September 1, 2025 • 26 mins
This podcast episode delves into the complexities of treating this differences between perimenopause and menopause, emphasizing that the challenges experienced during these transitional phases extend far beyond mere hormonal fluctuations. We examine the myriad symptoms that accompany this journey, including weight gain, brain fog, and increased risks of various health conditions such as cardiovascular disease and osteoporosis. Our discourse advocates for a nuanced understanding of these stages, highlighting the necessity for tailored treatment approaches that address the unique needs of women during both perimenopause and menopause. A significant focus is placed on the importance of hormone replacement therapy, alongside lifestyle modifications, as means to alleviate the debilitating effects of these transitions. Ultimately, we aim to empower listeners with knowledge and resources, encouraging them to advocate for their health and well-being amidst societal misconceptions surrounding aging and hormonal health.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:01):
Ever find yourself at 2amlike, what the actual is happening
to me?
Spoiler.
It's not just your hormones.
It's your life cracking wideopen and no one warned you.
I'm Jenna Clinic CEO,menopause whisperer and recovering
people pleaser turned truth slayer.
And I am Dr. Liana, menopauseexpert and medical rebel who's done
(00:21):
playing nice.
Welcome to Smoke, Mirrors and Perimenopause.
We're not here to gracefully age.
We're here to blow shit upwith truth, science and zero Filter.
To follow the show and stepinto your I don't give a fuck era.
No shame, all flame.
Let's do this.
Hello.
Hello, Hello.
(00:44):
Hello.
I had a dream the other nightthat I was speaking in a British
accent.
So I don't know if I don'tknow why, but like, I was with a
group of friends and they wereBritish and I was out here, like,
just all out with my Britishaccent, you know, because, like,
I've been practicing it forsome reason.
(01:04):
I don't know why.
Maybe something weird in theuniverse is preparing me for a British
man.
I don't know.
Maybe.
So I. I just had this dream and.
And my.
My accent was so good.
It was so good in the dream.
I was just like scaring myself.
Yeah.
Oh, God.
Now you put me on the spot.
So it's really difficult, butI really do try to have it to be
(01:27):
Johnny on the spot.
Ready to do, Ready to rule.
I love the accent.
I'm obsessed.
It's so sexy and I just lovethe people.
The people are so great.
I worked over in London forlike a period of time back in my
corporate days and I never hadso much fun.
(01:47):
Oh, my God.
I. I've yet to go to London.
So that's on.
That's on my list.
Let's put that on the list forthe road show.
Let's put that on the list.
Yeah, let's do.
Although, isn't it true that in.
In the UK they actuallyprescribe hormones BHRT to women
as part of like socialized medicine?
(02:07):
Have you ever heard that?
I don't know much about pretty.
I'm pretty sure it's like partof the standard of care.
I think it is.
I think.
Well, yeah, I think it is.
There's a lot more optionsover there, but, you know, I mean,
I'm sure after this episodepeople are going to be shooting us
messages, schooling us on every.
All things.
I love it.
(02:28):
Yeah, I mean, yeah, we'llaccept it.
So.
Yeah.
So today we're talking aboutthe differences in.
In treating perimenopause andmenopause, because they are two different
things.
And then we're also talkinggoing into the ramifications of menopause
because, like, what actually happens.
Right, right.
(02:48):
Like what.
What are the detriments tohealth potentially for women.
Yeah.
If left untreated.
Right.
Mm.
So, I mean, it's easy.
I mean, it's all the symptoms.
Right.
So that's number one.
I know women are familiar withthe symptoms.
The brain fog, the weightgain, the depression, the anxiety,
(03:14):
the insomnia.
Like, I'm going to keep going.
The, the osteoporosis, the.
Did I say heart disease,hypertension, dementia, potentially
insulin resistance.
Neurogenital stuff.
Oh, you're ut.
(03:34):
Urinary tract infections,vaginal dryness, vaginal atrophy,
constipation, diarrhea, likeIBS could also general immune system
dysfunction.
Autoimmunity.
Autoimmunity.
I mean, there's 103 plus symptoms.
Yeah.
We could just be.
Yeah, yeah.
(03:55):
But those are also theramifications, too.
Like the, The.
The.
The disease states.
Right.
So the osteoporosis.
Yeah.
Cardiovascular disease.
So whether that looks likeheart disease or, you know, cerebral
vascular disease, meaning,like, not.
Not that you, you know, Idon't think people get this, but,
(04:15):
like, you can also have, like,plaque and like, cholesterol plaques
sit in, like, the arteries ofyour brain.
Right.
They just think of cholesteroland cholesterol plaques causing heart
attacks.
But you can also.
Like that it's anywhere.
It's also, like, you can alsolay down cholesterol plaques in your
kidneys and your brain, in thecarotid arteries.
Right.
In your neck.
(04:36):
I mean, just.
And a lot of men actually havearterial disease, and it can affect
their sexual function.
So anywhere that you have verysmall capillaries and arteries, like,
if you have inflammation andnot that cholesterol is bad.
I'm not demonizingcholesterol, but if you have oxidized
(04:57):
cholesterol.
Cholesterol.
You know what I mean?
So, like, that's a whole nother.
That's a whole nother episode.
Right.
But like, the, the hormonal.
The hormone deficient statescan increase that risk and.
Yeah, like, hugely.
Like, not just a little bit.
Right.
Not just a little bit.
Like by a lot.
So, so when we're, when we'reevaluating patients clinically, we're
(05:17):
not just looking at the symptomatology.
Right.
Like, that's the whole aspectand foundation for modern menopause
Rx, is that it's Root causebased, it's functional, integrative
approach, holistic approach.
So we're not just definingpatients by symptomatology, but the
goal is to figure out what isat the root of that.
And so I think at the root ofthat, what we're hoping to go beyond
(05:39):
is not just, you know, we'renot just looking and talking about
symptoms.
