Latest / Pretty In Pink Again / Episode 30: The Hormone Conversation: Reclaiming Wellness in Perimenopause with Dr. Erica Lambert (Part 1)

Transcript

Episode 30: The Hormone Conversation: Reclaiming Wellness in Perimenopause with Dr. Erica Lambert (Part 1) · Pretty In Pink Again

• 0:00
  I'm Christina, and I'm t And this is the Pretty and Pink Again podcast.
• 0:03
  where Motherhood meets rediscovery.
• 0:17
  Today we are sitting down with Dr.
• 0:18
  Erica Lambert, a board certified urologist and the founder of Uplift Medical Aesthetics.
• 0:23
  Dr.
• 0:24
  Lambert is also certified in hormone replacement therapy and has dedicated her career to helping women navigate the changes that come with perimenopause, menopause, pelvic floor health and beyond.
• 0:35
  Her work blends science, compassion, and innovation to address issues that so many of us women struggle with, but very rarely talk about openly.
• 0:44
  We are so excited to dive into this conversation with her today.
• 0:47
  This is part one of our conversation with Dr.
• 0:49
  Erica Lambert and then next week in part two, we'll be talking all about pelvic floor health, what it is, why it matters, and the real solutions that are out there.
• 0:58
  So let's get into it.
• 0:59
  I Hello.
• 1:00
  Hi.
• 1:01
  We are welcoming a virtual guest today, Dr.
• 1:04
  Erica Lambert.
• 1:05
  Hello.
• 1:06
  Hi.
• 1:07
  Thank you for having me.
• 1:09
  Thank you for coming on here.
• 1:11
  This has been long overdue.
• 1:14
  Very long overdue, we've been teasing this to our listeners, to friends, to family, and we, everybody's oh my God, when is she coming on?
• 1:22
  I often say this about like our guests that are really experts in their fields because everybody has a voice on social media and like we even talked about this, like anybody can go on social media and your algorithm right now, if you're in between the ages of like 35 and 45 is perimenopause is everywhere.
• 1:41
  And I was telling you like, you are an expert in this.
• 1:44
  You are a urologist, you know about perimenopause, sexual health, all these different things.
• 1:49
  So I'm so excited for our listeners to get to hear it from an actual expert who specializes in this i'm really passionate about this and I'm really excited to answer any questions that come up about this.
• 2:04
  I can tell you a little bit about my story Yes.
• 2:06
  And why urologists would be talking about perimenopause and menopause and sexual dysfunction.
• 2:13
  I so I'll tell you a quick blurb about myself.
• 2:15
  So I, graduated medical school back in 2003 and did a urology residency up in New York City and then did a fellowship in actually cancer.
• 2:26
  So how does someone that's doing urologic cancers get into this field?
• 2:32
  So one, one reason is, being a girl or a woman in urology, there were only about 2% of us when I first became board certified.
• 2:43
  I ended up seeing all these female patients.
• 2:46
  So I started realizing that I do have to treat them for a lot of their pelvic floor disc function and some of the recurrent UTIs and certain things that we see.
• 2:58
  But then, just to give you some information about my personal life.
• 3:02
  I had my kids later in life, us being doctors, we wait and wait and wait.
• 3:06
  And then obviously when we wanna have kids, we wanted to have them yesterday.
• 3:10
  So I had both my kids both actually are 10 months apart in 2013.
• 3:15
  It was a big year for us.
• 3:17
  And then I was around 38 when I had my daughter.
• 3:21
  And then basically two years later I stopped getting my period and I was like, oh my God.
• 3:27
  What is happening?
• 3:29
  And really for me aside from your sort of typical symptoms you hear about is the hot flashes, knife, sweats, moodiness.
• 3:37
  I didn't even have a ton of that, but I would always joke around my vagina died.
• 3:42
  What is happening?
• 3:43
  All of a sudden, like my libido was different and all of these things changed.
• 3:48
  And the first thing I did was I went to my gynecologist and I said, is this really happening to me?
• 3:55
  And she's like, no, no, no, you're fine.
• 3:56
  You're fine.
• 3:57
  And I was like I'm not getting my period.
• 3:59
  Very long story short, I didn't get a lot of good information and not a lot of people were treating menopause, whether it's gynecology, primary care, endocrine.
• 4:09
  And then I started exploring urology.
• 4:11
  So obviously we do a ton of male sexual dysfunction, billion dollar business, right?
• 4:16
  Every, you watch ESPN, you're watching sports during the fall season everywhere.
• 4:22
  Testosterone, Viagra, yada, yada, right?
• 4:25
  But female sexual dysfunction no one talks about.
• 4:29
  So I started getting interested in this and, through my journey of my own sort of pelvic floor issues and hormonal issues, I became really interested.
• 4:40
  And actually Christina has helped me so much and really was an inspiration to me and got me going with, a lot of these ideas of how can we let women live their best lives, their best sexual lives, their best everything life.
• 4:58
  And which Christina helped me start uplift medical aesthetic, which was a pop of your very well established urology practice.
• 5:06
  Urology practice, exactly right.
• 5:08
  So I started to do a lot of female sexual dysfunction, vaginal rejuvenation some work with stress incontinence and public floor work.
• 5:19
  And it really has led to.
• 5:23
  Such a passion of mine.
• 5:25
  I started learning more about hormones and hormone replacement and perimenopause.
• 5:30
  And all of a sudden all the people that are finally, or unfortunately finally catching up with me are all my own peers.
• 5:36
  And now I'm 49 and all of my friends are starting to talk about it is what is this?
• 5:43
  And I realize I'm just bringing so many women together to finally talk about it, give women voices, and it, it's really been so rewarding.
• 5:54
  Although I still do general urology I do have a hormone practice, one or two days a week where I just spend time treating women and talking to them and seeing how we could make their lives better.
• 6:08
  So I came to Erica.
• 6:10
  'Cause we're gonna talk about all the different things that affect your pelvic floor.
• 6:13
  So I came to Erica,'cause we've been friends for a while, since you moved here.
• 6:17
  So probably right around the time that you were going through menopause, early on right after you had the kids we met, yes.
• 6:23
  And I was going to Erica'cause I was having recurrent UTIs.
