September 14, 2025 • 39 mins
What happens when you outlive your ovaries? Dr. Kelly Casperson, board-certified urologist and award-winning author, joins us to unpack the truth about menopause and hormones in her characteristically honest, evidence-based approach.
Kelly challenges the outdated narrative that hormones are dangerous, walking us through why the 2002 Women's Health Initiative study has been widely misinterpreted. "The paper is free online," she explains, "and it says breast cancer does not reach statistical significance." Yet two decades later, this misunderstanding continues to prevent women from accessing treatments that could significantly improve their quality of life.
We dive deep into the timing hypothesis—why starting hormone therapy early provides the best preventative benefits against conditions like heart disease and dementia—and why baby boomers should be "pissed" about being denied hormones when they needed them most. Kelly doesn't hold back when debunking the patronizing "grandmother hypothesis" or addressing vaginal health with her trademark blend of medical expertise and humor.
Perhaps most valuable is her balanced approach to menopause management. While advocating for hormone therapy when appropriate, she emphasizes that slapping on an estrogen patch won't help much "if you're drinking and not sleeping and not exercising and your mood about getting older is shitty." The real power comes from combining hormone knowledge with lifestyle changes and a positive mindset.
Whether you're approaching perimenopause, deep in the menopause transition, or supporting someone who is, this episode delivers the straightforward education women deserve. As Kelly reminds us, "Nobody is more in charge of your body and your knowledge about it than you."
Be sure to order her new book, "The Menopause Moment," available at all your favorite bookstores.
Dr. Kelly Casperson is a board-certified urologist, best-selling author, and top-ranked international podcaster empowering women to take charge of their health, hormones, and sexuality. Known for blending science with storytelling, she turns complex medical topics into relatable, actionable insights that help women live fully, especially in midlife.
With her signature candor and clarity, Dr. Casperson dismantles myths around sex, menopause, and desire. Her acclaimed podcast, You Are Not Broken, is a trusted resource for hundreds of thousands of women seeking real answers about their bodies and brains. Her work fuses urology, neuroscience, and mindset coaching to spark lasting change in intimacy, confidence, and well-being.
As a speaker and educator, Dr. Casperson challenges outdated norms in medicine while offering bold, science-backed solutions. Whether on stage, in clinic, or behind the mic, she is leading a health revolution through smart, honest conversations.
Website: https://kellycaspersonmd.com
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MiDOViA is dedicated to changing the narrative about menopause by educating, raising awareness & supporting women in this stage of life, both at home and in the workplace. Visit midovia.com to learn more.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
April Haberman (00:00):
Welcome to the MiDOViA Menopause Podcast, your
trusted source for informationabout menopause and midlife.
Join us each episode as we havegreat conversations with great
people.
Tune in and enjoy the show.
Hi everyone.
Did you know?
MiDOViA has the first and onlymenopause-friendly accreditation
(00:21):
program in the U?
S.
Our program is the benchmark ofexcellence, backed by five
years of experience, workingwith hundreds of employers
around the globe, with ourworldwide partners.
You can join now with a 20%discount off your first year's
membership in honor ofperimenopause and world
menopause months.
Joined before October 31st toreceive your discount by
(00:45):
visiting menopause months.
Join before October 31st toreceive your discount by
visiting menopausefriendlyuscom.
Kim Hart (00:51):
Hey, welcome back everybody.
We have our favorite doctor,kelly Kasperson, on board today.
She's a board certifiedurologist, author, speaker and
the host of the top rankingpodcast.
You Are Not Broken, and beforewe hit record today, we were
talking about all the greatthings she's doing with that
podcast, but you probably knowher through her best-selling and
(01:13):
award-winning book, right?
Dr. Kelly Casperson (01:15):
You Are Not Broken.
I'm now an award-winning author.
Kim Hart (01:18):
I know, of course you are.
It's a good week.
It is a good week.
Stop shooting over yourself.
And her courses and her podcast, dr Kasperson equips women with
practical tools andevidence-based education to
reclaim pleasure and confidenceat every stage of life.
She also makes you laugh, andwelcome to the podcast, welcome
(01:40):
back to the podcast.
Dr. Kelly Casperson (01:42):
Thanks for having me.
I was on like two years agomaybe.
Kim Hart (01:45):
Yeah, yeah, you were one of our first guests.
We were all important Look atyou still podcasting?
Dr. Kelly Casperson (01:51):
I know Right.
April Haberman (01:53):
It's fun.
It's one of our favorite thingsto do.
Dr. Kelly Casperson (01:55):
Really, it is the most fun.
Kim Hart (01:56):
Okay, before we start talking about this new book,
which I am mesmerized by, I wantto swing back to your
award-winning book.
You Are Not Broken.
I was at dinner with a fewgirlfriends a couple nights ago
and your name came up.
I don't know why it came up Imean because everybody's a fan
(02:17):
but they said they saidsomething like Kelly says that
you can have five orgasms in arow.
Dr. Kelly Casperson (02:24):
And we were all like, like Kelly says that
you can have five orgasms in arow, and we were all like I
never said that.
Kim Hart (02:33):
No, but but what?
Dr. Kelly Casperson (02:34):
I went back to Instagram and it was a title
that someone suggested.
Someone said you should callyour book how to have five
orgasms in a row.
But I don't tell people how tohave five orgasms in the book,
it's just the knowledge you gainfrom that book could cause five
orgasms in a row.
We were like, oh I don't know.
Kim Hart (02:48):
We're like what.
Yeah, is that funny?
Dr. Kelly Casperson (02:51):
I was like I had to do a reel on that
because I'm like that's a prettygood recommendation well, it
was, and it was clearly a topicof conversation.
Kim Hart (03:03):
Yeah, so yeah okay, I just thought that was such a
funny story, cause I was like,oh my gosh, okay, I'm talking to
her this week and I have tobring this up, cause we were
like.
Dr. Kelly Casperson (03:12):
I don't remember the instruction manual.
April Haberman (03:15):
I didn't put it.
We missed that part.
Dr. Kelly Casperson (03:17):
Yeah, yeah, I didn't specifically put that
in there.
Kim Hart (03:20):
Okay, well, you've been super busy.
I don't even know how you keepup with your own life.
You were on the FDA panel andtalked about you're talking
about vaginal estrogen.
You have a new clinic, you werehot on testosterone and now you
have this new book.
I mean, testifying on an FDApanel is a huge deal, and then
all these things are happeningtoo at the same time.
(03:42):
Why did you feel that themenopause moment was a book that
needed to be written right now?
Dr. Kelly Casperson (03:47):
Oh, because there's 80 million women over
the age of 40 in the UnitedStates alone and everybody,
first of all, nobody knows whatmenopause is.
And the definition of menopauseis the natural cessation of
periods, which is actuallymeaningless, right?
So, like the.
What's actually happening iswe're outliving our ovaries and
(04:09):
nobody knows that, right?
It'd be a lot easier if therewere like testicles and we could
just watch them shrivel up.
But so you know, the publishersreached out with the you Are Not
Broken, came out and they'relike will you write another book
about sex?
And I said, yeah, sure, but Iwould really like to write a
book about menopause.
And they're like will you writeanother book about sex?
And I said, yeah, sure, but Iwould really like to write a
book about menopause.
And they said, great, writethat.
(04:29):
And that's why I told peoplelike my life's not normal,
because I just told thepublisher what I wanted to write
a book about.
And they're like, yeah, so I'meternally grateful that I don't
know anything else about likebook publishing.
I'm just like, how, about amenopause book?
(04:50):
They're like, yeah, and I'mlike, great, let's do that.
I think my book's really a.
It's very interesting becausewhen I started writing this book
two plus years ago, I was likeI'm going to come out with the
gloves on and basically say,listen, hormones are great for
you, you need to know that.
And I really wanted to have abook that supported women in
(05:13):
their decision, because evenwomen who are on hormones they
get this backlash from likefriends or doctors or whatever.
Like I.
Just I needed to be strongerthan that.
So I'm like listen, I'm goingto give you all the data on what
hormones do and it gets you tounderstand that these are
molecules in our bodies thatmake our cells and our
mitochondria function.
Like you have to understand whata hormone is and what happens
(05:35):
when you choose to live withouthormones.
And so I was like, oh, thatmight be kind of an aggressive
stance at the time, two and ahalf years ago, and that's how,
that's how fast this is allmoving.
Because now, like I mean you'veread it, like I don't think
it's actually coming across thatNot that it was aggressive, but
like time, I'm like I'm nothere to tell you what to do.
(05:57):
I don't care, I don't have yourbody, I don't have your life
goals.
Like I don't care what you do,but I care greatly that you have
the knowledge and the educationand the tools to advocate and
communicate.
April Haberman (06:12):
Yeah, you're clearly about choice, but be
informed so that you can makehealthy choices for your overall
well-being right.
So we have to educate ourselvesso that we can make healthy
choices.
Otherwise, what are the?
Dr. Kelly Casperson (06:26):
choices we're not empowering.
And I think what's much morecommon is women thinking they
can't be on hormones, whenactually the truth is that they
can.
And for people to understand,everything has risks, right,
medications have risks.
Not being on hormones has riskslike.
Just understand that instead ofthinking that this is like an
(06:47):
easy black and white yes or no.
You know, the other big myth isage is a cutoff, right.
So there's just so many mythsout there and I really think my
book is like the 2.0.
To like ask your doctor if it'sright for you, it's like no, no
, you get to.
