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Real Talk on Perimenopause, Hormones, and HRT Explained I Dr. Salome Masghati
This episode reveals the hidden risks of hormonal birth control, how it alters your gut, mood, and long-term health, and why most OB/GYNs are missing the mark on hormone therapy. Learn how estrogen and progesterone rhythms affect everything from your brain to your bones — and what you need to know about bioidentical HRT, perimenopause symptoms, fertility decline, and why synthetic hormones can derail your metabolism. If you’ve ever been dismissed by a doctor or handed a pill without options, this episode is a must-listen.
KEY TOPICS
- How birth control affects mood, gut health, and nutrient absorption
- Why rhythmic estrogen and progesterone cycles are vital for healthspan
- The difference between synthetic hormones and bioidentical HRT
- Perimenopause symptoms that are often misdiagnosed or ignored
- How thyroid, adrenal, and insulin imbalances intersect with female hormones
TIMESTAMPS
[00:00] Birth control, mood changes, and neurotransmitter disruption
[01:38] Meet Dr. Salome Masghati and her shift from surgery to root-cause care
[04:02] Gaps in OB/GYN training around menopause and hormone prevention
[06:52] Why birth control is overprescribed and how functional care differs
[09:26] The critical role of estrogen-progesterone rhythm in women's health
[15:08] Long-term effects of oral contraceptives and synthetic progestins
[21:10] Risks and misconceptions around IUDs and systemic effects
[26:18] When to consider bioidentical hormones and signs of perimenopause
[34:26] How to prepare the body for pregnancy and optimize egg quality
[40:30] Hormones and weight gain, insulin resistance, and gut health
[42:19] Adrenal, thyroid, and sex hormone interplay in perimenopause
[43:53] Why skipping HRT may accelerate aging and long-term health decline
[48:02] What are optimal hormone levels for estradiol, progesterone, testosterone
[51:10] Should you bleed postmenopause? Pros and cons of cyclical HRT
[55:15] Testosterone therapy myths, administration routes, and risks
[59:46] Estrogen detox, gut flora, and hormone metabolism explained
[61:08] Mental health, ADHD, and red flags for hormonal imbalance
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Website: https://www.drsalomemasghati.com/
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Transcript
Up to 20, 30% of women can experience depression and anxiety on oral birth control.
Speaker A:So if you look at it, it's because it lowers your estrogen, the natural estrogen which you need for serotonin, the happiness hormone, dopamine for the motivation hormone.
Speaker A:It can affect your adrenaline or adrenaline.
Speaker A:And then if you add to that that you're now maybe absorbing less B vitamins, which makes you also more prone for mood issues.
Speaker A:Now you have a combination of gut issues and neurotransmitters being changed from estrogen.
Speaker A:You're set up for maybe having anxiety, depression.
Speaker A:A lot of young girls get put on antidepressants when they start on birth control.
Speaker A:It happened to me personally, so I am very familiar with that.
Speaker A:I developed depression after being put on birth control.
Speaker A:I was extremely.
Speaker A:Just detached from life.
Speaker A:I felt like my, my, my thoughts and my feelings were blunted.
Speaker A:Just didn't feel anything and I gained some weight on it.
Speaker B:Welcome to the Optimized Woman, the podcast for high performing women ready to take back their health.
Speaker B:I'm Ori Magn, a board certified holistic health practitioner and functional nutritionist.
Speaker B:If you're tired of feeling stuck, you can't lose the weight.
Speaker B:No matter what you do, your energy is in the toilet, your metabolism feels like it's at a standstill, and you lost the spark you once had, then you're in the right place.
Speaker B:We are here to unleash the unstoppable force you meant to be and give you the tools to fix what's holding you back.
Speaker B:So if you're ready to own it, start thriving again and live the life you deserve.
Speaker B:And let's get to it.
Speaker A:Hey.
Speaker B:Welcome, friends.
Speaker B:Today I'm joined by Dr.
Speaker B:Salome Muscotti, a gynecologist and expert in women's hormones.
Speaker B:In this episode, we explore practical insights on navigating perimenopause and menopause, the impact of hormones on mood and energy, and how rhythmic hormone therapy can Support Women's Healthspan.
Speaker B:Dr.
Speaker B:Mascati shares her unique approach to blending functional and traditional medicine with tips on lifestyle changes to support hormone balance and manage midlife transitions with confidence.
Speaker B:So if you're curious about optimizing your health, you'll want to take some notes on this one.
Speaker B:Let's dive right in.
Speaker A:I've always been in love with hormones ever since I was a young girl.
Speaker A:I really chose OBGYN as a specialty because it was related to women and their hormones.
Speaker A:And I chose to go into a surgical subspecialty of that where I Worked with women who had conditions like fibroid and endometriosis, which can be hormone related.
Speaker A:But when the pandemic happened and a lot of things changed for people that were healthcare professionals that thought outside of the box and maybe didn't want to be part of the hospital system the way it was, there was a whole paradigm shift that happened for me mentally in terms of what kind of system do I want to be part of and how do I want to help women?
Speaker A:Is surgery the only way I can do that?
Speaker A:And I figured that there was a big need for women to address the underlying causes that can lead to all these issues that they would come to me for, for surgeries.
Speaker A:And so I got more and more into functional medicine.
Speaker A:Understanding gut health, understanding inflammation, understanding heavy metal toxicity, mold toxicity, understanding diet, lifestyle, you know, macronutrients, micronutrients.
Speaker A:What is the need of magnesium, B vitamins, how does those.
Speaker A:How do those things affect your health?
Speaker A:And then from there, I also got into focusing more into hormones.
Speaker A:And so I help women now in my practice anywhere with, you know, younger women with pcos, to perimenopausal and menopausal women, which is what I'm mostly focused on.
Speaker A:And I.
Speaker A:I love that I get to do that.
Speaker B:So I'm curious, you're coming from a traditional obgyn training.
Speaker B:What are some of the gaps in traditional training?
Speaker B:So in the allopathic space concerning women's.
Speaker A:Health, you know, I find that in the regular, like obgyn residency, when we undergo training, everything is more emergency focused.
Speaker A:We learn a lot about how to take care of women at the worst crisis in their lives.
Speaker A:You know, in obstetrics, it's about, we have to learn how to do a C section.
Speaker A:If someone has a condition where they have an emergency during their pregnancy or childbirth, we have to jump in.
Speaker A:We have to help women that come through the emergency room, they're bleeding extremely or having extreme pain.
Speaker A:It's always extreme scenarios.
Speaker A:And I got incredible training in that.
Speaker A:I mean, to be able to save babies if there's an umbilical cord prolapse or a placenta that ruptures or a woman that's bleeding to death from an ectopic pregnancy.
Speaker A:I am very grateful for this training, but it was a little bit more lackluster when it came to prevention.
Speaker A:So when we did have clinic rotations, but we never had continuity in the clinic, where if I had someone that I placed on a certain medication or hormone therapy, that I would see them afterwards and see how they were doing.
Speaker A:Because we had constantly to jump from one rotation to another.
Speaker A:So I got incredible training, learning about cancer, learning about obstetrics, learning about how to do surgeries.
Speaker A:But when it came to prevention, it was lackluster.
Speaker A:And within that, menopausal education was also very lackluster.
Speaker A:We would maybe get a few hours in all the four years that I had OB GYN residency, and then when I did fellowship for two years, additionally, we learned a little bit of how hormones are implicated in endometriosis, fibroids and all that, but not enough.
Speaker A:And so everything I've taught myself today is through all the trainings I've paid for, all the things I've done outside of medical training.
Speaker B:Isn't that crazy?
Speaker B:Because, I mean, I think most women expect really OBGYNs to be the most knowledgeable about hormones, I mean, besides maybe endocrinologists.
Speaker B:But like, we really go to an obgyn and we expect that knowledge.
Speaker B:And I think the vast majority of women, that's their expectation.
Speaker B:But then they end up getting the standard of care, whatever that is.