• 6:27
  But what was happening with me is that after having kids, I couldn't empty my bladder.
• 6:33
  It would stay full.
• 6:34
  And so it would feel like I had a UTI'cause I could never fully void.
• 6:38
  So you always felt like you had to pee?
• 6:40
  I always felt like I had to pee and Erica tried.
• 6:44
  All these different medications and they worked.
• 6:46
  But what worked best was she had this technology that she had just brought in that nobody else around us had.
• 6:52
  And it was called the Ella Chair.
• 6:54
  And it was essentially a chair that pulsates and it does the, essentially does what was it, like 10,000 Kegels or something?
• 7:02
  It's, yeah.
• 7:03
  It's almost if you've ever been to like a chiropractor or physical therapist where they do a Tims, the skin, whatever.
• 7:10
  Yes.
• 7:10
  It's like that for your pelvic floor.
• 7:12
  Okay.
• 7:12
  And it really retrains your pelvic floor and brings blood flow to the pelvic floor.
• 7:17
  And it treats all different things, but for me it does.
• 7:20
  For me it was life changing.
• 7:21
  Yeah.
• 7:21
  'cause it allowed me to void fully.
• 7:23
  When was the last time I called you for a prescription?
• 7:25
  Oh, I have a UTI.
• 7:26
  I think I have another, yeah.
• 7:27
  Haven't done it in years.
• 7:29
  Yeah, because I ne I didn't really ever have one.
• 7:32
  Wow.
• 7:32
  And again, that's very benign on the scale of what women have to go through in terms of their pelvic floor.
• 7:37
  Erica has to sometimes intervene surgically, which she'll talk about.
• 7:40
  But that was just like my entry point into this.
• 7:43
  And then when we, I went into the office and Erica was like, I'm envisioning this space back here and women are asking me about hormone replacement therapy and this, and people are peeing their pants when they do a jumping jack or when they sneeze and then there's people are having like dryness and they can't have sex and this and that.
• 8:03
  Erica was like, I know how to fix all of this and treat all of this.
• 8:07
  And I love and respect so much that this became like a dedicated part of your business.
• 8:13
  Like not the full business.
• 8:15
  But just that it spun off from this need that.
• 8:18
  We know women are lost.
• 8:20
  And you keep saying this, the opposite for males, it's just it's, there's a plethora of information.
• 8:28
  There's the waiting room was full of males that day.
• 8:30
  There's a plethora of information.
• 8:31
  Old men like resources.
• 8:33
  You for them.
• 8:33
  And women tend to feel very lost and they don't even know who to go to.
• 8:37
  Do I go see my ob, do I go see my primary care?
• 8:40
  Like you don't even know where to go.
• 8:42
  There's just, and Right.
• 8:43
  And it's taboo to bring it up, like in, in public or to, to people.
• 8:47
  And so I, this is amazing and incredible.
• 8:50
  That's what I have noticed, that it's really hard for women to find information.
• 8:56
  So they're going on Facebook and, all these podcasts and TikTok I'll have people coming to see me and they're like, okay, based on an algorithm I found on Instagram, I have low testosterone.
• 9:12
  And I'm like, oh, it is fascinating.
• 9:15
  I'm like the TikTok doctors, the Instagram mike mic.
• 9:19
  But, maybe we can, investigate and, and really dive into what your symptoms are, how you're feeling, and what is actually going on with you.
• 9:30
  So I have to admit though, even with perimenopause, I feel like that's a buzzword.
• 9:35
  That's hot right now.
• 9:36
  Like tea was saying.
• 9:37
  Yes.
• 9:37
  It's all over the place.
• 9:38
  I know we're in the age range, of that could happen to us.
• 9:42
  We're both.
• 9:43
  And I'm not aging tea by one day, but we're both 39 and so we could be in that timeframe of perimenopause.
• 9:50
  But I started seeing this kind of recently, like obviously everybody knows, every woman knows about menopause, but I started seeing this word thrown around within the last several years.
• 10:02
  And I've always been curious about what that means.
• 10:04
  So my first question would be, what is the difference between perimenopause and menopause?
• 10:11
  Sure.
• 10:11
  So menopause, is what everyone thinks of you.
• 10:15
  You are no longer getting a period.
• 10:17
  Okay.
• 10:19
  The time before menopause, which could be one year, six months, 10 years is perimenopause.
• 10:26
  And what's happening during that time is your hormones made by your ovaries are starting to decrease.
• 10:33
  And which hormones are those?
• 10:34
  And those are your estrogen, progesterone, and testosterone.
• 10:37
  So all of these hormones the brain is working harder and harder to get those, the ovaries and stimulating them to get these hormones out.
• 10:45
  And over time, they start getting less and less the reason perimenopause is so confusing is because you might still be getting regular periods, but just something feels off.
• 11:00
  And I think a lot of doctor, I'll say the primary care doctors who, you know.
• 11:07
  I think are wonderful.
• 11:08
  So needed.
• 11:09
  And they, but they don't treat really well.
• 11:13
  They're not specialists in this.
• 11:13
  They're very generalized.
• 11:15
  They don't do this.
• 11:16
  But what they generally do, like a lot of the women will say I just don't feel right.
• 11:21
  I'm irritable.
• 11:22
  I don't feel depressed, but I'm so irritable.
• 11:25
  I'm so anxious.
• 11:26
  I'm just getting, more short with things that I never really felt that way about or some complaints are, ah, I'm just like, something is wrong with my sleep.
• 11:36
  I'm scrolling between one and three in the morning.
• 11:38
  Why am I doing that?
• 11:39
  I'm just awake.
• 11:40
  I fall asleep easy.
• 11:41
  This is not that I'm tired, but I'm awake.
• 11:45
  Some people will feel like they're just getting hotter.
• 11:49
  Like they're not having night sweats.
• 11:50
  They're not having flashes, but something just feels off.
• 11:56
  Their libido may be down.
• 11:57
  Now libido is tough to treat because you have tiny kids.
• 12:01
  Obviously your libido is gonna be down, but when it's just so much more than you would have anticipated, these are some of the things that people will complain about.
• 12:12
  And you know what's really remarkable and Christina, when you said like this is a new buzzword, perimenopause is because that is the time where if you are really in tune with what's going on in your body, and you may start some low dose replacement, you're protecting, your bones, your cardiovascular system, your brain.