You know, we're not all doctors, but we can understand basic
physiology, right.
(07:07):
We understand dental care, weunderstand periods right, we can
understand basic physiology.
Kim Hart (07:18):
You do a great job of how to talk to your doctor in
this book.
Thank you, yeah, because wetalk.
We talk all the time in theworkplace about how to talk to
your doctor.
I'm going to be reading thatsection over and over again.
It's a really good one, but youare unapologetically
pro-hormone.
Dr. Kelly Casperson (07:34):
Yeah, I mean, I'm pro-functioning bodies
.
April Haberman (07:36):
Yeah Right, You're like.
Dr. Kelly Casperson (07:38):
I still stutter on that because haters
will take it and they'll be likeyou just want everybody to be
on testosterone and I'm like no,I have never said I want.
Side note possibly vaginalestrogen is probably.
We're probably at the point ofpreventative health for
everybody with vaginal estrogen.
But as far as hormones go, likeI'm pro you understanding if
(07:59):
this is a good decision for youor not.
And I think the other thing,the layer under that, is like
this paternalistic like only ifyou're suffering enough, which
is a completely non-objective,subjective marker of like if
you're worthy of hormones or not.
And it's like hormones don'tcare if you're worthy or not or
if you've suffered enough.
Hormones make your cells andmitochondria function.
(08:21):
Yeah, yeah, they'renonjudgmental.
It's the humans who are judging.
April Haberman (08:28):
Yes, yeah, absolutely.
But can I?
I don't.
It seems like every time wehave a conversation about
hormones, we come back to thefallout of the WHI study in 2002
.
But I do want to come back tothat for just a moment, because
yeah, I think you have to, Ithink we have to too, I think we
have to.
It's part of the culturalnarrative.
At this point it's still here.
Dr. Kelly Casperson (08:47):
Yeah, it's still here, yeah, and I think,
like why women are afraid of thezeitgeist or the ether, even if
they, even if women can't sayI'm afraid because of the WHI,
like they can't say where itcomes from, and so I think the
education goes a long way oflike this is why you're afraid.
Because there was some big shitwent down in 2002 before social
(09:08):
media, before doctors couldcommunicate on a grand scale,
when the big legacy media hadall the power to influence
movement in this country.
Right, there was some big, bigwind that blew that year and it
was basically saying thathormones caused breast cancer,
which, yeah, I mean.
The other fascinating thingabout the WHI is you know that
paper is free online right now?
(09:30):
Oh, it wasn't before.
Kim Hart (09:33):
It always has been 22 years.
Dr. Kelly Casperson (09:36):
It's always been free online.
April Haberman (09:37):
But your point being is that we don't
understand it yet.
It's free and it's accessiblefor everyone, so go read it.
Dr. Kelly Casperson (09:43):
You can go read it and it says it doesn't
reach breast cancer, does notreach statistical significance
and in the medical world we'restill living around this fear
and the outdated perception thatit causes cancer.
Yeah.
And how do you get rid of fear?
You can't tell people not to beafraid, right, that's not how
(10:05):
it works.
That's not how brains work.
And how do you get rid of fear?
You can't tell people not to beafraid, Right?
That's not how it works.
That's not how brains work.
The only way to get rid of fearis to say here's all the
knowledge, read it if you wantRight, right.
But telling people like you knowit's like cognitive dissonance
we see it in politics all thetime right now of like if you
(10:28):
tell somebody, no, that's notright, they will double down
Right.
And then they'll tell you abouttheir cousin who was on
hormones and had breast cancer,which correlation doesn't equal
causation.
Right, but brains don't knowthat.
So how do you get rid of fear?
Education.
I don't know a better way.
April Haberman (10:38):
Yeah, which is is what you're doing, um, in so
many ways and we're soappreciative.
But you talk about the timinghypothesis and I want to break
that down a little bit.
I want you to break that down alittle bit for listeners and
talk about why you think babyboomers should be pissed.
Dr. Kelly Casperson (10:58):
Yeah.
So the timing hypothesis is thetheory and it was first
developed in monkeys and thenextrapolated to humans and done
some research.
And the theory is that ourbodies age and things happen
with aging and if you starthormones before your body starts
to significantly age, hormonesdo a better job at preventing
(11:19):
disease.
Hormones don't do a good job attreating disease.
Hormones don't do a good job attreating disease.
So the timing hypothesis is atage 50, when your hormones go
away, you start aging at a ratethat you didn't age before
hormones.
There's plenty of data on that.
50 is this huge physiologic agepoint, roughly 50, but
different for everybody.
And so by age 60, there's beensome physiologic changes because
(11:53):
you've lived longer than yourhormone production that you
can't reverse just by startinghormones again, right?
So the timing hypothesisbasically says that the best
time to prevent heart disease,prevent dementia, is early
menopause.
Now we're pushing it, we'resaying probably perimenopause,
because remember, nothingmagical about your last period,
zero magic about the last period.
The hormone changes really dostart perimenopause.
So that's your best bet.
And you know, I tell peoplelike on that horrible Tuesday
(12:16):
when you or your loved one is 73years old and they get
diagnosed with dementia on that,really really bad day.
That dementia started 20 yearsago, right, and when is that?
That's the average age ofmenopause for women.
And so, tying back to why arethe boomers pissed?
The boomers should be pissedbecause they were told they
can't have hormones, yeah, andnow they're being told it's too
(12:38):
late for hormones, which is avery interesting discussion.
I just did a lecture on it lastweek that like filled up my
Zoom to its limit.
Because the boomers are pissedand the boomers aren't doing
okay in like, oh, don't worry,the hot flashes end.
Yeah, these people are.
They have mood issues, theyhave sleep issues, they have
joint aches and pains, they haveuntreated menopause symptoms
(13:02):
yeah, and they're completelyvoiceless, they're completely
blown off.
They're asked if they'resuffering enough and, by and
large, they're doing everythingright they're eating healthy,
they're exercising, they'retrying to manage their stress,
they're staying a healthy weight, they're lifting weights right,
like they're doing everythingthey can, and they continue to
suffer and they likely will notget the preventative benefits of
(13:29):
if you started when you were 50, but if they choose hormones,
they will get the hormonebenefits of bone protection less
joint aches and pains.
Better sleep, less hot flashes alot of these ones.
They're still having hotflashes, yeah yeah, we hear that
it's this grand paradox andthere is.
You know.
People say, oh, my doctor saysit's too late, and I'm like
(13:51):
there's no guideline that saysit's too late.
North menopause societyguidelines 2022 says best
benefit is early, right.
They do not say and then, asyou get older and you get more
comorbidities, it's a riskbenefit discussion.
So to behave as if it's blackand white is hurting a lot of
women.
I'd say about a third of my ago, and she woke up in the middle
(14:13):
of the night with night sweatsand had to change everything.
Kim Hart (14:16):
See, she would benefit .
They're suffering, yeah, she'ssuffering.
Bank time.
April Haberman (14:29):
For years and years and years.
By the way, yeah, yeah, shedidn't just wake up in her 70s
having hot flashes, the onlyboomers that aren't pissed are
the ones who don't like.
Dr. Kelly Casperson (14:38):
They've never heard that this is an
option.
Once they get educated, they'relike what about me?
Yeah.
Kim Hart (14:43):
Yeah, well, and so, speaking of my mom, who's a
grandmother, I read over andover the section on your point
of view around the grandmotherhypothesis, because yours was
the first one that was likehow'd I do Well, no, you did
great and I totally understoodit, but it was different than
anything.
Your point of view is differentthan anything I've ever read on
(15:05):
the grandmother hypothesis.
Can you talk about that and howto debunk?
April Haberman (15:08):
that myth?
What is it for the listenersthat don't know what that is?
And then, what's your?
Dr. Kelly Casperson (15:12):
point the grandmother hypothesis is this
it's been used as a patronizingway of saying we were meant to
go through menopause because weneeded to stop having babies so
we could have more resourcesdevoted towards our children's
children.
So it's basically ajustification, which is so.
(15:35):
I basically debunk it and say Fthe grandmother hypothesis,
because average age ofmenstruation, let's say 15, just
because it's unpleasant tothink about a 12-year-old
getting pregnant, but you canget pregnant.
I would say average age ofmarriage in Abraham Lincoln's
time was 17.
Okay, so you're having a kid inyour teens in the natural world
(15:57):
?
Uh-huh, all right.
That means you're a grandma by40.
Yeah, right, right, okay, right, all right.
You could be a great grandma,maybe by 48, if the math's right
, right.
And then average lifeexpectancy, excluding infant
mortality, maybe 60.
Right, right.
(16:18):
But if you're a grandma at 30,because you had a kid when you
were 15, and then that kid had akid at 15, which is completely
possible and it's how our bodieswork, there's nothing about oh,
thank God, my period stopped soI could be a grandma, right.
So what the patronizinggrandmother hypothesis did?
It says in modern times wedon't tend to have babies until
(16:38):
we're 30.
Right, but that's not hownature works.
That's called birth control andlike controlled family planning
.
April Haberman (16:46):
Exactly.
Kim Hart (16:47):
Not our bodies.
Dr. Kelly Casperson (16:48):
So to say, oh, menopause is natural,
because people will take it andthey'll be like menopause is
natural.
Therefore you shouldn't treatit because you're supposed to be
a grandma and you're notsupposed to have kids so you can
take care of it Like that's howkind of dark the grandmother
hypothesis has gotten.
