Latest / FitMitTuro Fitness Podcast / Hormones, Not Just “Getting Older”: Dr. Melissa Miskell on Menopause, HRT & Feeling Like Yourself Again

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Hormones, Not Just “Getting Older”: Dr. Melissa Miskell on Menopause, HRT & Feeling Like Yourself Again · FitMitTuro Fitness Podcast

• 1:06
  melissamiskell: Maybe going through perimenopause or menopause and not understand what's happening or getting bad advice.
• 1:16
  Turo Virta: Yeah, so what was I want to know a little bit about you, your background and what led you to specialized in women's hormones and menopause care.
• 1:30
  melissamiskell: So I'm a board certified obstetrician gynecologist and have been practicing for about 30 years.
• 1:39
  melissamiskell: And when I first went into private practice a few years later, the Women's Health Initiative trial came out in the US, and basically said that hormones were the devil going to cause breast cancer, heart disease, dementia, and so as a gynecologist, I, along with every other physician, we pulled our patients off of their hormone replacement therapy due to the Women's Health Initiative trial. The problem with that over the next couple of years is that it started to be recognized that this trial was terrible. It was very poorly done and should never have been published at all. So a lot of research began to be done on hormone replacement therapy and how beneficial it was for women. And so really, I had a patient of mine that came to me that was a breast cancer survivor, and she said, I can't live like this anymore. This is I am miserable, and my life is not worth living, and this was probably in about 2005 and so from there, I kind of started doing my own research, because they didn't teach us anything about bioidentical hormones in medical school or residency, and just following That path to try and help my patients is where I designed a hormone injection that is once a month, that is specific for each woman. So that's kind of my journey into hormone replacement, really, at the behest of my patients being very miserable
• 3:28
  Turo Virta: was this kind of moment when you realized that those women were being Misty, agnosed with the depression or anxiety, or When was the moment and when you had that moment and when, when The real issue was actually hormones and not that.
• 3:48
  Turo Virta: Actually that depression and anxiety?
• 3:52
  melissamiskell: Yes, well, I had hundreds, if not 1000s of patients by that time who would go to their family practice, doctor, typically, and be depressed, but not really depressed, but diagnosed that way, mood swings, vaginal dryness, brain fog, insomnia and so they would be typically dia prescribed three medications, annex for anxiety, an antidepressant and a sleep medication. And so they would be given three pharmaceuticals that they didn't need when all they needed was to have their hormones checked.
• 4:39
  Turo Virta: Yeah. So what is the what is, what are like? The first like, if you what are the first like kind of hormonal changes that typically start around age of 40,
• 4:54
  melissamiskell: your hormones can start to decline even earlier than that, even as early as 35 because it is kind of a slow decline. Women have three hormones that they're most important to their bodies, estrogen, progesterone and testosterone. One that typically declines the first is progesterone, and so that's when the inability to sleep kind of comes in, and then and mood swings, some testosterone is next, which is going to affect your energy and your libido, your sex drive, and estrogen is usually the last so the hot flashes and that kind of thing typically don't start until closer to 50, but the decline of all of those hormones is a progression. So that's why it's very important for women to get their hormone levels checked so that they have a baseline when they're probably in their late 30s.
• 5:51
  Turo Virta: And why do you think that doctors often miss that perimenopause?
• 5:58
  melissamiskell: Well, the main reason is they're scared to death of hormones. So we have been trained that hormones are terrible. They cause cancer, they cause heart disease. That's just how physicians are trained, and so they're very unwilling to prescribe hormone therapy.
• 6:16
  melissamiskell: That's just the norm.
• 6:22
  Turo Virta: And what is, then, if you if you think that those symptoms, what you should be, if listeners, they are having, like, all these kind of like, fatigue, brain folk, maybe weight gain around the belly, insomnia, mood swings, what you already mentioned, mentioned, what are, what are Those symptoms you should never ignore?