We're talking about what isactually happening in the body as
a result of going through thisprocess where your hormones become
entirely depleted unlessthey're restored.
Right, right, right.
Because there's no way.
And I want to say that, too.
I love that you said.
Said it that way, like, whenyour hormones are depleted unless
(06:00):
they are restored.
Because there are a lot ofpeople out there who do not want
to take hormone replacementtherapy, because I know in the past
it's gotten a very bad rap.
And there are people who wantto stay completely natural and not
take any form of apharmaceutical, even if it's a bioidentical,
compounded, you know, medication.
(06:21):
And that's okay.
Like, there's nothing wrongwith that.
You are entitled to, you know, your.
The freedom of choice.
Right.
We're all about that.
And we're here to support youeither way.
Right.
We will support you.
I don't always put people on hrt.
I talk to them about risks andbenefits, and I let them make their
own choice.
And however I did to.
(06:46):
To kind of bring it back fullcircle, there are lots of natural
things you can do to boost hormones.
However, in a post menopausalstate, meaning after menopause or
after the hormones drop, it'svery difficult to get them back up
to the levels that arenecessary to protect your brain,
your bones and your heart,your cardiovascular system.
(07:08):
Unless you get them back tothe levels of repleting them with,
you know, actual hormonereplacement therapy.
Yeah.
Does that make sense?
It totally does.
And it's a really good point,because I think in.
In another episode, we talkabout kind of the.
Well, it's about the fda,recent FDA panel and some of the
findings and the reversing of,like, the Women's Health Initiative
(07:30):
study, which was back in 2020.
And part of the challenge inthat study was that the population
was.
Were women who were in their60s already.
So I know that in.
From what I've understood andhave learned about this phase, there's
kind of a window forintervention with hormone replacement
(07:53):
therapy.
Right.
And so those women wereprobably outside that window.
Right, right.
I'm laughing because.
Were you gonna say 2002?
2002.
I think you were gonna say,no, it is accurate.
It was accurate.
And I just like.
But I feel like that's showing.
Like, you know, we're of that generation.
We're of that age of, like, 20.
(08:14):
Yeah.
Not everybody says that.
I mean, I remember vividly 2002.
I know, I know.
I'm just like, oh, my gosh,you just brought it back.
I just got, like a flashback,like, 2004, 2005.
Like.
Yes, yes, you're right.
Yes.
So going back to that, the.
(08:37):
So there's.
There's a time frame aroundintervention for prevention.
Right.
And.
And you know what?
Even that's going away.
I mean, that's going away.
That's.
We're.
We're.
So that's going away because the.
The need for these women thathave missed out on the.
The hormone replacementtherapy in and around the age of
(08:58):
menopause, that they went intomenopause, are now really struggling
with urinary tract infections,which is a huge epidemic.
Someone on social media and I.I forget to look this up, spouted
a number of how much moneygoes into health care based on women
who are in their 70s and up.
They need to be hospitalizedbecause of urinary tract infections.
(09:21):
Like, literally, like a Euro sepsis.
Like, literally having sepsis.
Because the way that weexperience symptoms after menopause
with a uti, it's not the sameas it used to be.
So, like, I.
It's already happening for me.
Like, when I was in my 20s andI had a UTI, I knew, like, the minute
it.
It struck.
Right.
It was like lightning.
(09:42):
Now it's completely different.
So.
Yeah, And I think thestatistic around that is over, like,
50 of women experienceurogenital issues.
Oh, yeah.
Right.
Yeah.
Because perimenopause and postin menopause.
Yeah.
Because of the.
The drying out of mucosal membranes.
So we have vaginal dryness,vaginal atrophy.
(10:03):
And it's not just only I thinkthat people.
People have been.
And this is.
This is like the sexist thingabout it is that people have been
attributing, like, oh, youknow, it's just for, you know, so
women can have better sex.
Right.
Like, that's why we restoretheir vaginal, like, mucosa.
It's like.
No, because what's actuallyhappening is the skin around the
(10:26):
urethra, which is the holewhere your pee comes out of, is right
at the bottom of the vagina.
And when that skin gets very.
It's very thin, it's very gentle.
And when the Skin recedes andgets very dry.
The mucosa around there, youwill definitely have.
You.
You can create a uti.
You will have pain, you willhave symptoms, you can have bleeding.
(10:49):
I mean, there's just a lotthat can happen from that.
And so restoring the vaginalmucosa and having vaginal estrogen
is more than just aboutrestoring sexual function.
It's also about just ensuringthat we.
We have also, you know,optimal urogenital health.
So, yeah, I mean, there's somuch that happens, the metabolic
(11:10):
thing, like the weight gainthing, that so many women complain
about.
I think on average, women gainlike five to ten pounds.
It might be even.
Even, like, annually.
I don't remember the exactstatistic around that.
But what we do know is thatwomen in midlife are three times
more likely to developmetabolic syndrome.
Right?
Whatever that looks like.
(11:31):
Insulin resistance, bloodglucose dysregulation, all of the
above.
So that makes sense.
Right?
So we're seeing the symptom ofweight gain.
We're seeing the symptom of,like, you know, the things that used
to work don't work anymore.
All of that coming into play.
A big one is thecardiovascular risk, right.
I. I believe after age 60, itbecomes the leading cause of death
(11:54):
in women.
And I. I mean, I think it'ssomething like one in three women
will.
Will die over 50 or 60 willdie from cardiovascular disease,
right?
Yeah.
Yeah.
Well, the risk starts after 50for women still.
So it's still a low number.
It's still a low number.
I mean, that's.
That's three years from nowfor me.
(12:15):
Two and a half.
Like, that's wild.
And a lot of that, you know,can be really, you know, going back
to, like, why just.
Why is testosterone notprescribed or regulated for women?
And, you know, lowtestosterone, I mean, having a low
testosterone will accelerateabdominal fat, right?