And even so I put in the bookthat even the guy who like kind
of coined the grandmotherhypothesis was like I'm not so
(17:09):
sure about this.
I mean, the other big thing islike what I wanted to name this
book, aging in Captivity,because I think my audience gets
that.
My publishers did not get that.
But I got it because I'm like ifyou take any animal, except for
orca whales, who do really,really shitty in captivity
because we keep them in smallpools.
(17:29):
But if you take any animal andyou give them clean food and
water.
You eliminate natural predators, you give them great health
care.
They live longer in captivitythan in nature.
Right, there's a harbor seal inOregon that's like 49 years old
right now.
In nature they live to be 18,right.
(17:52):
And so, like we are aging incaptivity, we've got clean water
.
Antibiotics alone has increasedlife expectancy by 16 years on
average per person.
Like it's insane, right?
We're really good at trauma.
We're really good at treatingcancer.
We're really good at keeping usalive.
Yeah, our average lifeexpectancy now is 40 years with
(18:15):
no hormones, and that hasconsequences.
I would also like to argue thaterectile dysfunction and
enlarged prostate are naturaloccurrences and nobody goes
around telling men that that'snatural and we shouldn't treat
it Very true.
Really, the book is justchallenging the dogma that I
truly believe is built to keepwomen quiet in their place and
(18:38):
resulting exhausted dropping outof their workforce.
April Haberman (18:43):
Yeah, 100% right , yeah, 100% Right.
And, by the way, I we often saythat we need to change language
, that menopause is a naturalprocess, right?
It's not natural.
For someone that isexperiencing menopause, that's
going through surgical ormedical menopause, it feels
anything but natural.
So it's a normal process, butit's not a natural process for
(19:06):
everyone.
So just want to throw that inthere for our listeners.
Dr. Kelly Casperson (19:10):
Yeah, and we know I mean to speak to like
the, not that we want to competeon who's having their menopause
managed most poorly, but theaward probably goes to the early
menopause women because we havevery clear data, very clear
data of increased risk ofdementia, increased risk of
death by heart disease if yourhormones end before the for lack
(19:31):
of a better word natural age ofmenopause of 50.
Like that's standard data.
And we know that Louise Newsomedid this study in the UK and we
don't think it's better inAmerica that surgical
oophorectomy is treated withhormones 5% of the time.
April Haberman (19:50):
I can't believe that 5% of the time.
It's a disgrace.
Dr. Kelly Casperson (19:55):
I'm a urologist, I will remove
testicles for tumors and otherreasons.
It is a never event to removetesticles and not replace with
testosterone Never event.
April Haberman (20:09):
Unbelievable.
Dr. Kelly Casperso (20:11):
Unbelievable If a urologist did that they
would be reported to the medicalboard and probably would lose
their license.
April Haberman (20:17):
Oh yeah, that ticks me off it should.
Okay, I want to talk a littlebit more about things that
frustrate us, because why not,while we're on that subject,
myths, misconceptions, that thatfrustrate us, because why not?
Dr. Kelly Casperson (20:28):
uh, while we're on that subject, myths,
misconceptions, misconceptionsthat still frustrate you uh, you
can't be on systemic hormonesand vaginal hormones at the same
time.
That hormone replacementtherapy only means estrogen.
That you have to stop hormonesat a certain age because I said
so.
Because now you're too old.
You can't start hormones at acertain age because I said so,
(20:49):
or you're too old.
What else?
That sex, that painful sex isnormal.
That it's really awkward totalk about sex, so we shouldn't
talk about sex.
That your doctor knows bestabout hormones.
Kim Hart (21:05):
Just a few.
Dr. Kelly Casperson (21:07):
Just a few yeah.
Kim Hart (21:08):
Okay, let's talk about sex, because you let's talk,
you're the best one to talkabout this with of anybody.
April Haberman (21:15):
Mainly take that as a compliment well at any age
too, by the way, because um ourdaughters love your last book
and um, they do and and you knowwhat?
They're giving your book totheir friends and they're in
their 20s.
Yeah, yes, way, I think it'sfabulous, and that conversation
is happening at a younger age,so bravo.
(21:36):
Yeah, thanks for breaking itdown in such.
Dr. Kelly Casperson (21:39):
Go young.
April Haberman (21:40):
Go young, yeah Kim go the senile vagina.
Kim Hart (21:43):
What is it?
Dr. Kelly Casperson (21:45):
Senile vagina is a medical term in the
1980s to describe a what we nowcall genital urinary syndrome of
menopause.
So thinning of the tissues,decreased lubrication, dryness,
tearing pain with withpenetration and so what do I
mean?
Kim Hart (22:02):
do we get it?
How do we not get it?
Like what, what?
How do we keep it?
We all yeah.
Dr. Kelly Casperson (22:06):
Hopefully nobody gets senile vagina
anymore, because it's anantiquated term and we try not
to use it, but I use it in mytalks a lot because it makes
people laugh and makes them mad,also Mad laughter.
That's really what I'm goingfor 50 to 90% of women post
menopause and again the problemis women don't know what's
(22:26):
actually going on.
You've outlived your ovaries.
Ovaries make hormones that makeyour body function well.
Right, Like that's what theydon't understand.
Or I'll be like you know thisis because of menopause, and
they're like my last period waseight years ago.
You're like, oh, you thoughtthis was just the end of periods
.
Periods is just a symptom ofwhat happens because of low
hormones, right?
So I mean even the wholeconversation about menopause and
(22:49):
a lot of thought leaders noware like we need to stop
actually talking about menopausebecause it's not clear of
what's actually happening.
But there's no female word forcastration, which is very
interesting because words matter.
But so, yeah, GSM can happenyears after your last period.
It can happen in perimetopause,it can happen with
(23:11):
breastfeeding, it can happenwith cancer treatment, Like
there's lots of things willaffect the tissues.
The gold standard is hormonetherapy, because that's why it's
happening.
Right, and this is localvaginal hormone therapy, most
commonly an estradiol product.
The DHEA product is also lovely, but it's expensive in America
(23:33):
and it works wonderful.
And people use moisturizers andlubricants for comfort.
Nothing wrong with that.
They help hold in moisture, butit doesn't solve the underlying
pathophysiology of why it'shappening in the first place
underlying pathophysiology ofwhy it's happening in the first
place.
April Haberman (23:54):
Well, and you mentioned earlier that we're
getting closer to vaginalestrogen being a preventative
medicine as well, Because Ithink, typically what happens
correct me if I'm wrong but weend up in the doctor's office
because our vaginas are so dry,because the sex is so painful
that we want you to suffer first.
Yeah we've reached a point wherewe're like I am freaking
miserable and what is happeningto my body?
Right, I don't understand,because nobody told me that this
(24:16):
was coming Horrible place to be.
So can you speak to that alittle bit and maybe even
sprinkle in there yourconversation on the FDA panel?
What's happening with thatblack box warning?
Dr. Kelly Casperson (24:32):
Because of the WHI, which we now know,
nearly everything's been walkedback on the risks of that.
The FDA put on what we call aboxed warning on all estrogen
products.
What I mean is syntheticestrogen, oral estrogen,
synthetic oral estrogen,transdermal estrogen, vaginal
estrogen.
Anything remotely that wasn'teven studied in a WHI, they just
(24:57):
went.
That would be like putting alabel on a statin and then
applying it to a blood pressuremedication and being like, well,
they're both on the heart, sowe should call it all the same.
Like.
Synthetic estrogen that youswallow is very different than a
vaginal bioidentical estrogenproduct.
I don't expect everybody toknow that, but I'm trying to
explain the madness of putting awarning label on things that
(25:19):
are not the same thing RightStroke, heart attack, liver
disease, probable dementia,which is a stronger term than
possible dementia on a vaginalestradiol product, which is just
skin care, it's just skin care.
If I measured your blood afteryou going on a vaginal estrogen
product, it would still bepostmenopausal.
(25:40):
It's not getting into yourbloodstream.
And the reason why?
Because people don't know this,they're like why doesn't it get
into your bloodstream?
Dosing, dosing, why?
Because people don't know this,they're like why doesn't it get
into your bloodstream, dosing,dosing.
So it's a skincare product,skincare for down there, which
is already trademarked, not byme oh shoot, because I attribute
it to you all the time.
No, I just say it but it's notjust.
(26:00):
I can't sell it.
April Haberman (26:02):
So you can say it but can't sell it I can say
it, but I can't sell it.
Dr. Kelly Casperson (26:07):
Twice a week is the maintenance dose.
And here's the proof of it.
It's preventative medicine.
So a woman comes in withrecurrent UTIs or bad bladder,
urgency frequency getting up atnight.
We put her on a vaginalestrogen product and it gets
better.
Do we tell her to stop it?
No, no, tell her to stay on it.
So we're already using vaginalestrogen products for
(26:30):
preventative health.
I don't want you to get anotherUTI.
I don't want you to get up fivetimes a night to pee.
I don't want you to starthaving pain with sex again,
right, so we're already usingthat product as preventative
health, and I think the needleis, you know, the biggest thing
for the lay population is whenthey're like you mean, my labia
minora goes away and my clitorisshrinks with hormone changes.
(26:52):
We're like, yes, they becameadult via hormones and now
you're outliving your hormones,so they go away and so they want
to go on the products just topreserve function, and there's
nothing wrong with that.
Now, from a doctor's point ofview, we're like that's not the
worst thing that can happen, butfrom their point of view, it is
the worst thing that can happen, of course.
