1 00:00:00,720 --> 00:00:03,840 Speaker 1: It is just disgusting how little money is spent on 2 00:00:04,840 --> 00:00:08,600 Speaker 1: us after we're done reproducing. As far as research training. 3 00:00:08,840 --> 00:00:11,039 Speaker 1: You know, we're just kind of small men, and you know, 4 00:00:11,119 --> 00:00:13,560 Speaker 1: here we study this and a bunch of old white guys. 5 00:00:13,720 --> 00:00:14,520 Speaker 2: It'll work for you. 6 00:00:16,920 --> 00:00:21,600 Speaker 3: Welcome to off the cup my personal anti anxiety antidote. 7 00:00:22,400 --> 00:00:26,119 Speaker 3: If you've ever heard the phrase woman of a certain age, 8 00:00:27,400 --> 00:00:29,640 Speaker 3: you know it's rough out in these streets for women 9 00:00:30,000 --> 00:00:33,120 Speaker 3: in their forties and fifties. Perimenopause is no joke, guys. 10 00:00:33,159 --> 00:00:37,240 Speaker 3: It's a huge transition time for women. There are dozens 11 00:00:37,240 --> 00:00:39,159 Speaker 3: of symptoms that come along with it. Half the planet 12 00:00:39,200 --> 00:00:42,120 Speaker 3: will go through it. And yet it's like we hardly 13 00:00:42,120 --> 00:00:44,920 Speaker 3: ever talk about it. And I don't just mean publicly, 14 00:00:45,760 --> 00:00:49,680 Speaker 3: I mean like with our girlfriends, with our doctors. Even 15 00:00:50,720 --> 00:00:54,440 Speaker 3: it's wild, there's still such a shroud over women's health. 16 00:00:54,520 --> 00:00:57,440 Speaker 3: And you know, we talked to Sherry Shepherd and Heather 17 00:00:57,600 --> 00:01:01,000 Speaker 3: Dubrow and some other folks about perimenopause on this podcast. 18 00:01:01,040 --> 00:01:03,080 Speaker 3: I've talked a little bit about it too, because a minute, 19 00:01:03,320 --> 00:01:06,160 Speaker 3: but it just doesn't get the attention it deserves. 20 00:01:06,160 --> 00:01:06,480 Speaker 4: I think. 21 00:01:06,520 --> 00:01:09,000 Speaker 3: So when women reach this stage, it's a really confusing 22 00:01:09,600 --> 00:01:12,800 Speaker 3: and scary time, and I don't know why that needs 23 00:01:12,840 --> 00:01:16,200 Speaker 3: to be the case. As is always the case on 24 00:01:16,240 --> 00:01:18,480 Speaker 3: this pod, we think that when you talk about stuff, 25 00:01:18,480 --> 00:01:21,360 Speaker 3: it makes it easier to talk about stuff. So that's 26 00:01:21,400 --> 00:01:23,240 Speaker 3: why we talk about mental health, and to talk about 27 00:01:23,280 --> 00:01:25,360 Speaker 3: mental health makes it easier to talk about mental health. 28 00:01:25,360 --> 00:01:28,679 Speaker 3: We're gonna do the same today with perimenopause. Doctor Mary 29 00:01:28,720 --> 00:01:31,200 Speaker 3: Claire Haver is a Board certified o bg YN and 30 00:01:31,280 --> 00:01:34,840 Speaker 3: founder of Mary Clare Wellness, which focuses on women's health 31 00:01:34,880 --> 00:01:37,560 Speaker 3: in midlife. She's the New York Times best selling author 32 00:01:37,640 --> 00:01:41,240 Speaker 3: of The New Menopause and The Galveston Diet, and she's 33 00:01:41,240 --> 00:01:44,720 Speaker 3: got a new book coming out, The New Peri Menopause. 34 00:01:45,400 --> 00:01:47,840 Speaker 3: Here to debunk all the misconceptions and tell us some 35 00:01:47,880 --> 00:01:50,320 Speaker 3: of the secrets and advocate for women. 