• 12:37
  We have estrogen receptors everywhere.
• 12:40
  So as we start losing.
• 12:42
  All of this, it really does impact our entire bodies.
• 12:46
  Being proactive about it.
• 12:48
  And then once you hit menopause, if you're already starting, you may really save yourself from a lot of the, real miserable symptoms that people talk about.
• 12:59
  So what would be like an entry point for somebody if they came to you?
• 13:03
  Yeah.
• 13:03
  And expl and expressed all of this.
• 13:05
  And as a 39-year-old who's still getting I regular period, but is up all night scrolling.
• 13:11
  Yeah.
• 13:12
  Hot, join some of these other things.
• 13:14
  How would you then look for like further investigate?
• 13:17
  Would you do blood work?
• 13:18
  I put it all together.
• 13:19
  Yeah.
• 13:19
  So I usually do blood work day 19 of your period.
• 13:23
  Where I'll check a lot of different hormones, mostly estradiol, testosterone, progesterone, FSA, all the typical female hormones.
• 13:31
  And what's range know, and then range, we assess.
• 13:35
  So a normal range for someone not in menopause, someone not, pre menopause would be, a low FSH and elevated, estrogen levels in the sixties, seventies.
• 13:48
  Progesterone one or two, like they, they would be higher levels when we see them fall.
• 13:55
  The FSH being pretty low.
• 13:57
  When you start seeing people and their labs start changing, you might see FSH levels in the thirties, and the estradiol dropping in the twenties, and then you might, the first hormone usually to decrease is your progesterone.
• 14:12
  So we'll see that go less than one or, it's just starting to decrease.
• 14:17
  Your testosterone levels may be a little low, like in the teens and, your free testosterone, which is your available testosterone may be pretty low in the, 1.1, like in kind of those ranges.
• 14:31
  It's hard to say like flat in numbers because obviously everybody's different.
• 14:35
  But that's generally what I see.
• 14:37
  Okay.
• 14:38
  So I have a question because Sure.
• 14:40
  Me and you had our kids a little bit later in our later thirties.
• 14:44
  Are you seeing,'cause I'm sure once you run a lab, the lab confirms like what you're saying that these things, yes.
• 14:50
  You are in pre menopause, the labs are indicating that this is all adding up.
• 14:55
  Are you seeing people coming in that have kids later in life that are also dealing with these symptoms?
• 15:03
  Because I feel like when you're going from a postpartum period where a lot of these things seem very similar, a lot of these hot flashes, the brain fog, the insomnia, the low libido, the anxiety, the bladder issues, the incontinence, all of these issues, do they overlap with postpartum and are you seeing a little bit of a, it's funny you ask not specifically but I think what's happening is as women are getting out of the baby years.
• 15:34
  And then their symptoms are still persisting.
• 15:38
  That tends to be some red flags for me.
• 15:40
  Okay.
• 15:40
  When like the babies are starting to sleep again, like you're getting into a routine because you're right.
• 15:45
  Postpartum, you're up all night.
• 15:48
  It's a really tough time in our lives, because the responsibilities put on us, caring for a newborn, feeding the newborn being up all night with the newborn and the crying and the, everything that we go through and trying to, manage the other kids at home.
• 16:04
  And so I think it's really hard to really understand those symptoms.
• 16:09
  The other thing that's pretty hard is, to understand the contraception part of it, so a lot of women, when they're done having babies, they'll go on like a marina or they'll be on the birth control pill and when things start getting a little.
• 16:25
  Different with the way they're feeling.
• 16:27
  You're wondering, is this the marina?
• 16:29
  Is it not working?
• 16:30
  Is this perimenopause?
• 16:31
  What, what's happening?
• 16:32
  So I think it's, I think it's really a challenge in this age group because we don't really know, I had so much that's so much going on yeah.
• 16:41
  There's so much going on.
• 16:42
  And I had someone see me, who's on the birth control pill.
• 16:45
  She's 47 years old, and she's I think I'm going through this.
• 16:49
  I just, I don't feel right, I don't let you know.
• 16:52
  She's still on the birth control pill and so she doesn't do a bleed cycle.
• 16:57
  You know how you can have the placebos, right?
• 16:59
  So she was saying, she's but I'm getting hotter and I'm irritable.
• 17:03
  And so it's but how do you even check the labs, right?
• 17:06
  Because you're on the birth control pill, you're on a high dose of estrogen and, it's sometimes hard to determine that and, when do you pull the trigger from the morena or when do you pull the trigger from the birth control pill and start switching things out.
• 17:20
  But I think you bring up a great point.
• 17:22
  I think it is really tough.
• 17:23
  To determine.
• 17:24
  I do see, some women in their late thirties and sometimes I'm like you still have really little kids.
• 17:30
  It's really hard for me to, I'm happy to test your hormones, we can see what's going on, it might be a better, environmental.
• 17:37
  Yeah.
• 17:38
  That's me right now.
• 17:39
  It might be environmental.
• 17:40
  I am always spiraling with symptoms and I'll see something.
• 17:43
  Of course, like we've been talking about like the TikTok doctors and all these things.
• 17:46
  I will see something and I'm like, I have that and then.
• 17:50
  I'll come here.
• 17:51
  Like t will be like, no, you have a one and a 3-year-old.
• 17:54
  That's what's happening.
• 17:54
  We went from a generation of mothers who shared nothing'cause they knew nothing.
• 17:59
  Really.
• 18:00
  They didn't know anything.
• 18:01
  They went through this alone.
• 18:03
  Alone and they had to just suck it off and sweat through their sheets every night.
• 18:07
  To, we've now skipped to a generation that overshare and you can't differentiate what's correct, what's not, where you're getting the information from.
• 18:16
  So now it's coming straight from the doctor.
• 18:18
  Yep.
• 18:19
  And I think that the FDA just came out with a statement that it's really been a tragedy for women and probably the, biggest tragedy of the modern era in the last 20 years that we have not offered women hormone replacement.
• 18:32
  So talk to us about that a little bit.
• 18:34
  Yeah.
• 18:34
  Hormone replacement therapy.
• 18:36
  I know.