April Haberman (27:11):
Yeah, it's shocking Right?
Dr. Kelly Casperson (27:13):
So to me I'm like there's a little
disconnect in, like we thinkthis is the biggest problem.
The doctors are like but you'renot having recurrent UTIs, it's
not indicated.
April Haberman (27:21):
Right.
Dr. Kelly Casperson (27:21):
So I think it's worth it.
Like shrink, They'd want to dosomething about that.
So I think it's very fair.
In America it's still aprescription product, but we are
getting closer.
Universal agreement that thiswarning shouldn't be on vaginal
estrogen products.
Universal agreement by theexperts.
(27:43):
There's studies on over 55,000women, including breast cancer
survivors, including people onaromatase inhibitors.
So it's near universal thatvaginal estrogen is safe.
Then begs the question whyisn't it over the counter Right
exactly?
It is limiting access that youactually have to see a doctor
and hope your doctor's trainedto give you-.
April Haberman (28:05):
Well, and I think that's a key point there,
I'll share the story.
My mom is in her 70s.
She had recurring UTIs foryears and years and years,
antibiotic resistant, like itwas getting scary, right.
I asked her the question nottoo long ago hey, mom, are you
on vaginal estrogen?
She said and she doesn't mindif I share this she said I don't
(28:29):
need that.
You know.
I didn't ask what that meant,but I don't need that.
And I said yes, you do Talk toyour doctor and here's what you
need to ask for.
And she talked to her doctorand doctor was like oh, are you
sure?
And she said yeah.
I said be adamant, Tell her youwant it, Write the prescription
, don't take no for an answer.
She did.
She hasn't had another UTI.
(28:51):
I mean, come on, Right, but thisis what we're facing, right.
We need more education.
We need to education forhealthcare practitioners.
We need more education for thegeneral public so that they
understand what's happening, sothat they make those healthy
choices that we talked about inthe beginning of the podcast.
Absolutely, but just just torecap, we can take vaginal
(29:14):
estrogen combined with ourtransdermal estrogen or systemic
estrogen.
We can start vaginal estrogeneven in perimenopause.
Yes, Yep, Yep, and you can withyour vaginal estrogen.
Okay, I'm going to get a littlebit more in detail here for
listeners, but it comes in atablet, it comes in a cream.
(29:37):
It varies forms, but you alsowant to apply the cream on the
outside as well as the inside tokeep it healthy.
Dr. Kelly Casperson (29:46):
If you care about your genitals.
Yes, yeah, okay, yeah, I mean Imean that's, some people like
the tabs because it's less messy, right Right.
But the tabs are actuallypretty low dose and they're
contained in the vagina.
So it can be great for anon-sexually active person who
has recurrent UTIs and you justneed a little bit of estrogen in
(30:08):
there.
But if you're sexually active,especially if you started
noticing decrease in sensation,tightness, pain, decreased
lubrication, all of those thingsthat's not in your head.
Those are hormone issues.
I like the cream.
People are like, oh, it's alittle messy, and I'm like, do
you remember your 18-year-oldvagina?
That is messy.
(30:29):
Want it back?
Yeah, that's lubrication.
Kim Hart (30:32):
Yeah, absolutely.
Dr. Kelly Casperson (30:33):
And so I joke around about it a little
bit.
But I truly, if you put it likefinger, index finger, fingertip
to first knuckle that amount inthe vagina and then fingertip
to first knuckle are in theexternal genitalia and rub it in
, like I always say, it's likeyou're in Texas in August with
sunscreen.
With sunscreen and you don'twant to get burned Like, rub it
in, that's great.
(30:54):
Get it in the tissue, don'tjust like slap it on and put on
your underwear and have it go onyour underwear.
April Haberman (30:58):
Yeah, and then it's on your underwear.
It's not going to help, right?
Dr. Kelly Casperson (31:02):
And then here's the next question, which
is telling.
But sweet People are like whatif it gets on my partner's penis
and I'm like they have?
They have estrogen in theirbody.
Number one, number two it'sit's skincare, right, like it's
not gonna hurt them.
(31:22):
Don't use, don't use estrogencream as a sexual lubricant.
That's not what it's designedto do.
But if you happen to put onyour vaginal estrogen that night
and the mood strikes, it's nota reason to say no, you're not
going to hurt anybody.
They've actually done study onthis, that's good.
April Haberman (31:37):
Yeah, that's actually a good point.
Kelly, we have about fiveminutes left on our podcast and
I have so many questions for you, but I really want to come back
to your book, and there's somuch information contained in
that book.
I hope everybody goes andpurchases that book.
But what haven't we talkedabout?
That's in your book that isclose to your heart, that you
(31:59):
want our listeners to know.
Dr. Kelly Casperson (32:04):
Oh, I really don't think everybody
knows how bad alcohol is foryour brain oh yeah, it's going
to bring that up and how, howbeneficial exercise and lifting
weights is for dementiaprevention and breast cancer
prevention.
And I think we we lose those inwhen we talk about hormones,
because hormones are hot and youknow, everybody kind of wants
(32:25):
them to be the Holy Grail.
But it's like I can't.
I can't slap on an estrogenpatch and expect it to do much
if you're drinking and you'renot sleeping and you're not
exercising and your mood aboutgetting older is shitty.
So I talk about mindset andreally that you know, so many
people are like, ah, growingolder, bah.
(32:47):
And I'm like my grandma saidthere's only one alternative and
she's right, she made it to 96.
And there's actually data onyour mindset about growing older
actually affects your health.
So I have a chapter in there onmindset, because estrogen patch
won't do that all for you andthere's so much we can do.
That isn't hormones, because,again, all hormones are our
(33:09):
messengers that help our cellsfunction.
That's all.
They are right.
We still have to do all theseother amazing things that feel
good and help us thrive, and notjust age, but age with health.
April Haberman (33:21):
Mm-hmm.
I really appreciated thatbalanced approach because you
are pro-hormone, but youemphasize lifestyle and mindset
and have that balanced approachin the book and it's extremely
important.
Kim and I both believe in that.
We're health coaches for yogainstructors.
I mean it's, it's the full mealdeal, as we call it, it's not
just one solution.
(33:41):
All right, Kelly, we're gonnaask you this question again, and
because I can't remember whatyour answer was the first time
that you were on the podcast,and it's probably different now,
but we ask everyone the samequestion at the end of our
podcast what the best piece ofadvice you've ever received or
given has been.
So what would your answer betoday?
Dr. Kelly Casperson (34:01):
I think this might be the same answer.
Okay, I was a medical studentdoing my general surgery
rotation.
I remember where I was standing.
I remember that I was a medicalstudent doing my general
surgery rotation, Like Iremember where I was standing.
I remember that I was halfwayup a flight of stairs turning
around looking down Like I wasprofound statement and it was a
general surgery chief residentand he said nobody is more in
(34:22):
charge of your education thanyou.
And I think that ties into likewhy I'm reading, writing these
books and why I want women tohave the knowledge, because
nobody is more in charge of yourbody and your knowledge about
it than you.
April Haberman (34:38):
Such a good reminder.
Kim Hart (34:40):
That's huge.
And your book does such a goodjob of informing you about your
body.
I mean I like, for example, youtalk about men having estrogen.
I didn't know that for a year.
I mean, I didn't know thatuntil I started getting into the
menopause business, that thiswas.
There's so many things likethat that you just need to know,
and this book does such a goodjob of describing all the things
(35:03):
that are happening to your bodyand what your options are, and
I can't, I can't tell you enoughyour body and what your options
are, and I can't, I can't tellyou enough it just it has, as I
said in my LinkedIn post, it hasyour sense of humor and also
great knowledge and just reallyreally appreciate.
Appreciate it Cause it's it isdifferent for our listeners.
You know, it is different thanthe other books that that have
(35:25):
come out on this topic, becauseit's so it's so informative.
Dr. Kelly Casperson (35:32):
Yeah, I think, and I think it's really
approachable and friendly and Ireally want to narrow the gap
between medical knowledge andyou.
Like, I want to narrow the gapbetween, like this unobtainable
stuff is like no, no, no, we can.
We can all understand this andit's a true compliment because
I'm like I was worried you arenot broken, is so loved, right,
(35:53):
and it's so it's so me and mypersonality it's an it's
award-winning what can I say?
at this point, but reallyworrying that, like did the
science overwhelm thepersonality to the detriment of
the menopause moment, and so farI'm hearing that it hasn't no,
I mean you f-bomb throughout thebook you like.
Kim Hart (36:11):
are you kidding me?
April Haberman (36:12):
You're real.
You're persecuting me.
Thank you, Kelly I texted afriend.
Dr. Kelly Casperson (36:17):
I was like pages before the F word comes
out in this book like 63.
It's okay.
April Haberman (36:26):
Kelly, where can our listeners get your book?
Where can they get?
Dr. Kelly Casperson (36:29):
it Wherever they want.
April Haberman (36:31):
So it's on Amazon.
Dr. Kelly Casperson (36:31):
Barnes Noble.
If people want to do mom andpop, local bookstores, great, I
know a lot of them are carryingthem and on my website under
books, I actually have a wholelist for mom and pop.
If they want to do a retailer,that isn't that local chain
started in Seattle.
Kim Hart (36:52):
Fantastic, and you're traveling the and you're
traveling I mean the world,essentially, so people could
look up on your website.
Dr. Kelly Casperson (36:57):
yeah, I just got an event long like long
overdue.