Speaker B:Which can you, can you tell me, like, what is the standard of care?
Speaker B:And I know that's, that's a big question because it depends on your age and what issues you have.
Speaker B:But specifically, when it comes to hormonal imbalance, if somebody comes to you, as far as maybe a teenager or a young woman or a perimenopausal woman, different stages of life, how does the allopathic space address that?
Speaker B:And then compared to that with the more functional holistic lens, how are you looking at it differently?
Speaker A:Yeah, it's a great question.
Speaker A:Most regular conventional OB GYNs, for any condition where someone has painful bleeding, heavy bleeding, irregular bleeding, the answer is always the same thing.
Speaker A:Oral birth control or some sort of birth control, nobody thinks about what is their gut health testing, you know, health look like, what does their gut health look like?
Speaker A:What does their diet look like?
Speaker A:What is their lifestyle?
Speaker A:What is their light environment?
Speaker A:What is their sleep?
Speaker A:Sleep?
Speaker A:Are they getting exposed to endocrine disruptors?
Speaker A:There's no time for that in an insurance run, conventional practice.
Speaker A:I don't blame anybody.
Speaker A:We're not taught that in residency.
Speaker A:There's no time for it.
Speaker A:I think one of the biggest differences between me and a conventional OB GYN is that I know everything an OB GYN does or knows, and I know more.
Speaker A:So I add to that the functional approach where I can help people address their lifestyle.
Speaker A:I can look at their gut health, I can look at their hormone imbalances and believe it or not, you can have hormone imbalances already.
Speaker A:When you're like as young as 20 or 17.
Speaker A:You could have unhealthy ovulation, the egg quality being disrupted by something.
Speaker A:You could have inadequate progesterone.
Speaker A:You could have thyroid conditions.
Speaker A:You could even find that women are hypoestrogenic when they're younger because they're under eating or over exercising or their nutrient levels are off.
Speaker A:There's also other conditions that I treat women for.
Speaker A:For example, thyroid.
Speaker A:I always look at the thyroid.
Speaker A:I want to be a one stop shop for women for hormones.
Speaker A:And then there's other things like pcos, prolactin, elevated hyperprolactinemia from a pituitary adenoma.
Speaker A:I look at it all in a holistic aspect.
Speaker A:I don't have to refer people to 10 specialists for that.
Speaker A:I, I try to make it a one stop shop.
Speaker A:Now there's certain conditions or certain circumstances where I will refer out, but I usually try to address the root cause of it.
Speaker A:And I don't just give women a birth control pill.
Speaker A:That's I think the biggest difference between me and a conventional OB gyn.
Speaker B:Yeah, you're in many ways a unicorn.
Speaker B:This is exactly what we are looking for.
Speaker B:And there's such a few of you out there, so it's such a pleasure having you on and giving us the opportunity to pick your brain a little bit here.
Speaker B:So I want to start by talking about the unique rhythm between estrogen and progesterone and why is that so crucial for women's overall health?
Speaker A:The more I learn about our menstrual cycle, the more I have appreciation for mother Nature and incredible symbiosis between the hormones.
Speaker A:It's incredible how much we spend our younger years trying to suppress our natural periods because we don't like it because it's inconvenient.
Speaker A:And here we go and we find out there was a purpose behind it all.
Speaker A:The menstrual cycle and the rhythms of the hormones throughout the menstrual cycle represent a rhythm between the main hormones, estradiol and progesterone in every organ system of the body, not just the uterus.
Speaker A:The uterus and the uterine lining are just because they're the primary target organs for fertility.
Speaker A:As a woman is younger, obviously nature wants us to make babies.
Speaker A:That is what our hormones are based on, whether we like it or not, whether we stay single forever and don't have children.
Speaker A:Nature has made our hormones to be so that we can get pregnant and have children.
Speaker A:But that's not the only organs that these hormones work on.
Speaker A:So the same effect that they have on the uterus, they have in a rhythmic fashion on our bones, on our vessels, on our brain, on our mood, on our gut flora.
Speaker A:This is what I'm doing on my social media a lot is I'm trying to explain to people that rhythm between estradiol and progesterone is really important because estradiol comes in in the first half of the cycle and peaks around day 12 and stimulates all the good things, the proliferation of and growth of cells, it stimulates stem cells, it stimulates life, it stimulates growth.
Speaker A:We need that, right?
Speaker A:We want healthy bones, we want healthy breast tissue, we want great skin, we want collagen in our skin, hair, we want lubrication of our vagina, we want everything.
Speaker A:We want our immune system to be intact because estradiol impacts our immune system, our gut flora.
Speaker A:And then progesterone comes in and together with estradiol in the second half, they modify each other and they work together in a balanced way.
Speaker A:And when they both fall, right before the period, we shed all these old cells and then regenerate them again in the next cycle.
Speaker A:This is the most beautiful cycle of life.
Speaker A:If we don't get pregnant every month, we grow cells and we shed them.
Speaker A:If a woman gets pregnant, things change.
Speaker A:And for a transition of like a few months, her hormone levels go extreme high levels to maintain a baby, suppress the immune system further, there is changes to her hormone levels.
Speaker A:And then when she delivers the baby and breastfeeds, the hormone levels fall to a low, which is a transition again.
Speaker A:So woman undergoes big transitions throughout her life.
Speaker A:In puberty, when her hormones come in through, like pregnancy, postpartum period, and then in perimenopause and menopause, all these hormonal shifts are transition periods.
Speaker A:But between those, when we are at the best of our hormones and we have regular cycles, these hormones are exactly, perfectly where they should be and how they.
Speaker A:They have the best effects for our health.
Speaker A:So maintaining a healthy menstrual cycle, I'm getting more and more familiar with this, seems to have a lot of benefits down the line.
Speaker A:I'm going to give you another example.
Speaker A:If a woman reaches her peak bone mass around age 25, if we suppress her menstrual cycles in the years before that and in the years around that, we actually potentially increase her risk for osteoporosis at a younger age, because she has never reached her peak bone mass.
Speaker A:And we all lose bone mass as we age because our Ovaries make less and less hormones.
Speaker A:So if we suppress those hormones at a younger age, when it matters, we are potentially impacting her bones later on.
Speaker A:Well, the same thing might apply to her cardiovascular system, to her brain health, to breast tissue, you know, all of those things.
Speaker A:So if we just tell someone, take a birth control and suppress all your natural hormones, suppress your natural periods, they might not live to their full potential in terms of what their hormones were meant to do for them.
Speaker A:And women often come at you and say, well, what about my reproductive rights?
Speaker A:And I want to be on some sort of birth control.
Speaker A:There's options other than the oral birth control.
Speaker A:That's where I tell them there may be ways that don't impact your natural cycles as much.
Speaker B:And that is so scary, what you just said.
Speaker B:Like, how many women are birth control pill in their 20s?
Speaker B:Like, almost everyone.
Speaker B:I mean, maybe not everyone now, hopefully women are getting a little bit more educated about this.
Speaker B:But certainly, like, when I was in my 20s, I had no clue.
Speaker B:I had no clue.
Speaker B:And just as you said, the standard of care is birth control pill for everything.
Speaker B:That's what I was given to.
Speaker B:And that's what I think the vast majority of at least women of my age were given.
Speaker B:It may be slightly shifting now with different options, but that is so scary to think that you may not reach peak bone density, that your cognitive function may be affected.
Speaker B:None of those are really being given to you.
Speaker B:Like, you don't know when you're getting that prescription.
Speaker B:They just hand you the prescription thinking, oh, your acne will go away, or whatever you were asking for, where your symptom presentation was.
Speaker B:But they don't tell you that you could have all these symptoms down the road as you're aging or potentially as you get older.
Speaker B:So what would be like, the biggest concerns with birth control pill?
Speaker B:Because we already mentioned a couple of them, but why don't we go through the laundry list?
Speaker B:What are the other issues?
Speaker A:There's a lot of things that doctors will not tell you.