(12:38):
So that's why the tire in themiddle and people, women, that's
the.
The biggest thing.
Women are like, the tire inthe middle won't go away.
And they'll feel like they'lllook skinny fat.
Right?
They'll be skinny everywhere else.
They'll lose weight.
But they can't lose that body that.
That tire in the middle.
They become insulin resistantbecause of the testosterone.
And then you also haveaccelerated, like, atherosclerosis.
(13:01):
Like my soapbox that I got ona few minutes ago about, you know,
increased plaques in thearteries of your vascular system.
Like, having low testosteronewill accelerate that and then heart
disease in general.
So low, low testosterone canhave a lot of Ramifications.
And so testosterone, really,I've seen in clinical practice, most
(13:23):
of the women that come to meare about in their late 30s, early
40s, with very low tanked testosterone.
And I mean.
In the toilet.
Yeah, in the toilet.
And what I've seen is, youknow, if you have a testosterone
level of 30 or below, usuallyyou feel the symptoms of that.
Sure.
Which are like low libido,brain fog, low energy, feeling like
(13:45):
you can't keep up, you know.
You know, or in a, you know,an orgasmia, like an inability to
climax or have orgasms, likejust so many different things.
And also if the going back tothe ramifications of not treating
your low testosterone, you canend up with osteoporosis.
Like, you need that for your bones.
(14:06):
Yeah.
Not to mention just.
I know for me, when my test,when I started to notice that my
test testosterone wasdropping, because what we know is
that it starts dropping at age 25.
But I guess you have enoughright to not feel the impact of that
until probably your 40s.
For most people.
Yeah.
But I felt like I lost myconfidence, I lost my mojo.
(14:28):
Like my get up and go.
My energy totally shifted, allof that.
And with a little bit ofreplacement and restoration, like,
I got it back.
I got my groove back.
Jenna got a groove back.
So that's a big, that is a big thing.
Let's talk about the mentalhealth stuff.
I know rates of depression andanxiety increase significantly.
(14:51):
We know that the, theincidence of docs prescribing antidepressants
and antianxiety drugsincreases significantly.
I saw a statistic not thatlong ago that the, that women age.
I want to say it's like 45 to60 or 45 to 65 have the highest suicide
(15:13):
rates for any women.
Which to me was pretty shocking.
Right.
Because I, I would, I wouldhave assumed that like younger women
trying to figure it out, youknow, maybe like teen years into
maybe 30, because that's justsuch a transitional identity building
time of life.
So this was really surprisingto me.
Like 45 to 60, right?
(15:35):
Yeah, that is really surprising.
You are a repository of ste.
Statistics.
Told you that.
But like, I mean, I, I'm justnot a person that retains statistic
numbers like that.
Like I'll retain differentkind of knowledge, but like your
brain is, is like has this superpower.
I just wanted to say that.
(15:55):
Well, I'm, I'm very, I'm veryleft brained.
Like, I don't know that I.
Other than from like anentrepreneurial perspective, I don't
really have a creative bone inmy body.
Like, I, I'm like, can come upwith things from a business perspective,
but like, can't draw.
I can't blame you.
I can't do any of that.
So, like, my right brain doesn't.
I'm all left brained.
So.
Yeah.
And for me, I'm very evidencebased, so I need the numbers to support
(16:18):
the information, Support the data.
What?
No.
Yes.
Yes, that.
Yes.
Okay.
I agree with all of that,except I have to say that coming
up with brilliant businessideas is actually creative.
So I'm going to argue that.
Okay.
I think, I think that's the thing.
So that's where you're right brained.
It's just that you're wired tobe right brained for the left brain
(16:41):
thing.
In a left brain way.
Yes, yes.
Yeah.
So we have all these thingsgoing on as we've just detailed,
so what can we do about themand how do we address that differently
in our, you know, when you're40 versus when you're 60.
Right.
Thank you.
(17:02):
Well, so we taught, you know,I think we mentioned the whole paradigm
of how we're treatingmenopause is, is changing because
a lot of the time women willget turned down for hormone replacement
therapy if they're 10 yearsout from menopause, even if it's
surgical menopause.
So I think that's really alsoimportant to note here too.
(17:23):
Like, women are going throughsurgical menopause where they're
getting their lady partsyanked out and go into menopause
literally overnight.
Put that on the list for episodes.
That's a list of.
Yeah, needs to be an episode list.
Surgical menopause.
And also like, some people aregetting one ovary taken out, both
or the full whammy all out.
And it's like, like overnight,overnight, overnight with no support.
(17:47):
And so, you know, I recentlyhad a patient who, you know, we,
we've actually been ramping upher HRT the further out she gets
from her surgery.
But she, they, when she, whenthey talked to her, they were, they
were like, okay, so what?
She's like, what?
Okay, so they took her uterus,they left ovaries, and she's like,
okay, well when's this, whenam I gonna feel this, right?
(18:09):
Like, what am I gonna do aboutmy hormones?
And they're like, oh, you'llbe fine.
Oh, okay, like, what does that mean?
Just, you'll be fine.
That's it.
Like, I don't, I don'tunderstand that.
I don't, I don't understandhow you, how a healthcare professional
like, oh, you'll be fine,don't worry.
Like it, you, you have, you'llhave your ovaries and it's like,
(18:30):
okay, I, I, I've seen and I'veseen and granted I've seen a lot
of women who have had justtheir uterus taken out and then before
the age, like average age of50 to 52, maybe in their 40s.
And then they'll feel themenopause effects because their ovaries
may still be putting out some estrogen.
And then they finally feel themenopause or the low estrogen states
(18:53):
around the age they were kindof supposed to go through real menopause.
I've seen that.
And there are women like thatthat are unicorns in the wild that
will go through their postsurgical phase feeling unscathed.
Now there are women who comeout of the OR wake up the next morning
and they're like, what, theactual different person?
They're like a different person.