Uh, just got an events page onthe website, because now I think
we're up to eight cities.
We just like added connecticutLove it.
Love it, so it's hard to keeptrack of, and we'll see you guys
in Seattle and Bellingham.
Yeah, we'll see you on the 29thof October.
Kim Hart (37:16):
So if you're in the Seattle area, come join us
October in.
April Haberman (37:20):
Seattle.
Yeah, and if you'd like to seeDr Kelly, you have your own
clinic as well up in Bellingham,washington, so you can look her
up on the website there as well, but I see my poor math like.
Dr. Kelly Casperson (37:34):
These are percentages, but it's about a
third perimenopause, a thirdboomers who are pissed 70 plus,
and then a third regularmenopause people and then
probably about 5% men Love it.
I love seeing partners, so wehave a good time, we get lunch,
we take care of everybody.
It's really fun.
April Haberman (37:54):
I love that Great reminder too, that you see
men as well, and couples.
Kelly, it's been a joy, it'sbeen a pleasure.
We could talk all day long, butwe thank you for your time and
listeners.
Until we meet again.
Go find joy in the journey,thanks everyone.
Thank you for listening to theMedovia menopause podcast.
(38:16):
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Subscribe for future episodes,leave a review and share this
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There are more than 50 millionwomen in the US who are
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The situation is compounded bythe presence of stigma, shame
(38:38):
and secrecy surroundingmenopause, posing significant
challenges and disruptions inwomen's personal and
professional spheres.
Medovia is out to change thenarrative.
Learn more at medoviacom.
That's M-I-D-O-V-I-A dot com.
Welcome to the MiDOViA Menopause Podcast, your
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Kim Hart (00:51):
Hey, welcome back everybody.
We have our favorite doctor,kelly Kasperson, on board today.
She's a board certifiedurologist, author, speaker and
the host of the top rankingpodcast.
You Are Not Broken, and beforewe hit record today, we were
talking about all the greatthings she's doing with that
podcast, but you probably knowher through her best-selling and
(01:13):
award-winning book, right?
Dr. Kelly Casperson (01:15):
You Are Not Broken.
I'm now an award-winning author.
Kim Hart (01:18):
I know, of course you are.
It's a good week.
It is a good week.
Stop shooting over yourself.
And her courses and her podcast, dr Kasperson equips women with
practical tools andevidence-based education to
reclaim pleasure and confidenceat every stage of life.
She also makes you laugh, andwelcome to the podcast, welcome
(01:40):
back to the podcast.
Dr. Kelly Casperson (01:42):
Thanks for having me.
I was on like two years agomaybe.
Kim Hart (01:45):
Yeah, yeah, you were one of our first guests.
We were all important Look atyou still podcasting?
Dr. Kelly Casperson (01:51):
I know Right.
April Haberman (01:53):
It's fun.
It's one of our favorite thingsto do.
Dr. Kelly Casperson (01:55):
Really, it is the most fun.
Kim Hart (01:56):
Okay, before we start talking about this new book,
which I am mesmerized by, I wantto swing back to your
award-winning book.
You Are Not Broken.
I was at dinner with a fewgirlfriends a couple nights ago
and your name came up.
I don't know why it came up Imean because everybody's a fan
(02:17):
but they said they saidsomething like Kelly says that
you can have five orgasms in arow.
Dr. Kelly Casperson (02:24):
And we were all like, like Kelly says that
you can have five orgasms in arow, and we were all like I
never said that.
Kim Hart (02:33):
No, but but what?
Dr. Kelly Casperson (02:34):
I went back to Instagram and it was a title
that someone suggested.
Someone said you should callyour book how to have five
orgasms in a row.
But I don't tell people how tohave five orgasms in the book,
it's just the knowledge you gainfrom that book could cause five
orgasms in a row.
We were like, oh I don't know.
Kim Hart (02:48):
We're like what.
Yeah, is that funny?
Dr. Kelly Casperson (02:51):
I was like I had to do a reel on that
because I'm like that's a prettygood recommendation well, it
was, and it was clearly a topicof conversation.
Kim Hart (03:03):
Yeah, so yeah okay, I just thought that was such a
funny story, cause I was like,oh my gosh, okay, I'm talking to
her this week and I have tobring this up, cause we were
like.
Dr. Kelly Casperson (03:12):
I don't remember the instruction manual.
April Haberman (03:15):
I didn't put it.
We missed that part.
Dr. Kelly Casperson (03:17):
Yeah, yeah, I didn't specifically put that
in there.
Kim Hart (03:20):
Okay, well, you've been super busy.
I don't even know how you keepup with your own life.
You were on the FDA panel andtalked about you're talking
about vaginal estrogen.
You have a new clinic, you werehot on testosterone and now you
have this new book.
I mean, testifying on an FDApanel is a huge deal, and then
all these things are happeningtoo at the same time.
(03:42):
Why did you feel that themenopause moment was a book that
needed to be written right now?
Dr. Kelly Casperson (03:47):
Oh, because there's 80 million women over
the age of 40 in the UnitedStates alone and everybody,
first of all, nobody knows whatmenopause is.
And the definition of menopauseis the natural cessation of
periods, which is actuallymeaningless, right?
So, like the.
What's actually happening iswe're outliving our ovaries and
(04:09):
nobody knows that, right?
It'd be a lot easier if therewere like testicles and we could
just watch them shrivel up.
But so you know, the publishersreached out with the you Are Not
Broken, came out and they'relike will you write another book
about sex?
And I said, yeah, sure, but Iwould really like to write a
book about menopause.
And they're like will you writeanother book about sex?
And I said, yeah, sure, but Iwould really like to write a
book about menopause.
And they said, great, writethat.
(04:29):
And that's why I told peoplelike my life's not normal,
because I just told thepublisher what I wanted to write
a book about.
And they're like, yeah, so I'meternally grateful that I don't
know anything else about likebook publishing.
I'm just like, how, about amenopause book?
(04:50):
They're like, yeah, and I'mlike, great, let's do that.
I think my book's really a.
It's very interesting becausewhen I started writing this book
two plus years ago, I was likeI'm going to come out with the
gloves on and basically say,listen, hormones are great for
you, you need to know that.
And I really wanted to have abook that supported women in
(05:13):
their decision, because evenwomen who are on hormones they
get this backlash from likefriends or doctors or whatever.
Like I.
Just I needed to be strongerthan that.
So I'm like listen, I'm goingto give you all the data on what
hormones do and it gets you tounderstand that these are
molecules in our bodies thatmake our cells and our
mitochondria function.
Like you have to understand whata hormone is and what happens
(05:35):
when you choose to live withouthormones.
And so I was like, oh, thatmight be kind of an aggressive
stance at the time, two and ahalf years ago, and that's how,
that's how fast this is allmoving.
Because now, like I mean you'veread it, like I don't think
it's actually coming across thatNot that it was aggressive, but
like time, I'm like I'm nothere to tell you what to do.
(05:57):
I don't care, I don't have yourbody, I don't have your life
goals.
Like I don't care what you do,but I care greatly that you have
the knowledge and the educationand the tools to advocate and
communicate.
April Haberman (06:12):
Yeah, you're clearly about choice, but be
informed so that you can makehealthy choices for your overall
well-being right.
So we have to educate ourselvesso that we can make healthy
choices.
Otherwise, what are the?
Dr. Kelly Casperson (06:26):
choices we're not empowering.
And I think what's much morecommon is women thinking they
can't be on hormones, whenactually the truth is that they
can.
And for people to understand,everything has risks, right,
medications have risks.
Not being on hormones has riskslike.
Just understand that instead ofthinking that this is like an
(06:47):
easy black and white yes or no.
You know, the other big myth isage is a cutoff, right.
So there's just so many mythsout there and I really think my
book is like the 2.0.
To like ask your doctor if it'sright for you, it's like no, no
, you get to.
You know, we're not all doctors, but we can understand basic
physiology, right.
(07:07):
We understand dental care, weunderstand periods right, we can
understand basic physiology.
Kim Hart (07:18):
You do a great job of how to talk to your doctor in
this book.
Thank you, yeah, because wetalk.
We talk all the time in theworkplace about how to talk to
your doctor.
I'm going to be reading thatsection over and over again.
It's a really good one, but youare unapologetically
pro-hormone.
Dr. Kelly Casperson (07:34):
Yeah, I mean, I'm pro-functioning bodies
.
April Haberman (07:36):
Yeah Right, You're like.
Dr. Kelly Casperson (07:38):
I still stutter on that because haters
will take it and they'll be likeyou just want everybody to be
on testosterone and I'm like no,I have never said I want.
Side note possibly vaginalestrogen is probably.
We're probably at the point ofpreventative health for
everybody with vaginal estrogen.
But as far as hormones go, likeI'm pro you understanding if
(07:59):
this is a good decision for youor not.
And I think the other thing,the layer under that, is like
this paternalistic like only ifyou're suffering enough, which
is a completely non-objective,subjective marker of like if
you're worthy of hormones or not.
And it's like hormones don'tcare if you're worthy or not or
if you've suffered enough.
Hormones make your cells andmitochondria function.
(08:21):
Yeah, yeah, they'renonjudgmental.
It's the humans who are judging.
April Haberman (08:28):
Yes, yeah, absolutely.
But can I?
I don't.
It seems like every time wehave a conversation about
hormones, we come back to thefallout of the WHI study in 2002
.
But I do want to come back tothat for just a moment, because
yeah, I think you have to, Ithink we have to too, I think we
have to.
