August 19, 2025 • 37 mins
Dr. Sarah Daccarett is a board-certified physician, hormone specialist, and founder and CEO of Inner Balance, a personalized hormone therapy platform that just closed a significant investment round and is scaling quickly.
Today’s episode is all about menopause (perimenopause, menopause, and post-menopause) and the physical, emotional, and hormonal shifts that come with it. We talk about common symptoms, how they’re often dismissed or misdiagnosed, and what women can do to start feeling better.
Now, Dr. Sarah’s expertise is in hormone replacement therapy, so that’s a big part of our discussion. But there are many approaches to menopause care, and this episode is meant to inform, not prescribe. My hope is that it helps you feel more seen, ask better questions, and advocate for a path that feels right for you.
This conversation is not medical advice. It’s for informational purposes only. Always consult your licensed healthcare provider when making decisions about your personal health.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 2 (00:08):
Welcome to how I Built my Small Business.
I'm Anne McEntee.
Your host and today's guest isDr Sarah Dacorette, a
board-certified physician,hormone specialist and founder
and CEO of Inner Balance, apersonalized hormone therapy
platform that just closed asignificant investment round and
is scaling quickly.
(00:28):
Dr Sarah is on a mission tohelp women take control of their
health, while also highlightingthe serious gaps in women's
medical care and research.
Today's episode is all aboutmenopause, perimenopause,
menopause and postmenopause isall about menopause,
perimenopause, menopause andpostmenopause and the physical,
emotional and hormonal shiftsthat come with it.
(00:53):
We talk about common symptoms,how they're often dismissed or
misdiagnosed, and what women cando to start feeling better Now.
Dr Sarah's expertise is inhormone replacement therapy, so
that's a big part of ourdiscussion, but there are many
approaches to menopause care andthis episode is meant to inform
, not prescribe.
My hope is that it helps youfeel more seen, ask better
questions and advocate for apath that feels right for you.
(01:16):
This conversation is notmedical advice.
It's for informational purposesonly.
Speaker 1 (01:25):
Women shouldn't feel like, oh, I'm 35.
I'm too young to be goingthrough this.
That is not true.
You could be 28 and goingthrough it.
It could be your genetics, itcould be your environment, it
could be your stress, likeeverything that's combining
together to make your ovariesfatigue or fail.
There's no rule book that youshould or shouldn't be doing
this.
Your body is just doing it andyou need to support it.
So if they remember that, thenthey'll kind of take some of the
(01:47):
shame away, because I alsothink, as we're aging, women
feel more shame about thisperimenopause, that they
shouldn't be aging.
That's not true.
We need to age, but we need tosupport ourself aging.
A lot of the first signs andsymptoms are ignored, because
one it'll be like slow weightgain, and then it'll be like
slow weight gain, and then it'llbe attributed to I'm not
(02:08):
exercising enough or I'm noteating well enough.
A lot of the early signs can beanxiety or stress, even
depression or low mood, and thenthey'll think that it's just
something like their job ortheir kids or their life or
their husband or partner orwhatever, and they don't
attribute it to a drop inhormones and then they'll even
maybe start an antidepressant oranti-anxiety, because that's
what they're offered.
You know, another early sign isinsomnia, and the sleep
(02:29):
disruption is fairly hormonalalmost all the time.
And so a lot of these earlysigns get missed.
They get attributed tosomething else.
They're told that they haveleaky gut.
Oh, I have all these foodinsensitivities.
I have bloating.
They say 90% of the populationis bloated.
Now this can be drop inhormones that cause this
bloating.
Women will have high cortisol.
That's an early sign, and thenthey'll say that all of their
(02:50):
problems are from cortisol.
So you can kind of see how wewill miss perimenopause for a
very long time until she's goingmad and then finally her
symptoms are so bad that we'llfinally recognize her and tell
her that she's perimenopause inher 40s, but when she's actually
been struggling for probably adecade.
Autoimmunity women are like fourtimes as likely to get it and
the hormones drop first and thenthe autoimmunity comes.
(03:12):
So autoimmunity is also anearly sign that hormones are not
optimal, because our hormonesare needed in a woman's body to
boost and modulate the immunesystem.
When autoimmunity presents, weshould automatically be thinking
low hormones, but we don't.
They're going to their generalpractitioner, their OB-GYN,
their primary care physician, anendocrinologist.
It's like going to your dentistto ask about your back pain.
(03:34):
You're going to a doctor that'snot specialized.
They have no idea.
What women need instead need tobe thinking is when do I need to
see a specialist?
So this is like you get whatyou pay for.
You want to go to somebody whoonly does that thing.
You know if you're going to goto a surgery, you're only going
to go to the surgeon that doesthat thing right.
So women need to start thinkingabout hormones as an entirely
different medical specialty andthey need to be thinking about
(03:57):
it early, even in your twenties,like should we be getting
baseline panels so that womenknow what their hormones are
when they're younger?
Probably because you can startto see the decline when they
start feeling they lost thatkind of vibrancy in life.
They should be thinking aboutit, because hormones literally
give us that life force that weneed.
Speaker 2 (04:15):
And how do you help women distinguish between normal
aging and symptoms they don'thave to tolerate?
So what's the line we?
Speaker 1 (04:26):
have to age, but we don't have to feel terrible
while we're aging.
So we really have the choice ofhow we want to age.
Now you have to age, but youdon't have to have joint pain,
muscle aches, really heavyperiods, painful periods, awful
skin and hair bloating, weightgain, anxiety, depression,
irritability, insomnia, vaginaldryness, low libido.
I could go on and on.
(04:46):
So, as the ovaries start tofail and fatigue, what happens
first is the ovaries cannot makeprogesterone, which is our main
hormone.
So then the brain freaks out,starts making FSH.
Fsh is a follicle stimulatinghormone that will rise and it's
a feedback loop.
So it'll stimulate the ovariesto try to make more hormone, but
the ovaries cannot.
They cannot no longer makeprogesterone in like reasonable
(05:09):
quantities and they can makelike a spike of estrogen, and so
women in perimenopause willfeel somewhat of a rollercoaster
because they have noprogesterone and then they're
getting these like wild spikesof estrogen, and then this goes
on for a very long time 15 yearsor more.
Like it could be that womenwill go through this where they
don't have a lot of support fromprogesterone on their body.
(05:30):
Their uterus is beginning toatrophy, for example, and the
vagina and everything like allof the body starts to atrophy
and then you get to menopause.
So let's say perimenopause is15 years worth of your life.
It's a long time and then menoppause is one day it's one day,
but we spend a lot of timetalking about it and then
postmenopause is just wherethere is essentially the atrophy
(05:52):
and aging just continue.
And we know that, likeAlzheimer's and osteoporosis and
heart disease and cancer and alot of problems start and
diseases of aging like diabeteshappen after menopause.
But heart disease doesn't justhappen overnight.
Heart disease started happenafter menopause.
But you know heart diseasedoesn't just happen overnight.
Heart disease started inperimenopause when you were 35
years old, right, and so we wantto start to prevent heart
disease and Alzheimer's anddementia and osteoporosis when
(06:14):
you're 35, not be thinking aboutit when you're 51 and your
period stops.
Like we don't wait untildiabetes happens to treat it.
We try to prevent it.
Like traditional medicine tellswomen if you're menstruating
and you're perimenopausal, youneed birth control and then,
once your period has stopped foran entire year, then you can
have HRT hormone replacementtherapy.
(06:35):
Birth control is a lot morerisky and it's not like
bioidentical, it's syntheticallymade.
I don't know why we all onewould think that it's safer than
our own hormones.
So this is kind of a little bittwisted Birth control should not
be a hormone replacementtherapy.
It's not effective forperimenopause that we should be
giving bioidentical hormonereplacement therapy.
We can give it earlier.
The earlier the better, youknow, and so this thought is
(06:56):
changing and we're reallygetting more proactive about our
health instead of reactive.
Speaker 2 (07:01):
But there also is a lot of disagreement still about
the use of hormone therapy.
Why is that?
Speaker 1 (07:07):
You know, I think that it's people don't like
change, especially doctors.
Doctors are very dogmatic.
They are resistant to thatinnovation.
I think that's a big part of it.
I think there's some underlyingsexism that happens with women
still, that they want to controlwomen's bodies.
This is still anotheropportunity to control what
women are doing with their body.
A lot of it is defensivemedicine and based on fear.
(07:29):
It's not based on science.
So the resistance is becauseI'm unwilling to look at the
literature.
I'm unwilling to learn about itmyself.
I don't want to say that Idon't know.
Doctors have a hard time sayingI don't know.
A lot of doctors don't like toadmit that they don't know about
hormone replacement therapy.
And just like nutrition.
Doctors aren't trained innutrition, so they'll just be
like nutrition isn't important,and so they'll just kind of
(07:50):
undermine it quite a bit.
And they're doing the samething to hormones Also.
Another reason is because thatWomen's Health Initiative that
was published really did do alot of damage.
It was grossly misinterpreted.
Mark Twain said that a lie willtravel halfway around the world
before the truth can put itsshoes on.
This is exactly what happenedwith estrogen and women and
hormone replacement therapy.
And when they held a pressconference which is unheard of
(08:11):
for a study, we spent a billiondollars worth of taxpayer
dollars on the Women's HealthInitiative and told everybody
that it caused breast cancer,when that was not what the study
showed.
And doctors never forgot it.
They saw it on the news andthen just never bothered to like
learn about it themselves.
And so we have an entiregeneration of doctors that
forgot how to prescribe hormonereplacement therapy.
Women were told no, moms toldtheir daughters and now women
(08:35):
like our age are still veryconfused, like does it cause
breast cancer, doesn't it?
And I think our daughters willbe lucky enough that they will
not be in the same position,that they will know that it's
not that.
So we're kind of in thistransition phase where we're
really trying to eliminate thisbad press.