36 00:01:50,520 --> 00:01:52,480 Speaker 4: She's my guest today. Welcome to Off the cop. 37 00:01:52,320 --> 00:01:54,480 Speaker 2: Mary Claire have thanks for having me. 38 00:01:54,760 --> 00:01:55,560 Speaker 4: No, I'm excited. 39 00:01:55,640 --> 00:02:00,240 Speaker 3: I'm I mean, I'm not excited about perri menopause. It's 40 00:02:00,240 --> 00:02:02,840 Speaker 3: not fun, but I'm excited to have you here to 41 00:02:02,880 --> 00:02:05,200 Speaker 3: talk about it because we just need to demystify it 42 00:02:05,240 --> 00:02:09,560 Speaker 3: and make it like normal in a conversation. To be 43 00:02:09,680 --> 00:02:13,840 Speaker 3: talking about this stage of our lives which can last years. 44 00:02:14,160 --> 00:02:16,040 Speaker 2: So in medicine, normal means common. 45 00:02:16,160 --> 00:02:19,600 Speaker 1: It does not mean acceptable, right, it just means this 46 00:02:19,680 --> 00:02:22,080 Speaker 1: happens to a certain percentage of the population. 47 00:02:22,440 --> 00:02:23,200 Speaker 2: I don't know how. 48 00:02:23,080 --> 00:02:25,920 Speaker 1: More normal you can be than one hundred percent of 49 00:02:25,960 --> 00:02:29,480 Speaker 1: women who live long enough going through this transition exactly. 50 00:02:29,639 --> 00:02:32,239 Speaker 1: And so in medical school I got a one hour 51 00:02:32,360 --> 00:02:37,440 Speaker 1: lecture on menopause, nothing on perimenopause. And in residency and 52 00:02:37,440 --> 00:02:41,080 Speaker 1: of statrics and gnecology, we are the experts, right, I 53 00:02:41,120 --> 00:02:45,960 Speaker 1: got six hours total no clinics. Perimenopause was never barely 54 00:02:46,040 --> 00:02:46,840 Speaker 1: mentioned ever. 55 00:02:47,400 --> 00:02:48,200 Speaker 2: That's so crazy. 56 00:02:48,919 --> 00:02:51,680 Speaker 3: Yeah, I mean I can feel that as on this 57 00:02:51,760 --> 00:02:54,240 Speaker 3: side of it, as the patient right on this side 58 00:02:54,240 --> 00:02:56,880 Speaker 3: of it, I can just feel that there's so much 59 00:02:56,919 --> 00:02:57,840 Speaker 3: inattention to it. 60 00:02:57,880 --> 00:02:59,040 Speaker 4: And it's great right now. 61 00:02:58,919 --> 00:03:00,840 Speaker 3: Because we're in a bit of a kind of a 62 00:03:00,880 --> 00:03:05,800 Speaker 3: boomlet around this conversation with people like calle Berry and 63 00:03:06,000 --> 00:03:09,280 Speaker 3: Naomi Watts and some other folks talking about it. It's 64 00:03:09,320 --> 00:03:11,880 Speaker 3: great when like famous people talk about it because. 65 00:03:11,600 --> 00:03:13,400 Speaker 2: It normalizes it, and normally it does. 66 00:03:13,440 --> 00:03:14,200 Speaker 4: It normalizes it. 67 00:03:14,240 --> 00:03:17,760 Speaker 3: And if a beautiful woman like calle Berry, the thinking 68 00:03:17,840 --> 00:03:22,000 Speaker 3: goes can be honest about some of these uncomfortable symptoms 69 00:03:22,160 --> 00:03:26,959 Speaker 3: or you know, the scariness around it. It does break 70 00:03:27,040 --> 00:03:29,360 Speaker 3: down a lot of doors and barriers. But I just 71 00:03:30,720 --> 00:03:32,760 Speaker 3: I'm just so glad you're here because this topic is 72 00:03:32,800 --> 