It's part of the culturalnarrative.
At this point it's still here.
Dr. Kelly Casperson (08:47):
Yeah, it's still here, yeah, and I think,
like why women are afraid of thezeitgeist or the ether, even if
they, even if women can't sayI'm afraid because of the WHI,
like they can't say where itcomes from, and so I think the
education goes a long way oflike this is why you're afraid.
Because there was some big shitwent down in 2002 before social
(09:08):
media, before doctors couldcommunicate on a grand scale,
when the big legacy media hadall the power to influence
movement in this country.
Right, there was some big, bigwind that blew that year and it
was basically saying thathormones caused breast cancer,
which, yeah, I mean.
The other fascinating thingabout the WHI is you know that
paper is free online right now?
(09:30):
Oh, it wasn't before.
Kim Hart (09:33):
It always has been 22 years.
Dr. Kelly Casperson (09:36):
It's always been free online.
April Haberman (09:37):
But your point being is that we don't
understand it yet.
It's free and it's accessiblefor everyone, so go read it.
Dr. Kelly Casperson (09:43):
You can go read it and it says it doesn't
reach breast cancer, does notreach statistical significance
and in the medical world we'restill living around this fear
and the outdated perception thatit causes cancer.
Yeah.
And how do you get rid of fear?
You can't tell people not to beafraid, right, that's not how
(10:05):
it works.
That's not how brains work.
And how do you get rid of fear?
You can't tell people not to beafraid, Right?
That's not how it works.
That's not how brains work.
The only way to get rid of fearis to say here's all the
knowledge, read it if you wantRight, right.
But telling people like you knowit's like cognitive dissonance
we see it in politics all thetime right now of like if you
(10:28):
tell somebody, no, that's notright, they will double down
Right.
And then they'll tell you abouttheir cousin who was on
hormones and had breast cancer,which correlation doesn't equal
causation.
Right, but brains don't knowthat.
So how do you get rid of fear?
Education.
I don't know a better way.
April Haberman (10:38):
Yeah, which is is what you're doing, um, in so
many ways and we're soappreciative.
But you talk about the timinghypothesis and I want to break
that down a little bit.
I want you to break that down alittle bit for listeners and
talk about why you think babyboomers should be pissed.
Dr. Kelly Casperson (10:58):
Yeah.
So the timing hypothesis is thetheory and it was first
developed in monkeys and thenextrapolated to humans and done
some research.
And the theory is that ourbodies age and things happen
with aging and if you starthormones before your body starts
to significantly age, hormonesdo a better job at preventing
(11:19):
disease.
Hormones don't do a good job attreating disease.
Hormones don't do a good job attreating disease.
So the timing hypothesis is atage 50, when your hormones go
away, you start aging at a ratethat you didn't age before
hormones.
There's plenty of data on that.
50 is this huge physiologic agepoint, roughly 50, but
different for everybody.
And so by age 60, there's beensome physiologic changes because
(11:53):
you've lived longer than yourhormone production that you
can't reverse just by startinghormones again, right?
So the timing hypothesisbasically says that the best
time to prevent heart disease,prevent dementia, is early
menopause.
Now we're pushing it, we'resaying probably perimenopause,
because remember, nothingmagical about your last period,
zero magic about the last period.
The hormone changes really dostart perimenopause.
So that's your best bet.
And you know, I tell peoplelike on that horrible Tuesday
(12:16):
when you or your loved one is 73years old and they get
diagnosed with dementia on that,really really bad day.
That dementia started 20 yearsago, right, and when is that?
That's the average age ofmenopause for women.
And so, tying back to why arethe boomers pissed?
The boomers should be pissedbecause they were told they
can't have hormones, yeah, andnow they're being told it's too
(12:38):
late for hormones, which is avery interesting discussion.
I just did a lecture on it lastweek that like filled up my
Zoom to its limit.
Because the boomers are pissedand the boomers aren't doing
okay in like, oh, don't worry,the hot flashes end.
Yeah, these people are.
They have mood issues, theyhave sleep issues, they have
joint aches and pains, they haveuntreated menopause symptoms
(13:02):
yeah, and they're completelyvoiceless, they're completely
blown off.
They're asked if they'resuffering enough and, by and
large, they're doing everythingright they're eating healthy,
they're exercising, they'retrying to manage their stress,
they're staying a healthy weight, they're lifting weights right,
like they're doing everythingthey can, and they continue to
suffer and they likely will notget the preventative benefits of
(13:29):
if you started when you were 50, but if they choose hormones,
they will get the hormonebenefits of bone protection less
joint aches and pains.
Better sleep, less hot flashes alot of these ones.
They're still having hotflashes, yeah yeah, we hear that
it's this grand paradox andthere is.
You know.
People say, oh, my doctor saysit's too late, and I'm like
(13:51):
there's no guideline that saysit's too late.
North menopause societyguidelines 2022 says best
benefit is early, right.
They do not say and then, asyou get older and you get more
comorbidities, it's a riskbenefit discussion.
So to behave as if it's blackand white is hurting a lot of
women.
I'd say about a third of my ago, and she woke up in the middle
(14:13):
of the night with night sweatsand had to change everything.
Kim Hart (14:16):
See, she would benefit .
They're suffering, yeah, she'ssuffering.
Bank time.
April Haberman (14:29):
For years and years and years.
By the way, yeah, yeah, shedidn't just wake up in her 70s
having hot flashes, the onlyboomers that aren't pissed are
the ones who don't like.
Dr. Kelly Casperson (14:38):
They've never heard that this is an
option.
Once they get educated, they'relike what about me?
Yeah.
Kim Hart (14:43):
Yeah, well, and so, speaking of my mom, who's a
grandmother, I read over andover the section on your point
of view around the grandmotherhypothesis, because yours was
the first one that was likehow'd I do Well, no, you did
great and I totally understoodit, but it was different than
anything.
Your point of view is differentthan anything I've ever read on
(15:05):
the grandmother hypothesis.
Can you talk about that and howto debunk?
April Haberman (15:08):
that myth?
What is it for the listenersthat don't know what that is?
And then, what's your?
Dr. Kelly Casperson (15:12):
point the grandmother hypothesis is this
it's been used as a patronizingway of saying we were meant to
go through menopause because weneeded to stop having babies so
we could have more resourcesdevoted towards our children's
children.
So it's basically ajustification, which is so.
(15:35):
I basically debunk it and say Fthe grandmother hypothesis,
because average age ofmenstruation, let's say 15, just
because it's unpleasant tothink about a 12-year-old
getting pregnant, but you canget pregnant.
I would say average age ofmarriage in Abraham Lincoln's
time was 17.
Okay, so you're having a kid inyour teens in the natural world
(15:57):
?
Uh-huh, all right.
That means you're a grandma by40.
Yeah, right, right, okay, right, all right.
You could be a great grandma,maybe by 48, if the math's right
, right.
And then average lifeexpectancy, excluding infant
mortality, maybe 60.
Right, right.
(16:18):
But if you're a grandma at 30,because you had a kid when you
were 15, and then that kid had akid at 15, which is completely
possible and it's how our bodieswork, there's nothing about oh,
thank God, my period stopped soI could be a grandma, right.
So what the patronizinggrandmother hypothesis did?
It says in modern times wedon't tend to have babies until
(16:38):
we're 30.
Right, but that's not hownature works.
That's called birth control andlike controlled family planning
.
April Haberman (16:46):
Exactly.
Kim Hart (16:47):
Not our bodies.
Dr. Kelly Casperson (16:48):
So to say, oh, menopause is natural,
because people will take it andthey'll be like menopause is
natural.
Therefore you shouldn't treatit because you're supposed to be
a grandma and you're notsupposed to have kids so you can
take care of it Like that's howkind of dark the grandmother
hypothesis has gotten.
And even so I put in the bookthat even the guy who like kind
of coined the grandmotherhypothesis was like I'm not so
(17:09):
sure about this.
I mean, the other big thing islike what I wanted to name this
book, aging in Captivity,because I think my audience gets
that.
My publishers did not get that.
But I got it because I'm like ifyou take any animal, except for
orca whales, who do really,really shitty in captivity
because we keep them in smallpools.
(17:29):
But if you take any animal andyou give them clean food and
water.
You eliminate natural predators, you give them great health
care.
They live longer in captivitythan in nature.
Right, there's a harbor seal inOregon that's like 49 years old
right now.
In nature they live to be 18,right.
(17:52):
And so, like we are aging incaptivity, we've got clean water
.
Antibiotics alone has increasedlife expectancy by 16 years on
average per person.
Like it's insane, right?
We're really good at trauma.
We're really good at treatingcancer.
We're really good at keeping usalive.
Yeah, our average lifeexpectancy now is 40 years with
(18:15):
no hormones, and that hasconsequences.
I would also like to argue thaterectile dysfunction and
enlarged prostate are naturaloccurrences and nobody goes
around telling men that that'snatural and we shouldn't treat
it Very true.
Really, the book is justchallenging the dogma that I
truly believe is built to keepwomen quiet in their place and
(18:38):
resulting exhausted dropping outof their workforce.
April Haberman (18:43):
Yeah, 100% right , yeah, 100% Right.
And, by the way, I we often saythat we need to change language
, that menopause is a naturalprocess, right?
It's not natural.
For someone that isexperiencing menopause, that's
going through surgical ormedical menopause, it feels
anything but natural.
So it's a normal process, butit's not a natural process for
(19:06):
everyone.