We're blaming everything onestrogen weight gain, cancer,
like everything you know andthat's basically telling women
that they're the problem, thatestrogen is the problem.
(08:56):
It's the same thing.
A lot of it's sexism too, in myopinion.
A lot of the studies too.
When you look at the sciencethey're done on these synthetic
hormones progestin, especiallyprogestin and it's not
progesterone, it's not ournatural hormone.
And so when you look at mixedstudies about it potentially
causing Alzheimer's or somethingor heart disease or increasing
blood pressure or stroke, thoseare from those fake synthetic
(09:17):
hormones too, those studies.
And even then the risk is small.
So I don't want to like worryanybody like on birth control,
but it's still like, hey, wehave to recognize that
bioidentical hormones they'renot patented, they're natural.
We don't study them because bigpharma doesn't have any interest
in making money off of them.
So they're not, they're notstudied the way that we have
thousands of studies on birthcontrol.
Doctors also need to recognizethat it is a natural type of
(09:39):
therapy that's not going to bestudied at the same extent that
a pharmaceutical drug is goingto be studied.
But we even then we still havehundreds of studies, so there's
no excuse.
I wish the doctors would say Idon't know, you need to go to a
specialist.
Instead, they'll tell patientsjust the wrong thing.
Speaker 2 (09:54):
Well, in these studies that you're referencing,
aren't some of them, like, over20 years old or so?
Speaker 1 (09:59):
Oh, yes, we have an 18-year follow-up from the
Women's Health Initiative.
18 years we followed thosewomen, the same cohort, it's
like 40,000 women.
We followed them and that studywas published in JAMA, the
Journal of American MedicalAssociation, which is one of the
most prestigious journals, andthey showed that not only does
estrogen not cause breast cancer, it protects against breast
(10:20):
cancer.
When I say that, that should belike on every news channel,
everybody should be talkingabout it.
Every 40 year old should be onit to protect against breast
cancer.
The same people that weresaying that it was dangerous are
now being very quiet.
Speaker 2 (10:33):
Well, so what about people with a family history of
hormone sensitive cancers,though?
I mean, how should they thinkabout hormone replacement
therapy?
Speaker 1 (10:50):
their decision needs to be based with a provider on
risks and benefits.
The cancer cell has a receptorfor estrogen and progesterone on
it.
That's a good thing.
That means that the cell hasnot lost its signal like it's
normal, signaling that the bodyis able to, like, control that
cell.
So when people say, like I'mestrogen receptor positive,
that's a great thing.
Actually, that's a really goodthing, because that means that
(11:11):
that cell is not so malignantthat it lost its receptors and
is completely malignant androgue in the body.
Now, you know, with prostatecancer, for example, in men, and
testosterone, if men haveprostate cancer, we know that
testosterone has the potentialto make it grow.
So we they're not a candidatefor hormone therapy at the time
that they're being treated forcancer.
When they're in remission andthey no longer have prostate
(11:34):
cancer, they are a candidate andcan choose to take testosterone
if they want to and they can befollowed Right.
So we do this for men.
Why?
You know?
Again, it's about control.
Like we are putting, fear is avery good way to control women.
Alcohol causes breast cancer.
Aging causes breast cancer.
Lack of exercises causes it.
(11:54):
These things are way biggercontributors.
Right, we have a lot ofenvironmental chemicals that are
like fragrances and plasticsand pesticides that bind to the
estrogen receptor and causecancer.
The idea is that you need tokeep your body as healthy as
possible and that will preventdisease, but women are going to
more likely die from heartdisease.
One in like three women die ofheart disease.
(12:15):
But we keep talking aboutbreast cancer when it's actually
very rare compared to heartdisease.
And what protects against heartdisease?
Estrogen.
Speaker 2 (12:23):
It's an interesting perspective.
I see where you're coming fromand just how many differing
points of view there are.
So, with hormone replacementtherapy, though, is there any
physiological or psychologicalreliance that develops when you
use it?
Is there a dependency?
So does your body stopproducing its own level of
(12:44):
hormones once you come in andstep in and start giving it?
So this is an interestingquestion.
Speaker 1 (12:49):
The answer is yes, but that's also.
You shouldn't be taking HRT ifyou're making plenty of hormones
.
If you no longer made a vitamin, you would just take it.
You have to supplementsomething that you can no longer
make.
So when a perimenopausal womanis like, well, what if I'm going
to suppress my own production?
It's like what production?
If they're making these wildspikes of estrogen, you can stop
(13:10):
and suppress these naturalspikes.
Give her like a stable level.
She's going to feel great.
So this is where, yes, thehormone receptors and suppress
your own production and we givemen testosterone replacement
therapy.
Most of the time you can takethem off the testosterone.
They'll start making spermagain.
The same thing is for women.
(13:43):
If you suppress their ownhormone production and kind of
you're suppressing this cycle inthe brain, it usually can come
back when you stop it if they'reat an age where they can still
ovulate.
But I will say that hormonereplacement therapy doesn't
necessarily suppress ovulationeither.
I've had a ton of women getpregnant on hormone replacement
therapy, right.
So it's really like how you'redoing at the formulation.
This is not a drug, right?
This is not a pharmaceutical.
(14:04):
The hormones are made bynaturally.
They're probably arguably themost natural thing that you can
do.
We don't make herbs, like wedon't make black cohosh and
donkwai and ashwagandha.
We make estrogen andprogesterone.
Is that a bad thing to bedependent on my own natural
hormones?
No, it's about acceptance.
Women, it's not shameful thatyou're aging Like it's okay to
(14:24):
accept that you're no longermaking estrogen and progesterone
and that you need to supplementand take it.
It's okay.
It doesn't mean anything aboutyou.
It doesn't mean that you'reinferior to like your friend
who's still making it Like.
It's not something to beashamed of that you're dependent
on having to take thissupplement.
Does that make sense?
It's also a shift with the wayof thinking about it.
Speaker 2 (14:41):
Like that perspective and argument because I do rely
on ashwagandha and otheradaptogens to just help me
maintain my level of cortisoland, as you're saying, it's not
something that my body naturallyproduces and the bioidentical
hormone replacement therapy isderived from plants.
Is that correct?
Speaker 1 (15:01):
Yeah, typically like well, very rarely do you see
something sourced from animalsanymore.
So I think, really, estrogen issourced from soy and
progesterone is sourced from yam, and they're very highly
regulated, and so you know howmuch you're getting in a
prescription, for example.
And women want a naturaltreatment, and I do too.
I get it.
I wouldn't want to treatanything not naturally.
They just need to startthinking about their own.
(15:22):
Hormones is more natural thanherbs, and herbs are great.
Herbs are medicine, they have arole to play, but on and herbs
are great.
Herbs are medicine, they have arole to play, but on top of the
hormones, like once, hormonesare your foundation.
Can I add an ashwagandha ormaca or something else to boost
my testosterone a little bitmore or block a pathway?
That they're powerful, likegreen tea extract is literally
(15:42):
toxic to ovarian cancer cells.
Women should be drinking greentea every day.
So the herbs have their place,it's just not in place of
hormones, like they don'treplace a hormone.
Speaker 2 (15:58):
When it comes to women who either can't, for one
reason or another, or don't wantto take HRT, what are some
non-hormonal interventions thatyou could recommend that they
could use to support theirbodies during this time?
Speaker 1 (16:07):
Really hard to do.
There's no way to either boostor replace the hormone that's
missing, and when the receptorsare free, you're more
susceptible to environmentalchemicals.
So you would have to completely, like eliminate every
environmental chemical in frontof you in order to maintain,
like, some type of stability inthe body and prevent cancer, but
in the sense that you'reeliminating gluten and dairy and
(16:29):
a lot of grains.
Diet matters, and I knowthere's a lot of different
theories out there.
Women will do vegan diets andvegetarian diets, but it will
actually make their hormonesmuch, much lower.
So if you're looking at keepingthem a little bit higher to
help with aging, protein isgoing to do that for you.
Women are like well, I want todo menopause because it's more
natural.
Just because it's naturaldoesn't mean that it's better
for you.
(16:49):
I have friends that areperimenopausal that don't want
to do HRT, and I'm like theirfriend and could really optimize
them.
And they're still turning itdown and it's because they one.
They just want to try it alittle bit longer, to do it
themselves, but their diet is sorestricted they fall off the
wagon one day and they feel itfor like three days.
Women who want to try to dowithout hormones, really have to
have everything so dialed in,it's a lot more challenging.
Speaker 2 (17:12):
Yeah, so it sounds like the hormone replacement
therapy is kind of like ashortcut, but there are options
for people who are willing to doall of the different things for
their hair, their skin, theirnails, their cortisol,
maintaining their level ofstress.
But it sounds like it's morework.
Speaker 1 (17:30):
A ton more work and a lot more money and a lot more
everything Like you're reallygoing to be spending a lot of
time doing it, for sure.
Speaker 2 (17:35):
So just to go down that avenue a little bit, cause
I know we've spoken a lot abouthormones and I know that's your
specialty, so you can stop me ifyou, if you don't feel like
answering these, but outside ofsay, multivitamins, what sort of
daily supplements do you findto be most helpful for women who
are in menopause orpostmenopause, specifically for
skin cognition and just overallvitality?
Speaker 1 (17:59):
So it is true, it is not just a hike.
Collagen really does benefitwomen in a lot of different ways
, and for the obvious skin andhair reasons, but also for the
mental reasons.
So we need, as we age, we needdopamine in the brain to be,
like, alert and focused and haveas much mental clarity as we
can.
And so the obvious way to raisedopamine is estrogen.
(18:21):
But if you don't want to dothat, you need something to make
dopamine really readily, andcollagen is just like drinking
straight amino acids that yourbrain can use and turn into
dopamine.
So if you do collagen inconjunction with, like creatine
and something like L-tyrosine,which is just an amino acid, you
can effectively raise dopamine.