(19:15):
Yes.
It shocks me how quicklyconventional medicine is, goes to,
let's just yank that out.
Yeah, it's like they just takeit out and then they're left with,
no, no, no.
Now if you are in surgicalmenopause, you got to work with somebody
because you may be one ofthose unicorns or you may be like
my patient who like needs stepwise.
(19:35):
Like we first, we just startedtestosterone, later on down the road,
then we started progesteroneand soon I'm sure we're going to
need estrogen.
You know what I mean?
So, but that takes constant monitoring.
That takes, that takesconstant monitoring.
That takes like working withsomeone on a regular basis and doing
(19:55):
all the holistic stuff too,because at that point you can still
naturally do things to boostyour hormones if you still have your
ovaries.
So anyway, that's kind of atangent and that, that's definitely
another episode, but myperimenopause brain is kicking in.
What were we talking about?
So we're so sorry, kind of towrap this segment up, we were talking
(20:16):
about we, Right.
We have all these things goingon, symptoms as well as underlying,
like inherent risk.
Right.
Due to the hormones.
How do we address that inperimenopause and menopause?
Oh, right.
So treating, yeah, treatingperimenopause and menopause differently.
So definitely there's a bigdifference from a clinical standpoint.
(20:39):
If you're, if you are someonewho is not having a hysterectomy
and you're not having yourlady parts taken out naturally in
perimenopause, the treatmentapproach is different and again,
that's why you need constant monitoring.
Like sometimes it can be everythree to six months that you need
your hormones looked at.
Like it's not good enough tohave a one time snapshot of blood
(21:02):
work.
Like, yeah, I can gauge what'shappening with one time snapshot.
I can, I can help make a careplan out of that.
But I'm still going to needhormones again in three months.
You know, I'm still going toneed, I'm going to need to see a
trend and see where things aregoing to tweak things to, you know,
because the natural state ofperimenopause is that hormones will
(21:25):
fluctuate and sometimes we'll,we'll have, and this is another episode
too.
We need to be, we need, I needto be, we need to be taking notes
on what episodes.
Yeah, right.
But like we need, but youknow, estrogen will fluctuate up
and down and there will betimes and months where your cycle
is really good or be cyclewill be really bad and the cycle
(21:48):
length will change over time.
So in perimenopause it's just,the uncertainty is just the nature
of it.
And that's what can maketreating it so hard.
Because one month you couldneed estrogen and the other month
you don't.
And that's my pet peeve withlike throwing so much fiber at women
because fiber binds estrogenin the large intestine.
(22:09):
And if we're telling everyonein perimenopause ton of fiber to
like take a ton of fiber, whatdo you do on the months where your
estrogen's already going to be low?
Like then you're going to feelreally low estrogen, you know what
I'm saying?
So it's like you have to know,you have to be really in tune with
your body.
And this is why lifestyle matters.
Because you have to know whento pull back on fiber.
(22:30):
You have to know when to carbcycle, you have to know all these
things.
And that's what we help youwith in the modern menopause method.
But it's true, it's true, youknow that I mean, all joking aside,
like, you've really got towork with someone who's gonna take
that roller coaster ride withyou and be willing to walk you through
it.
Now in menopause, like full onmenopause, women have already stopped
(22:53):
a period for 12 months.
There's, they're, they're,they're golden, right?
The golden girls.
They're Golden.
It's so easy for me.
It's so easy for me as a clinician.
I'm like, okay, one timesnapshot, you were probably good
to go.
You know, that's all I need.
And we can start all thethings right away.
(23:14):
And obviously it's anindividual approach, right?
I'm, I'm, I'm saying that alittle tongue in cheek, but, you
know, it, it is generally mucheasier for me in practice when someone's
already menopausal, like,because I know that since they're
technically menopausal, thingsare going to be more stable, right.
They're not going to bechanging like they were in perimenopause.
(23:36):
So I know that the estrogen isgoing to be super low.
And, and if I check again inthree months, it's probably going
to be low again.
Like, just what it's going to be.
So you don't have this wildride of estrogen that's taking place
because, like, what'shappening is that, yes, your testosterone,
testosterone tends to drop,like linearly.
Your progesterone for mostwomen drops linearly, but when you're
(23:58):
perimenopausal woman, it's.
Your estrogen is a frickinroller coaster.
Like literally one day to thenext could look totally different.
I know with me, I had a problem.
One of my, one of theproviders I was working with had
put me on a compounded creamthat actually had progesterone, estrogen
and testosterone all in one compound.
But the challenge was like,okay, yeah, testosterone, progesterone,
(24:20):
probably should have beentogether, but I'm still perimenopausal,
I'm still cycling.
So I would get to pointswithin my cycle where I was feeling
totally estrogen dominant andI would just have to stop all my
hormones because of how theywere being prescribed and delivered
to me.
So it's super important aswell just to work with a provider
who understands that andunderstands how these things can
(24:42):
be delivered and dosedappropriately based on where you
are in the process.
Yeah, yeah, that's everything.
Thank you for beautifullysumming that up.
Your.
Your right brain just went.
Left it up with a left brain explanation.
Thank you.
(25:02):
And there's a lot more we cantalk about with respect to that.
Right.
So, yeah.
So out of this episode we'vealready covered, we've got three
new episodes that we need to.
Then came out of this one.
All good.
All right, Is that a wrap forus for this?
That's a wrap.
All right, y', all, see you soon.
(25:22):
All right all flame, no shame.
Bye all.
We hope you love the show asmuch as we love doing it.
To learn more and join themodern menopause movement, visit
modernmenow.com that'smodernmenow.com because.
This conversation doesn't end here.
And until next time, keepquestioning the smoke and mirrors.
And remember, you're notlosing your mind, you're finding
(25:45):
your truth and a quick.
But boring disclaimer justnecessary to say anything discussed
in this podcast is foreducational and informational purposes
only and solely as a self helptool for your own use.