• 6:46
  melissamiskell: Well, the symptoms that we're talking about are the ones that make women miserable, right? So, hot flashes. You have a CEO that's in a board meeting and she's drenched in sweat, vaginal dryness, which is going to impede women with their sexual activity, mood swings, brain fog, that's one of the big ones, where you just can't remember anything like you used to, and you think that you're getting old, you're getting dementia. So those are the things that affect our daily living. But really what's more important for a woman's health is the protectiveness that estrogen has for their bones and their heart and their brain.
• 7:36
  Turo Virta: And what is then like you you like you said that, like, what is then like somebody, someone might, might be thinking like that. This is, it's part of aging, like, you know you are, you don't remember any some things anymore or or if there is some brain folk like, could you explain what is the difference like between normal aging versus hormonal imbalance?
• 8:02
  melissamiskell: Well, normal aging, especially if you're talking about something like dementia, unless it's a very aggressive form, but just typically, that's not going to occur until you're in your 70s.
• 8:12
  melissamiskell: And so if you're in your 40s and 50s and you are having trouble remembering things you feel like your moods are are just uncontrollable all over the place, those are signs of menopause, not of early dementia or that type of thing. So it's again, very important to to get your your labs tested. That's the most important thing for women that are having those types of symptoms.
• 8:47
  Turo Virta: No, I want to talk little bit about the hormone replacement therapy. Like, what women are getting wrong. Like, what are for you the biggest myths about hormone replacement therapy?
• 9:01
  melissamiskell: Well, the biggest myths, and I'm not sure if this is widely known, but the FDA has just pulled the black box warning for estrogen, which has been on estrogen since the Women's Health Initiative trial.
• 9:13
  melissamiskell: So for 23 years, the FDA has said that women should not be prescribed estrogen, and so that is the number one myth. Estrogen has been shown now to be the number one thing that relieves hot flashes, vaginal dryness, mood swings and brain fog. It also the number one killer of women is heart disease. Most women die from heart disease, which is not widely known. Most women think they that they're going to die of cancer, but heart disease is far and above more deadly than all cancers combined, and so way more deadly than breast cancer women who have survived from breast cancer, which is about 95% of women survive from breast cancer now they're going to die from heart disease, and so estrogen is the number one thing that is preventative for women, for heart disease and osteoporosis and Alzheimer's.
• 10:21
  Turo Virta: Wow. What is the like with the heart hormone replacement therapy. Because what I hear a lot is that they, there was a some studies earlier that it's, it's dangerous. There was, like a famous wall women's health, right, creative study.
• 10:43
  Turo Virta: And what is that? But there was something that study gets got something wrong. What was wrong with that study? Right?
• 10:51
  melissamiskell: That study was terrible, and so it has been completely nullified now. But what that study showed so unfortunately, the average age of women in that study was 63 which is 10 years beyond menopause. And so they also did not take women that were symptomatic. They 50% of the women were smokers, 50% were obese, and a large percentage already had heart disease. And so the cohort that they were watching was already so damaged that it was not a valid study.
• 11:32
  melissamiskell: So that is the real problem with with the Women's Health Initiative trial. So that's where estrogen got its bad rap is from that trial that it caused breast cancer and heart disease, and so we know now that that that is just not true. It is a huge mistake that the medical community made in believing that trial and not looking at the science behind it. So now all of that is being done, and that's why the warning label has been taken off of estrogen. We actually know now that it is very beneficial,
• 12:15
  Turo Virta: yeah. And this is like, this is when was this study done to 2002 and it's still like, but this is, that is, that is why it's so important to stay updated with all these things like that. You know, there might be like because these things are changing all the time. And you know, if we would have this conversation like 2003 when that study just came out, you probably would have totally different opinion. And now, with knowledge, what is all the time and coming up, new studies, new trials, understanding the science, like you mentioned, it's, it's all the time going on, and there is happening something. So this is, this is, and it's, of course, like a normal consumer or people who is not maybe in so into science or doing this in daily job. They might have heard about that study, or someone have mentioned it. Someone is making some social media content. And obviously, like nowadays, how information is getting you get to somewhere, somebody is doing some video, like probably, if you think that you see in social media, you most likely would see that this one is dangerous or killing. It's getting so much more attention than someone is saying that, no, that's actually it's okay. So obviously, so many people still believe that it's that's the truth. What is out there, and it's a myth, or there's not updated information anymore,
• 13:51
  melissamiskell: right? Well, now that this has come out from the FDA, then I think physicians, so physicians are just very concerned about litigious types of things, being sued for doing the wrong thing. And so that's why most physicians would not prescribe estrogen, because of this black box warning. And so now that it's been released, the problem that's going to happen is that physicians will go back to prescribing what we used to prescribe, which is Premarin and Provera, because that's really all they know about. And the the detriment to that is that primerin is made from pregnant mare urine. That's where the name comes from. So it's equine estrogens, and a whole group of them, I think there's 20 plus different estrogens in that so that's what we're giving women.