You know there's other likenatural things that raise
(18:42):
dopamine, like microdosingpsilocybin is popular with some
practitioners who will work withyou on that Turmeric a thousand
milligrams of turmeric, likethe curcumin, will also help
raise dopamine.
Turmeric will also support awoman's immune system, so
something like reishi andturmeric as she's aging, because
immunity like if you want toage well, like especially if you
want to prevent heart diseaseand cancer it's all about the
(19:04):
immune system.
Immune system is like key.
So, as I say, like hormones arethe fastest and easiest and
most effective.
But if you're trying to boostyour immune system, turmeric
will really help you.
Glutathione will help boostyour immune system and so will
keeping and maintaininggluten-free and dairy-free diets
will help you with your immunesystem.
So, as we are more prone toautoimmunity as we're aging, I
(19:24):
would still recommend these forautoimmunity, even with hormones
.
I'd be like turmeric,gluten-free, dairy-free and
glutathione.
So glutathione is like sopowerful, but NAD is also.
So if you inject NAD andthere's other ways to like raise
NAD, like these saunas.
There's more longitudinalstudies on sauna use and women
and anti-aging and prevention ofaging signs with regular sauna
(19:45):
use, so you definitely can getthere.
Like if you were just look atthe immune system, that would be
like a collection of thingsthat you could do for your
immune system.
For example, mushrooms aregreat, like reishi is my
favorite when you want to boostthe immune system.
It'll raise natural killercells.
Natural killer cells are whatreally survey the body and kill
cancer cells.
So if you're really interestedin like preventing cancer,
(20:08):
something like a daily reishimushroom could potentially raise
your natural killer cells andprotect you.
Look, your immune system is keyto like really feeling well and
if you protect your immunesystem.
You will feel this like lowerinflammation in the body.
Gluten and dairy are like oneof the worst things to eat, so I
would say anybody aging toavoid these two.
Speaker 2 (20:25):
Yeah, I'm already off of gluten and dairy.
I know that it was a hard shiftto make, but it's had a
tremendous benefit to my health.
So what about exercise?
Like what do you do?
Or how important is resistance,training and sleep and managing
symptoms as well?
Like what can you say aboutthis?
Speaker 1 (20:45):
I tell women like I just want you to keep doing what
you like doing, and then I'mgoing to try to support you so
that you can keep doing what youlike doing.
Because I hate it whenpractitioners are like, ok, you
got to stop running, I knowyou're a runner, but you got to
stop.
And now you got to like liftreally heavy weights and like
completely shift your entireroutine now that you're a
menopausal, and this is likekind of devastating for a shift
(21:08):
when they would like to doPilates and yoga and running and
hiking and like some of theother stuff that they naturally
have been done doing their wholelife, so they've been able to
maintain their weight and theirhealth, like just by doing the
cardio or whatever they weredoing before.
I don't really care.
Like whatever you liked doingand you're going to do is what
we need to keep you doing.
But that being said, like ifyou're not going to do HRT, you
(21:28):
are going to rapidly lose muscle, because this is what helps us
maintain our muscle, ourhormones.
So you have to be aware that ifyou're not going to do HRT,
they will decline and this meansmore protein and more
resistance training.
I would say if you're going todo HRT and stay on good HRT
regimen.
It's less important, likeyou're, going to maintain your
bones and your muscles withoutlike the extreme heavy lifting
which, although it's still goodfor you, like I would say, the
(21:50):
more muscle mass we have,obviously the better off.
We're going to age so and whatabout creatine?
Speaker 2 (21:55):
I know you mentioned it before, but how do you feel
about women taking creatineregularly?
Speaker 1 (22:00):
I think it's more for like a mental clarity.
If you supplement with creatineyou only have to take a little
bit, whereas you have to eatlike a ton of meat to get like
the same amount of creatine.
I wasn't on the bandwagon for awhile.
I was like there's no way thatworks.
But I actually started takingit for mental clarity.
I'm like, okay, maybe, maybethere I get it.
I get it Cause it's hard to eatthat much meat, I think is the
problem.
So the supplementing reallyhelps you get like the core
(22:21):
nutrients that are in the meatthat you don't really feel like
eating all the time.
So I do think it helps withmental clarity and I think
anything that you could do tohelp with recovery is obviously
going to help like NAD.
Nad really helps with musclerecovery.
Nad is like a molecule that isfor the powerhouse, the
mitochondria of the cell, andyou can inject it.
It's a peptide that peoplereadily inject and it helps with
(22:41):
like mental clarity.
It raises dopamine in the brain, helps organize the immune
system.
It activates CERT1 pathways,which are longevity genes.
Then you can raise NAD bygetting in the sauna so you can
still do it.
Nad is more expensive to injector you can just, I guess, do it
in the sauna, but these willhelp you live longer.
They lower lipids.
There's a lot of research onNAD to show how beneficial it is
(23:01):
and it helps with musclerecovery.
Women should be keeping theirblood sugar as stable as
possible.
If you focus on a fat and acarb and a protein, so that you
are keeping a stable blood sugar, this really helps with
perimenopause and menopause ingeneral.
Whatever diet you choose, keepyour blood sugar really stable.
Sugar spikes will cause achange in fluctuation and
(23:22):
hormones enough for you to feelit.
And if they eliminate sugar andthey just keep their blood
sugar really stable, then theirmood is also stable.
Even if you're on HRT, I wouldsay women, if they can keep your
blood sugar stable, then theirmood is also stable.
Even if you're on HRT, I wouldsay women, if they can keep your
blood sugar stable.
Our moods and periods andeverything are very much
connected to blood sugar.
Like we need to stabilize itand balance it, and that's
another key to like aging andfeeling great as you're.
Aging is keeping these stable,unfortunately, because it's like
(23:44):
I want to eat all the goodstuff too.
Speaker 2 (23:47):
So what about the long-term effects of using HRT?
Is there any say what thelong-term effects may be?
Speaker 1 (23:57):
There are conflicting studies, but I would say that
overall, the benefits outweighany risks, and this is really
what women need to think of it,because nothing in life is
risk-free.
The most dangerous thing youcan do is get in your car and go
drive on the highway, but I'mnever going to give up driving
on the highway because it givesme the benefits.
And so every time we make adecision about anything,
especially medication orsomething we're going to do
(24:18):
forever, it needs to be a riskversus benefit conversation in
your head.
I think the longest study wehave is like 18, 20 years.
We don't know what thatantidepressant is going to do
for 40 years.
We don't know what thatstimulant that you're taking for
adhd is going to do.
Is that going to give youparkinson's when you're an old
person, right?
So we don't actually have thoselong-term studies.
And women will take Xanax andbirth control.
(24:40):
They'll take it for a decade.
We're doing a lot of things inmedicine that we don't have
studies for.
We don't need the study tosupport the long-term use.
The question is what are therisks of not doing hormone
replacement therapy?
Because they're big.
If you do not do hormonereplacement therapy, your risk
for osteoporosis, dementia,alzheimer's.
If you do not do hormonereplacement therapy, your risk
for osteoporosis, dementia,alzheimer's, colon cancer,
(25:00):
potentially breast cancer, heartdisease, urinary tract
infections, yeast infections,urinary incontinence they go up
dramatically when hormones drop.
People are asking the wrongquestion.
They're asking what's the riskof taking the HRT long-term?
The question actually is whatare the risks of not taking the
HRT long-term?
And they're big.
Speaker 2 (25:18):
That's really interesting.
So for the men that arelistening in partners, sons,
colleagues what do you wish thatthey better understood about
women that are going throughthis phase of life and how can
they support them?
Speaker 1 (25:33):
Men can encourage if their wife wants to do these
things that we're talking about.
They're not hormones, but, likeshe wants to do the things that
we're talking about, they'renot hormones.
She wants to do the diet, sheneeds to take care of herself
and she wants to set that asideand make it a priority.
Spouses can be hugelysupportive of women knowing that
they might need a little bit ofspace.
If she's still cycling acertain time of month, he could
be very helpful during that timeand just understanding that we
(25:53):
do not have stable levels ofhormones and they do and they
don't get it, and it's okay thatthey don't get it.
But they can be very supportiveof whatever she wants to do.
I think that's just the key.
It's like, whatever herdecision is, he can be on board
with it and then also be alittle bit patient, knowing that
it's not him.
You know cause I think theyinternalize it because they're
you know, sorry guys out there alittle.
(26:14):
It's not being self-centered,but it's not always about you,
and so they he can justrecognize that it's not about
him.
It's something that she needsto just figure out and it can
take some time, like women willspend one or two years or more
trying to feel better.
She can do that and spend a lotof money at the same time
trying different things andseeing what works for her, and I
think a spouse may notunderstand that and he can just
(26:34):
realize that that is true, thatshe needs to be doing that.
We'll treat men with Viagra andtestosterone all day long, but
we will tell women when shecomes into the doctor's office
and complains of low libido orvaginal dryness or sex is
painful, she's told to like usesome lube and read a sexy novel
and like go date your husband.
You know and this is reallyunfortunate it's a downright
(26:54):
criminal that we would give aman Viagra and testosterone and
not treat his wife.
I think for relationships thatmen need to be a little bit more
like, understanding of like andhelp and supporting their wife
that, hey, your wife, it's notbecause she's not into you.
Her hormones are low and sheneeds some like.
If she doesn't want to have sexwith you, it's not because of
(27:15):
you or your relationship.
She needs like help and this isa health problem.
She needs to like get herestrogen up so that she can have
sex with you, and so if hestops internalizing so much, I'm
thinking it's his fault, causeI've had I've had male friends
tell me this, but they're justlike I just thought she didn't
have sex with me.
You know what I mean.
I just thought that she wasn'tinto me and it's like it's not
about you, dude, and they'relike I know it's patient.
This is such an everyday thingfor relationships.