Speaker A:For example, one of the things is there's a higher risk of Crohn's disease with the birth control pill.
Speaker A:And I recently gave a talk about this on a virtual conference for Gut Health, and I looked into how birth control can actually change the microbiome, and not for the better.
Speaker A:It can lower the diversity of the microbiome because when we have natural estradiol and progesterone, they come in and affect the microbiome differently throughout the cycle when you suppress those hormones.
Speaker A:And I want to be Very clear.
Speaker A:If you are in oral birth control, you're suppressing your natural estrad and progesterone production because you're preventing your egg from ovulating and maturing and making those hormones.
Speaker A:So the birth control can affect your gut microbiome.
Speaker A:One risk, okay?
Speaker A:So you are a little bit of higher risk of Crohn's disease.
Speaker A:If you have Crohn's disease in your family, for example, maybe something to consider.
Speaker A:It does increase your risk for micronutrient absorption to be decreased, like, for example, folate and B12.
Speaker A:And it can also affect your iron absorption.
Speaker A:It can also affect your stomach acidity and how you digest foods.
Speaker A:So it could make you potentially more prone for gut dysbiosis and leaky gut and potentially lack of certain B vitamins.
Speaker A:Okay.
Speaker A:When you add to that that the estrogen that you are having in the birth control is a synthetic form, it's not the one that looks like the one that your body makes.
Speaker A:It's not bioidentical.
Speaker A:It's synthetic.
Speaker A:It's a different chemical structure now that has to go through your liver and be processed.
Speaker A:One of the things the liver needs for that is magnesium and B vitamins.
Speaker A:So you're reducing your nutrients and you're putting more pressure on your liver to get rid of those synthetic hormones, and you can't keep up with that.
Speaker A:That's one thing.
Speaker A:We do know that some people have underlying clotting problems.
Speaker A:And even if they don't, birth control pill can increase the clotting risk because it's a synthetic hormone, it's not a natural hormone.
Speaker A:So clotting means you could get a blood clot in your leg, and it could potentially, from your leg, go up to your.
Speaker A:To your lung and be potentially very dangerous.
Speaker A:We have a family friend who at the age of 24, died from a pulmonary embolism.
Speaker A:And her only risk factors were the.
Speaker A:The birth control.
Speaker A:She wasn't a smoker, she wasn't overweight.
Speaker A:I think it's scary to think about it, right?
Speaker A:The other thing is, we know from data that because it's synthetic hormones and there's synthetic progestins in the birth control, there is potentially a little bit of a risk of breast cancer increase, which is only temporary as you're staying on the birth control.
Speaker A:When you come off it, that risk goes down.
Speaker A:There's also higher risk of osteoporosis because you're reducing the bone density.
Speaker A:If you are decreasing your own estrogen levels, that might not happen in every woman because everyone's estrogen levels will vary how much they still make it.
Speaker A:But overall they found some significant changes for bone mass, which is also reversible.
Speaker A:When you come off the birth control, There is higher incidence of.
Speaker A:Of gallbladder issues on the birth control because it makes the gallbladder sluggish.
Speaker A:There is higher incidence of prolactinomas, which is a tumor in the pituitary.
Speaker A:There's higher risk of mental changes, mood changes.
Speaker A:There's a certain percentage in the population that can experience depression.
Speaker A:Up to 20, 30% of women can experience depression and anxiety on oral birth control.
Speaker A:So if you look at it, it's because it lowers your estrogen, the natural estrogen, which you need for serotonin, the happiness hormone, dopamine for the motivation hormone.
Speaker A:It can affect your adrenaline or adrenaline.
Speaker A:And then if you add to that that you're now maybe absorbing less B vitamins, which makes you also more prone for mood issues.
Speaker A:Now you have a combination of gut issues and neurotransmitters being changed from estrogen.
Speaker A:You're set up for maybe having anxiety, depression.
Speaker A:A lot of young girls get put on antidepressants when they start on birth control.
Speaker A:It happened to me personally, so I am very familiar with that.
Speaker A:I developed depression after being put on birth control.
Speaker A:Nobody put it together, and I became suicidal.
Speaker A:It was terrible.
Speaker A:I'd never had suicidal thoughts before.
Speaker A:I became extremely suicidal.
Speaker A:Instead of taking me off the birth control, I was given antidepressants, which made me extremely detached from like anything.
Speaker A:I was extremely.
Speaker A:Just detached from life.
Speaker A:I felt like my.
Speaker A:My.
Speaker A:My thoughts and my feelings were blunted.
Speaker A:Just didn't feel anything, and I gained some weight on it.
Speaker A:So I speak from personal experience that there's a certain subtype of people that don't react well.
Speaker A:I'm not saying this is terrible for everyone.
Speaker A:I'm just saying if you're someone who's not doing great on it and you want to find someone that listens to you, maybe find someone that is more educated with functional medicine and has an approach to it that's more holistic so they take your complaints seriously.
Speaker B:And it can also affect your libido, right?
Speaker B:Being on a birth control pill, there's so many things.
Speaker A:I just didn't mention one of them.
Speaker B:It's such a long laundry list.
Speaker A:Douglas, what birth control does, it increases sex hormone binding Globalin in the liver, which then binds testosterone, which, when testosterone is bound.
Speaker A:This is why acne clears up for people.
Speaker A:It lowers the testosterone, but with that, it lowers their libido.
Speaker A:It can also change the size of the clitoris permanently.
Speaker A:So it can make the clitoris shrink and it can decrease the sensation of the clitoris.
Speaker A:So a lot of young women get like a lot of yeast infections because it changes the vaginal microbiome.
Speaker A:They get a lot of bv.
Speaker A:They can get, like, decreased clitoris sensation if they're on the birth control for a long time.
Speaker A:And I don't even know why.
Speaker A:They don't even know why.
Speaker A:They don't feel anything if their partner, like, stimulates their clitoris.
Speaker A:And I don't feel anything.
Speaker A:That could be the birth control because it lowers the testosterone too much.
Speaker B:Wow.
Speaker B:Sure.
Speaker B:They don't give all that information when they get the prescription for sure.
Speaker B:Now, a lot of women instead then go to like an iud.
Speaker B:And I know that that is sort of sometimes a plan B.
Speaker B:What are the issues with different IUDs?
Speaker A:Well, there's two types of IUDs.
Speaker A:There's hormonal and non hormonal IUDs.
Speaker A:With the hormonal ones, you have different strengths of the synthetic progestin that's on the IUD.
Speaker A:You can have IUDs that last eight years in your body and you can I.
Speaker A:That last about three to four years.
Speaker A:If you get the ones with the lower dose, you probably have less systemic effects on your body just because the total dose that's secreted daily is less.
Speaker A:But in general, if you look at the packaging of the iod, the one that is called the Mirena, that lasts anywhere from five to eight years, it actually does suppress ovulation.
Speaker A:So when they say it only works inside your uterine lining, how can it suppress ovulation?
Speaker A:In the studies that they did, if it doesn't go into the bloodstream and affects your brain, which then signals the ovary to not ovulate.
Speaker B:Yeah.
Speaker B:And it's a.
Speaker B:It's a synthetic progestin, right?
Speaker A:It's a synthetic progestin.
Speaker A:It's levonorgestrel.
Speaker A:There's different generations of progestins with which are synthetic progesterone.
Speaker A:And they're not the same as progesterone.
Speaker A:They don't have the same effect.
Speaker A:Some of them also dock on testosterone receptors, so they can have some androgenic effects.
Speaker A:So some people can experience hair growth or hair thinning.
Speaker A:Again, something that happened to me because I also got an IOD when I was in residency.
Speaker A:I couldn't afford again, I didn't understand how important menstrual periods were.
Speaker A:I was like, I can't have periods.
Speaker A:I have to work 90 hours a day, a week.
Speaker A:I have no time for it.
Speaker A:So I was on an.
Speaker A:I.
Speaker A:I experienced some hair growth on my chin and some hair thinning and I didn't know why.