00:03:36,640 Speaker 3: so important and not just for women to hear more about, 73 00:03:36,680 --> 00:03:40,520 Speaker 3: but men too, because the women in your life, whether 74 00:03:40,560 --> 00:03:43,440 Speaker 3: that's your mother, your wife, your sister, your daughter, they're 75 00:03:43,480 --> 00:03:45,480 Speaker 3: all going to go through this, like you said, God 76 00:03:45,520 --> 00:03:47,640 Speaker 3: willing if they live long enough, so better to know 77 00:03:47,680 --> 00:03:48,600 Speaker 3: as much as possible. 78 00:03:48,640 --> 00:03:52,480 Speaker 4: And I'm I just I'm excited to demystify it a 79 00:03:52,480 --> 00:03:52,920 Speaker 4: little bit. 80 00:03:54,480 --> 00:03:56,920 Speaker 3: So so doctor, I'm a woman of a certain age, 81 00:03:56,960 --> 00:03:59,960 Speaker 3: I've been in perimenopause for some time. Does not mess 82 00:04:00,080 --> 00:04:04,840 Speaker 3: surround It comes on slowly, gradually, a symptom here, another there, 83 00:04:05,280 --> 00:04:08,680 Speaker 3: and you don't always immediately put it together that oh, 84 00:04:09,320 --> 00:04:10,400 Speaker 3: this is perimenopause. 85 00:04:10,440 --> 00:04:13,119 Speaker 4: What are sorry? That could based common symptoms. 86 00:04:14,040 --> 00:04:18,719 Speaker 1: So we serve a fourteen hundred women and we're just like, hey, 87 00:04:19,560 --> 00:04:22,200 Speaker 1: tell us about your symptoms that you were having. So 88 00:04:22,400 --> 00:04:24,320 Speaker 1: you have to learn how to ask the right questions 89 00:04:24,320 --> 00:04:28,080 Speaker 1: in science, right, and so when you're perimenopause is defined 90 00:04:28,080 --> 00:04:30,520 Speaker 1: by the presence serapsis of a hot flash or the 91 00:04:30,560 --> 00:04:34,160 Speaker 1: present serabsence of a period. It's a very different discussion 92 00:04:34,320 --> 00:04:37,080 Speaker 1: than me saying, hey, you tell me. 93 00:04:37,320 --> 00:04:38,560 Speaker 2: What you're experiencing. 94 00:04:39,000 --> 00:04:41,280 Speaker 1: Yes, and that is your experience and we're going to 95 00:04:41,320 --> 00:04:44,720 Speaker 1: accept it as that. You have to remember, I graduated 96 00:04:44,720 --> 00:04:46,839 Speaker 1: from the Bitches be Crazy School of Medicine. 97 00:04:47,240 --> 00:04:48,920 Speaker 2: So there was this one. 98 00:04:49,800 --> 00:04:52,960 Speaker 1: There is this underlying you know, women are a little crazy, right, 99 00:04:53,160 --> 00:04:58,520 Speaker 1: Like they tend to somaticize. Women tend to somaticize psychological issues, 100 00:04:58,520 --> 00:05:01,640 Speaker 1: and women have psychological issues. So when you can't figure 101 00:05:01,640 --> 00:05:04,400 Speaker 1: it out, she's you know, it's all on her. 102 00:05:04,360 --> 00:05:07,640 Speaker 4: Head, right, And you hear those thought That. 103 00:05:07,760 --> 00:05:08,880 Speaker 2: Was how I was trained. 104 00:05:08,920 --> 00:05:09,240 Speaker 4: Okay. 105 00:05:09,320 --> 00:05:13,240 Speaker 1: I took that as gospel truth until I got into practice. 106 00:05:13,279 --> 00:05:15,160 Speaker 2: And like the seven. 107 00:05:15,000 --> 00:05:18,560 Speaker 1: Hundredth time, you're like, I know her, I go to 108 00:05:18,640 --> 00:05:20,880 Speaker 1: church with her, we go to dinner, we run marathon. 