• 14:48
  melissamiskell: Is horse estrogen. The other, I know, right, the other part of that progestin, progesterone. So Prem pro Provera is a progestin, which is a man made molecule.
• 15:08
  melissamiskell: It's not progesterone, which is bioidentical or what a woman's body naturally makes. So women are going to have to be very smart and very aware of what hormones are being prescribed to them. So the alternative for that is a bioidentical hormone, which is estradiol and progesterone testosterone, should also be in there as well, because women also make testosterone. So that that would be something that I would really want women to know, is to be aware of what you're being prescribed for your hormone replacement,
• 15:53
  Turo Virta: and what is the you mentioned that bioidentical hormones, what is the difference between synthetic and versus the dose bio identical hormones like, and how You can be how you can know, yes, prescribed.
• 16:11
  melissamiskell: So bioidentical hormones are going to be the exact chemical formulation of what a woman's body makes, or a man's if they're getting testosterone. And so that means that it's going to work in your body the same way that your natural hormones that your ovaries made are going to work.
• 16:33
  melissamiskell: So you have to one go to a practitioner that you have researched some and that they will prescribe bioidentical hormones, and and you'll know because Premarin and Provera, or any other pharmaceutical like that, you'll be able to tell what that name is, estradiol and progesterone are going to say that on on the prescription,
• 17:05
  Turo Virta: what is then? Who would be then, like a good candidate for the bioidentical hormone therapy, and who is the nut?
• 17:13
  melissamiskell: So there are, there are a few, like someone with an active cancer does not need to take bioidentical hormone or any hormones. That's really probably the most, most most important thing, there are a couple of unusual clotting diseases or disorders that those women also should not take hormones. But other than that, the there, they're the hormones that you used to make before you went into menopause. So they're incredibly safe. They prevent breast cancer, prevent heart disease, prevent dementia, yeah, so as well as get eliminating all the other symptoms that actually affect a woman's daily living,
• 18:06
  Turo Virta: it was that is that is like, what I what I have heard from my clients, like some of them, that hormonal replacement therapy have been really helpful for someone. It didn't help that much. What is like, is there some kind of rule? What would you say that?
• 18:25
  Turo Virta: Okay, this person I would recommend for hormonal replacement therapy, or at least to try it. Or is there someone like, some like, red flags, or something like that? Okay, this might be or is it able to all people should be trying it.
• 18:44
  melissamiskell: Or so as long as you you know, don't have the clotting disorder or active cancer, then every woman should try it. So what I would tell someone who doesn't feel like they are getting any relief is that they don't have the right dosage. So that's the other thing. With permarin and Provera, every woman got the same dose, exactly the same.
• 19:10
  melissamiskell: With bioidentical hormones, you can adjust that dosing so that it fits that woman specifically.
• 19:14
  melissamiskell: Yeah.
• 19:18
  Turo Virta: And then it's, is it then like that? You You can you obviously, you can't, probably know, or you can only guess what is the right doses in the beginning, and then you see if it's helping to access the doses and see how it works, or how is it working in practical field, yes.
• 19:39
  melissamiskell: And so at my clinics, what we do is we draw a woman's lab at the very beginning, and so she comes in to see the practitioner already having her labs. So the practitioner then talks to her about her symptoms, which are actually more important than what her labs show, because it's her life and what she's living.