• 18:37
  A lot of women are afraid of that, yeah.
• 18:39
  Talk to us a little bit about if we came into you and you looked at our levels and you said, okay, you would be a terrific candidate for this because as you get older and your estrogen decreases, you said like you're at risk of like bone loss and muscle loss.
• 18:53
  And your cognitive.
• 18:55
  You always said you have estrogen receptors everywhere.
• 18:57
  Yeah.
• 18:57
  So what would be, the next step and what exactly is hormone replacement therapy?
• 19:01
  Yeah, so I could kinda, again, overshare.
• 19:05
  So I was not on hormone replacement.
• 19:07
  Love overshare.
• 19:07
  Go for it.
• 19:07
  Yeah.
• 19:08
  Wait, I love to overshare.
• 19:09
  All my patients know me.
• 19:10
  It's funny, my husband's also a urologist and he'll see some of my patients.
• 19:14
  He's like, how do they all know about our lives?
• 19:16
  I'm like,'cause I overshare.
• 19:18
  I like to talk.
• 19:19
  He does not overshare connections.
• 19:20
  He does not overshare.
• 19:21
  There's always one that marries the other one.
• 19:22
  That's, That's always how it works.
• 19:24
  Yeah, he does not overshare.
• 19:25
  He'd probably be horrified that I'm even talking about this.
• 19:28
  But so what happened with me, I'm like the best example of this, I did not go on hormone replacement for a multitude of reasons, but really, I really.
• 19:38
  I was not properly educated on it.
• 19:41
  And at 47 I got a bone density scan and I had osteopenia, almost osteoporosis.
• 19:50
  So that is strictly from not having hormones for seven years.
• 19:56
  And I was devastated.
• 19:58
  I was like, oh my God I have to do something because it's very like for our, I'm way too young.
• 20:02
  Our, for our listeners that don't know what that is, do you wanna just explain in lay terms Yeah.
• 20:06
  And why that's so dangerous?
• 20:07
  It's basic.
• 20:08
  Yeah.
• 20:09
  If you see, if you think about sort of your grandparents and what they look like, a lot of the women were like this.
• 20:15
  Yeah, right?
• 20:16
  They're all like, punched over.
• 20:17
  Yep.
• 20:17
  Punched over.
• 20:18
  They have fractures, hip fractures their bones are brittle.
• 20:23
  So basically when you see your bones have.
• 20:26
  Estrogen receptors, and it's very important to have estrogen, to build your bombs.
• 20:32
  So what happens is as you go through menopause and when you stop having estrogen, your bones become really thin, really brittle, and we talk about osteoporosis.
• 20:43
  And osteoporosis is a leading cause of hip fractures, any type of bone fractures, and really has a lot of mortality associated with it.
• 20:52
  You stop being able to move, you hear about blood clots and all of these different things.
• 20:57
  And it's, it can be very debilitating and we have a lot of medications to treat it once you have it.
• 21:04
  But really, I think in today's, in the modern era, a lot of people are looking for prevention.
• 21:10
  And I think, aside from saying anything, I think our health system should be focusing more on prevention and when we talk about some of these myths right about the Women's Health Initiative that came out in about 2002 that basically stopped all hormone replacement, and I'll get into that in a minute.
• 21:28
  But what they did show was that it did prevent osteoporosis and it did, lead to less mortality for women.
• 21:38
  So there's a lot of problems with the Women's health Initiative study, the truth is what had come out of that study was that that estrogen caused breast cancer.
• 21:49
  That was the big thing that when people were on estrogen, they had a higher likelihood of breast cancer.
• 21:56
  So is that true?
• 21:57
  Yes, but the way it was done, it was a lot of women were on oral estrogens.
• 22:02
  The patients in the study were a lot older.
• 22:05
  They were already 10 years post menopause, which the, so they had a higher rate of breast cancer anyway.
• 22:12
  Exactly.
• 22:12
  And were being given oral estrogen and oral estrogen.
• 22:17
  The byproducts, like when it gets transferred through the liver is something called estro, which does increase your risk of breast cancer.
• 22:24
  So a lot of times the gynecologist will take women over the age of 45 to 50 off their birth control pills because we don't wanna give women oral estrogens.
• 22:35
  Got it.
• 22:36
  Okay.
• 22:36
  So that really affected the study.
• 22:39
  So this is why this was getting like a bad reputation this study came out and it was done in the late nineties, so it all came out in about 2000.
• 22:49
  My mother's age when they were going through all of this, none of them were on hormone replacement because they said cause breast cancer.
• 22:56
  Okay.
• 22:56
  Exactly.
• 22:57
  Okay.
• 22:57
  Because that's always what I thought.
• 22:58
  So yes.
• 22:59
  I was gonna say, I feel like I even grew up with that messaging, hearing that, and it was like hormone replacement therapy was like a scary thing, it was, yeah.
• 23:07
  Yeah.
• 23:07
  So now, but I think 20, 25.
• 23:09
  Yeah.
• 23:10
  You talk about hormone replacement therapy and you do patches, it's not just oral estrogen, it's a patch estrogen.
• 23:16
  So that bypasses the liver.
• 23:18
  That, and that's exactly right.
• 23:20
  That bypasses the liver.
• 23:22
  We're not giving synthetic hormones, they're all plant-based hormones and they're not going through the liver.
• 23:27
  So it's really going right to the areas of the body where it's needed.
• 23:32
  Okay.
• 23:32
  The reason it's so important sort of to understand perimenopause and even to be thinking about this, is because once you go into menopause, you had the best bang for your buck in terms of starting hormone replacement is those first 10 years.
• 23:48
  And those are the years where, you'll have the bone protection, the cardiovascular protection, the brain protection, then one would say my mom is 65.
• 24:00
  What about she was never on hormones.
• 24:02
  Can she go on hormones?
• 24:03
  Yes.
• 24:05
  Or if she's symptomatic probably not with top flashes anymore, but they, some women do have that.
• 24:11
  And, but I would say libido and vaginal dryness and all different reasons.
• 24:15
  They may wanna start hormones, but that bone protection is may or may not be there.
• 24:21
  We still need more studies to really understand that.
• 24:24
  So it's definitely, it's within the first 10 years of menopause, that's when you really wanna get this going.