Speaker A:I also experienced depression.
Speaker A:Again, I think I'm more prone to depression because I have adhd.
Speaker A:But.
Speaker A:And I really need my dopamine and serotonin and any birth control affects me in a negative way.
Speaker A:We were Talking about the IODs just to finish that thought.
Speaker A:So the idea is that the iodine is when they're hormonal, they only work in the uterine lining.
Speaker A:I don't think they do only work on the uterus.
Speaker A:I think they do have systemic effects.
Speaker A:I do think they can inhibit ovulation and by that that lower your natural estrogen.
Speaker A:What I also think is that it's not just based on me thinking, it's based on looking at the data.
Speaker A:They've also been shown to increase anxiety and depression in a subset of women.
Speaker A:They've also shown in a German study that the IUD can increase breast density.
Speaker A:So they can cause brain breast inflammation because it's a synthetic progestin.
Speaker A:It's not a natural progesterone.
Speaker A:Your natural hormones do not cause breast inflammation.
Speaker A:Okay.
Speaker A:It's the synthetic hormones.
Speaker A:Now let's say you want to do a non hormonal, that's called the Paraguard.
Speaker A:It's a copper IOD that lasts for 10 years.
Speaker A:Maybe better option, but in some women because the way it works, it increases inflammation in a cervical mucus and in the cervix and in the uterus.
Speaker A:It makes their menstrual cramping worse because they release more inflammatory cytokines.
Speaker A:And so they get heavier, period.
Speaker A:They get more painful, period.
Speaker A:And copper can be systemically absorbed.
Speaker A:So I have diagnosed copper toxicity in some women with copper IUDs.
Speaker A:I'm telling you, I wish there was an ideal situation.
Speaker A:If someone said what could I do that has no impact on my body in a negative way.
Speaker A:You can use natural fertility awareness.
Speaker A:You can use basal body temperature, cervical mucus.
Speaker A:When they're done correctly, you can have 99% success.
Speaker A:You can also use barrier methods like diaphragm or condoms, which also a condom would protect you from STDs in addition to protecting you from pregnancy.
Speaker A:If you want to be on a birth control, maybe choose the one with the lowest dose of hormones, you know, or use the one that is.
Speaker A:There's something called low, low estrang.
Speaker A:Or use one that is only with the Progestin, not the ethyl estradiol and the progestin.
Speaker A:There's no ideal world out there, and I don't judge anyone making decisions.
Speaker A:I just want you to be informed.
Speaker A:I just want you to know what's out there.
Speaker A:And one of the other things that bothers me, since we're talking birth control, a lot of women in their 40s, when they're in perimenopause, the doctors say, if we start, your birth control is the same as giving you natural bioidentical hormones.
Speaker A:That is such a big, big false lie.
Speaker A:I don't even know how to.
Speaker A:How to address that without getting angry, because now all the things I told you the birth control can do increase osteoporosis, breast inflammation, depression.
Speaker A:A woman in perimenopause is already at risk for that.
Speaker A:So now I'm worsening that for her, and I'm lowering her already declining natural hormone levels.
Speaker A:So I'm not a fan of oral birth control for a woman in their 40s at all.
Speaker B:Yeah.
Speaker B:And yet so many women actually stay on their birth control pill or some other form of synthetic hormone combination all the way to menopause.
Speaker B:And then only in menopause, they either they stop it, and then all of a sudden they have a whole bunch of symptoms.
Speaker B:And.
Speaker B:And that's like, don't take my hormones.
Speaker B:And I think hopefully by then women start to explore other options.
Speaker B:So maybe this would be a good segue into what are other options as far as natural sort of bioidentical hormones?
Speaker B:At what age do you start exploring that option for women?
Speaker B:What are the physical symptoms that you look for?
Speaker A:You know, to be honest, this can be happening in any woman.
Speaker A:I have women as young as 25 undergoing perimenopause.
Speaker A:What perimenopause is, is the period between you having perfect, normal, healthy hormone levels and menopause.
Speaker A:It's the transition that.
Speaker A:And what happens is that your eggs are basically declining in number because we only have a limited amount of eggs that we have in our ovaries.
Speaker A:And then as they decline, we produce less estradiol, and we don't make enough estradiol.
Speaker A:We don't ovulate regularly, and when we don't ovulate, we don't make progesterone.
Speaker A:So when we are lacking both of these hormones, the same symptoms arise.
Speaker A:Like your period becomes irregular, it can become heavier, or you miss a period, or it becomes lighter.
Speaker A:It can be that you develop PMS symptoms more than usual.
Speaker A:You develop menstrual migraines, Vaginal dryness, dryness of your eyes.
Speaker A:Again, mood changes, sleep changes, waking up at night and not being able to sleep, breast tenderness, water retention, weight changes, getting more weight around your belly, even though you're doing everything the same way, you're eating the same way, you're exercising the same way.
Speaker A:It's a lot of things.
Speaker A:Some women start feeling like less joy, less connected with life.
Speaker A:They start feeling more depressed or anxious.
Speaker A:So our mental health is really impacted by our hormones.
Speaker A:And perimenopause can be difficult.
Speaker A:If you had babies and in postpartum you felt a certain way, that can be a small window into how you might feel when you're undergoing perimenopause and menopause.
Speaker A:So women with postpartum depression have higher risk of depression later on when they undergo menopause.
Speaker A:I would say if you have any changes in your menstrual health, in your cycle, in your mood, in anything, just get your levels checked.
Speaker A:Find someone that checks your levels, checks your thyroid, checks your esty, checks your progesterone, checks your testosterone.
Speaker A:Why not?
Speaker A:It doesn't.
Speaker A:It's just a poke, you know, and, and, and always go with blood work.
Speaker A:So if you do it for the blood is better for hormones.
Speaker A:If you want saliva, saliva is really the best method for cortisol, but not for all the other hormones.
Speaker A:So I would use blood for thyroid and female sex hormones.
Speaker B:Now, I would love to talk a little bit about reproductive health and the balance of estrogen and progesterone.
Speaker B:How do they play a role in fertility and reproductive health?
Speaker A:We need healthy eggs to produce healthy amounts of estradiol, and we need enough estradiol to peak around day 12 so that the brain gets the signal to secrete something called lh, which then makes the egg ovulate.
Speaker A:So if women don't have enough estradiol because the quality of the egg wasn't enough, or she had a lot of stress on her body during the first half of the cycle, she is going to not have that peak around day 12.
Speaker A:So she's not going to secrete LH and she's not going to ovulate.
Speaker A:And if she doesn't ovulate, she doesn't get regular periods, and she can't get pregnant without ovulation because that's when the egg is released and she doesn't make progesterone.
Speaker A:So there's all these implications.
Speaker A:So you need healthy estradiol and progesterone levels for your fertility, because once you ovulate, you also need to have enough Progesterone to maintain a pregnancy and the lining around the uterine lining.
Speaker A:I would say beyond that, you also need healthy thyroid levels, because thyroid is very important for reproductive health and fertility as well.
Speaker A:Thyroid, if you're underactive, it can affect your evolution, and it can also affect how successful your first trimester would be.
Speaker A:There's high risk of miscarriages when someone has low thyroid.
Speaker A:Other hormones you want to look at is prolactin.
Speaker A:You want to look at making sure there's not too much testosterone on board, because if someone is hypertestosterone in their levels, it could potentially impact the baby in utero.
Speaker A:So things like that.
Speaker A:Insulin is a hormone that is also very important for reproductive health, because if you are having insulin, metabolism issues, like if you have too high of insulin, which is the hormone that gets secreted by the pancreas to go and bring glucose into the tissue.
Speaker A:If you are having glucose or insulin issues, your fertility declines because it can affect the quality of the eggs and the ovarian function.
Speaker A:High insulin will make the ovaries function less effectively, and women develop something called pcos.
Speaker B:Yeah.
Speaker B:And nowadays fertility is becoming more and more of an issue for so many people.