Speaker 2 (27:45):
Well.
So this also makes me thinkjust about accessibility.
Is hormone therapy a luxury, oris it essential enough that it
should be considered a basicright for women's health?
I think that's a great question.
Speaker 1 (27:52):
I love how you phrased it.
I've never heard it that way,but it's amazing that you say it
that way.
It should be a right, it shouldbe democratized, it should be
accessible, it should be easy,with no gatekeeping.
It's safe.
It's safe for them to try.
If it works, it works.
If it doesn't, it doesn't.
You know, it's kind of one ofthose things that it's like a
supplement.
If it doesn't work, then theyjust stop it and you don't have
to keep doing it.
It's not like this right nowthey're doing and it's like
(28:12):
thousands of dollars.
They're going to charge you alot for labs, they're going to
have you do it quarterly, and sowhen I started my company
online, the idea was to make itmore accessible.
What if you're?
Speaker 2 (28:26):
in a really small town.
Speaker 1 (28:27):
Like I'm in a small town in Idaho, like what if
you're in Montana, north Dakota,and you don't have access to
the LA longevity docs?
Or even if you're in LA and youdon't want to spend 10 grand
and so we're in 44 states andsoon to be 50.
And the idea is that can wemake it a price point that is
more affordable Because it'sgoing to be out of pocket no
matter what?
I think that's also what womenwant health insurance to pay for
(28:48):
it, and they don't understandthat health insurance doesn't
see your perimenopause asmedically necessary to treat
Like they're.
Just like they have to waituntil you're like menopausal or
a lot of times.
Insurance sometimes covers it Ishould say that but they're
going to be limited in what theydo cover and how much they
cover.
So women just have to get kindof used to the idea that for a
while that's going to have to beout of pocket.
It doesn't mean it's be forever, but for the next few years
(29:08):
probably we'll be out of pocket.
And can we do that there?
are a few online companies thatare trying to make it more
accessible.
Speaker 2 (29:14):
For women who are thinking that they're in
perimenopause or they're inmenopause.
They need some help.
They want to consider hormonereplacement therapy.
What is the next step?
Do they go and get a test tosee what their levels of
hormones are?
Speaker 1 (29:29):
So the problem with the testing is one there's a lot
of analytical and biologicalvariability.
If they come back abnormal,then you have some supporting
evidence that you're not goingcrazy.
It's not in your head, but Ithink what tends to happen is
that we only rely on thelaboratory testing and then
women are like dismissed, sayingthat your labs are normal and
this is the problem, thatthey'll use the lab if it
(29:51):
supports them.
But symptoms should alwaystrump a lab test.
For example, the best lab testmight be to get is actually an
FSH, because we mentioned thatFSH will continue to rise.
So even if your estrogen andprogesterone are like kind of
normal, every time you get yourcast and you're going crazy
because every time you get atest everything's normal, but
you don't feel normal.
But that FSH is like slowlygetting higher and higher.
That should be like your key.
(30:12):
That you're perimenopausal.
You are better than any labtest.
You know better than any labtest.
You know better than anyphysician You're the one that
has to live with yourself everyday.
So if you don't feel well,you're the one that needs to
take action on it and get helpand be proactive, right?
No doctor is going to do thatfor you.
You have to do it.
You need to find the doctorthat's not going to turn you
away and say, no, that's theproblem.
(30:39):
The doctors are like no, theurine, we have an FSH, we have
some genetic testing.
You can test COMT and look atmetabolism so that you can get a
bigger picture.
But very few practitioners willdo this for you.
Instead, they'll just get anestrogen level.
Oh, it's normal, you're fromyour normal, you're too young to
be experiencing this, and sowomen need to just know that you
can get a panel of lab testingand it could be abnormal, but it
(31:02):
could also be completely normal.
So I think, in general, a lot ofpractitioners are now saying
that, look, perimenopause is aclinical diagnosis, it's not a
laboratory one.
So you have to work withsomebody who's willing to just
say hey, the hormones are safe,you can try them.
If you just have weight gainbut you feel fine, you have a
really crappy diet, okay, thenchange your diet and try that
first.
If you're gaining weight andyour hair is falling out and
(31:23):
your skin looks terrible and youcan't sleep and you have
anxiety, like you have like 10or 15 symptoms together and
you're like food sensitive andyou know what I mean.
Like there's just all thisstuff that you're like I just
don't feel like it's right andno matter what, this is hormonal
at its core, because thehormones basically regulate
every pathway in the body and soyou are going to get a lot of
symptoms at one time.
That's a good rule of thumb.
(31:43):
If I just have one thing goingon, maybe I could just try to
address that one thing.
But if you have a lot,sometimes I'll just like want to
look at the lab, you know.
But then I'm like okay, let'sput the labs aside and like tell
me what's going on with you,because I can do a much better
job just hearing what yoursymptoms are and what's
bothering you the most, becauseshe will tell you exactly what
you need to know.
The labs are kind of like onesnapshot in the day and they're
(32:05):
maybe not even accurate, butlike she will tell you what
she's been going through andthis is so much more powerful to
listen to than a lab test.
And providers and everybodygets so wrapped up in this like
data driven, but they need tounderstand how hormones are.
There's a wide therapeutic rangethere.
They're all over the place inthe body and so labs are not
quite as helpful as some of theother.
(32:26):
We can get labs like on heartdisease and LDLs like.
That's reliable, like your LDLis what it is, but your estrogen
level?
Take it an hour later.
It'll probably be different.
Take it the end of the day,it's going to be completely
different, you know?
Speaker 2 (32:38):
Oh, interesting, yeah , and labs are downstream.
And then also, as you weresaying, it impacts you
differently than it will impactme and all of our friends.
Speaker 1 (32:47):
Exactly, so, even though, if, even if your
hormones, like, are a certainlevel, you might feel okay Like
you because you're also doing alot of different things, like
with your adapt.
You know you have like yourstuff dialed in, you're gluten,
dairy free, you're doing like alot, so you may not feel as
terrible as like someone else.
So it's also the labs are youknow you should.
I shouldn't force you into somereference range and then say
that you should be feeling okay,it's all like.
(33:09):
It's an open system and yourdiet and genetics play a huge
role.
We need to just need to belistening to women.
Speaker 2 (33:15):
So, just as a closing question here, if you could
leave women and the people wholove them with one message about
this phase of life, what wouldit be?
It?
Speaker 1 (33:23):
would be that, like it's going to be, it could
potentially be like the besttime of your life, Like you
could have the most enjoyabletime where you're set in your
career.
You have kids, you have, likeyour partner, you have financial
security most of us and you canlook good and feel good.
And, like your partner, youhave financial security most of
us and you can look good andfeel good.
And there are like things thatyou can do and sometimes it
takes all of them, but it'spossible.
So, like don't ever let anybodytell you that like this is how
(33:46):
you have to feel, or this is theway it is just being a woman,
or we have to age a certain way.
You get to choose, that we havethe choice and capacity and
control of how our journey lookslike and so just take control
of it.
Like it's your responsibilityto make sure that you take care
of your body and the body is sointelligent and how they can
actually heal.
So if you're suffering fromsomething and you don't think
(34:07):
it's ever going to get better,like I, just this is just the
way it is and this is how I'mgoing to feel, like this forever
.
That's not true.
The body has the ability toheal.
If you give it the foundationand the building blocks that it
needs.
Whatever that is like you giveit to, the body will get better,
and so it's it's remarkableLike, and so it's it's it's a
positive note like.
Menopause and perimenopause arenot about suffering.
We don't need to get togetheras women and talk about our
(34:28):
symptoms and how stuff, how muchwe're suffering.
In fact, we should be able tostop like a miserable time.
It's actually not.
It shouldn't be.
Speaker 2 (34:40):
Well, dr.
Sarah, thank you so much forcoming on and sharing your
insights with us.
I've never spoken with anybodyabout perimenopause, menopause
or postmenopause, and so I'velearned a lot from listening to
you.
Thank you for having me.
Speaker 1 (34:50):
I really had a good time talking to you.
Speaker 2 (34:56):
Today's key takeaways .
Perimenopause can start earlierthan you think.
Hormonal decline might begin inyour late 20s or early 30s, not
just your 40s, and the symptomsoften look like other things
Anxiety, fatigue, mood swings,insomnia, bloating.
We blame stress, parenting,food sensitivities, when really
(35:20):
it might be your hormones.
Even if your labs are normal,your symptoms are real.
Hormone levels fluctuate andblood tests are just a snapshot
downstream from your actualexperience.
If you feel off that matters,perimenopause is often best
recognized through your livedexperience and not a lab result.
(35:41):
Autoimmunity might be a sign ofhormonal decline.
Women are far more likely todevelop autoimmune issues and
hormone shifts can play a role.
If you're dealing withautoimmune symptoms, it may be
worth exploring your hormonalhealth.
Estrogen and progesterone aren'tjust about reproduction.
(36:03):
They support your brain, bones,heart, mood, metabolism and
immune system.
When introduced appropriately,hrt may help reduce long-term
risks of heart disease,osteoporosis, dementia and more.
We don't make men wait, so whyare women told to?
Men don't have to wait fortestosterone to fully disappear
(36:26):
before getting support.
Yet women are often told towait until a year after their
last period to even consider HRT.
The fear around estrogen isoutdated.
The original Women's HealthInitiative study was widely
misinterpreted and causeddecades of fear, but long-term
follow-ups, including onepublished in JAMA, found that
(36:50):
estrogen may actually reduce therisk of breast cancer.
There are other ways to supportyour health, but they take more
effort.
Diet supplements, adaptogens,collagen, creatine, sauna,
resistance, training all ofthese can help, but they require
a lot of consistency.
Hrt, for many, is a moreefficient way to feel well
(37:11):
because it restores what yourbody used to produce naturally
To the partners out there.
This isn't about you.