• 19:57
  melissamiskell: So we design an injection with estrogen and testosterone that is going to fit that woman's symptoms. And so then, and then they get progesterone oil orally. And so then we see them back in a month, and we have their labs again, so then we can see are they better or not. Are they still having hot flashes?
• 20:22
  melissamiskell: Then we need to increase their their estrogen, or is their libido still not great, then we need to increase their testosterone, and we have their lab so that we're never going outside of a range that it's going to get them too high. Also we'll know if they're still too low. So that's the thing about bioidentical hormones, is that you can, you can make it specific for each woman.
• 20:48
  Turo Virta: Yeah, that sounds amazing. Like, I like, I said I'm maybe my questions are, are, like, I'm not, I'm not any specialist on this, and, but I'm so curious, just learning how this process is working and, and, thank you so much for explaining it so simple way.
• 21:04
  Turo Virta: It's so so helpful for me and and hopefully listeners too. So next one, I want to talk a little bit about symptoms that women are mitigated for that are actually hormonal. So of course, you said that many women are prescribed antidepressants, anxiety meds, or sleep mids, when the real issue is hormone decline. Why does this happen?
• 21:35
  melissamiskell: Well, it happens because physicians don't want to prescribe hormones, because they're scared to death of them.
• 21:41
  melissamiskell: And so if a woman comes in and she's like, Oh, I have these mood swings and I can't sleep, and, you know, I also have anxiety when I'm driving or something, you know, those types of things, then a physician is just going to write a prescription that handles that specific symptom. So that's why women, you know, I have women all the time that that come in, they're like, Well, I got this antidepressant, but I don't think I'm depressed. I just have have these moments when I have this brain fog that I can't remember, and so just all of these symptoms that are not actually for antidepressants.
• 22:22
  melissamiskell: And the women typically are the ones who are like but I'm I'm not depressed. And so the antidepressants will just make them numb. You know, that's what they do. You just really don't You don't cry, you don't laugh, you're just no emotion.
• 22:38
  Turo Virta: Yeah, yeah. Like, I'm originally from Finland, so that is, like, Finnish, typical fish. Any? Any emotion. So no, but it's just a joke aside. So is there like, how would you then, can a woman know if her symptoms are rather like, are hormonal rather than physiological?
• 23:04
  melissamiskell: Well, so I have a website called feel better from day one.com, and on that website, there's a whole list of symptoms that you can have from low estrogen, low progesterone and low testosterone. So that would certainly there's there's Google that can help with that as well. But if you have those symptoms listed, you should have your hormones checked
• 23:34
  Turo Virta: and and of course, it's, it's it's often it's so hard to recognize like, or if it's like the geological or hormonal issue, and because there they are, if I understood correctly, they are kind of overlapping also.
• 23:53
  melissamiskell: Yes, the most important thing, though, is that women understand that they don't have to feel this way. This is not what their new norm is. They don't this is not a part of healthy aging. So there, there is relief from their symptoms.
• 24:14
  Turo Virta: And it's there are many, many, would you say it and like that? How many like, if you think percent, it's like, how many women are having some kind of that kind of like, issues or struggles during the menopause that they would need hormone replacement therapy. Or who would say that, you know, you just wait and pass like? What is the like around percentage?
• 24:45
  melissamiskell: So there's only about 20% of women, maybe even a little less, are have no menopausal symptoms. There are some women that are like that.
• 24:53
  melissamiskell: The vast majority, 80% maybe more, have some sort of hormonal, hormonal symptom. But the thing that's also important to remember is the protectiveness that estrogen has that does not have anything really to do with fixing those symptoms, heart disease, bone disease and dementia are also very, very much dependent on the decrease in estrogen that women have in menopause. So estrogen is protective for your heart, your bones and your brain. So even women who aren't symptomatic should still be on estrogen therapy. Wow,
• 25:37
  Turo Virta: always, this is something like I would, I would never think about it even, and probably listeners like who are listening, who don't have, like, any but you know, like, when you say it like that, it's, it's still there is still there is no like negative side, if I correctly, so that's correct.