• 24:31
  That's when you start.
• 24:32
  Yeah, absolutely.
• 24:33
  So what about, absolutely.
• 24:33
  What about preventative in perimenopause?
• 24:36
  Is this something that you can start earlier?
• 24:39
  Yeah, so I have a lot of women that are still menstruating, that are on low dose hormone therapy, and it's really just to regulate mood, to regulate their periods.
• 24:49
  Like you'll notice in perimenopause you might get longer periods, shorter periods, heavier periods, and real cramping, the gynecologist said that there's, it's all considered normal, having these variations.
• 25:04
  When I asked him, I'm like, that's right.
• 25:06
  If it's, I was like, some months it's five days, some months it's 10 days.
• 25:09
  And he said, that's all considered normal.
• 25:12
  And I said, but it's not normal for me.
• 25:14
  But it's right, normal for him enough to say it's, he's not gonna do anything more.
• 25:21
  He's not worried.
• 25:22
  He's not worried.
• 25:22
  Yeah.
• 25:23
  Yeah.
• 25:23
  I think it's more of when the time between the periods.
• 25:27
  Start changing, right?
• 25:28
  Like they're getting longer, like you might miss a period and then you get a period or you got your period and it was three weeks apart instead of four weeks.
• 25:37
  Those kinds of changes the length of the period and the heaviness of the period are also, are changes.
• 25:43
  Like I would say a lot of women come to me and they're just, they're cramping.
• 25:47
  They have really heavy periods when all of that happens.
• 25:51
  I would like to say I am a urologist.
• 25:53
  I'm not a gynecologist, so I always tell the women to make sure they see their gynecologist just to make sure that there's no pathologic bleeding, right?
• 26:02
  But a lot of times putting people on a low dose progesterone supplement, a lot of times it will help a lot of those symptoms.
• 26:10
  And that's all perimenopause.
• 26:11
  And is the progesterone oral as well?
• 26:13
  Or is it a patch?
• 26:14
  Like how does that work?
• 26:15
  Progesterone is oral.
• 26:17
  It's taken at night because the progesterone will help you sleep.
• 26:20
  Oh.
• 26:21
  So I have women hugging me, after the visit.
• 26:23
  They're like, I'm sleeping.
• 26:24
  And it's real.
• 26:25
  So you have women taking low dose of progesterone in the evening?
• 26:29
  A coupled with a patch of, is it estradiol that you said?
• 26:33
  Or Estradiol?
• 26:35
  Estradiol.
• 26:35
  Estradiol.
• 26:35
  Which is that the, and sometimes they will be.
• 26:37
  Yeah.
• 26:37
  And then what about testosterone?
• 26:40
  That's like the third one that we talked about.
• 26:42
  What does that control and what does that do?
• 26:45
  So testosterone actually was the first hormone I felt most comfortable giving, just because I am a urologist and we give obviously a lot.
• 26:52
  And you said you're giving it to men?
• 26:53
  Testosterone, yeah.
• 26:55
  Forever.
• 26:56
  Men walk and they're like, I have low testosterone.
• 26:59
  I'm like, why do you think that?
• 27:00
  I just feel it, typical man, I know.
• 27:02
  But there is, we were joking something.
• 27:05
  If I have to give one more man a shot of testosterone, I'm gonna scream.
• 27:09
  It's they all come in and they all want it.
• 27:11
  It's like doping, and they want more.
• 27:13
  Now.
• 27:13
  Some women start to want that as well, but it's different in women.
• 27:17
  So I would say testosterone is really important for libido.
• 27:21
  Really important for joints and muscles for muscle mass.
• 27:26
  And you'll hear a lot of people perimenopause, menopause, who will complain of like muscle wasting and they just feel weaker.
• 27:33
  They have joint pains brain fog and testosterone is really good for that.
• 27:38
  The problem with testosterone that I tell everybody is that there also are side effects of testosterone and, a lot of the women that have gone through menopause, they'll talk about facial hair, but once you're on supplement that will.
• 27:53
  Be worse.
• 27:54
  People will definitely get that.
• 27:55
  They get acne.
• 27:57
  They can have a deepening of their voice.
• 27:59
  A lot of people really like the other effects, meaning the increased libido, increased sexuality, and, we can get your testosterone levels pretty high in women.
• 28:10
  We don't wanna get it too high'cause you can get, so your clitoris can get larger.
• 28:15
  You can almost feel hypersexual, which people don't like either.
• 28:19
  I haven't prescribed any testosterone that had that for women, but a really close friend who's also a urologist, she had really bad side effects from testosterone.
• 28:32
  You could give medication to stop it, but, so you really just, again, all of hormone.
• 28:38
  Management is all teetering the doses and figuring out the right balance.
• 28:43
  And then the nice thing is once you are on a good regimen, you're, you fly and as long as you are, getting your annual mammograms and make sure you come in for appointments just to make sure you're feeling good, it's really beneficial for women and women are happier, their relationships are better.
• 29:04
  I always say when I started, it just, it just took the edge off Yeah.
• 29:08
  Of that kinda, oof, because like I have a wonderful life.
• 29:11
  Osteo, have you, has your osteoporosis or osteopenia has it.
• 29:16
  Reversed or improved since you've been on estrogen?
• 29:19
  No, I've just started it.
• 29:21
  So I'll be a year in November, so I'm gonna be getting bone density scans, so when I come back in a couple months to talk, I'll let you know.
• 29:29
  Perfect.
• 29:30
  Yes, we can, you can give us an update.
• 29:32
  That's amazing.
• 29:33
  But I'll give you updates now what about if you have a family history of breast cancer or if you had breast cancer?
• 29:41
  Are you no longer a candidate for this and how does what do you do about that?
• 29:44
  Yeah, so I think anyone with a family history of breast cancer as long as they don't have breast cancer, I think they are candidates with the knowledge that it's really important to get annual mammograms.
• 29:56
  And work with the doses.
• 29:57
  You don't wanna go on oral estrogens, I think any of the patches, creams, pellet, something that is not being taken by mouth and controlling the doses.
• 30:06
  If you have breast cancer, that's a lot of women I see.
• 30:10
  Or they're, what is that time again?
• 30:13
  I think the most important person to talk to is your medical oncologist to feel, there's all different types of breast cancer, estrogen positive, negative.