109 00:05:21,000 --> 00:05:21,840 Speaker 2: She's not crazy. 110 00:05:22,040 --> 00:05:23,159 Speaker 4: Yeah, Like this is real. 111 00:05:23,839 --> 00:05:26,720 Speaker 1: So it took me stepping out of the exam room 112 00:05:27,000 --> 00:05:29,200 Speaker 1: and like going to the internet to say, hey, is 113 00:05:29,240 --> 00:05:30,720 Speaker 1: this anybody else's experience? 114 00:05:30,760 --> 00:05:31,880 Speaker 2: And then the world exploded. 115 00:05:32,600 --> 00:05:35,039 Speaker 1: So I totally blamed the internet, good and bad for 116 00:05:35,920 --> 00:05:37,720 Speaker 1: menopause conversation. 117 00:05:38,080 --> 00:05:41,520 Speaker 3: Yeah, so talk about some of the most common symptoms though. 118 00:05:41,440 --> 00:05:44,800 Speaker 1: Okay, so symptoms, symptoms, So yeah, I digress. So when 119 00:05:44,880 --> 00:05:49,760 Speaker 1: we survey, okay, weight gain and redistribution, these are like 120 00:05:49,800 --> 00:05:53,200 Speaker 1: in the eighty ninety percent of women experiencing this, anxiety, depression, 121 00:05:53,200 --> 00:05:58,719 Speaker 1: and panic attacks. Okay, reach, sleep disturbances one of the 122 00:05:58,760 --> 00:06:06,240 Speaker 1: top fatigue YEP, YEP, sexual dysfunction and vaginal changes, gastroomtestinal problems, 123 00:06:06,600 --> 00:06:12,240 Speaker 1: brain fog, migrains, dizziness, memory problems, joint pain, muscle aches, osteopenia, osteoporosis, 124 00:06:12,520 --> 00:06:16,240 Speaker 1: heart palpitations, a regular heartbeat, vertigo, tenatus like ringing in 125 00:06:16,279 --> 00:06:19,400 Speaker 1: the ears, dry skin, dry eyes, dry mouth, drive vagina, 126 00:06:19,480 --> 00:06:22,080 Speaker 1: dry everything, itchy. 127 00:06:21,760 --> 00:06:23,040 Speaker 2: Skin, itchy ears. 128 00:06:23,600 --> 00:06:27,719 Speaker 1: So these are it is a multi organ system effect. 129 00:06:28,000 --> 00:06:30,359 Speaker 1: And so most of those are above the fiftieth. You know, 130 00:06:30,440 --> 00:06:33,160 Speaker 1: more than fifty percent of patients were complaining. 131 00:06:32,839 --> 00:06:37,960 Speaker 2: Of these things. So I noticed no one said. 132 00:06:38,000 --> 00:06:40,640 Speaker 4: Periods, right, or hot flashes. 133 00:06:41,000 --> 00:06:44,040 Speaker 2: The hot flashes were in there. Yeah, I didn't say, yeah, yeah, 134 00:06:44,120 --> 00:06:46,280 Speaker 2: hot flashes are real. Eighty five percent of us will 135 00:06:46,320 --> 00:06:46,640 Speaker 2: have no. 136 00:06:46,640 --> 00:06:47,919 Speaker 4: They're real, but I feel like they are. 137 00:06:48,160 --> 00:06:51,760 Speaker 1: They come later, they're really at the end of perimenopaus. 138 00:06:51,839 --> 00:06:52,039 Speaker 4: Yeah. 139 00:06:52,200 --> 00:06:55,120 Speaker 1: So the first symptoms, the first thing that the experience 140 00:06:55,560 --> 00:06:58,920 Speaker 1: is brain sleep disruption, mental health change is brain fog 141 00:06:59,320 --> 00:07:02,640 Speaker 1: almost category or And there's a beautiful paper that came 142 00:07:02,640 --> 00:07:04,040 Speaker 1: out last year we talked about in the book. 143 00:07:04,320 --> 00:07:05,320 Speaker 2: I just don't feel. 144 00:07:05,080 --> 00:07:06,520 Speaker 4: Like myself right. 