• 25:57
  Turo Virta: It's only like, even regardless if you have symptoms or not, it should be first of all to get checked. And then even in the worst case, you get, get it, get it. It's there is no real like, it's only possible benefits, what you are getting from it,
• 26:16
  melissamiskell: right? And I mean, the benefits last your entire life. So the, you know, a third of our lives are spent in menopause, so the average age of death at this point is around 80, menopause is around 50, so we still have three decades left, and so certainly you want to feel your best and most optimal and not think At 55 like this is this? Is it? This is as good as it's gonna be. So it's very important.
• 26:53
  Turo Virta: Oh, yeah. What about them? Like, one of the most common like, when people like, let's say that they come to work, they search fitness goals, or they want to lose weight, they have gained weight suddenly, and what they complain to me, or what they often what I hear is that they suddenly gain fat in their belief, and even they haven't changed their diet.
• 27:22
  Turo Virta: So why is that happening? Yeah,
• 27:25
  melissamiskell: it's in that is definitely hormonal. And so as your estrogen and progesterone and testosterone start to decline, then you start to lose muscle mass, and the muscle mass will go as into fat. And so that's one of the main reasons that you get that, that spare tire, kind of, that around your around your middle, is just that decline in in your hormones that makes a change in your body.
• 27:59
  Turo Virta: And why is that? Is there some reason like, why it's specifically on a pillar here?
• 28:03
  Turo Virta: Like, is it do those hormonal changes or, or, what is the, what is the root cause of that?
• 28:12
  Turo Virta: It's like, if it was earlier, let's say that it was in your legs or hips, and now all of sudden, it's, it's you, like, maybe legs or hips are not changing, but you are suddenly gaining fat more on belly area, right?
• 28:28
  melissamiskell: And sometimes, you know, a lot it can be estrogen related, definitely.
• 28:31
  melissamiskell: Sometimes it's cortisol related, because that's where you accumulate fat as you age, is more in that belly area. And you actually start, you know, losing muscle from your hips and legs.
• 28:47
  Turo Virta: Yeah, yeah. And what about them? What about like?
• 28:51
  Turo Virta: There is still one of the most common ways like that, you know, then many people think that, you know, I want to lose it, so it's either eating less or moving more and or even exercising on that, that problem area, like, let's say that if you have gained belly fat, you are doing maybe more up exercises because you think it's going to help to burn more fat on that specific area. Is there? Is there? Like, what is still the way, how you are still, is there some way how to lose fat in specific area, or how in people in menopause was, is there some difference how fat loss is, how you are able to lose in losing fat in what it changes is, if it's if you are in your 20s, if you are in your 40s, in menopause, is there some difference how you are losing that?
• 29:47
  melissamiskell: Well, there really isn't as far as if you're not going to do hormone replacement, it's if you do hormone replacement, you're going to see a difference in that. But otherwise, you know, it, it's so frustrating, right?
• 30:02
  melissamiskell: That it's just like, we'll eat less, or, you know, increase your cardio, and it women will be so frustrated with that because they're just not seeing any change at all.
• 30:13
  Turo Virta: Yeah, no, that's, I was just curious. I didn't want to lead you, to give you the answer, what I actually wanted to hear, because it's, it's often like, it's so misunderstood theme like that, because things would you would have maybe worked in your 20s or 30s, and then at that age, you think that okay, in my 20s, I was just fasting or just not eating or eating less for a month or two months, whatever how long it took, and I got rid of my fat, and now the same things are not working, or even if they work, they you are not able to maintain those results very long. It's all of a sudden you recognize and that all that fat have come back, usually even more. And that is like, still like, because there is no like, like, it's still that calorie deficit, but also you have to, like, especially at that date, you have to do some kind of resistance training to keep me at least, to maintain your muscle mass. Because what happens then, with the metabolism you you are anyway, losing already muscle mass, and if you don't maintain your muscle mass, metabolism, amount of calories you need, it's going to decline. And it means that to maintain everything you need all the time, less and less calories. And of course, those hormonal changes, they affect also on a place where you are gaining to fat but still losing to fat. It's, it's still the same principles as always. It's just blood harder, right?