We are not providing medical,psychological or nutrition therapy
advice.
You should not use thisinformation to diagnose or treat
any health problems or anyillnesses without consulting your
own medical practitioner.
(26:05):
Always seek the advice of yourown medical practitioner and or mental
health provider about yourspecific health situation.
Even though I am a doctor andphysician, I am not your physician
and this podcast does notcreate a doctor patient relationship.
Ever find yourself at 2amlike, what the actual is happening
to me?
Spoiler.
It's not just your hormones.
It's your life cracking wideopen and no one warned you.
I'm Jenna Clinic CEO,menopause whisperer and recovering
people pleaser turned truth slayer.
And I am Dr. Liana, menopauseexpert and medical rebel who's done
(00:21):
playing nice.
Welcome to Smoke, Mirrors and Perimenopause.
We're not here to gracefully age.
We're here to blow shit upwith truth, science and zero Filter.
To follow the show and stepinto your I don't give a fuck era.
No shame, all flame.
Let's do this.
Hello.
Hello, Hello.
(00:44):
Hello.
I had a dream the other nightthat I was speaking in a British
accent.
So I don't know if I don'tknow why, but like, I was with a
group of friends and they wereBritish and I was out here, like,
just all out with my Britishaccent, you know, because, like,
I've been practicing it forsome reason.
(01:04):
I don't know why.
Maybe something weird in theuniverse is preparing me for a British
man.
I don't know.
Maybe.
So I. I just had this dream and.
And my.
My accent was so good.
It was so good in the dream.
I was just like scaring myself.
Yeah.
Oh, God.
Now you put me on the spot.
So it's really difficult, butI really do try to have it to be
(01:27):
Johnny on the spot.
Ready to do, Ready to rule.
I love the accent.
I'm obsessed.
It's so sexy and I just lovethe people.
The people are so great.
I worked over in London forlike a period of time back in my
corporate days and I never hadso much fun.
(01:47):
Oh, my God.
I. I've yet to go to London.
So that's on.
That's on my list.
Let's put that on the list forthe road show.
Let's put that on the list.
Yeah, let's do.
Although, isn't it true that in.
In the UK they actuallyprescribe hormones BHRT to women
as part of like socialized medicine?
(02:07):
Have you ever heard that?
I don't know much about pretty.
I'm pretty sure it's like partof the standard of care.
I think it is.
I think.
Well, yeah, I think it is.
There's a lot more optionsover there, but, you know, I mean,
I'm sure after this episodepeople are going to be shooting us
messages, schooling us on every.
All things.
I love it.
(02:28):
Yeah, I mean, yeah, we'llaccept it.
So.
Yeah.
So today we're talking aboutthe differences in.
In treating perimenopause andmenopause, because they are two different
things.
And then we're also talkinggoing into the ramifications of menopause
because, like, what actually happens.
Right, right.
(02:48):
Like what.
What are the detriments tohealth potentially for women.
Yeah.
If left untreated.
Right.
Mm.
So, I mean, it's easy.
I mean, it's all the symptoms.
Right.
So that's number one.
I know women are familiar withthe symptoms.
The brain fog, the weightgain, the depression, the anxiety,
(03:14):
the insomnia.
Like, I'm going to keep going.
The, the osteoporosis, the.
Did I say heart disease,hypertension, dementia, potentially
insulin resistance.
Neurogenital stuff.
Oh, you're ut.
(03:34):
Urinary tract infections,vaginal dryness, vaginal atrophy,
constipation, diarrhea, likeIBS could also general immune system
dysfunction.
Autoimmunity.
Autoimmunity.
I mean, there's 103 plus symptoms.
Yeah.
We could just be.
Yeah, yeah.
(03:55):
But those are also theramifications, too.
Like the, The.
The.
The disease states.
Right.
So the osteoporosis.
Yeah.
Cardiovascular disease.
So whether that looks likeheart disease or, you know, cerebral
vascular disease, meaning,like, not.
Not that you, you know, Idon't think people get this, but,
(04:15):
like, you can also have, like,plaque and like, cholesterol plaques
sit in, like, the arteries ofyour brain.
Right.
They just think of cholesteroland cholesterol plaques causing heart
attacks.
But you can also.
Like that it's anywhere.
It's also, like, you can alsolay down cholesterol plaques in your
kidneys and your brain, in thecarotid arteries.
Right.
In your neck.
(04:36):
I mean, just.
And a lot of men actually havearterial disease, and it can affect
their sexual function.
So anywhere that you have verysmall capillaries and arteries, like,
if you have inflammation andnot that cholesterol is bad.
I'm not demonizingcholesterol, but if you have oxidized
(04:57):
cholesterol.
Cholesterol.
You know what I mean?
So, like, that's a whole nother.
That's a whole nother episode.
Right.
But like, the, the hormonal.
The hormone deficient statescan increase that risk and.
Yeah, like, hugely.
Like, not just a little bit.
Right.
Not just a little bit.
Like by a lot.
So, so when we're, when we'reevaluating patients clinically, we're
(05:17):
not just looking at the symptomatology.
Right.
Like, that's the whole aspectand foundation for modern menopause
Rx, is that it's Root causebased, it's functional, integrative
approach, holistic approach.
So we're not just definingpatients by symptomatology, but the
goal is to figure out what isat the root of that.
And so I think at the root ofthat, what we're hoping to go beyond
(05:39):
is not just, you know, we'renot just looking and talking about
symptoms.
We're talking about what isactually happening in the body as
a result of going through thisprocess where your hormones become
entirely depleted unlessthey're restored.
Right, right, right.
Because there's no way.
And I want to say that, too.
I love that you said.
Said it that way, like, whenyour hormones are depleted unless
(06:00):
they are restored.
Because there are a lot ofpeople out there who do not want
to take hormone replacementtherapy, because I know in the past
it's gotten a very bad rap.