So just want to throw that inthere for our listeners.
Dr. Kelly Casperson (19:10):
Yeah, and we know I mean to speak to like
the, not that we want to competeon who's having their menopause
managed most poorly, but theaward probably goes to the early
menopause women because we havevery clear data, very clear
data of increased risk ofdementia, increased risk of
death by heart disease if yourhormones end before the for lack
(19:31):
of a better word natural age ofmenopause of 50.
Like that's standard data.
And we know that Louise Newsomedid this study in the UK and we
don't think it's better inAmerica that surgical
oophorectomy is treated withhormones 5% of the time.
April Haberman (19:50):
I can't believe that 5% of the time.
It's a disgrace.
Dr. Kelly Casperson (19:55):
I'm a urologist, I will remove
testicles for tumors and otherreasons.
It is a never event to removetesticles and not replace with
testosterone Never event.
April Haberman (20:09):
Unbelievable.
Dr. Kelly Casperso (20:11):
Unbelievable If a urologist did that they
would be reported to the medicalboard and probably would lose
their license.
April Haberman (20:17):
Oh yeah, that ticks me off it should.
Okay, I want to talk a littlebit more about things that
frustrate us, because why not,while we're on that subject,
myths, misconceptions, that thatfrustrate us, because why not?
Dr. Kelly Casperson (20:28):
uh, while we're on that subject, myths,
misconceptions, misconceptionsthat still frustrate you uh, you
can't be on systemic hormonesand vaginal hormones at the same
time.
That hormone replacementtherapy only means estrogen.
That you have to stop hormonesat a certain age because I said
so.
Because now you're too old.
You can't start hormones at acertain age because I said so,
(20:49):
or you're too old.
What else?
That sex, that painful sex isnormal.
That it's really awkward totalk about sex, so we shouldn't
talk about sex.
That your doctor knows bestabout hormones.
Kim Hart (21:05):
Just a few.
Dr. Kelly Casperson (21:07):
Just a few yeah.
Kim Hart (21:08):
Okay, let's talk about sex, because you let's talk,
you're the best one to talkabout this with of anybody.
April Haberman (21:15):
Mainly take that as a compliment well at any age
too, by the way, because um ourdaughters love your last book
and um, they do and and you knowwhat?
They're giving your book totheir friends and they're in
their 20s.
Yeah, yes, way, I think it'sfabulous, and that conversation
is happening at a younger age,so bravo.
(21:36):
Yeah, thanks for breaking itdown in such.
Dr. Kelly Casperson (21:39):
Go young.
April Haberman (21:40):
Go young, yeah Kim go the senile vagina.
Kim Hart (21:43):
What is it?
Dr. Kelly Casperson (21:45):
Senile vagina is a medical term in the
1980s to describe a what we nowcall genital urinary syndrome of
menopause.
So thinning of the tissues,decreased lubrication, dryness,
tearing pain with withpenetration and so what do I
mean?
Kim Hart (22:02):
do we get it?
How do we not get it?
Like what, what?
How do we keep it?
We all yeah.
Dr. Kelly Casperson (22:06):
Hopefully nobody gets senile vagina
anymore, because it's anantiquated term and we try not
to use it, but I use it in mytalks a lot because it makes
people laugh and makes them mad,also Mad laughter.
That's really what I'm goingfor 50 to 90% of women post
menopause and again the problemis women don't know what's
(22:26):
actually going on.
You've outlived your ovaries.
Ovaries make hormones that makeyour body function well.
Right, Like that's what theydon't understand.
Or I'll be like you know thisis because of menopause, and
they're like my last period waseight years ago.
You're like, oh, you thoughtthis was just the end of periods
.
Periods is just a symptom ofwhat happens because of low
hormones, right?
So I mean even the wholeconversation about menopause and
(22:49):
a lot of thought leaders noware like we need to stop
actually talking about menopausebecause it's not clear of
what's actually happening.
But there's no female word forcastration, which is very
interesting because words matter.
But so, yeah, GSM can happenyears after your last period.
It can happen in perimetopause,it can happen with
(23:11):
breastfeeding, it can happenwith cancer treatment, Like
there's lots of things willaffect the tissues.
The gold standard is hormonetherapy, because that's why it's
happening.
Right, and this is localvaginal hormone therapy, most
commonly an estradiol product.
The DHEA product is also lovely, but it's expensive in America
(23:33):
and it works wonderful.
And people use moisturizers andlubricants for comfort.
Nothing wrong with that.
They help hold in moisture, butit doesn't solve the underlying
pathophysiology of why it'shappening in the first place
underlying pathophysiology ofwhy it's happening in the first
place.
April Haberman (23:54):
Well, and you mentioned earlier that we're
getting closer to vaginalestrogen being a preventative
medicine as well, Because Ithink, typically what happens
correct me if I'm wrong but weend up in the doctor's office
because our vaginas are so dry,because the sex is so painful
that we want you to suffer first.
Yeah we've reached a point wherewe're like I am freaking
miserable and what is happeningto my body?
Right, I don't understand,because nobody told me that this
(24:16):
was coming Horrible place to be.
So can you speak to that alittle bit and maybe even
sprinkle in there yourconversation on the FDA panel?
What's happening with thatblack box warning?
Dr. Kelly Casperson (24:32):
Because of the WHI, which we now know,
nearly everything's been walkedback on the risks of that.
The FDA put on what we call aboxed warning on all estrogen
products.
What I mean is syntheticestrogen, oral estrogen,
synthetic oral estrogen,transdermal estrogen, vaginal
estrogen.
Anything remotely that wasn'teven studied in a WHI, they just
(24:57):
went.
That would be like putting alabel on a statin and then
applying it to a blood pressuremedication and being like, well,
they're both on the heart, sowe should call it all the same.
Like.
Synthetic estrogen that youswallow is very different than a
vaginal bioidentical estrogenproduct.
I don't expect everybody toknow that, but I'm trying to
explain the madness of putting awarning label on things that
(25:19):
are not the same thing RightStroke, heart attack, liver
disease, probable dementia,which is a stronger term than
possible dementia on a vaginalestradiol product, which is just
skin care, it's just skin care.
If I measured your blood afteryou going on a vaginal estrogen
product, it would still bepostmenopausal.
(25:40):
It's not getting into yourbloodstream.
And the reason why?
Because people don't know this,they're like why doesn't it get
into your bloodstream?
Dosing, dosing, why?
Because people don't know this,they're like why doesn't it get
into your bloodstream, dosing,dosing.
So it's a skincare product,skincare for down there, which
is already trademarked, not byme oh shoot, because I attribute
it to you all the time.
No, I just say it but it's notjust.
(26:00):
I can't sell it.
April Haberman (26:02):
So you can say it but can't sell it I can say
it, but I can't sell it.
Dr. Kelly Casperson (26:07):
Twice a week is the maintenance dose.
And here's the proof of it.
It's preventative medicine.
So a woman comes in withrecurrent UTIs or bad bladder,
urgency frequency getting up atnight.
We put her on a vaginalestrogen product and it gets
better.
Do we tell her to stop it?
No, no, tell her to stay on it.
So we're already using vaginalestrogen products for
(26:30):
preventative health.
I don't want you to get anotherUTI.
I don't want you to get up fivetimes a night to pee.
I don't want you to starthaving pain with sex again,
right, so we're already usingthat product as preventative
health, and I think the needleis, you know, the biggest thing
for the lay population is whenthey're like you mean, my labia
minora goes away and my clitorisshrinks with hormone changes.
(26:52):
We're like, yes, they becameadult via hormones and now
you're outliving your hormones,so they go away and so they want
to go on the products just topreserve function, and there's
nothing wrong with that.
Now, from a doctor's point ofview, we're like that's not the
worst thing that can happen, butfrom their point of view, it is
the worst thing that can happen, of course.
April Haberman (27:11):
Yeah, it's shocking Right?
Dr. Kelly Casperson (27:13):
So to me I'm like there's a little
disconnect in, like we thinkthis is the biggest problem.
The doctors are like but you'renot having recurrent UTIs, it's
not indicated.
April Haberman (27:21):
Right.
Dr. Kelly Casperson (27:21):
So I think it's worth it.
Like shrink, They'd want to dosomething about that.
So I think it's very fair.
In America it's still aprescription product, but we are
getting closer.
Universal agreement that thiswarning shouldn't be on vaginal
estrogen products.
Universal agreement by theexperts.
(27:43):
There's studies on over 55,000women, including breast cancer
survivors, including people onaromatase inhibitors.
So it's near universal thatvaginal estrogen is safe.
Then begs the question whyisn't it over the counter Right
exactly?
It is limiting access that youactually have to see a doctor
and hope your doctor's trainedto give you-.
April Haberman (28:05):
Well, and I think that's a key point there,
I'll share the story.
My mom is in her 70s.
She had recurring UTIs foryears and years and years,
antibiotic resistant, like itwas getting scary, right.
I asked her the question nottoo long ago hey, mom, are you
on vaginal estrogen?
She said and she doesn't mindif I share this she said I don't
(28:29):
need that.
You know.
I didn't ask what that meant,but I don't need that.
And I said yes, you do Talk toyour doctor and here's what you
need to ask for.
And she talked to her doctorand doctor was like oh, are you
sure?
And she said yeah.
I said be adamant, Tell her youwant it, Write the prescription
, don't take no for an answer.
She did.
She hasn't had another UTI.