• 31:55
  melissamiskell: Well, in the loss of testosterone for women is is also going to affect their muscle mass, so it just makes it worse. How?
• 32:04
  Turo Virta: How does it What?
• 32:04
  Turo Virta: What kind of role that esto estrogen is playing in your metabolism. Could you explain a bit more as
• 32:13
  melissamiskell: what estrogen is?
• 32:14
  Turo Virta: Yeah, no, yeah, and how, what kind of role it's it's playing in your metabolism?
• 32:20
  melissamiskell: Yeah, so estrogen is anabolic, and so it's going to help you burn fat.
• 32:25
  melissamiskell: It also is works against inflammation. It dilates your blood vessels, so it makes everything work faster and better. That's, you know, some of the metabolic areas where progesterone is going to is going to be helpful. So and testosterone, of course, it's going to help build muscle mass, so that's where its role comes in.
• 32:57
  Turo Virta: What is the role of hormonal hormone replacement therapy that with the fat loss or cravings? Can it help?
• 33:08
  melissamiskell: I mean, it is going to help with with fat loss. It will help redistribute that cravings is another that's kind of its own kind of deal. I I'm not sure I've seen anything where hormones actually will help with food cravings.
• 33:26
  Turo Virta: No it was. It's just that I want to know. You know, nowadays you see all kind of things in social media, what people are telling and it's this kind of information. It's so, so helpful to hear someone like with your experience and a science background. So thank you. So what is then, if you, if like, you think that now this conversation got some thoughts that maybe that I should need to, I need to get some labs done so well. So most actors, they only test that D is H and I. And what are what labs every woman over 40 to should be testing.
• 34:17
  melissamiskell: Well, definitely, just generally, you should have a complete blood count and a chemistry panel for your hormones. You should have estradiol, progesterone and testosterone. If you're 40 to 55 you should also have a hormone called FSH, follicle stimulating hormone. That's the hormone that gives us some idea of where you are in perimenopause and menopause. So those are, those are the main hormones that that I would recommend.
• 34:51
  Turo Virta: What is the when you get those results? What is the what numbers matter the most?
• 34:55
  Turo Virta: Well,
• 34:58
  melissamiskell: so again, we, we don't look at just lab values.
• 35:03
  melissamiskell: Now, the FSH is, is a standard number. It's gonna if it's over 24 you're in menopause. If it's like eight, then you're still probably menstruating. But if a woman doesn't have a uterus, then she doesn't know that. And so but the other three hormones, estrogen, progesterone, testosterone, I don't really care so much what their lab values are. I care what their symptoms are, and then we put those things together, because every woman's different. So my testosterone might be mid range, and I'm completely happy with that. There might be another woman who has that same level, and her her libido is terrible, so she wants her testosterone to be higher. So every you know, some women have worse hot flashes than others, so their estrogen might need to be higher. So as far as what the lab values are, we just use those as a marker for evaluating symptoms.
• 36:07
  Turo Virta: No, it makes so much sense, like it's and it's we, you still have probably, like, some kind of markers. What do you ideally where you should be, but even if you are in a average range or something, but you still have those symptoms, it might be because it values are not same for each person, like you said, exactly. So that is, that is so important. So what is the if you get, would you conduct into your with some with the doctor, or how you when you get those tests done and and talk like someone, like in your practice, or what is, what would be? Then, when you get those labs done, what, what are the next steps, right?
• 36:55
  melissamiskell: So then, then they would meet with a practitioner, yes, and so they get those labs done before they ever see a practitioner. And so that way the practitioner can look at their symptoms and what their lab results are and design a hormone injection for them that they get that day. So hence why we say feel better from day one.