And there are people who wantto stay completely natural and not
take any form of apharmaceutical, even if it's a bioidentical,
compounded, you know, medication.
(06:21):
And that's okay.
Like, there's nothing wrongwith that.
You are entitled to, you know, your.
The freedom of choice.
Right.
We're all about that.
And we're here to support youeither way.
Right.
We will support you.
I don't always put people on hrt.
I talk to them about risks andbenefits, and I let them make their
own choice.
And however I did to.
(06:46):
To kind of bring it back fullcircle, there are lots of natural
things you can do to boost hormones.
However, in a post menopausalstate, meaning after menopause or
after the hormones drop, it'svery difficult to get them back up
to the levels that arenecessary to protect your brain,
your bones and your heart,your cardiovascular system.
(07:08):
Unless you get them back tothe levels of repleting them with,
you know, actual hormonereplacement therapy.
Yeah.
Does that make sense?
It totally does.
And it's a really good point,because I think in.
In another episode, we talkabout kind of the.
Well, it's about the fda,recent FDA panel and some of the
findings and the reversing of,like, the Women's Health Initiative
(07:30):
study, which was back in 2020.
And part of the challenge inthat study was that the population
was.
Were women who were in their60s already.
So I know that in.
From what I've understood andhave learned about this phase, there's
kind of a window forintervention with hormone replacement
(07:53):
therapy.
Right.
And so those women wereprobably outside that window.
Right, right.
I'm laughing because.
Were you gonna say 2002?
2002.
I think you were gonna say,no, it is accurate.
It was accurate.
And I just like.
But I feel like that's showing.
Like, you know, we're of that generation.
We're of that age of, like, 20.
(08:14):
Yeah.
Not everybody says that.
I mean, I remember vividly 2002.
I know, I know.
I'm just like, oh, my gosh,you just brought it back.
I just got, like a flashback,like, 2004, 2005.
Like.
Yes, yes, you're right.
Yes.
So going back to that, the.
(08:37):
So there's.
There's a time frame aroundintervention for prevention.
Right.
And.
And you know what?
Even that's going away.
I mean, that's going away.
That's.
We're.
We're.
So that's going away because the.
The need for these women thathave missed out on the.
The hormone replacementtherapy in and around the age of
(08:58):
menopause, that they went intomenopause, are now really struggling
with urinary tract infections,which is a huge epidemic.
Someone on social media and I.I forget to look this up, spouted
a number of how much moneygoes into health care based on women
who are in their 70s and up.
They need to be hospitalizedbecause of urinary tract infections.
(09:21):
Like, literally, like a Euro sepsis.
Like, literally having sepsis.
Because the way that weexperience symptoms after menopause
with a uti, it's not the sameas it used to be.
So, like, I.
It's already happening for me.
Like, when I was in my 20s andI had a UTI, I knew, like, the minute
it.
It struck.
Right.
It was like lightning.
(09:42):
Now it's completely different.
So.
Yeah, And I think thestatistic around that is over, like,
50 of women experienceurogenital issues.
Oh, yeah.
Right.
Yeah.
Because perimenopause and postin menopause.
Yeah.
Because of the.
The drying out of mucosal membranes.
So we have vaginal dryness,vaginal atrophy.
(10:03):
And it's not just only I thinkthat people.
People have been.
And this is.
This is like the sexist thingabout it is that people have been
attributing, like, oh, youknow, it's just for, you know, so
women can have better sex.
Right.
Like, that's why we restoretheir vaginal, like, mucosa.
It's like.
No, because what's actuallyhappening is the skin around the
(10:26):
urethra, which is the holewhere your pee comes out of, is right
at the bottom of the vagina.
And when that skin gets very.
It's very thin, it's very gentle.
And when the Skin recedes andgets very dry.
The mucosa around there, youwill definitely have.
You.
You can create a uti.
You will have pain, you willhave symptoms, you can have bleeding.
(10:49):
I mean, there's just a lotthat can happen from that.
And so restoring the vaginalmucosa and having vaginal estrogen
is more than just aboutrestoring sexual function.
It's also about just ensuringthat we.
We have also, you know,optimal urogenital health.
So, yeah, I mean, there's somuch that happens, the metabolic
(11:10):
thing, like the weight gainthing, that so many women complain
about.
I think on average, women gainlike five to ten pounds.
It might be even.
Even, like, annually.
I don't remember the exactstatistic around that.
But what we do know is thatwomen in midlife are three times
more likely to developmetabolic syndrome.
Right?
Whatever that looks like.
(11:31):
Insulin resistance, bloodglucose dysregulation, all of the
above.
So that makes sense.
Right?
So we're seeing the symptom ofweight gain.
We're seeing the symptom of,like, you know, the things that used
to work don't work anymore.
All of that coming into play.
A big one is thecardiovascular risk, right.
I. I believe after age 60, itbecomes the leading cause of death
(11:54):
in women.
And I. I mean, I think it'ssomething like one in three women
will.
Will die over 50 or 60 willdie from cardiovascular disease,
right?
Yeah.
Yeah.
Well, the risk starts after 50for women still.
So it's still a low number.
It's still a low number.
I mean, that's.
That's three years from nowfor me.
(12:15):
Two and a half.
Like, that's wild.
And a lot of that, you know,can be really, you know, going back
to, like, why just.
Why is testosterone notprescribed or regulated for women?
And, you know, lowtestosterone, I mean, having a low
testosterone will accelerateabdominal fat, right?
(12:38):
So that's why the tire in themiddle and people, women, that's
the.
The biggest thing.
Women are like, the tire inthe middle won't go away.
And they'll feel like they'lllook skinny fat.
Right?
They'll be skinny everywhere else.
They'll lose weight.
But they can't lose that body that.
That tire in the middle.
They become insulin resistantbecause of the testosterone.
And then you also haveaccelerated, like, atherosclerosis.