To the partners out there, thisisn't about you.
When the woman you love startsto shift physically, emotionally
, sexually it can feel personal,but it's not rejection, it's
not distance, it's biology.
And your understanding, yourpatience, your support is
(37:35):
everything.
Relationships thrive when womenfeel seen and backed.
Aging is a part of life, butsuffering through it is not
required.
That's it for today.
I release episodes once a week,so come back and check it out.
(37:56):
Have a great day.
Welcome to how I Built my Small Business.
I'm Anne McEntee.
Your host and today's guest isDr Sarah Dacorette, a
board-certified physician,hormone specialist and founder
and CEO of Inner Balance, apersonalized hormone therapy
platform that just closed asignificant investment round and
is scaling quickly.
(00:28):
Dr Sarah is on a mission tohelp women take control of their
health, while also highlightingthe serious gaps in women's
medical care and research.
Today's episode is all aboutmenopause, perimenopause,
menopause and postmenopause isall about menopause,
perimenopause, menopause andpostmenopause and the physical,
emotional and hormonal shiftsthat come with it.
(00:53):
We talk about common symptoms,how they're often dismissed or
misdiagnosed, and what women cando to start feeling better Now.
Dr Sarah's expertise is inhormone replacement therapy, so
that's a big part of ourdiscussion, but there are many
approaches to menopause care andthis episode is meant to inform
, not prescribe.
My hope is that it helps youfeel more seen, ask better
questions and advocate for apath that feels right for you.
(01:16):
This conversation is notmedical advice.
It's for informational purposesonly.
Speaker 1 (01:25):
Women shouldn't feel like, oh, I'm 35.
I'm too young to be goingthrough this.
That is not true.
You could be 28 and goingthrough it.
It could be your genetics, itcould be your environment, it
could be your stress, likeeverything that's combining
together to make your ovariesfatigue or fail.
There's no rule book that youshould or shouldn't be doing
this.
Your body is just doing it andyou need to support it.
So if they remember that, thenthey'll kind of take some of the
(01:47):
shame away, because I alsothink, as we're aging, women
feel more shame about thisperimenopause, that they
shouldn't be aging.
That's not true.
We need to age, but we need tosupport ourself aging.
A lot of the first signs andsymptoms are ignored, because
one it'll be like slow weightgain, and then it'll be like
slow weight gain, and then it'llbe attributed to I'm not
(02:08):
exercising enough or I'm noteating well enough.
A lot of the early signs can beanxiety or stress, even
depression or low mood, and thenthey'll think that it's just
something like their job ortheir kids or their life or
their husband or partner orwhatever, and they don't
attribute it to a drop inhormones and then they'll even
maybe start an antidepressant oranti-anxiety, because that's
what they're offered.
You know, another early sign isinsomnia, and the sleep
(02:29):
disruption is fairly hormonalalmost all the time.
And so a lot of these earlysigns get missed.
They get attributed tosomething else.
They're told that they haveleaky gut.
Oh, I have all these foodinsensitivities.
I have bloating.
They say 90% of the populationis bloated.
Now this can be drop inhormones that cause this
bloating.
Women will have high cortisol.
That's an early sign, and thenthey'll say that all of their
(02:50):
problems are from cortisol.
So you can kind of see how wewill miss perimenopause for a
very long time until she's goingmad and then finally her
symptoms are so bad that we'llfinally recognize her and tell
her that she's perimenopause inher 40s, but when she's actually
been struggling for probably adecade.
Autoimmunity women are like fourtimes as likely to get it and
the hormones drop first and thenthe autoimmunity comes.
(03:12):
So autoimmunity is also anearly sign that hormones are not
optimal, because our hormonesare needed in a woman's body to
boost and modulate the immunesystem.
When autoimmunity presents, weshould automatically be thinking
low hormones, but we don't.
They're going to their generalpractitioner, their OB-GYN,
their primary care physician, anendocrinologist.
It's like going to your dentistto ask about your back pain.
(03:34):
You're going to a doctor that'snot specialized.
They have no idea.
What women need instead need tobe thinking is when do I need to
see a specialist?
So this is like you get whatyou pay for.
You want to go to somebody whoonly does that thing.
You know if you're going to goto a surgery, you're only going
to go to the surgeon that doesthat thing right.
So women need to start thinkingabout hormones as an entirely
different medical specialty andthey need to be thinking about
(03:57):
it early, even in your twenties,like should we be getting
baseline panels so that womenknow what their hormones are
when they're younger?
Probably because you can startto see the decline when they
start feeling they lost thatkind of vibrancy in life.
They should be thinking aboutit, because hormones literally
give us that life force that weneed.
Speaker 2 (04:15):
And how do you help women distinguish between normal
aging and symptoms they don'thave to tolerate?
So what's the line we?
Speaker 1 (04:26):
have to age, but we don't have to feel terrible
while we're aging.
So we really have the choice ofhow we want to age.
Now you have to age, but youdon't have to have joint pain,
muscle aches, really heavyperiods, painful periods, awful
skin and hair bloating, weightgain, anxiety, depression,
irritability, insomnia, vaginaldryness, low libido.
I could go on and on.
(04:46):
So, as the ovaries start tofail and fatigue, what happens
first is the ovaries cannot makeprogesterone, which is our main
hormone.
So then the brain freaks out,starts making FSH.
Fsh is a follicle stimulatinghormone that will rise and it's
a feedback loop.
So it'll stimulate the ovariesto try to make more hormone, but
the ovaries cannot.
They cannot no longer makeprogesterone in like reasonable
(05:09):
quantities and they can makelike a spike of estrogen, and so
women in perimenopause willfeel somewhat of a rollercoaster
because they have noprogesterone and then they're
getting these like wild spikesof estrogen, and then this goes
on for a very long time 15 yearsor more.
Like it could be that womenwill go through this where they
don't have a lot of support fromprogesterone on their body.
(05:30):
Their uterus is beginning toatrophy, for example, and the
vagina and everything like allof the body starts to atrophy
and then you get to menopause.
So let's say perimenopause is15 years worth of your life.
It's a long time and then menoppause is one day it's one day,
but we spend a lot of timetalking about it and then
postmenopause is just wherethere is essentially the atrophy
(05:52):
and aging just continue.
And we know that, likeAlzheimer's and osteoporosis and
heart disease and cancer and alot of problems start and
diseases of aging like diabeteshappen after menopause.
But heart disease doesn't justhappen overnight.
Heart disease started happenafter menopause.
But you know heart diseasedoesn't just happen overnight.
Heart disease started inperimenopause when you were 35
years old, right, and so we wantto start to prevent heart
disease and Alzheimer's anddementia and osteoporosis when
(06:14):
you're 35, not be thinking aboutit when you're 51 and your
period stops.
Like we don't wait untildiabetes happens to treat it.
We try to prevent it.
Like traditional medicine tellswomen if you're menstruating
and you're perimenopausal, youneed birth control and then,
once your period has stopped foran entire year, then you can
have HRT hormone replacementtherapy.
(06:35):
Birth control is a lot morerisky and it's not like
bioidentical, it's syntheticallymade.
I don't know why we all onewould think that it's safer than
our own hormones.
So this is kind of a little bittwisted Birth control should not
be a hormone replacementtherapy.
It's not effective forperimenopause that we should be
giving bioidentical hormonereplacement therapy.
We can give it earlier.
The earlier the better, youknow, and so this thought is
(06:56):
changing and we're reallygetting more proactive about our
health instead of reactive.
Speaker 2 (07:01):
But there also is a lot of disagreement still about
the use of hormone therapy.
Why is that?
Speaker 1 (07:07):
You know, I think that it's people don't like
change, especially doctors.
Doctors are very dogmatic.
They are resistant to thatinnovation.
I think that's a big part of it.
I think there's some underlyingsexism that happens with women
still, that they want to controlwomen's bodies.
This is still anotheropportunity to control what
women are doing with their body.
A lot of it is defensivemedicine and based on fear.
(07:29):
It's not based on science.
So the resistance is becauseI'm unwilling to look at the
literature.
I'm unwilling to learn about itmyself.
I don't want to say that Idon't know.
Doctors have a hard time sayingI don't know.
A lot of doctors don't like toadmit that they don't know about
hormone replacement therapy.
And just like nutrition.
Doctors aren't trained innutrition, so they'll just be
like nutrition isn't important,and so they'll just kind of
(07:50):
undermine it quite a bit.
And they're doing the samething to hormones Also.
Another reason is because thatWomen's Health Initiative that
was published really did do alot of damage.
It was grossly misinterpreted.
Mark Twain said that a lie willtravel halfway around the world
before the truth can put itsshoes on.
This is exactly what happenedwith estrogen and women and
hormone replacement therapy.
And when they held a pressconference which is unheard of
(08:11):
for a study, we spent a billiondollars worth of taxpayer
dollars on the Women's HealthInitiative and told everybody
that it caused breast cancer,when that was not what the study
showed.
And doctors never forgot it.
They saw it on the news andthen just never bothered to like
learn about it themselves.
And so we have an entiregeneration of doctors that
forgot how to prescribe hormonereplacement therapy.
Women were told no, moms toldtheir daughters and now women
(08:35):
like our age are still veryconfused, like does it cause
breast cancer, doesn't it?
And I think our daughters willbe lucky enough that they will
not be in the same position,that they will know that it's
not that.
So we're kind of in thistransition phase where we're
really trying to eliminate thisbad press.
We're blaming everything onestrogen weight gain, cancer,
like everything you know andthat's basically telling women
that they're the problem, thatestrogen is the problem.
(08:56):
It's the same thing.
A lot of it's sexism too, in myopinion.
A lot of the studies too.
When you look at the sciencethey're done on these synthetic
hormones progestin, especiallyprogestin and it's not
progesterone, it's not ournatural hormone.