(28:51):
I mean, come on, Right, but thisis what we're facing, right.
We need more education.
We need to education forhealthcare practitioners.
We need more education for thegeneral public so that they
understand what's happening, sothat they make those healthy
choices that we talked about inthe beginning of the podcast.
Absolutely, but just just torecap, we can take vaginal
(29:14):
estrogen combined with ourtransdermal estrogen or systemic
estrogen.
We can start vaginal estrogeneven in perimenopause.
Yes, Yep, Yep, and you can withyour vaginal estrogen.
Okay, I'm going to get a littlebit more in detail here for
listeners, but it comes in atablet, it comes in a cream.
(29:37):
It varies forms, but you alsowant to apply the cream on the
outside as well as the inside tokeep it healthy.
Dr. Kelly Casperson (29:46):
If you care about your genitals.
Yes, yeah, okay, yeah, I mean Imean that's, some people like
the tabs because it's less messy, right Right.
But the tabs are actuallypretty low dose and they're
contained in the vagina.
So it can be great for anon-sexually active person who
has recurrent UTIs and you justneed a little bit of estrogen in
(30:08):
there.
But if you're sexually active,especially if you started
noticing decrease in sensation,tightness, pain, decreased
lubrication, all of those thingsthat's not in your head.
Those are hormone issues.
I like the cream.
People are like, oh, it's alittle messy, and I'm like, do
you remember your 18-year-oldvagina?
That is messy.
(30:29):
Want it back?
Yeah, that's lubrication.
Kim Hart (30:32):
Yeah, absolutely.
Dr. Kelly Casperson (30:33):
And so I joke around about it a little
bit.
But I truly, if you put it likefinger, index finger, fingertip
to first knuckle that amount inthe vagina and then fingertip
to first knuckle are in theexternal genitalia and rub it in
, like I always say, it's likeyou're in Texas in August with
sunscreen.
With sunscreen and you don'twant to get burned Like, rub it
in, that's great.
(30:54):
Get it in the tissue, don'tjust like slap it on and put on
your underwear and have it go onyour underwear.
April Haberman (30:58):
Yeah, and then it's on your underwear.
It's not going to help, right?
Dr. Kelly Casperson (31:02):
And then here's the next question, which
is telling.
But sweet People are like whatif it gets on my partner's penis
and I'm like they have?
They have estrogen in theirbody.
Number one, number two it'sit's skincare, right, like it's
not gonna hurt them.
(31:22):
Don't use, don't use estrogencream as a sexual lubricant.
That's not what it's designedto do.
But if you happen to put onyour vaginal estrogen that night
and the mood strikes, it's nota reason to say no, you're not
going to hurt anybody.
They've actually done study onthis, that's good.
April Haberman (31:37):
Yeah, that's actually a good point.
Kelly, we have about fiveminutes left on our podcast and
I have so many questions for you, but I really want to come back
to your book, and there's somuch information contained in
that book.
I hope everybody goes andpurchases that book.
But what haven't we talkedabout?
That's in your book that isclose to your heart, that you
(31:59):
want our listeners to know.
Dr. Kelly Casperson (32:04):
Oh, I really don't think everybody
knows how bad alcohol is foryour brain oh yeah, it's going
to bring that up and how, howbeneficial exercise and lifting
weights is for dementiaprevention and breast cancer
prevention.
And I think we we lose those inwhen we talk about hormones,
because hormones are hot and youknow, everybody kind of wants
(32:25):
them to be the Holy Grail.
But it's like I can't.
I can't slap on an estrogenpatch and expect it to do much
if you're drinking and you'renot sleeping and you're not
exercising and your mood aboutgetting older is shitty.
So I talk about mindset andreally that you know, so many
people are like, ah, growingolder, bah.
(32:47):
And I'm like my grandma saidthere's only one alternative and
she's right, she made it to 96.
And there's actually data onyour mindset about growing older
actually affects your health.
So I have a chapter in there onmindset, because estrogen patch
won't do that all for you andthere's so much we can do.
That isn't hormones, because,again, all hormones are our
(33:09):
messengers that help our cellsfunction.
That's all.
They are right.
We still have to do all theseother amazing things that feel
good and help us thrive, and notjust age, but age with health.
April Haberman (33:21):
Mm-hmm.
I really appreciated thatbalanced approach because you
are pro-hormone, but youemphasize lifestyle and mindset
and have that balanced approachin the book and it's extremely
important.
Kim and I both believe in that.
We're health coaches for yogainstructors.
I mean it's, it's the full mealdeal, as we call it, it's not
just one solution.
(33:41):
All right, Kelly, we're gonnaask you this question again, and
because I can't remember whatyour answer was the first time
that you were on the podcast,and it's probably different now,
but we ask everyone the samequestion at the end of our
podcast what the best piece ofadvice you've ever received or
given has been.
So what would your answer betoday?
Dr. Kelly Casperson (34:01):
I think this might be the same answer.
Okay, I was a medical studentdoing my general surgery
rotation.
I remember where I was standing.
I remember that I was a medicalstudent doing my general
surgery rotation, Like Iremember where I was standing.
I remember that I was halfwayup a flight of stairs turning
around looking down Like I wasprofound statement and it was a
general surgery chief residentand he said nobody is more in
(34:22):
charge of your education thanyou.
And I think that ties into likewhy I'm reading, writing these
books and why I want women tohave the knowledge, because
nobody is more in charge of yourbody and your knowledge about
it than you.
April Haberman (34:38):
Such a good reminder.
Kim Hart (34:40):
That's huge.
And your book does such a goodjob of informing you about your
body.
I mean I like, for example, youtalk about men having estrogen.
I didn't know that for a year.
I mean, I didn't know thatuntil I started getting into the
menopause business, that thiswas.
There's so many things likethat that you just need to know,
and this book does such a goodjob of describing all the things
(35:03):
that are happening to your bodyand what your options are, and
I can't, I can't tell you enoughyour body and what your options
are, and I can't, I can't tellyou enough it just it has, as I
said in my LinkedIn post, it hasyour sense of humor and also
great knowledge and just reallyreally appreciate.
Appreciate it Cause it's it isdifferent for our listeners.
You know, it is different thanthe other books that that have
(35:25):
come out on this topic, becauseit's so it's so informative.
Dr. Kelly Casperson (35:32):
Yeah, I think, and I think it's really
approachable and friendly and Ireally want to narrow the gap
between medical knowledge andyou.
Like, I want to narrow the gapbetween, like this unobtainable
stuff is like no, no, no, we can.
We can all understand this andit's a true compliment because
I'm like I was worried you arenot broken, is so loved, right,
(35:53):
and it's so it's so me and mypersonality it's an it's
award-winning what can I say?
at this point, but reallyworrying that, like did the
science overwhelm thepersonality to the detriment of
the menopause moment, and so farI'm hearing that it hasn't no,
I mean you f-bomb throughout thebook you like.
Kim Hart (36:11):
are you kidding me?
April Haberman (36:12):
You're real.
You're persecuting me.
Thank you, Kelly I texted afriend.
Dr. Kelly Casperson (36:17):
I was like pages before the F word comes
out in this book like 63.
It's okay.
April Haberman (36:26):
Kelly, where can our listeners get your book?
Where can they get?
Dr. Kelly Casperson (36:29):
it Wherever they want.
April Haberman (36:31):
So it's on Amazon.
Dr. Kelly Casperson (36:31):
Barnes Noble.
If people want to do mom andpop, local bookstores, great, I
know a lot of them are carryingthem and on my website under
books, I actually have a wholelist for mom and pop.
If they want to do a retailer,that isn't that local chain
started in Seattle.
Kim Hart (36:52):
Fantastic, and you're traveling the and you're
traveling I mean the world,essentially, so people could
look up on your website.
Dr. Kelly Casperson (36:57):
yeah, I just got an event long like long
overdue.
Uh, just got an events page onthe website, because now I think
we're up to eight cities.
We just like added connecticutLove it.
Love it, so it's hard to keeptrack of, and we'll see you guys
in Seattle and Bellingham.
Yeah, we'll see you on the 29thof October.
Kim Hart (37:16):
So if you're in the Seattle area, come join us
October in.
April Haberman (37:20):
Seattle.
Yeah, and if you'd like to seeDr Kelly, you have your own
clinic as well up in Bellingham,washington, so you can look her
up on the website there as well, but I see my poor math like.
Dr. Kelly Casperson (37:34):
These are percentages, but it's about a
third perimenopause, a thirdboomers who are pissed 70 plus,
and then a third regularmenopause people and then
probably about 5% men Love it.
I love seeing partners, so wehave a good time, we get lunch,
we take care of everybody.
It's really fun.
April Haberman (37:54):
I love that Great reminder too, that you see
men as well, and couples.
Kelly, it's been a joy, it'sbeen a pleasure.
We could talk all day long, butwe thank you for your time and
listeners.
Until we meet again.
Go find joy in the journey,thanks everyone.
Thank you for listening to theMedovia menopause podcast.
(38:16):
If you enjoyed today's show,please give it a thumbs up.
Subscribe for future episodes,leave a review and share this
episode with a friend.
There are more than 50 millionwomen in the US who are
navigating the menopausetransition.
The situation is compounded bythe presence of stigma, shame
(38:38):
and secrecy surroundingmenopause, posing significant
challenges and disruptions inwomen's personal and
professional spheres.
Medovia is out to change thenarrative.
Learn more at medoviacom.
That's M-I-D-O-V-I-A dot com.
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