• 37:16
  Turo Virta: And if then was, I want to end this like with some like practical action steps. So if, if someone who is listening now is feeling exhausted, is having those brain folks or folky and feeling like stuck, what is the first step they should take? The first
• 37:43
  melissamiskell: step is going to be to find a practitioner that is willing to draw labs that does this type of medicine. So in the US, we call them functional medicine doctors, and they're all, you know, medical physicians, but they just think about things a little bit differently. So that's the very first step, is to just talk to your friends, see if anybody has anyone, or do a search to see who might be a bioidentical doctor or a functional medicine doctor,
• 38:24
  Turo Virta: and then then they are able to help from that point on, or, and then it's coming to those Laplace or,
• 38:33
  melissamiskell: yes, they should. They should it not. Most doctors don't practice the way I do. And have labs drawn first so that we can treat them that day, most doctors are going to have them come in, have a meeting and then draw labs and come back
• 38:51
  Turo Virta: and is there then some like lifestyle habits that are supporting healthy hormones.
• 38:59
  melissamiskell: So you know that goes into probably everything that you teach your clients, a good diet, enough sleep, some exercise, all of those things are going to help your hormones to work better and and just make your your life happier.
• 39:18
  Turo Virta: Yeah, yeah. And what is like? Is it? What is the best or most effective way? I don't say best, but the most effective way is it like kind of combination of both. Could it be only hormonal replacement therapy or only like those healthy habits or or does it also depend on person?
• 39:40
  melissamiskell: Well, I think if a woman is symptomatic, then hormones are going to be essential. And when that happens and they get their life back, then the lifestyle stuff is just so much easier, so much easier to be eat healthy when you're happy with yourself and you're not going to starchy, sugary foods for that kind of satisfaction, because you already feel good about yourself, it makes you want to exercise more, eat healthy. All of those things fall into place.
• 40:14
  Turo Virta: Yeah, no. So it's kind of like a cycle, what you are, then when you get first step rolling, then it's second step is lot easier, because it's like in my world, like what I see like, when people are are like, I understand like most people like, they are busy. And then, you know, we find these excuses for ourselves or always.
• 40:36
  Turo Virta: They are not even excuses. They are real life situations. You are telling yourself that you don't have time. You are so exhausted you don't feel like working out, and then they are not working out. And then, you know, of course, how that is leading you are going to feel, you know, you are have lower energy throughout the day. Then your diet is going to go a little bit off. It makes everything even worse. And when you start start step by step, reversing this cycle and getting little bit like doing at least something, instead of just doing nothing, at least starting building habits. And then you start to feel so all of sudden, a bit better. You are eating automatically. If you are working out or going at least for walks, you are most likely eating already or making better decisions with your food, which, again, helps with the sleep, helps with everything. And so it's, it's kind of positive cycle where you get in into it and and it's, I think it's, it's it's the same thing with those hormones like you. It's just a one step which should be then repeated, or helping to take even more steps on a way.
• 41:58
  melissamiskell: Yes, I completely agree.
• 42:02
  Turo Virta: So then, how long does it take, or how quickly do women feel better with the proper hormone treatment?
• 42:12
  melissamiskell: So there, there are different ways to do hormone treatment. You can take it orally, which is the worst way, because then it goes through the second pass of the liver and then systemically. But you can take them orally. You can do a transdermal patch, which everybody absorbs differently.
• 42:32
  melissamiskell: So again, it's hard to regulate.
• 42:32
  melissamiskell: We, like I said, do injections, which is very easy to regulate, and gets into your system automatically. So most women feel better within seven to 10 days, wow, yeah, it's pretty.
• 42:46
  melissamiskell: It's dramatic,
• 42:52
  Turo Virta: yeah, wow, wow. So I want to, I want to ask some, like, personal questions. So what are, what is, for you, most surprising symptom of menopause.
• 43:05
  Turo Virta: Do women mention that the most
• 43:12
  melissamiskell: like the probably the number one thing is hot flashes. That's just the number one thing that women, when they start having in them, then they're like, they usually, typically would know that that's menopause. So that's the number one symptom.
• 43:28
  Turo Virta: Okay, what is the what? What frustrates you the most about how women are treated in traditional medicine?