Speaker B:Right.
Speaker B:So the fertility rates are declining, both in men and women.
Speaker B:What do you contribute this to?
Speaker A:Nobody will ever look into this because big pharma is not interested into looking what their own medication is doing to people.
Speaker A:But you could argue that maybe the use of oral birth control has impacted it because it's an endocrine disruptor and it suppresses women's own follicles.
Speaker A:Now, if you listen to certain people online, they will chase you for even making that statement, because there's no randomized control trial on that.
Speaker A:We don't always need randomized control dries to see what harms things can have.
Speaker A:You know, one of the other things we're all exposed to endocrine disruptors in general, the microplastics, the heavy metals.
Speaker A:We are exposed to a lot of toxins.
Speaker A:And then our diet has changed a lot over the last 45 years.
Speaker A:50 years with industrialization, there came the change to farming and mass production of food.
Speaker A:A lot of the way we, you know, cultivate our foods has changed.
Speaker A:The quality and the nutrient density of the food has gone down.
Speaker A:And then we were also more prone to eating processed food.
Speaker A:When you look at the US Versus Europe, there's a lot of things allowed here that are banned in Europe.
Speaker A:I know you're from Hungary.
Speaker A:I grew up in Austria and Vienna.
Speaker A:I know how the food tasted there and I know that it didn't make me gain weight just by looking at it.
Speaker A:So we spray our wheat, our corn, everything is genetically modified.
Speaker A:It has additives, food dyes, artificial flavors, artificial sweeteners, corn syrup.
Speaker A:Corn syrup is banned in most countries in the world.
Speaker A:So we have all those things in our food that are not also nutrient deprived.
Speaker A:So that affects our fertility.
Speaker A:Then we had a little bit of an obesity epidemic because of that.
Speaker A:And then also the lack of mobility.
Speaker A:Most people have cars that drive everywhere, nobody walks anymore.
Speaker A:And we have sedentary lifestyles with our work.
Speaker A:We work more from home and offices than we are physically active.
Speaker A:What else impacts us?
Speaker A:I believe that not living in rhythms of circadian can impact our fertility.
Speaker A:So if we don't go to sleep when natural sunlight, like when the sun goes down and we have the blue light, like the blue light is the ring that is shining on my eyes right now, disrupting my pineal gland and melatonin secretion, for example, we are exposed to blue light, we're more on screens and then we might not have the healthiest circadian rhythm.
Speaker A:And our circadian rhythm is very important for women because it can affect our fertility.
Speaker A:You know, again, lifestyle.
Speaker A:Also in terms of alcohol and sleep, how much sleep we're getting, Women are more in the workforce than men.
Speaker A:100 years ago there is different stressors of women because of that, because now they're wearing many hats like children and husband and parents and having a job.
Speaker A:So there's more adrenal stress on them and more stress.
Speaker A:More cortisol means less fertility.
Speaker A:So there's a lot of factors.
Speaker A:We could sit here forever.
Speaker A:I love this topic.
Speaker A:I love testing women for environmental toxins in their urine, heavy metals.
Speaker A:I like helping them detox from it.
Speaker A:I love testing them for hormones.
Speaker A:I mean, so many amazing things to talk about.
Speaker A:I'm very excited that there's so many things that can, can be discussed with a woman that are maybe new to her, you know.
Speaker A:So I love educating them.
Speaker B:So if you had, let's just say a 35 year old woman who came to you and say, okay, I'm ready to have a baby, but I want to take a year to prepare for this pregnancy.
Speaker B:What would be like your top three tips that you could give her?
Speaker B:Like three things that you should start doing right now?
Speaker A:Well, I would say, you know, like definitely work on the basic lifestyle, the light environment, the stress environment, exercise and diet.
Speaker A:Let's see what your macronutrients look like.
Speaker A:Are you hitting your protein goals?
Speaker A:Carbohydrate goals, healthy fat goals, your Omega 3 goals, all the things I know that impact her ovarian and egg quality.
Speaker A:Then I would do a macronutrient panel.
Speaker A:I love Nutrival, but there's other panels and I want to check her B vitamins and her magnesium and her zinc and her copper and her selenium.
Speaker A:And I want to check that because I know that a lot of like your vitamin A, your vitamin D, all of that impacts your egg quality.
Speaker A:Then I would want to check her hormones, I want to make sure her thyroid is on point.
Speaker A:I want to make sure she has enough progesterone, she's ovulating regularly and she has enough estrogen.
Speaker A:I would want to work with her on her body weight and her exercise routine, on her sleep.
Speaker A:Yeah, all of those things.
Speaker A:And if she gives me that year time, that's ideal because we can also dig into her gut health and see, hey, do you have got dysbiosis?
Speaker A:Is your gut health working?
Speaker A:Well, let's make sure your insulin, you know, is working okay.
Speaker A:You don't have, you know, insulin resistance because that's going to increase your risk of diabetes in pregnancy.
Speaker A:Like let's make sure your blood pressure is okay, your body weight is okay because you're going to have higher risk for preeclampsia.
Speaker A:Let's make sure you have enough progesterone because otherwise you're going to have high risk for first trimester miscarriage.
Speaker A:So many things that we can look into.
Speaker A:So if someone starts working early towards that with someone like you or someone like me, that's really gives a lot of space to optimize them.
Speaker A:Yeah, yeah.
Speaker B:And it probably should be both the whole couple, like the husband and the wife doing it together because the men's health is important too and their quality of their sperm.
Speaker B:Right.
Speaker B:For fertility and, and they are also setting up a healthy environment for this baby so they can have a healthier baby.
Speaker B:It's not just about leaving, but having a healthy baby.
Speaker A:Unexpected things that you might that did not mention that can impact the fertility.
Speaker A:First of all, in the last four years it was Covid and the COVID vaccine.
Speaker A:I have seen a lot of fertility issues with that and local Covid.
Speaker A:I help women with spike detox.
Speaker A:There's also women exposed to heavy metals.
Speaker A:For example, I had my mercury fillings removed in a non safe way and my ovarian function declined.
Speaker A:Like I know exactly when it happened because it happened pretty much quickly.
Speaker A:And I didn't know back then that when you remove Mercury.
Speaker A:It should be done in a safe way.
Speaker A:I was also given a certain vaccine that caused ovarian injury for me and premature ovarian failure.
Speaker A:And it was the garden cell vaccine.
Speaker A:So there's a lot of things that people don't even think about.
Speaker A:And there was a research paper that came out that Covid spike protein was found in male sperm.
Speaker A:Now, there's a life cycle to male sperm, but if you found it and that spike protein can reproduce, that can impact male fertility.
Speaker A:And I had a lot of women that had, after Covid, and the COVID vaccine came out, a lot of what it was, they got COVID infection infected or they got the COVID vaccine.
Speaker A:I've had all different kinds.
Speaker A:They had a lot of menstrual irregularities, and some of them actually stopped having periods.
Speaker A:And I've diagnosed some premature ovarian failure as well.
Speaker A:So there is a lot of things that can impact someone's fertility.
Speaker B:It's such a delicate balance.
Speaker B:And if you're a female getting ready to have a baby, you're going to be growing a baby for nine months out of your own body.
Speaker B:It's.
Speaker B:It's a miracle.
Speaker B:And, and it's such a delicate thing.
Speaker B:And, you know, we, we learned this later in life, unfortunately.
Speaker B:But I was born with a C section.
Speaker B:I wasn't breastfed.
Speaker B:I.
Speaker B:I was exposed to all these things as a baby.
Speaker B:And as a result of that, I had a whole, whole domino effect my whole life and my health.
Speaker B:And I can now look back and trace back a whole bunch of health issues I had because of my mother's health and the way I was born.
Speaker B:My mom, of course, was doing the best she could at the time, and she didn't know any better.
Speaker B:But, like, how that baby is born and how you bring that into the world makes a huge difference for the entire life of that little, little human.