And so when you look at mixedstudies about it potentially
causing Alzheimer's or somethingor heart disease or increasing
blood pressure or stroke, thoseare from those fake synthetic
(09:17):
hormones too, those studies.
And even then the risk is small.
So I don't want to like worryanybody like on birth control,
but it's still like, hey, wehave to recognize that
bioidentical hormones they'renot patented, they're natural.
We don't study them because bigpharma doesn't have any interest
in making money off of them.
So they're not, they're notstudied the way that we have
thousands of studies on birthcontrol.
Doctors also need to recognizethat it is a natural type of
(09:39):
therapy that's not going to bestudied at the same extent that
a pharmaceutical drug is goingto be studied.
But we even then we still havehundreds of studies, so there's
no excuse.
I wish the doctors would say Idon't know, you need to go to a
specialist.
Instead, they'll tell patientsjust the wrong thing.
Speaker 2 (09:54):
Well, in these studies that you're referencing,
aren't some of them, like, over20 years old or so?
Speaker 1 (09:59):
Oh, yes, we have an 18-year follow-up from the
Women's Health Initiative.
18 years we followed thosewomen, the same cohort, it's
like 40,000 women.
We followed them and that studywas published in JAMA, the
Journal of American MedicalAssociation, which is one of the
most prestigious journals, andthey showed that not only does
estrogen not cause breast cancer, it protects against breast
(10:20):
cancer.
When I say that, that should belike on every news channel,
everybody should be talkingabout it.
Every 40 year old should be onit to protect against breast
cancer.
The same people that weresaying that it was dangerous are
now being very quiet.
Speaker 2 (10:33):
Well, so what about people with a family history of
hormone sensitive cancers,though?
I mean, how should they thinkabout hormone replacement
therapy?
Speaker 1 (10:50):
their decision needs to be based with a provider on
risks and benefits.
The cancer cell has a receptorfor estrogen and progesterone on
it.
That's a good thing.
That means that the cell hasnot lost its signal like it's
normal, signaling that the bodyis able to, like, control that
cell.
So when people say, like I'mestrogen receptor positive,
that's a great thing.
Actually, that's a really goodthing, because that means that
(11:11):
that cell is not so malignantthat it lost its receptors and
is completely malignant androgue in the body.
Now, you know, with prostatecancer, for example, in men, and
testosterone, if men haveprostate cancer, we know that
testosterone has the potentialto make it grow.
So we they're not a candidatefor hormone therapy at the time
that they're being treated forcancer.
When they're in remission andthey no longer have prostate
(11:34):
cancer, they are a candidate andcan choose to take testosterone
if they want to and they can befollowed Right.
So we do this for men.
Why?
You know?
Again, it's about control.
Like we are putting, fear is avery good way to control women.
Alcohol causes breast cancer.
Aging causes breast cancer.
Lack of exercises causes it.
(11:54):
These things are way biggercontributors.
Right, we have a lot ofenvironmental chemicals that are
like fragrances and plasticsand pesticides that bind to the
estrogen receptor and causecancer.
The idea is that you need tokeep your body as healthy as
possible and that will preventdisease, but women are going to
more likely die from heartdisease.
One in like three women die ofheart disease.
(12:15):
But we keep talking aboutbreast cancer when it's actually
very rare compared to heartdisease.
And what protects against heartdisease?
Estrogen.
Speaker 2 (12:23):
It's an interesting perspective.
I see where you're coming fromand just how many differing
points of view there are.
So, with hormone replacementtherapy, though, is there any
physiological or psychologicalreliance that develops when you
use it?
Is there a dependency?
So does your body stopproducing its own level of
(12:44):
hormones once you come in andstep in and start giving it?
So this is an interestingquestion.
Speaker 1 (12:49):
The answer is yes, but that's also.
You shouldn't be taking HRT ifyou're making plenty of hormones
.
If you no longer made a vitamin, you would just take it.
You have to supplementsomething that you can no longer
make.
So when a perimenopausal womanis like, well, what if I'm going
to suppress my own production?
It's like what production?
If they're making these wildspikes of estrogen, you can stop
(13:10):
and suppress these naturalspikes.
Give her like a stable level.
She's going to feel great.
So this is where, yes, thehormone receptors and suppress
your own production and we givemen testosterone replacement
therapy.
Most of the time you can takethem off the testosterone.
They'll start making spermagain.
The same thing is for women.
(13:43):
If you suppress their ownhormone production and kind of
you're suppressing this cycle inthe brain, it usually can come
back when you stop it if they'reat an age where they can still
ovulate.
But I will say that hormonereplacement therapy doesn't
necessarily suppress ovulationeither.
I've had a ton of women getpregnant on hormone replacement
therapy, right.
So it's really like how you'redoing at the formulation.
This is not a drug, right?
This is not a pharmaceutical.
(14:04):
The hormones are made bynaturally.
They're probably arguably themost natural thing that you can
do.
We don't make herbs, like wedon't make black cohosh and
donkwai and ashwagandha.
We make estrogen andprogesterone.
Is that a bad thing to bedependent on my own natural
hormones?
No, it's about acceptance.
Women, it's not shameful thatyou're aging Like it's okay to
(14:24):
accept that you're no longermaking estrogen and progesterone
and that you need to supplementand take it.
It's okay.
It doesn't mean anything aboutyou.
It doesn't mean that you'reinferior to like your friend
who's still making it Like.
It's not something to beashamed of that you're dependent
on having to take thissupplement.
Does that make sense?
It's also a shift with the wayof thinking about it.
Speaker 2 (14:41):
Like that perspective and argument because I do rely
on ashwagandha and otheradaptogens to just help me
maintain my level of cortisoland, as you're saying, it's not
something that my body naturallyproduces and the bioidentical
hormone replacement therapy isderived from plants.
Is that correct?
Speaker 1 (15:01):
Yeah, typically like well, very rarely do you see
something sourced from animalsanymore.
So I think, really, estrogen issourced from soy and
progesterone is sourced from yam, and they're very highly
regulated, and so you know howmuch you're getting in a
prescription, for example.
And women want a naturaltreatment, and I do too.
I get it.
I wouldn't want to treatanything not naturally.
They just need to startthinking about their own.
(15:22):
Hormones is more natural thanherbs, and herbs are great.
Herbs are medicine, they have arole to play, but on and herbs
are great.
Herbs are medicine, they have arole to play, but on top of the
hormones, like once, hormonesare your foundation.
Can I add an ashwagandha ormaca or something else to boost
my testosterone a little bitmore or block a pathway?
That they're powerful, likegreen tea extract is literally
(15:42):
toxic to ovarian cancer cells.
Women should be drinking greentea every day.
So the herbs have their place,it's just not in place of
hormones, like they don'treplace a hormone.
Speaker 2 (15:58):
When it comes to women who either can't, for one
reason or another, or don't wantto take HRT, what are some
non-hormonal interventions thatyou could recommend that they
could use to support theirbodies during this time?
Speaker 1 (16:07):
Really hard to do.
There's no way to either boostor replace the hormone that's
missing, and when the receptorsare free, you're more
susceptible to environmentalchemicals.
So you would have to completely, like eliminate every
environmental chemical in frontof you in order to maintain,
like, some type of stability inthe body and prevent cancer, but
in the sense that you'reeliminating gluten and dairy and
(16:29):
a lot of grains.
Diet matters, and I knowthere's a lot of different
theories out there.
Women will do vegan diets andvegetarian diets, but it will
actually make their hormonesmuch, much lower.
So if you're looking at keepingthem a little bit higher to
help with aging, protein isgoing to do that for you.
Women are like well, I want todo menopause because it's more
natural.
Just because it's naturaldoesn't mean that it's better
for you.
(16:49):
I have friends that areperimenopausal that don't want
to do HRT, and I'm like theirfriend and could really optimize
them.
And they're still turning itdown and it's because they one.
They just want to try it alittle bit longer, to do it
themselves, but their diet is sorestricted they fall off the
wagon one day and they feel itfor like three days.
Women who want to try to dowithout hormones, really have to
have everything so dialed in,it's a lot more challenging.
Speaker 2 (17:12):
Yeah, so it sounds like the hormone replacement
therapy is kind of like ashortcut, but there are options
for people who are willing to doall of the different things for
their hair, their skin, theirnails, their cortisol,
maintaining their level ofstress.
But it sounds like it's morework.
Speaker 1 (17:30):
A ton more work and a lot more money and a lot more
everything Like you're reallygoing to be spending a lot of
time doing it, for sure.
Speaker 2 (17:35):
So just to go down that avenue a little bit, cause
I know we've spoken a lot abouthormones and I know that's your
specialty, so you can stop me ifyou, if you don't feel like
answering these, but outside ofsay, multivitamins, what sort of
daily supplements do you findto be most helpful for women who
are in menopause orpostmenopause, specifically for
skin cognition and just overallvitality?
Speaker 1 (17:59):
So it is true, it is not just a hike.
Collagen really does benefitwomen in a lot of different ways
, and for the obvious skin andhair reasons, but also for the
mental reasons.
So we need, as we age, we needdopamine in the brain to be,
like, alert and focused and haveas much mental clarity as we
can.
And so the obvious way to raisedopamine is estrogen.
(18:21):
But if you don't want to dothat, you need something to make
dopamine really readily, andcollagen is just like drinking
straight amino acids that yourbrain can use and turn into
dopamine.
So if you do collagen inconjunction with, like creatine
and something like L-tyrosine,which is just an amino acid, you
can effectively raise dopamine.
You know there's other likenatural things that raise
(18:42):
dopamine, like microdosingpsilocybin is popular with some
practitioners who will work withyou on that Turmeric a thousand
milligrams of turmeric, likethe curcumin, will also help
raise dopamine.
Turmeric will also support awoman's immune system, so
something like reishi andturmeric as she's aging, because
immunity like if you want toage well, like especially if you
want to prevent heart diseaseand cancer it's all about the
(19:04):
immune system.