• 43:37
  melissamiskell: Oh, you mean not heard at all that women are you know, I have another colleague of mine who her favorite thing to say is, I am not a little man, because all of medicine is geared off of men, and so it's super frustrating that women just don't have a voice, and that's why it's important to find a physician that will listen To you, actually listen to you about what your symptoms are. It's very frustrating. I hear that all the time,
• 44:13
  Turo Virta: yeah, yeah. And what is, what is the one thing you wish every doctor understood about menopause
• 44:23
  melissamiskell: that it is not normal aging. It does not have to be like that. That's that is what I wish everyone understood, is that this is not normal.
• 44:33
  melissamiskell: These are symptoms that can be alleviated with with hormones that are what your body made.
• 44:42
  melissamiskell: And so it's it you do that. I mean, that's the number one thing that male doctors love to say is, well, you're just gonna have to deal with it. This is normal aging. It is not,
• 44:54
  Turo Virta: yeah, I was that is, that is what I what I hear like when I I work with the women, and it's often they are just saying that, you know, it is what it is. And it's probably like becoming a normal thing, like if you, especially if you are somewhere that it's not so common, or your friends haven't went through, or someone who you know often, these are things like that. If you know someone personally, it's a different thing. You might have heard about it, but if you, if you, if you don't know anyone who have been through it, who have been that it have been actually helpful. And if all your friends are going through the same things, and they are just saying that, you know that's the normal thing. It's part of aging. It's part of being at this age that these things are normal, and that is actually it's must be frustrating to hear, or it's at least, for me, it's frustrating to hear those things. And when I say that, no, it don't have to be that way,
• 46:01
  melissamiskell: correct? Yeah.
• 46:01
  melissamiskell: Very frustrating. Yeah.
• 46:05
  Turo Virta: So thank you so much. I really, really enjoyed talking, learning from you.
• 46:11
  Turo Virta: Where can listeners find your clinic? Is there? Do you have some resources or learn more about your hormone blueprint?
• 46:23
  melissamiskell: Yes, so feel better from day one.com. Is where people can go and and there's a lot of information on that website about hormones, and specific what the hormones will will help with is symptomatically. And our clinic is called hormones by design.
• 46:45
  melissamiskell: And so either one of those websites will give them tons of information,
• 46:54
  Turo Virta: and I will put those, all those links to show notes. So please make sure you check them from show notes. And is there some is, do you have any social media, anything else you want to share.
• 47:10
  melissamiskell: We have a Facebook page, but typically it would just be better just to go the website.
• 47:16
  Turo Virta: Yeah, yeah, got it.
• 47:16
  Turo Virta: Got it. And what is one message you want every woman to hear about aging and hormones?
• 47:26
  melissamiskell: The number one thing is find a doctor that will listen to you and hormones will change your life. Awesome.
• 47:36
  Turo Virta: Thank you so much, Dr Miskell for sharing your time, your wisdom. I really, really appreciate it. I hope also listeners appreciate it, and I hope you if you learn to understand how your symptoms and your body just to feel even a little bit better, and if you took something valuable from this episode, share it with a friend, a sister, a colleague, someone who is struggling with low energy, sleep problems or weight changes and feels like that they are not getting real answers. You can find all Dr Miskell links, clinic information and resources in the show notes, and if you want support with strength training, improving your habits or creating a balanced lifestyle, you can always check my coaching options at persontainer turo.com thank you again for being here and you are not behind. You are just getting started. Have an amazing day. Awesome. Thank you so much. Thank you. I learned again. So much myself and I hope listeners got also something new, because these are usually topics that are really, really interesting. People are messaging me about these topics, and they want to listen more even it's amazing to have someone like you in the show your experience and the way how you explained everything amazing.
• 49:11
  melissamiskell: Thank you. Thank you so much. I appreciate you asking me
• 49:15
  Turo Virta: thank you. And yeah, I think I will be publishing this episode already next week, Thursday. I published my episodes on Thursday. I will add all the information in the show notes, and if there's anything, just let me know. Okay,
• 49:31
  melissamiskell: thank you so much.
• 49:33
  Turo Virta: Enjoy have a you have a nice weekend. Thank you, bye bye, bye bye.