Speaker A:So breastfeeding is so helpful for their gut flora and their immune system, and it also helps the woman with breast tissue remodeling and a lot of things.
Speaker A:And it releases more oxytocin, which makes the mother more attached to the child.
Speaker A:Nature always finds a way to make us do the right choices.
Speaker A:It's.
Speaker A:It's terrible when it doesn't work out for a woman because of inverted nipples or the child has a tongue tie or a lot of undiagnosed things, because a lot of mothers can feel very impacted if they can breastfeed.
Speaker A:Breastfeeding can be amazing for the child.
Speaker A:And then a lot of other things is when children become sick as children, and then they're giving a lot of antibiotics for sinus infections or infections, and that impacts their gut flora.
Speaker A:A lot of women that come to me, the very minority of them, are metabolically healthy.
Speaker A:A lot of them have underlying issues, and it impacts how they're going to react to the hormones that I'm going to give them in menopause.
Speaker A:So if someone comes to me and they're not at a healthy body weight, they're not going to do as well with the hormones I'm going to give them.
Speaker A:Not because my hormones are harming her, but she doesn't have the best capacity to metabolize these hormones, and her tissue is going to react a certain way.
Speaker A:She might swell in a different way, or, you know, it might affect her in a different way because she has more inflammation.
Speaker A:Or if some has underlying gut issues and she gets hormones, she might not be able to metabolize or process them as well, which will impact the way she's going to react to them.
Speaker A:So she wants to reach certain levels with me because she knows what's optimal more, but she can't get there quiet because she has underlying inflammation that needs to be addressed.
Speaker A:So I love, I love addressing that for women, and I love working with health coaches and nutritionists that help adjust that for people because that optimizes their outcome for hormones.
Speaker B:That's really interesting.
Speaker B:So let's just say you have a perimenopausal woman who comes to you, wants to start hormone replacement therapy, but maybe she's 30 pounds overweight, maybe have a slight insulin resistance, blood sugar, somewhat dysregulated, gut health is.
Speaker B:So.
Speaker B:So what do you do?
Speaker B:How do you get her started on hormones?
Speaker A:Obviously, I make everything very individualized, but in overall, I'm gonna make it very clear to her that she's gonna struggle a little bit more in the optimization of her hormones if she doesn't change her lifestyle and address some of the underlying issues that are gonna chase her down the line too.
Speaker A:Like, I can give you the best hormone regimen, I can give you the best estradiol and progesterone in the world, testosterone, whatever.
Speaker A:If you have underlying insulin resistance, that's not going to just disappear unless it was because of your hormone changes.
Speaker A:But if you have an unhealthy lifestyle, you still need to address that.
Speaker A:If you have gut health issues, I'm going to tell you you're probably going to have more bloating, more digestion issues.
Speaker A:If you're constipated, it's going to be hard for me to monitor your estrogen levels and having control over them the same way.
Speaker A:Because your poop is one way of detoxing hormones.
Speaker A:If you're not pooping regularly and regularly, please.
Speaker A:It means at least once a day.
Speaker A:At least once a day.
Speaker A:It is not normal to poop every two or three days.
Speaker A:That is constipation.
Speaker A:So if someone has poop issues or bloating or gas, that makes it a little bit harder.
Speaker A:Now, part of those things can get addressed through hormones, right?
Speaker A:So say someone didn't have those issues at all and it's only because her hormones went down.
Speaker A:I know that some of the stuff gets better, but we still need to address all the other organ systems and underlying health issues.
Speaker A:The ideal person for hormones is someone who's an active lifestyle, who.
Speaker A:Who tries to maintain a somewhat healthy body weight, who tries to not drink too much alcohol, smoke cigarettes, tries to have a good sleep.
Speaker A:I have night shift workers, nurses or stewardesses or pilots, and I can give them the best hormones because they don't have a regular schedule.
Speaker A:They have a hard time feeling as good on their hormones as someone who has a regular sleep cycle.
Speaker A:That's us.
Speaker B:So the relationship between adrenal function, you also mentioned thyroid function, and then hormones, sex hormones.
Speaker B:What is that?
Speaker B:Interplay looks like.
Speaker B:And because it.
Speaker B:It seems like you test all.
Speaker B:All of that, right?
Speaker B:And they all.
Speaker A:Yeah, I do.
Speaker A:When I find it's necessary.
Speaker A:One of the things that women experience is that they feel very stressed.
Speaker A:And it's often when estrogen goes down, cortisol cries like cortisone goes up and tries to.
Speaker A:To compensate so they have more cortisol and noradrenaline and they feel more stressed and that exhausts their adrenals a lot.
Speaker A:And then if you add to that that they don't get proper sleep because estrogen and progesterone have gone down, that makes it even worse.
Speaker A:That makes them more stressed.
Speaker A:And then the thyroid can impact it.
Speaker A:Too often the thyroid slows down in perimenopause too.
Speaker A:So that needs to be addressed.
Speaker A:And if the thyroid is under functioning, it can also impact the ovulation and the ovarian function.
Speaker A:But also lack of ovulation and lack of ovarian function, it can slow down the other body systems too.
Speaker A:So they're all interplay with each other.
Speaker A:It's important to understand that your doctor, if they're really a good hormone expert, they should understand all of these hormones, not just focus on estrogen or progesterone.
Speaker A:They should Understand how it all plays a role with each other.
Speaker B:So when a woman comes to you and they are debating between hormone replacement therapy or not not doing hormones, I know it's a very personal choice.
Speaker B:How do you support the path that people are going to take and what are the pros and cons of doing either hormone replacement or not doing it?
Speaker A:Okay, I'm definitely biased.
Speaker A:I think when it comes to natural bioidentical hormones, there's no downside to it.
Speaker A:Unless you have an active cancer that is hormone receptor positive, or you had a blood clot in your lungs or your leg and it's not treated with blood thinners, there's not a ton of contraindication to hormones because you make those hormones anyways.
Speaker A:You make these hormones every month, every day of the month.
Speaker A:And when you're pregnant, you make a lot of those hormones.
Speaker A:Your progesterone goes really high, your estradiol goes up to 10,000.
Speaker A:I mean, if those hormones were dangerous, why would nature make them so important for us and so bound to life and creating life?
Speaker A:So I don't see a lot of downside to the natural bioidentical hormones, but I respect everyone's choice saying that I'm not symptomatic.
Speaker A:I don't want to be on hormones.
Speaker A:I think one of the things that's really important and I think the wise and well, lady Kristen and Maria in their book the Menopause Myth, and there's other people talking about this emphasize is that you don't always feel the changes that happen to your body.
Speaker A:You might not have hot flashes, but you don't feel your bone losing density.
Speaker A:You don't feel it until it's too late.
Speaker A:And then you break your bone, right?
Speaker A:Or you don't feel how your cardiovascular system, the little vessels are building plaque until it's so advanced that you get a heart attack at some point or you have coronary artery disease.
Speaker A:I'm not saying every single woman will develop that, but we are seeing significant shifts in health in women before the age of menopause and afterwards.
Speaker A:So to dissociate that and say that's not the hormones that's causing those health changes, I think it's shortsighted.
Speaker A:We know that women have higher risk of depression and anxiety after menopause, higher risk of leaky gut afterwards, their immune system gets weaker because estrogen goes down.
Speaker A:It's an estrogen modulates immune system.
Speaker A:And now suddenly all these autoimmune health issues appear out of nowhere.
Speaker A:Everybody develops Hashimoto's and lupus and Ms.
Speaker A:And all that.
Speaker A:What we also know is brain health is very correlated before and after.
Speaker A:Women's cognitive abilities change significantly with menopause.
Speaker A:How can I say that's not hormone related?
Speaker A:That's the literally the only thing that changed for her.
Speaker A:She's still exercising, she's still eating the same, she's still sleeping.
Speaker A:But the only thing that changed was her hormones.
Speaker A:Of course it's the hormones.
Speaker A:So not everything that changes in someone's body is visible to the woman.