• 30:21
  There's so many things that go into it that it really has to be a joint decision between, the patient, the oncologist, myself, what everyone feels comfortable with.
• 30:32
  A lot of times after five years, if you're cancer free, and you have low risk disease, the oncologist feel that it would be okay to start hormone replacement.
• 30:41
  I know.
• 30:41
  So we've talked about this'cause you were very helpful with my mom when she had breast cancer.
• 30:45
  You set her up with the best team of doctors, I think like Erica, cherry picked a phenomenal team for her.
• 30:51
  She had excellent care, but she was also seeing Erica prior to breast cancer.
• 30:57
  And I mean my mom is very open about this, but she was seeing Erica to help her.
• 31:01
  'cause she was, she had gone through menopause, right?
• 31:03
  And so she had to stop the estrogen replacement therapy and she developed osteopenia.
• 31:10
  So she developed that because she had been off her hormones now Wow.
• 31:14
  For a couple of years.
• 31:15
  Wow.
• 31:16
  So she's now at this crossroads personally, we're going to Italy in a few weeks.
• 31:20
  And she's I'm afraid to fall'cause I'm afraid I'm gonna break my hip and what is worse?
• 31:24
  So it's hard.
• 31:25
  I guess that's, so I'm assuming I'm answering my own question, but then this is something that you have to continue on with because it can reverse back.
• 31:33
  If you go off of the hormone replacement therapy, this is something that you, this is ongoing.
• 31:38
  Yes.
• 31:38
  Yes.
• 31:39
  Okay.
• 31:39
  Yes.
• 31:40
  Yeah.
• 31:40
  Your body needs continued continuous estrogen of in order course.
• 31:44
  I didn't realize was responsible for so many things.
• 31:46
  Is it something that like, I know you're saying that you have to play around with the dosage to get it right.
• 31:52
  But then is it something that as you're aging, is it something that you need to keep up with and continue figuring out the dose?
• 31:58
  Because does stuff still start changing lowering?
• 32:01
  Do you is it something that you need to tweak?
• 32:03
  Yeah.
• 32:03
  Yeah.
• 32:03
  It's always open for discussion.
• 32:05
  Okay.
• 32:06
  Like, how are you feeling on your hormones?
• 32:08
  I think, it's really how they're feeling, and as long as you always have to check in with their medical history.
• 32:15
  And now unfortunately, as we age, high blood pressure, diabetes, you know, all those other things.
• 32:21
  I tend to think that a lot of women that are coming to me for hormone replacement, they're really looking for preventative medicine.
• 32:30
  How to prevent any type of further decline.
• 32:33
  Like we talk all about, this could be a whole other subject about lifestyle management, right?
• 32:39
  Like during menopause, what kind of exercises do you wanna do?
• 32:43
  You'll hear about weightbearing.
• 32:45
  I always tell people to get weighted vests and all these other things that you can do to really.
• 32:51
  Not so much prevent the aging process, but just to stay healthy and strong during the aging process.
• 32:56
  Because these are things that, because you're more specifically looking for people keeping their bones more dense, their bone strong.
• 33:05
  So it's more about exactly the exercise obviously is for the cardiovascular benefits of it too, but you're really looking for that bone density.
• 33:12
  Yes.
• 33:13
  And stronger.
• 33:15
  And that's where testosterone can come in and it can help, not so much with bone density, but it can help with muscle mass and strength and energy and which is why the men said, I guess I need to get my weighted vest.
• 33:27
  I had it in my Amazon cart and I never bought it.
• 33:29
  And Oh yeah, it's great.
• 33:31
  That's why people should use it for, that's there's a real reason.
• 33:34
  There's a science behind it.
• 33:35
  Right.
• 33:35
  That's really interesting.
• 33:36
  You should be able to pay for it with your HSA card.
• 33:38
  I know, right?
• 33:39
  That's right.
• 33:40
  You can't.
• 33:41
  You can't.
• 33:41
  But you should be able to fail.
• 33:42
  But you should if you think about it.
• 33:43
  Yeah.
• 33:44
  You should be able to.
• 33:45
  Yeah, I tell everyone to get a weight to best.
• 33:47
  I walk with my weight to best.
• 33:48
  I used to try to walk around the house, but I don't really do that.
• 33:51
  But I always, whenever I take walks, I just went up five pounds in it.
• 33:56
  Wow.
• 33:56
  But yeah, I really like it.
• 33:58
  Okay.
• 33:58
  Helps with your to Yeah, I know.
• 34:00
  I, it's really good.
• 34:00
  I miss walking with you.
• 34:01
  Yeah, I know.
• 34:03
  I know.
• 34:04
  And I have one great friend who's here that I tend to walk with, but it's not the same.
• 34:08
  It's harder as we get older and making friends.
• 34:11
  I just moved to New Jersey, which has been a good move from my family and I, but, and me, we but I do, I miss my people.
• 34:18
  Yeah.
• 34:19
  You are certainly missed here as well.
• 34:22
  Yeah.
• 34:23
  Yeah.
• 34:23
  So I guess as we wrap this up, what is one myth that you would want every woman listening to unlearn about perimenopause and menopause and hormones?
• 34:34
  Good question.
• 34:36
  So I would say the first one, which we didn't really talk about, but vaginal estrogen, it's so important.
• 34:44
  You get a lot of dryness even, through perimenopause.
• 34:48
  The birth control pill, the marina, all of that can cause a lot of vaginal dryness, vaginal estrogen.
• 34:55
  If I have one mantra, every vagina needs estrogen and vaginal estrogen is amazing.
• 35:02
  It does not cause cancer.
• 35:04
  It does not get absorbed.
• 35:05
  It is wonderful.
• 35:06
  It's local, it's necessary.
• 35:08
  And you will feel better on it.
• 35:10
  It will help.
• 35:11
  Is that a cream typically?
• 35:12
  Is It's a cream, yeah.
• 35:13
  Yeah.
• 35:14
  The vaginal estrogen.
• 35:15
  It comes in a cream.
• 35:16
  But, and you can write a prescription for this, or is this over the counter?
• 35:19
  Yeah.
• 35:19
  Or you were just gonna answer?