(13:01):
Like my soapbox that I got ona few minutes ago about, you know,
increased plaques in thearteries of your vascular system.
Like, having low testosteronewill accelerate that and then heart
disease in general.
So low, low testosterone canhave a lot of Ramifications.
And so testosterone, really,I've seen in clinical practice, most
(13:23):
of the women that come to meare about in their late 30s, early
40s, with very low tanked testosterone.
And I mean.
In the toilet.
Yeah, in the toilet.
And what I've seen is, youknow, if you have a testosterone
level of 30 or below, usuallyyou feel the symptoms of that.
Sure.
Which are like low libido,brain fog, low energy, feeling like
(13:45):
you can't keep up, you know.
You know, or in a, you know,an orgasmia, like an inability to
climax or have orgasms, likejust so many different things.
And also if the going back tothe ramifications of not treating
your low testosterone, you canend up with osteoporosis.
Like, you need that for your bones.
(14:06):
Yeah.
Not to mention just.
I know for me, when my test,when I started to notice that my
test testosterone wasdropping, because what we know is
that it starts dropping at age 25.
But I guess you have enoughright to not feel the impact of that
until probably your 40s.
For most people.
Yeah.
But I felt like I lost myconfidence, I lost my mojo.
(14:28):
Like my get up and go.
My energy totally shifted, allof that.
And with a little bit ofreplacement and restoration, like,
I got it back.
I got my groove back.
Jenna got a groove back.
So that's a big, that is a big thing.
Let's talk about the mentalhealth stuff.
I know rates of depression andanxiety increase significantly.
(14:51):
We know that the, theincidence of docs prescribing antidepressants
and antianxiety drugsincreases significantly.
I saw a statistic not thatlong ago that the, that women age.
I want to say it's like 45 to60 or 45 to 65 have the highest suicide
(15:13):
rates for any women.
Which to me was pretty shocking.
Right.
Because I, I would, I wouldhave assumed that like younger women
trying to figure it out, youknow, maybe like teen years into
maybe 30, because that's justsuch a transitional identity building
time of life.
So this was really surprisingto me.
Like 45 to 60, right?
(15:35):
Yeah, that is really surprising.
You are a repository of ste.
Statistics.
Told you that.
But like, I mean, I, I'm justnot a person that retains statistic
numbers like that.
Like I'll retain differentkind of knowledge, but like your
brain is, is like has this superpower.
I just wanted to say that.
(15:55):
Well, I'm, I'm very, I'm veryleft brained.
Like, I don't know that I.
Other than from like anentrepreneurial perspective, I don't
really have a creative bone inmy body.
Like, I, I'm like, can come upwith things from a business perspective,
but like, can't draw.
I can't blame you.
I can't do any of that.
So, like, my right brain doesn't.
I'm all left brained.
So.
Yeah.
And for me, I'm very evidencebased, so I need the numbers to support
(16:18):
the information, Support the data.
What?
No.
Yes.
Yes, that.
Yes.
Okay.
I agree with all of that,except I have to say that coming
up with brilliant businessideas is actually creative.
So I'm going to argue that.
Okay.
I think, I think that's the thing.
So that's where you're right brained.
It's just that you're wired tobe right brained for the left brain
(16:41):
thing.
In a left brain way.
Yes, yes.
Yeah.
So we have all these thingsgoing on as we've just detailed,
so what can we do about themand how do we address that differently
in our, you know, when you're40 versus when you're 60.
Right.
Thank you.
(17:02):
Well, so we taught, you know,I think we mentioned the whole paradigm
of how we're treatingmenopause is, is changing because
a lot of the time women willget turned down for hormone replacement
therapy if they're 10 yearsout from menopause, even if it's
surgical menopause.
So I think that's really alsoimportant to note here too.
(17:23):
Like, women are going throughsurgical menopause where they're
getting their lady partsyanked out and go into menopause
literally overnight.
Put that on the list for episodes.
That's a list of.
Yeah, needs to be an episode list.
Surgical menopause.
And also like, some people aregetting one ovary taken out, both
or the full whammy all out.
And it's like, like overnight,overnight, overnight with no support.
(17:47):
And so, you know, I recentlyhad a patient who, you know, we,
we've actually been ramping upher HRT the further out she gets
from her surgery.
But she, they, when she, whenthey talked to her, they were, they
were like, okay, so what?
She's like, what?
Okay, so they took her uterus,they left ovaries, and she's like,
okay, well when's this, whenam I gonna feel this, right?
(18:09):
Like, what am I gonna do aboutmy hormones?
And they're like, oh, you'llbe fine.
Oh, okay, like, what does that mean?
Just, you'll be fine.
That's it.
Like, I don't, I don'tunderstand that.
I don't, I don't understandhow you, how a healthcare professional
like, oh, you'll be fine,don't worry.
Like it, you, you have, you'llhave your ovaries and it's like,
(18:30):
okay, I, I, I've seen and I'veseen and granted I've seen a lot
of women who have had justtheir uterus taken out and then before
the age, like average age of50 to 52, maybe in their 40s.
And then they'll feel themenopause effects because their ovaries
may still be putting out some estrogen.
And then they finally feel themenopause or the low estrogen states
(18:53):
around the age they were kindof supposed to go through real menopause.
I've seen that.
And there are women like thatthat are unicorns in the wild that
will go through their postsurgical phase feeling unscathed.
Now there are women who comeout of the OR wake up the next morning
and they're like, what, theactual different person?
They're like a different person.
(19:15):
Yes.
It shocks me how quicklyconventional medicine is, goes to,
let's just yank that out.
Yeah, it's like they just takeit out and then they're left with,
no, no, no.
Now if you are in surgicalmenopause, you got to work with somebody
because you may be one ofthose unicorns or you may be like
my patient who like needs stepwise.
(19:35):
Like we first, we just startedtestosterone, later on down the road,
then we started progesteroneand soon I'm sure we're going to
need estrogen.