Speaker A:So I'm of the belief that if you want optimal longevity and biohack your body, the most important, important for a woman is her hormones.
Speaker A:First of all, before you do peptides and before you do any supplements that prolongs longevity, focus on your hormones first because these are the most longevity providing tools that you have.
Speaker A:And we're talking about not just looking young on the outside.
Speaker A:We're not even talking about it, we're not going to change that.
Speaker A:But it's the internal organs like your heart and your brain and your bones like longevity in terms of health.
Speaker A:Because you don't want to be 65 and be frail, break your bone, be forgetful, not remember your grandchildren's names, not being able to lift up the grocery bags, not being able to get out of a chair.
Speaker A:You don't want that.
Speaker A:Now you can have all of that without hormones.
Speaker A:But the hormones make it a lot easier, that's for sure.
Speaker A:And they optimize already an optimized lifestyle.
Speaker B:I think what I'd like to reiterate here is for the women that don't have symptoms or they don't think they have symptoms, symptoms, whether they are already postmenopausal and, and they just kind of sail through that journey and they are feeling good because there are women that don't have really those traditional menopausal symptoms.
Speaker B:But your take is that sort of the lowest hanging fruit for optimization is to still do a blood panel and see where your hormones are and, and potentially start within that 10 year range of post menopause or potentially even pre menopause or during the perimenopause group, getting onto some hormone replacement therapy to get into the optimal ranges.
Speaker B:What would you say like ideal ranges are for women?
Speaker A:I want to say one more thing about this 10 year window.
Speaker A:So that's called the window of opportunity.
Speaker A:And we from studies, they say that, that you have the most positive effects of hormones if you start them within that range.
Speaker A:I do however start women even after that if they have passed it, because there's still benefits for them beyond that just it's not as much benefit as if it started early enough.
Speaker A:But again, I wanted to retate that optimal ranges.
Speaker A:This is where I'm different from anybody else that is from NAMS or you know, ACOG or any official societies or the majority of the doctors in this country is I believe optimal levels are the ones that we have when we're still naturally cycling.
Speaker A:And that varies throughout the month.
Speaker A:But in a woman, I think for example, an estradiol level that someone often has when they're on a patch of anywhere between 40 and 80 picogram of estradiol is per ML is not enough.
Speaker A:Right.
Speaker A:Because when you're menstruating at your peak you are anywhere between 350 and 500.
Speaker A:And then your second half you're anywhere between 150 to 350, 350 at the very least.
Speaker A:I want to try to get you up above 100.
Speaker A:And then I like to optimize the hormones more in a cyclical fashion.
Speaker A:So I cycle progesterone and with testosterone I'm not as focused on testosterone as some other people where they raise their testosterone levels above what's a normal range.
Speaker A:I love testosterone for my patients.
Speaker A:I give it to them all the time if they want it or if I think it's required.
Speaker A:But I maintain it in the physiologic ranges, which is up to like 60 nanograms.
Speaker A:And for progesterone there is certain levels that you have when you're menstruating.
Speaker A:It's always hard to get that with replacement.
Speaker A:But you want to maintain healthy cycles and you want to look at progesterone levels to be at least 2 to 3, if not around 10 nanograms.
Speaker B:You mentioned that you cycle progesterone.
Speaker B:Do you still cycle that post menopause and do you think it it's good to have a bleed post menopause?
Speaker A:Yeah.
Speaker A:It's not based on randomized control studies and also not one the official like some of the guidelines are the Menopause society.
Speaker A:But again we have to be sure that we understand the Menopause Society is not the only authority or hormones.
Speaker A:And there are a self appointed group of people and they have experts from different fields and not all of them are are focused on hormone health.
Speaker A:So it's important.
Speaker A:But anyways, there's another official guidelines because what usually women are given are the same doses of hormones throughout every day.
Speaker A:What I do is I cycle it because what we know from the data that when a Woman is still menstruating.
Speaker A:As I explained at the beginning, the interplay between estradiol and progesterone is important because these two have a delicate balance with each other where they affect the tissue in different ways.
Speaker A:So if you do it cyclically, you help renew the tissue and then shut off that tissue and so you continue that cycle.
Speaker A:And there's some data that, for example, in bone health, in women in menopause, cycling progesterone has better outcomes for bone density, as if you were giving her the progesterone every day.
Speaker B:Do you also cycle estrogen?
Speaker B:Meaning do you follow sort of a peak, kind of like the Wiley protocol?
Speaker A:Yeah, with one of the.
Speaker A:One of the whys that I offer to women.
Speaker A:Yes, I do.
Speaker A:I do offer different ways of hormone therapy for whatever the woman wants and what she wants to use if she can afford out of pocket for bioidenticals compounded versus she wants to work with insurance.
Speaker A:But in an ideal way, I love doing estrogen cyclically as well, based on the fact that again, we know when the women are menstruating, they have that amazing interplay between the hormones so that we are trying to re imitate what nature does best.
Speaker A:So we're trying to remediate nature.
Speaker B:So with, with the progesterone, just to make sure I understood you, you are okay with having a bleed post menopause?
Speaker A:Yeah, because I'm using the bleeding as a controlled bleeding that I can actually plan for versus the uncontrolled, unpredicted bleeding that often leads to women having to get a biopsy or ultrasound and getting scared.
Speaker A:And that bleeding allows them to shed the lining and the old cells.
Speaker A:So I like the bleeding, but a lot of women are being told that the best thing about menopause is they don't have to have bleeding.
Speaker A:So they don't look forward to getting that period.
Speaker A:But I think it's a, it's a.
Speaker A:It's a mindset.
Speaker A:If you understand what that bleeding represents, you might be okay with having it again.
Speaker B:For women that don't want to have the bleed, what's your take on just not taking progesterone one day a week or two days a week and cycling it just weekly?
Speaker A:You're not imitating how nature was intending for things.
Speaker A:So the signaling to the stem cells and the apoptosis, the death of the old cells is not going to be the same.
Speaker A:It's just as simple as that.
Speaker A:But women are free to choose whatever works for them.
Speaker A:If someone says, I don't want bleeding.
Speaker A:And I want to do it this way they can.
Speaker A:You still are more at risk for having the unpredicted plant bleeding because the moment you give someone enough estradiol, that is enough to protect her bones and her heart and her brain, that's also going to be enough to stimulate the lining in the uterus, and that's going to lead to bleeding one way or another.
Speaker A:So it's just that she's going to probably get more of a scare out of it when it's unpredicted.
Speaker B:This is a good example where almost everyone has a different take.
Speaker B:I.
Speaker B:I've interviewed a lot of people in this space and everybody seemed to have a different opinion on how progesterone should be cycled, if it's okay or not okay to.
Speaker B:To have the urine.
Speaker B:Urine lining build up.
Speaker B:And so it's very interesting to hear everybody's thoughts.
Speaker B:So as far as testosterone therapy, how do you manage side effects of.
Speaker A:Can I add something?
Speaker B:Yeah, please.
Speaker A:The people say with such authority that there's no data on cyclical progesterone.
Speaker A:There's also no data that we should be giving it every day.
Speaker A:Menopause, that was a very random thing that people came up.
Speaker A:That's not based on any studies.
Speaker A:And I just said there are some studies where people looked at certain organ systems, for example, the bone.
Speaker A:And when progesterone was cyclical, they had better outcomes for bone density than when progesterone was given daily.
Speaker A:So I think we have some reason to believe there might be something to the rhythmic idea, but there's just not randomized control data on it.
Speaker A:But they also don't have the data that it is better to take it daily.
Speaker A:There's no data on that.
Speaker A:It was just an assumption out of air.
Speaker A:The fact that, well, the products that we developed were initially synthetic and the way they had to be given had to be given in a certain way.
Speaker A:But even the synthetic progestin, there is some data with methroxy progesterone that even.
Speaker A:That even that cyclically was better than daily.
Speaker A:So we have data like that.