• 35:20
  No you need a prescription.
• 35:22
  Okay.
• 35:22
  And then there's all different.
• 35:25
  Vaginal treatments we could do, but probably estrogen is the most important.
• 35:29
  If you have a history of breast cancer, you can do intra rows, which is DHEA, which will help not as good as estrogen, but still good.
• 35:38
  But really it's so important to prevent UTIs for pelvic floor health, for painful intercourse.
• 35:47
  So I would say that's really important and that, hormone replacement causes breast cancer or causes cancer, or causes blood clots, all of that now.
• 35:58
  In some situations you may not be a candidate for it based on your history, but in general, most people, the benefits outweigh the risks, right?
• 36:07
  And obviously this is all shared decision making with your doctor, with your personal medical history, your concerns.
• 36:14
  But I would say, for so many reasons, it's important and probably the most important will make you feel better.
• 36:22
  So you see patients now in New Jersey, but do you see patients remotely?
• 36:28
  And would you then work with, if you saw patients here in Connecticut, would you then work in tandem with their primary care doctor, ob, GYN Cardi, whoever, what other team of doctors would you be able to?
• 36:42
  Absolutely.
• 36:43
  And then can you order blood work?
• 36:45
  I definitely do the consultations.
• 36:46
  Yep.
• 36:47
  I can order blood work, I can do consultations.
• 36:50
  I still have a medical license in Connecticut so I can prescribe and Amazing.
• 36:55
  Okay, so that was, see all of our, Pippa, I know Pippa's, we're gonna leave all of her information of course, in our show notes, but I'm always curious about how to go about and who to ask.
• 37:05
  Like when you are on TikTok or you're on Instagram and you see something and it flags right, and you're like I might be having those symptoms.
• 37:13
  Or you start tracking your own body and you're curious, yeah, this sounds like this might be something that I'm going through or could be going through.
• 37:20
  Where does one start?
• 37:22
  Do you go to your primary?
• 37:23
  I not, do you go to your We start her with Erica Lambert.
• 37:26
  You just go right to you?
• 37:28
  Yeah, A lot of times it depends what type of insurance you have.
• 37:32
  Okay.
• 37:32
  It's very interesting.
• 37:34
  Most people will not go to a urologist and be like, I'm looking for hormone replacement.
• 37:38
  I would say most urologists don't do this.
• 37:40
  But a lot of people will start with our primary care doctors and a lot of them will have people they know that do hormone replacement.
• 37:50
  If you just look in your area, who does menopause, perimenopause there's, unfortunately there's not a ton of people that do it.
• 37:58
  I wish there was you even said you yourself are newer to this.
• 38:03
  It's been 10 years and you're, you're learning, you're doing tons of research because you knew there was such a need for it.
• 38:11
  Yeah, and I actually, I got my certification in hormone replacement.
• 38:15
  That's amazing.
• 38:15
  Because, I needed, I, I just wanna make sure I was doing it right and, make sure I understood everything.
• 38:22
  But, there's, a lot of the.
• 38:25
  Wellness centers, med spas, they're starting to pick this up, but I would try to go to someone that is certified in either NAMS is, the national Association of Menopause society, just so you make sure that you are, you're being heard, your voice is being heard.
• 38:43
  That's a great tip.
• 38:44
  That's a great tip.
• 38:45
  'cause people always wanna know who to go to the correct way.
• 38:49
  The, and like you're saying we just have had, I feel like multiple discussions if things become too buzzwordy, all of a sudden everybody offers these things.
• 38:59
  And you really wanna make sure, especially when it's something you're putting into your body, you wanna make sure that it's done correctly.
• 39:05
  You have the right people following you and giving you the advice and administrating the right prescriptions and Right.
• 39:11
  And you may not need what I need.
• 39:14
  Exactly.
• 39:14
  So it's best to have your blood work done followed up yearly.
• 39:18
  In tandem with, like you said, your annual pelvic exams, your mammograms, just so you don't wanna be doing more harm than good.
• 39:26
  Yeah.
• 39:26
  Like the person that does my hormone replacement is a primary care doctor.
• 39:30
  And she got certified and I found her, where I live close to the J or I live on the Jersey Shore.
• 39:38
  She's in Borhees an hour away, so there, there's no one down here.
• 39:43
  So it's been really exciting to be able to take care of the patients down here.
• 39:47
  That is amazing.
• 39:48
  I know.
• 39:48
  Thank you for sharing so much about this.
• 39:50
  We're gonna close out this episode and we do have Erica coming back next time in our next episode.
• 39:56
  And we're gonna get into what we're gonna talk about at the end of this episode.
• 39:59
  But we're gonna close out this episode with our pink spotlight, which is our person, place thing, mantra or tip that's making your life or your week a little bit better.
• 40:09
  So my mantra for everyone is every vagina needs estrogen.
• 40:14
  Please, if you are feeling vaginal dryness, please go to your doctor and get some vaginal estrogen.
• 40:20
  It will elevate your life, your sexual life to everything.
• 40:26
  And you spoke about this at length during the episode, how it has so many benefits.
• 40:30
  So it's really super important.
• 40:31
  Love that tip.
• 40:32
  What about Yout?
• 40:33
  Do you have anything today?
• 40:34
  So I have a product.
• 40:35
  I am.
• 40:37
  Obsessed with these drops.
• 40:39
  So my sister Nicole has like thinner hair and she's oh, my hair is getting thinner.
• 40:44
  I'm like, I know mine is getting thinner too.
• 40:47
  I always had like thick, coarse hair.
• 40:48
  So at the beginning of the summer she gave me these drops and I've been using them on my scalp.
• 40:54
  And I went to the hair salon today and my hairdresser told me she sees new hair growth.
• 41:00
  So I got the divvy scalp serum.
• 41:02
  I love divvy.
• 41:03
  Those are, you love this.
• 41:04
  I love that.
• 41:04
  I used that through both of my postpartum periods.
• 41:08
  And I love it.
• 41:09
  It works.
• 41:09
  And I've been wanting, I've been wanting to share it and I'm like, I don't even know if it's really working.
• 41:13
  I feel like my hair has been looking a little thicker.
• 41:16
  Like I took my hair extensions out at the beginning of the summer.