You know what I mean?
So, but that takes constant monitoring.
That takes, that takesconstant monitoring.
That takes like working withsomeone on a regular basis and doing
(19:55):
all the holistic stuff too,because at that point you can still
naturally do things to boostyour hormones if you still have your
ovaries.
So anyway, that's kind of atangent and that, that's definitely
another episode, but myperimenopause brain is kicking in.
What were we talking about?
So we're so sorry, kind of towrap this segment up, we were talking
(20:16):
about we, Right.
We have all these things goingon, symptoms as well as underlying,
like inherent risk.
Right.
Due to the hormones.
How do we address that inperimenopause and menopause?
Oh, right.
So treating, yeah, treatingperimenopause and menopause differently.
So definitely there's a bigdifference from a clinical standpoint.
(20:39):
If you're, if you are someonewho is not having a hysterectomy
and you're not having yourlady parts taken out naturally in
perimenopause, the treatmentapproach is different and again,
that's why you need constant monitoring.
Like sometimes it can be everythree to six months that you need
your hormones looked at.
Like it's not good enough tohave a one time snapshot of blood
(21:02):
work.
Like, yeah, I can gauge what'shappening with one time snapshot.
I can, I can help make a careplan out of that.
But I'm still going to needhormones again in three months.
You know, I'm still going toneed, I'm going to need to see a
trend and see where things aregoing to tweak things to, you know,
because the natural state ofperimenopause is that hormones will
(21:25):
fluctuate and sometimes we'll,we'll have, and this is another episode
too.
We need to be, we need, I needto be, we need to be taking notes
on what episodes.
Yeah, right.
But like we need, but youknow, estrogen will fluctuate up
and down and there will betimes and months where your cycle
is really good or be cyclewill be really bad and the cycle
(21:48):
length will change over time.
So in perimenopause it's just,the uncertainty is just the nature
of it.
And that's what can maketreating it so hard.
Because one month you couldneed estrogen and the other month
you don't.
And that's my pet peeve withlike throwing so much fiber at women
because fiber binds estrogenin the large intestine.
(22:09):
And if we're telling everyonein perimenopause ton of fiber to
like take a ton of fiber, whatdo you do on the months where your
estrogen's already going to be low?
Like then you're going to feelreally low estrogen, you know what
I'm saying?
So it's like you have to know,you have to be really in tune with
your body.
And this is why lifestyle matters.
Because you have to know whento pull back on fiber.
(22:30):
You have to know when to carbcycle, you have to know all these
things.
And that's what we help youwith in the modern menopause method.
But it's true, it's true, youknow that I mean, all joking aside,
like, you've really got towork with someone who's gonna take
that roller coaster ride withyou and be willing to walk you through
it.
Now in menopause, like full onmenopause, women have already stopped
(22:53):
a period for 12 months.
There's, they're, they're,they're golden, right?
The golden girls.
They're Golden.
It's so easy for me.
It's so easy for me as a clinician.
I'm like, okay, one timesnapshot, you were probably good
to go.
You know, that's all I need.
And we can start all thethings right away.
(23:14):
And obviously it's anindividual approach, right?
I'm, I'm, I'm saying that alittle tongue in cheek, but, you
know, it, it is generally mucheasier for me in practice when someone's
already menopausal, like,because I know that since they're
technically menopausal, thingsare going to be more stable, right.
They're not going to bechanging like they were in perimenopause.
(23:36):
So I know that the estrogen isgoing to be super low.
And, and if I check again inthree months, it's probably going
to be low again.
Like, just what it's going to be.
So you don't have this wildride of estrogen that's taking place
because, like, what'shappening is that, yes, your testosterone,
testosterone tends to drop,like linearly.
Your progesterone for mostwomen drops linearly, but when you're
(23:58):
perimenopausal woman, it's.
Your estrogen is a frickinroller coaster.
Like literally one day to thenext could look totally different.
I know with me, I had a problem.
One of my, one of theproviders I was working with had
put me on a compounded creamthat actually had progesterone, estrogen
and testosterone all in one compound.
But the challenge was like,okay, yeah, testosterone, progesterone,
(24:20):
probably should have beentogether, but I'm still perimenopausal,
I'm still cycling.
So I would get to pointswithin my cycle where I was feeling
totally estrogen dominant andI would just have to stop all my
hormones because of how theywere being prescribed and delivered
to me.
So it's super important aswell just to work with a provider
who understands that andunderstands how these things can
(24:42):
be delivered and dosedappropriately based on where you
are in the process.
Yeah, yeah, that's everything.
Thank you for beautifullysumming that up.
Your.
Your right brain just went.
Left it up with a left brain explanation.
Thank you.
(25:02):
And there's a lot more we cantalk about with respect to that.
Right.
So, yeah.
So out of this episode we'vealready covered, we've got three
new episodes that we need to.
Then came out of this one.
All good.
All right, Is that a wrap forus for this?
That's a wrap.
All right, y', all, see you soon.
(25:22):
All right all flame, no shame.
Bye all.
We hope you love the show asmuch as we love doing it.
To learn more and join themodern menopause movement, visit
modernmenow.com that'smodernmenow.com because.
This conversation doesn't end here.
And until next time, keepquestioning the smoke and mirrors.
And remember, you're notlosing your mind, you're finding
(25:45):
your truth and a quick.
But boring disclaimer justnecessary to say anything discussed
in this podcast is foreducational and informational purposes
only and solely as a self helptool for your own use.
We are not providing medical,psychological or nutrition therapy
advice.
You should not use thisinformation to diagnose or treat
any health problems or anyillnesses without consulting your
own medical practitioner.
(26:05):
Always seek the advice of yourown medical practitioner and or mental
health provider about yourspecific health situation.
Even though I am a doctor andphysician, I am not your physician
and this podcast does notcreate a doctor patient relationship.
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