Speaker A:So when I say better, I meant for bone density again, which is more.
Speaker A:Most of the studies came from.
Speaker A:And some of them from Europe.
Speaker A:But I'm just wanting to make sure if people are here and they have different opinions and they say with such authority as if that was the only voice and it was the truth.
Speaker A:I want women to just listen to their own intuition.
Speaker A:These people don't have any more studies to prove their concept than I do with the cyclicals.
Speaker A:So just making sure that's clear.
Speaker A:Yeah.
Speaker B:I'm curious.
Speaker B:Obviously, I've heard of the Wiley protocol that cycles all three hormones.
Speaker B:When you do your hormone replacement therapy, what do you use?
Speaker B:Pills, patch creams, what's your method of delivery and how do you cycle that?
Speaker A:I don't do the Wiley plan protocol, but it's something in the same type of theory.
Speaker A:We call it physiologic restoration, which improved the W protocol, but in that you can use creams for estrad, and you can use cream for progesterone or oral progesterone.
Speaker B:And you can mimic the natural cycle with both of them.
Speaker A:Yes.
Speaker A:And you can use testosterone cream, and that would be compounded.
Speaker A:If women don't want to use that and they want to use whatever their insurance for something, then they have access to patches, gels, and injections.
Speaker A:And oral.
Speaker A:I don't necessarily use oral because a little bit of a theory.
Speaker A:In studies, in some studies, some risk of potentially inflammation markers going up, like CRP and interleukins, and some risk for blood clotting.
Speaker A:Most of that data is from synthetic, like the primary in the horse urine.
Speaker A:But there is some data with oral ester now, and you were asking me about testosterone.
Speaker A:Where does.
Speaker A:Where does that come in?
Speaker A:I do think testosterone can be great additive to an already excellent hormone therapy.
Speaker A:So if your estrogen is not optimized, don't think by any means that testosterone is more important than estradiol.
Speaker A:It is not.
Speaker A:I'll tell you why a lot of people now are finding their niche by just flattering testosterone.
Speaker A:Because estrogen is what has been associated with breast cancer, and there's a fear.
Speaker A:So by talking about testosterone, they feel like they have some superiority in this conversation, and it's making it easier for them to give women hormones without having to have the breast cancer.
Speaker A:Discussion.
Speaker A:We'll talk about.
Speaker A:Let's talk about it.
Speaker A:First of all, the breast cancer conversation quickly wasn't confirmed in the largest randomized trial where estrogen did not increase breast cancer risk.
Speaker A:It was only the group that had the synthetic progestins on board.
Speaker A:And even that risk was very minimal and in absolute numbers, a very small increase in breast cancer.
Speaker A:Okay, Testosterone very quickly.
Speaker A:I think testosterone can be wonderful if a woman needs a little bit of a kick for energy, for libido.
Speaker A:Just overall can help with muscle building and all of that.
Speaker A:But if your estradiol is not optimized, you're not optimizing your testosterone receptors.
Speaker A:So testosterone, when it comes in as a palette or gel is not even going to work as well.
Speaker A:And the second thing is, if there is not enough estrogen but more testosterone on board, you are going to actually create problems.
Speaker A:You're going to have higher risk of insulin resistance, you're going to have higher risk of visceral adiposity.
Speaker A:There's data on that and some of it is associated from data that we have from transgender studies where women who are born female and then want to transition and are given higher testosterone but their estrogen goes down, they develop high risk of cardiovascular disease and all issues.
Speaker A:I'm the only one that I know that has been looking into that and talking about it.
Speaker A:Now.
Speaker A:I do want it to be known that I'm not comparing a menopausal woman to someone who undergoes gender transition.
Speaker A:But I compare that, for example, to pellets where testosterone is shooting up, like to such high levels that are not natural for a woman.
Speaker B:If you do choose to give somebody testosterone, what is your preferred administration of testosterone?
Speaker A:The most reversible and shorter acting one is the cream.
Speaker A:When you use creams, you activate more dht dihydrotestosterone.
Speaker A:So you can have some local like hair growth or whatever, but if you apply it to an area that doesn't grow hair anyways, it's not that much of a problem.
Speaker A:If you experience issues where the hair growth is in other places of the body, we might have to address that and the way we are giving you the testosterone.
Speaker A:But my preferred way is a cream.
Speaker A:You can do it as an oral, you can do it as an injection, you can do it as a gel.
Speaker A:I always love compounded because the base cream is hypoallergenic.
Speaker A:It doesn't contain alcohol or preservatives, it doesn't contain food dyes.
Speaker A:I love things organic too.
Speaker A:So for the testosterone, I love the cream.
Speaker A:But if someone comes and says, I don't want to use cream, there's some other options for them as well.
Speaker A:Yeah, I just don't like pellets anymore.
Speaker A:I used to be trained in them, but I learned a lot more about them afterwards.
Speaker A:So I don't like them anymore.
Speaker B:Now just going back to estrogen dominance and detoxification and the relationship to gut health.
Speaker B:Can you talk about that a little bit just to kind of wrap up this conversation on hormones?
Speaker B:Do you see that imbalance in women quite often?
Speaker A:So someone is given antibiotics a lot or the gut health is not working and they have inflammation.
Speaker A:If they have candida overgrowth or bacterial overgrowth, what can happen is it can change the gut flora and part of the gut flora that is important for estrogen metabolism, called the estrobolo.
Speaker A:So if that is suppressed with, for example, antibiotics, then she might have difficulty either actually retaining enough estrogen in her body or getting rid of it.
Speaker A:It can go either way and some of that has to be measured.
Speaker A:But the gut flora is extremely important for how your estrogen metabolizes.
Speaker A:If you have diarrhea, you're going to get rid of more estro.
Speaker A:If you have constipation, you retain more estrogen, for example.
Speaker A:It's a little bit simplified, it's more complicated than that.
Speaker A:But if you have inflammation overall in your gut, you're not going to do that well with just overall the hormones that I give you.
Speaker A:Because one of the other thing is progesterone comes and slows down digestion.
Speaker A:So if you have gut dysbiosis, it's going to feel worse on progesterone too.
Speaker A:So just gut health is really important for the hormones.
Speaker B:And just the last topic I wanted to touch on one more time is mental health and hormonal imbalances.
Speaker B:What are the biggest signs of that symptoms that women could have that would kind of red alert for you?
Speaker B:Have some flags go up that, okay, this is a hormonal imbalance.
Speaker A:Anxiety, pms, depression, mood changes, feeling like more angry, easily triggered, less joyful, less connected with life.
Speaker A:Yeah, just a lot of those symptoms that can be related to some imbalance of estrogen, progesterone.
Speaker A:It could be low thyroid.
Speaker A:So there's a lot of, of hormone changes.
Speaker A:I want to reiterate, when you have ADHD or you have a liberal predisposition to being kind of like in the ADHD spectrum, you are going to be very sensitive to the hormonal changes, even more than a regular person, because you have some enzyme deficiencies that make it harder for you to maintain certain neurotransmitters.
Speaker A:If you now, in addition to that are experiencing hormone changes now you're lacking that even more.
Speaker A:So you're going to have worsening of your symptoms.
Speaker A:If you have ADHD and you have lack of concentration, that's me.
Speaker A:Or you procrastinate, it's going to get worse in perimenopause, it could potentially.
Speaker A:I'm not going to say everybody experiences that.
Speaker A:Lack of focus gets worse, mood swings gets worse.
Speaker A:So there are certain people that have a genetic predisposition and environmental changes and trauma that can be so many different things that make them feel a certain way and have certain mood.
Speaker A:And if you're already more prone to mood swings.
Speaker A:It's only going to get worse in perimenopause men.
Speaker A:I have women that say I have been the sweetest person all my life.
Speaker A:Now I'm a bitch, I'm cranky, I'm moody.
Speaker A:So there are people who have never had mood changes and then it gets worse.
Speaker A:So I think any changes in your personality, any worsening can be a sign of hormonal changes.
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