you know, as a young girl at 12... So of course we're having to spend time midlife. Dr. Kristin Markell [00:45:17]: Yeah. Leslie Zanoff [00:45:17]: To, to learn these things and hopefully so that we can pass on and be educated for our own daughters. Dr. Kristin Markell [00:45:23]: Exactly right. And you know, I have education courses, some that talk about the menstrual cycle and like what's happening so that people that are still cycling can work with their hormones. Right. Understand what's happening in their body so that they can work with that. And while I love that perimenopause is getting such, you know, so much focus, it is a completely new decade for women. Because if the narrative was it's just aging, you just got to get over it and get used to it. Like having that education on, like what's happening in my body, how do I take care of myself in this full body change. Dr. Kristin Markell [00:46:10]: Right. It's not just hormones, it's metabolic health, it's neurotransmitters, it's a full body shift, knowing what's happening there and it doesn't have to be over. Like, you don't have to learn it all in a month. Right? You can learn it over a year. Like you can say, I'm going to take this time to really understand what's going on so I can support myself well. And that will serve you for the next half of your life. Right. Dr. Kristin Markell [00:46:35]: So there's no rush. And it's going to be helpful not just in this moment for the symptoms which you know, need support, but also for that second chapter that the women that I know are like very excited about. Leslie Zanoff [00:46:51]: Yes. Dr. Kristin Markell [00:46:52]: Right. Leslie Zanoff [00:46:53]: Because we're going to spend, as you've said. Right. 30 to 40 percent of your life in this after menopause. Dr. Kristin Markell [00:47:00]: Right. And when you look at your 80 year old self, whatever you want to be doing there. Right. You know, I have, like, I have patients that I'm like, yes, this is me. I want to be her at 80. Whatever you want to be doing there, we have to start that now. Leslie Zanoff [00:47:16]: Right. Dr. Kristin Markell [00:47:16]: That doesn't mean we have to do it all, you know, okay, in the next month, you do these 10 new things. But it means, like, okay, if we want to be mobile, if we want to be sharp, if we want to be strong, if we want to be traveling, if we want to be, you know, really engaging with our family and the people that we love, here's the things that we can do right now that. That just become who you are. Leslie Zanoff [00:47:39]: Right. Consistently. Dr. Kristin Markell [00:47:40]: Yes. At that point, like, you know, five years from now, you're like, oh, that's just who I am. These are the things that I do. Leslie Zanoff [00:47:46]: Yes. Dr. Kristin Markell [00:47:47]: And I know that that's hard for people because we've been doing things a certain way for two to three decades. Right. But remember when you were a baby, you know, you were doing things a lot differently then. And then you, you know, grew up and we did it. And this is kind of like that second big shift of, okay, we've been doing it like this, and it's been working. Now it's not working anymore. What do we need to pull in that will be our new normal one year, two year, three years from now? Yes. Leslie Zanoff [00:48:23]: Okay. One last question for you, which you talked about loving to learn, which I know that about you personally. You're always sharing the latest information with health and your knowledge. But is there something that's taken you a lifetime to learn since the name of the show is a lifetime to learn, is there something that's taken you a long time to learn? Dr. Kristin Markell [00:48:50]: I think Dr. Kristin Markell [00:48:54]: the thing that I remind myself over and over and I remind my patients of this, that I truly believe. But took me a while. Took me a while to get here, was just to trust yourself. Trust this, what your body's telling you and that I think I've had always had a bit of that, but over this last five years, it's just solidified. Dr. Kristin Markell [00:49:23]: Like, it's never steered me wrong. Leslie Zanoff [00:49:26]: Your intuition. Dr. Kristin Markell [00:49:27]: Yeah. Leslie Zanoff [00:49:27]: Your …just knowing. Dr. Kristin Markell [00:49:29]: Right. And it is something you strengthen. So some people will say, I don't trust myself. I don't know what … Dr. Kristin Markell [00:49:38]: And, you know, sometimes we'll play a little game where I'm like, okay, well, for a week, just believe it. Leslie Zanoff [00:49:46]: Yeah. Dr. Kristin Markell [00:49:46]: And act accordingly and see what happens and no one ever comes back to say, like, oh, that's not a great shift. Something horrible happened. They're like, wow, okay. Leslie Zanoff [00:49:57]: I can trust myself, right? Dr. Kristin Markell [00:49:59]: Yeah. Leslie Zanoff [00:50:00]: Yes. Dr. Kristin Markell [00:50:00]: Yes. Leslie Zanoff [00:50:01]: Okay. Thank you so much for being here. Dr. Kristin Markell [00:50:04]: You're welcome. Leslie Zanoff [00:50:04]: I love it. I could talk to you for hours, and as we do continue talking, but I want to make sure that. That our listeners know where to find you. Dr. Kristin Markell [00:50:14]: Yeah. Leslie Zanoff [00:50:15]: So will you tell. Tell us? Dr. Kristin Markell [00:50:17]: Yeah, it's very easy. So it's my name. So kristinmarkellmd.com is my website and you can find me on Instagram at kristinmarkelmd. Leslie Zanoff [00:50:28]: Okay. Perfect. Dr. Kristin Markell [00:50:29]: Yeah. Leslie Zanoff [00:50:29]: Thanks, friend. Dr. Kristin Markell [00:50:30]: Thank you. Leslie Zanoff [00:50:32]: Thanks for being here on a lifetime to learn. If today's episode inspired you or sparked a new thought, please share it with someone who might need it, too. And if you haven't yet, be sure to subscribe to get notifications when we launch new episodes. I've got conversations with extraordinary people lined up, and I can't wait for you to listen. For more information on how to work with me, visit lesliezanoff.com it's where I share resources to help you lead with presence and live with intention. Because. Because remember, we're not here to have it all figured out. We're here to keep showing up with open hearts and open minds because we've got a lifetime to learn. Leslie Zanoff [00:51:13]: Until next time, friends. Be well.