Immune system is like key.
So, as I say, like hormones arethe fastest and easiest and
most effective.
But if you're trying to boostyour immune system, turmeric
will really help you.
Glutathione will help boostyour immune system and so will
keeping and maintaininggluten-free and dairy-free diets
will help you with your immunesystem.
So, as we are more prone toautoimmunity as we're aging, I
(19:24):
would still recommend these forautoimmunity, even with hormones
.
I'd be like turmeric,gluten-free, dairy-free and
glutathione.
So glutathione is like sopowerful, but NAD is also.
So if you inject NAD andthere's other ways to like raise
NAD, like these saunas.
There's more longitudinalstudies on sauna use and women
and anti-aging and prevention ofaging signs with regular sauna
(19:45):
use, so you definitely can getthere.
Like if you were just look atthe immune system, that would be
like a collection of thingsthat you could do for your
immune system.
For example, mushrooms aregreat, like reishi is my
favorite when you want to boostthe immune system.
It'll raise natural killercells.
Natural killer cells are whatreally survey the body and kill
cancer cells.
So if you're really interestedin like preventing cancer,
(20:08):
something like a daily reishimushroom could potentially raise
your natural killer cells andprotect you.
Look, your immune system is keyto like really feeling well and
if you protect your immunesystem.
You will feel this like lowerinflammation in the body.
Gluten and dairy are like oneof the worst things to eat, so I
would say anybody aging toavoid these two.
Speaker 2 (20:25):
Yeah, I'm already off of gluten and dairy.
I know that it was a hard shiftto make, but it's had a
tremendous benefit to my health.
So what about exercise?
Like what do you do?
Or how important is resistance,training and sleep and managing
symptoms as well?
Like what can you say aboutthis?
Speaker 1 (20:45):
I tell women like I just want you to keep doing what
you like doing, and then I'mgoing to try to support you so
that you can keep doing what youlike doing.
Because I hate it whenpractitioners are like, ok, you
got to stop running, I knowyou're a runner, but you got to
stop.
And now you got to like liftreally heavy weights and like
completely shift your entireroutine now that you're a
menopausal, and this is likekind of devastating for a shift
(21:08):
when they would like to doPilates and yoga and running and
hiking and like some of theother stuff that they naturally
have been done doing their wholelife, so they've been able to
maintain their weight and theirhealth, like just by doing the
cardio or whatever they weredoing before.
I don't really care.
Like whatever you liked doingand you're going to do is what
we need to keep you doing.
But that being said, like ifyou're not going to do HRT, you
(21:28):
are going to rapidly lose muscle, because this is what helps us
maintain our muscle, ourhormones.
So you have to be aware that ifyou're not going to do HRT,
they will decline and this meansmore protein and more
resistance training.
I would say if you're going todo HRT and stay on good HRT
regimen.
It's less important, likeyou're, going to maintain your
bones and your muscles withoutlike the extreme heavy lifting
which, although it's still goodfor you, like I would say, the
(21:50):
more muscle mass we have,obviously the better off.
We're going to age so and whatabout creatine?
Speaker 2 (21:55):
I know you mentioned it before, but how do you feel
about women taking creatineregularly?
Speaker 1 (22:00):
I think it's more for like a mental clarity.
If you supplement with creatineyou only have to take a little
bit, whereas you have to eatlike a ton of meat to get like
the same amount of creatine.
I wasn't on the bandwagon for awhile.
I was like there's no way thatworks.
But I actually started takingit for mental clarity.
I'm like, okay, maybe, maybethere I get it.
I get it Cause it's hard to eatthat much meat, I think is the
problem.
So the supplementing reallyhelps you get like the core
(22:21):
nutrients that are in the meatthat you don't really feel like
eating all the time.
So I do think it helps withmental clarity and I think
anything that you could do tohelp with recovery is obviously
going to help like NAD.
Nad really helps with musclerecovery.
Nad is like a molecule that isfor the powerhouse, the
mitochondria of the cell, andyou can inject it.
It's a peptide that peoplereadily inject and it helps with
(22:41):
like mental clarity.
It raises dopamine in the brain, helps organize the immune
system.
It activates CERT1 pathways,which are longevity genes.
Then you can raise NAD bygetting in the sauna so you can
still do it.
Nad is more expensive to injector you can just, I guess, do it
in the sauna, but these willhelp you live longer.
They lower lipids.
There's a lot of research onNAD to show how beneficial it is
(23:01):
and it helps with musclerecovery.
Women should be keeping theirblood sugar as stable as
possible.
If you focus on a fat and acarb and a protein, so that you
are keeping a stable blood sugar, this really helps with
perimenopause and menopause ingeneral.
Whatever diet you choose, keepyour blood sugar really stable.
Sugar spikes will cause achange in fluctuation and
(23:22):
hormones enough for you to feelit.
And if they eliminate sugar andthey just keep their blood
sugar really stable, then theirmood is also stable.
Even if you're on HRT, I wouldsay women, if they can keep your
blood sugar stable, then theirmood is also stable.
Even if you're on HRT, I wouldsay women, if they can keep your
blood sugar stable.
Our moods and periods andeverything are very much
connected to blood sugar.
Like we need to stabilize itand balance it, and that's
another key to like aging andfeeling great as you're.
Aging is keeping these stable,unfortunately, because it's like
(23:44):
I want to eat all the goodstuff too.
Speaker 2 (23:47):
So what about the long-term effects of using HRT?
Is there any say what thelong-term effects may be?
Speaker 1 (23:57):
There are conflicting studies, but I would say that
overall, the benefits outweighany risks, and this is really
what women need to think of it,because nothing in life is
risk-free.
The most dangerous thing youcan do is get in your car and go
drive on the highway, but I'mnever going to give up driving
on the highway because it givesme the benefits.
And so every time we make adecision about anything,
especially medication orsomething we're going to do
(24:18):
forever, it needs to be a riskversus benefit conversation in
your head.
I think the longest study wehave is like 18, 20 years.
We don't know what thatantidepressant is going to do
for 40 years.
We don't know what thatstimulant that you're taking for
adhd is going to do.
Is that going to give youparkinson's when you're an old
person, right?
So we don't actually have thoselong-term studies.
And women will take Xanax andbirth control.
(24:40):
They'll take it for a decade.
We're doing a lot of things inmedicine that we don't have
studies for.
We don't need the study tosupport the long-term use.
The question is what are therisks of not doing hormone
replacement therapy?
Because they're big.
If you do not do hormonereplacement therapy, your risk
for osteoporosis, dementia,alzheimer's.
If you do not do hormonereplacement therapy, your risk
for osteoporosis, dementia,alzheimer's, colon cancer,
(25:00):
potentially breast cancer, heartdisease, urinary tract
infections, yeast infections,urinary incontinence they go up
dramatically when hormones drop.
People are asking the wrongquestion.
They're asking what's the riskof taking the HRT long-term?
The question actually is whatare the risks of not taking the
HRT long-term?
And they're big.
Speaker 2 (25:18):
That's really interesting.
So for the men that arelistening in partners, sons,
colleagues what do you wish thatthey better understood about
women that are going throughthis phase of life and how can
they support them?
Speaker 1 (25:33):
Men can encourage if their wife wants to do these
things that we're talking about.
They're not hormones, but, likeshe wants to do the things that
we're talking about, they'renot hormones.
She wants to do the diet, sheneeds to take care of herself
and she wants to set that asideand make it a priority.
Spouses can be hugelysupportive of women knowing that
they might need a little bit ofspace.
If she's still cycling acertain time of month, he could
be very helpful during that timeand just understanding that we
(25:53):
do not have stable levels ofhormones and they do and they
don't get it, and it's okay thatthey don't get it.
But they can be very supportiveof whatever she wants to do.
I think that's just the key.
It's like, whatever herdecision is, he can be on board
with it and then also be alittle bit patient, knowing that
it's not him.
You know cause I think theyinternalize it because they're
you know, sorry guys out there alittle.
(26:14):
It's not being self-centered,but it's not always about you,
and so they he can justrecognize that it's not about
him.
It's something that she needsto just figure out and it can
take some time, like women willspend one or two years or more
trying to feel better.
She can do that and spend a lotof money at the same time
trying different things andseeing what works for her, and I
think a spouse may notunderstand that and he can just
(26:34):
realize that that is true, thatshe needs to be doing that.
We'll treat men with Viagra andtestosterone all day long, but
we will tell women when shecomes into the doctor's office
and complains of low libido orvaginal dryness or sex is
painful, she's told to like usesome lube and read a sexy novel
and like go date your husband.
You know and this is reallyunfortunate it's a downright
(26:54):
criminal that we would give aman Viagra and testosterone and
not treat his wife.
I think for relationships thatmen need to be a little bit more
like, understanding of like andhelp and supporting their wife
that, hey, your wife, it's notbecause she's not into you.
Her hormones are low and sheneeds some like.
If she doesn't want to have sexwith you, it's not because of
(27:15):
you or your relationship.
She needs like help and this isa health problem.
She needs to like get herestrogen up so that she can have
sex with you, and so if hestops internalizing so much, I'm
thinking it's his fault, causeI've had I've had male friends
tell me this, but they're justlike I just thought she didn't
have sex with me.
You know what I mean.
I just thought that she wasn'tinto me and it's like it's not
about you, dude, and they'relike I know it's patient.
This is such an everyday thingfor relationships.
Speaker 2 (27:45):
Well.
So this also makes me thinkjust about accessibility.
Is hormone therapy a luxury, oris it essential enough that it
should be considered a basicright for women's health?
I think that's a great question.
Speaker 1 (27:52):
I love how you phrased it.
I've never heard it that way,but it's amazing that you say it
that way.
It should be a right, it shouldbe democratized, it should be
accessible, it should be easy,with no gatekeeping.