• 41:19
  And I was like, oh, my hair feels thin.
• 41:21
  But I thought maybe, ah, it felt thin'cause of the extensions.
• 41:24
  But then after like several washes, I was like, I don't know, it still feels thin.
• 41:27
  But then when Sam and Shawnee said to me, you are getting new growth.
• 41:32
  That's amazing.
• 41:32
  So it's working, so it's this divvy, scalp serum.
• 41:35
  I guess it works with your, like the pores on your scalp and keeps things, open and clean.
• 41:40
  It does.
• 41:41
  And detoxifies.
• 41:42
  So I guess that's like the science behind it, so that's why it helps promote hair growth.
• 41:46
  You feel like a little s.
• 41:48
  Ting you feel like a little, yep.
• 41:49
  Tingle ish, but I don't know.
• 41:51
  I really like it a lot.
• 41:52
  Yep.
• 41:53
  They're great.
• 41:53
  And I was finding, obviously with postpartum hair loss, it's it's gonna come back.
• 41:57
  It's like everybody always says, it's oh I, I have all this hair growth.
• 42:01
  And it's it's supposed to come back, but with that, I really felt,'cause I used that especially the last time, and it was like more of that detoxifying feeling of the buildup.
• 42:10
  Because when you're going through postpartum, I feel not only do you lose your hair, but like your hair feels different.
• 42:16
  It just doesn't feel the same.
• 42:18
  It feels lifeless.
• 42:19
  I've talked to so many people about it and I've shared it on my own stories and I've always had people respond.
• 42:24
  And that helped a lot with that.
• 42:26
  It just felt like it gave it some life back.
• 42:28
  Like after, I would use it for a couple of days and I tried to be like pretty religious about it and use it all the time.
• 42:33
  But it would just really, it just gives you like that, a really good feeling on your scalp.
• 42:36
  And I felt like it lifted everything and helped to volumize.
• 42:39
  So I love that too.
• 42:42
  I'm stealing yours, but good.
• 42:44
  Good.
• 42:44
  That's a good recommendation.
• 42:45
  Good product.
• 42:45
  Every so often I like a good product.
• 42:47
  Fine.
• 42:47
  What about you?
• 42:48
  So mine, I'm guilty of buying these for my husband and then I liked them so much that I bought them for myself.
• 42:54
  But they are, I thought you were gonna say you stole them from him because that would be I that also on brand.
• 42:58
  I was, but I did.
• 43:00
  I, no, I did not.
• 43:01
  But I love these.
• 43:03
  They are a Bose ear pod.
• 43:05
  Okay.
• 43:05
  Like for listening to things and, but it's a cuff.
• 43:09
  And I like this so much because I've always struggled with the Apple AirPods.
• 43:13
  Like they just don't sit well in my ears or they start to hurt my ears after a long time.
• 43:18
  And you're also feels like a hearing aid.
• 43:20
  Yes.
• 43:20
  And they also like block what else is going on.
• 43:23
  So what I end up doing is I wear one.
• 43:26
  Yeah.
• 43:26
  Because I'm like, I don't want my hearing impaired.
• 43:29
  If I'm out on a walk or if I'm doing something or if I'm with my kids, but I'm just trying to listen to something or multitask or do something else.
• 43:35
  I can't just be, it's not like I have my noise canceling headphones.
• 43:39
  But then I didn't like the fact that it was like.
• 43:42
  Impairing my hearing.
• 43:43
  Like when I'm trying to do other things.
• 43:44
  So this actually sits in your ear.
• 43:46
  I can't do it'cause I have my headphones on, but it sits in your ear like an ear cuff.
• 43:50
  And so you can hear it's wonderful sound quality, but you can hear life around you.
• 43:55
  And so you could actually have both in and go for a walk and not feel like you're going to get killed on your walk because you're not paying attention to your surroundings.
• 44:02
  Or if you're trying to do other things, if you wanna still hear your kids asking for you, you're not tuned out as much.
• 44:08
  And I like it.
• 44:09
  It works for like when you don't wanna be tuned out.
• 44:11
  If you're trying to go on a flight or something, that's probably not when you would wanna use these, but if you want just to listen to something without being zoned out, it's wonderful.
• 44:20
  They look too, they like, they're so cute.
• 44:22
  Yeah.
• 44:22
  It's like a clip on your Is the cost, so is the price point.
• 44:24
  They're about 200 something.
• 44:27
  So they're still Yeah, the Apple, they're similar to Apple and the Sound Boys girl you love.
• 44:32
  I'm a Bose girl and I have their noise canceling headphones, so I love those.
• 44:35
  But there's a time and a place and like these, I've actually gotten so much more use out of, and they are so comfortable.
• 44:40
  I've had them in my ear like.
• 44:42
  For 10 hours.
• 44:43
  Like I forget that they're there.
• 44:44
  Oh, wow.
• 44:45
  And you, I could never do that.
• 44:46
  What are you doing for 10 hours?
• 44:48
  I'm not listening to something for 10 hours, but I'll have something on and then it's it's usually when it's an accessory.
• 44:53
  They're on and they're comfortable enough that you could wear them all day.
• 44:55
  And then it's, I don't know if I'm going to listen to something, I don't have to put it back in my ear.
• 44:59
  It's like literally been life changing, oh, I love that.
• 45:02
  Good tip.
• 45:02
  Yeah, they're really great.
• 45:03
  Link those away.
• 45:04
  I will, I'll link these in the show notes too, but we are so excited.
• 45:07
  We're gonna have Erica back next week.
• 45:10
  Next week Erica will be back on.
• 45:11
  And we're gonna go into, what else, Erica, what else are we gonna talk about next week?
• 45:15
  I think we're gonna do some pelvic floor health.
• 45:18
  Yes.
• 45:18
  Urinary incontinence.
• 45:19
  After childbirth, we're gonna do some painful intercourse.
• 45:24
  We're gonna get into more of the pelvic floor genital area.
• 45:29
  Alright, so this was just the tip.
• 45:31
  Pun intended.
• 45:32
  Alright, we'll see everybody next week.
• 45:34
  Thank you.
• 45:35
  Thank you Erica, so much.
• 45:36
  Okay, bye.
• 45:37
  Thank you so much.
• 45:38
  Bye bye.