It's safe.
It's safe for them to try.
If it works, it works.
If it doesn't, it doesn't.
You know, it's kind of one ofthose things that it's like a
supplement.
If it doesn't work, then theyjust stop it and you don't have
to keep doing it.
It's not like this right nowthey're doing and it's like
(28:12):
thousands of dollars.
They're going to charge you alot for labs, they're going to
have you do it quarterly, and sowhen I started my company
online, the idea was to make itmore accessible.
What if you're?
Speaker 2 (28:26):
in a really small town.
Speaker 1 (28:27):
Like I'm in a small town in Idaho, like what if
you're in Montana, north Dakota,and you don't have access to
the LA longevity docs?
Or even if you're in LA and youdon't want to spend 10 grand
and so we're in 44 states andsoon to be 50.
And the idea is that can wemake it a price point that is
more affordable Because it'sgoing to be out of pocket no
matter what?
I think that's also what womenwant health insurance to pay for
(28:48):
it, and they don't understandthat health insurance doesn't
see your perimenopause asmedically necessary to treat
Like they're.
Just like they have to waituntil you're like menopausal or
a lot of times.
Insurance sometimes covers it Ishould say that but they're
going to be limited in what theydo cover and how much they
cover.
So women just have to get kindof used to the idea that for a
while that's going to have to beout of pocket.
It doesn't mean it's be forever, but for the next few years
(29:08):
probably we'll be out of pocket.
And can we do that there?
are a few online companies thatare trying to make it more
accessible.
Speaker 2 (29:14):
For women who are thinking that they're in
perimenopause or they're inmenopause.
They need some help.
They want to consider hormonereplacement therapy.
What is the next step?
Do they go and get a test tosee what their levels of
hormones are?
Speaker 1 (29:29):
So the problem with the testing is one there's a lot
of analytical and biologicalvariability.
If they come back abnormal,then you have some supporting
evidence that you're not goingcrazy.
It's not in your head, but Ithink what tends to happen is
that we only rely on thelaboratory testing and then
women are like dismissed, sayingthat your labs are normal and
this is the problem, thatthey'll use the lab if it
(29:51):
supports them.
But symptoms should alwaystrump a lab test.
For example, the best lab testmight be to get is actually an
FSH, because we mentioned thatFSH will continue to rise.
So even if your estrogen andprogesterone are like kind of
normal, every time you get yourcast and you're going crazy
because every time you get atest everything's normal, but
you don't feel normal.
But that FSH is like slowlygetting higher and higher.
That should be like your key.
(30:12):
That you're perimenopausal.
You are better than any labtest.
You know better than any labtest.
You know better than anyphysician You're the one that
has to live with yourself everyday.
So if you don't feel well,you're the one that needs to
take action on it and get helpand be proactive, right?
No doctor is going to do thatfor you.
You have to do it.
You need to find the doctorthat's not going to turn you
away and say, no, that's theproblem.
(30:39):
The doctors are like no, theurine, we have an FSH, we have
some genetic testing.
You can test COMT and look atmetabolism so that you can get a
bigger picture.
But very few practitioners willdo this for you.
Instead, they'll just get anestrogen level.
Oh, it's normal, you're fromyour normal, you're too young to
be experiencing this, and sowomen need to just know that you
can get a panel of lab testingand it could be abnormal, but it
(31:02):
could also be completely normal.
So I think, in general, a lot ofpractitioners are now saying
that, look, perimenopause is aclinical diagnosis, it's not a
laboratory one.
So you have to work withsomebody who's willing to just
say hey, the hormones are safe,you can try them.
If you just have weight gainbut you feel fine, you have a
really crappy diet, okay, thenchange your diet and try that
first.
If you're gaining weight andyour hair is falling out and
(31:23):
your skin looks terrible and youcan't sleep and you have
anxiety, like you have like 10or 15 symptoms together and
you're like food sensitive andyou know what I mean.
Like there's just all thisstuff that you're like I just
don't feel like it's right andno matter what, this is hormonal
at its core, because thehormones basically regulate
every pathway in the body and soyou are going to get a lot of
symptoms at one time.
That's a good rule of thumb.
(31:43):
If I just have one thing goingon, maybe I could just try to
address that one thing.
But if you have a lot,sometimes I'll just like want to
look at the lab, you know.
But then I'm like okay, let'sput the labs aside and like tell
me what's going on with you,because I can do a much better
job just hearing what yoursymptoms are and what's
bothering you the most, becauseshe will tell you exactly what
you need to know.
The labs are kind of like onesnapshot in the day and they're
(32:05):
maybe not even accurate, butlike she will tell you what
she's been going through andthis is so much more powerful to
listen to than a lab test.
And providers and everybodygets so wrapped up in this like
data driven, but they need tounderstand how hormones are.
There's a wide therapeutic rangethere.
They're all over the place inthe body and so labs are not
quite as helpful as some of theother.
(32:26):
We can get labs like on heartdisease and LDLs like.
That's reliable, like your LDLis what it is, but your estrogen
level?
Take it an hour later.
It'll probably be different.
Take it the end of the day,it's going to be completely
different, you know?
Speaker 2 (32:38):
Oh, interesting, yeah , and labs are downstream.
And then also, as you weresaying, it impacts you
differently than it will impactme and all of our friends.
Speaker 1 (32:47):
Exactly, so, even though, if, even if your
hormones, like, are a certainlevel, you might feel okay Like
you because you're also doing alot of different things, like
with your adapt.
You know you have like yourstuff dialed in, you're gluten,
dairy free, you're doing like alot, so you may not feel as
terrible as like someone else.
So it's also the labs are youknow you should.
I shouldn't force you into somereference range and then say
that you should be feeling okay,it's all like.
(33:09):
It's an open system and yourdiet and genetics play a huge
role.
We need to just need to belistening to women.
Speaker 2 (33:15):
So, just as a closing question here, if you could
leave women and the people wholove them with one message about
this phase of life, what wouldit be?
It?
Speaker 1 (33:23):
would be that, like it's going to be, it could
potentially be like the besttime of your life, Like you
could have the most enjoyabletime where you're set in your
career.
You have kids, you have, likeyour partner, you have financial
security most of us and you canlook good and feel good.
And, like your partner, youhave financial security most of
us and you can look good andfeel good.
And there are like things thatyou can do and sometimes it
takes all of them, but it'spossible.
So, like don't ever let anybodytell you that like this is how
(33:46):
you have to feel, or this is theway it is just being a woman,
or we have to age a certain way.
You get to choose, that we havethe choice and capacity and
control of how our journey lookslike and so just take control
of it.
Like it's your responsibilityto make sure that you take care
of your body and the body is sointelligent and how they can
actually heal.
So if you're suffering fromsomething and you don't think
(34:07):
it's ever going to get better,like I, just this is just the
way it is and this is how I'mgoing to feel, like this forever
.
That's not true.
The body has the ability toheal.
If you give it the foundationand the building blocks that it
needs.
Whatever that is like you giveit to, the body will get better,
and so it's it's remarkableLike, and so it's it's it's a
positive note like.
Menopause and perimenopause arenot about suffering.
We don't need to get togetheras women and talk about our
(34:28):
symptoms and how stuff, how muchwe're suffering.
In fact, we should be able tostop like a miserable time.
It's actually not.
It shouldn't be.
Speaker 2 (34:40):
Well, dr.
Sarah, thank you so much forcoming on and sharing your
insights with us.
I've never spoken with anybodyabout perimenopause, menopause
or postmenopause, and so I'velearned a lot from listening to
you.
Thank you for having me.
Speaker 1 (34:50):
I really had a good time talking to you.
Speaker 2 (34:56):
Today's key takeaways .
Perimenopause can start earlierthan you think.
Hormonal decline might begin inyour late 20s or early 30s, not
just your 40s, and the symptomsoften look like other things
Anxiety, fatigue, mood swings,insomnia, bloating.
We blame stress, parenting,food sensitivities, when really
(35:20):
it might be your hormones.
Even if your labs are normal,your symptoms are real.
Hormone levels fluctuate andblood tests are just a snapshot
downstream from your actualexperience.
If you feel off that matters,perimenopause is often best
recognized through your livedexperience and not a lab result.
(35:41):
Autoimmunity might be a sign ofhormonal decline.
Women are far more likely todevelop autoimmune issues and
hormone shifts can play a role.
If you're dealing withautoimmune symptoms, it may be
worth exploring your hormonalhealth.
Estrogen and progesterone aren'tjust about reproduction.
(36:03):
They support your brain, bones,heart, mood, metabolism and
immune system.
When introduced appropriately,hrt may help reduce long-term
risks of heart disease,osteoporosis, dementia and more.
We don't make men wait, so whyare women told to?
Men don't have to wait fortestosterone to fully disappear
(36:26):
before getting support.
Yet women are often told towait until a year after their
last period to even consider HRT.
The fear around estrogen isoutdated.
The original Women's HealthInitiative study was widely
misinterpreted and causeddecades of fear, but long-term
follow-ups, including onepublished in JAMA, found that
(36:50):
estrogen may actually reduce therisk of breast cancer.
There are other ways to supportyour health, but they take more
effort.
Diet supplements, adaptogens,collagen, creatine, sauna,
resistance, training all ofthese can help, but they require
a lot of consistency.
Hrt, for many, is a moreefficient way to feel well
(37:11):
because it restores what yourbody used to produce naturally
To the partners out there.
This isn't about you.
To the partners out there, thisisn't about you.
When the woman you love startsto shift physically, emotionally
, sexually it can feel personal,but it's not rejection, it's
not distance, it's biology.
And your understanding, yourpatience, your support is
(37:35):
everything.
Relationships thrive when womenfeel seen and backed.
Aging is a part of life, butsuffering through it is not
required.
That's it for today.
I release episodes once a week,so come back and check it out.
(37:56):
Have a great day.
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