145 00:07:06,600 --> 00:07:09,320 Speaker 1: I don't know what's wrong. Something's not right. I'm not 146 00:07:09,440 --> 00:07:12,200 Speaker 1: clicking the life. I built, this beautiful life I built, 147 00:07:12,200 --> 00:07:12,760 Speaker 1: and I had. 148 00:07:12,640 --> 00:07:15,520 Speaker 2: It, managed the ups and downs, the you know, I 149 00:07:15,640 --> 00:07:18,080 Speaker 2: had it. I had it. I built this so I 150 00:07:18,120 --> 00:07:21,720 Speaker 2: could do this. I can't do it. I've lost my resilience. 151 00:07:22,520 --> 00:07:24,000 Speaker 4: How do you distinguish though? 152 00:07:24,320 --> 00:07:27,760 Speaker 3: So I had a nervous breakdown at forty two, and 153 00:07:27,840 --> 00:07:31,600 Speaker 3: it was for a lot of reasons. Primarily I had 154 00:07:31,840 --> 00:07:34,360 Speaker 3: not been paying attention to an anxiety disorder I had 155 00:07:34,440 --> 00:07:37,600 Speaker 3: and had had for years and years, and it was 156 00:07:37,640 --> 00:07:39,040 Speaker 3: just a perfect storm of things. 157 00:07:39,560 --> 00:07:41,520 Speaker 4: But how do you distinguish between. 158 00:07:43,280 --> 00:07:49,600 Speaker 3: The onset of perimenopause and maybe needing some mental health help, 159 00:07:50,040 --> 00:07:52,440 Speaker 3: which could all be related, but they could also not 160 00:07:52,480 --> 00:07:53,000 Speaker 3: be related. 161 00:07:53,080 --> 00:07:56,480 Speaker 1: Well, we can't untangle those, right, because the changes in 162 00:07:56,520 --> 00:08:02,800 Speaker 1: your hormones are changing your reability to make neurotransmitters, the 163 00:08:02,880 --> 00:08:05,679 Speaker 1: chemical signals that bounce from neuron to neuron in the brain. 164 00:08:06,200 --> 00:08:09,840 Speaker 1: So you know, if you have a patient who's never 165 00:08:09,840 --> 00:08:12,280 Speaker 1: hate anxiety in her life, then all of a sudden 166 00:08:12,320 --> 00:08:16,160 Speaker 1: in her forties is struggling with a nuancet anxiety or 167 00:08:16,240 --> 00:08:20,080 Speaker 1: depression or combination of the two. The first thought in 168 00:08:20,120 --> 00:08:22,920 Speaker 1: your head is, this is menopause, okay, And she says, 169 00:08:23,200 --> 00:08:26,240 Speaker 1: nothing in my life has changed, right, wow, because there's 170 00:08:26,280 --> 00:08:28,840 Speaker 1: no new environmental factor. There's no not a death in 171 00:08:28,880 --> 00:08:31,120 Speaker 1: the family or or you know, lost your job, whatever 172 00:08:31,240 --> 00:08:32,560 Speaker 1: you know, would make us anxious. 173 00:08:32,679 --> 00:08:36,319 Speaker 2: Right So if she can look at you. 174 00:08:36,280 --> 00:08:38,320 Speaker 1: And say, I've been through these stressors before and it 175 00:08:38,400 --> 00:08:40,959 Speaker 1: never caused this, that's my first thought is menopause. It 176 00:08:41,000 --> 00:08:43,240 Speaker 1: doesn't mean she's not going to need an ssri or 177 00:08:43,480 --> 00:08:47,000 Speaker 1: antidepressant or you know whatever medication, but you need to 178 00:08:47,040 --> 00:08:50,480 Speaker 1: recognize that there's a hormonal component here and giving her 179 00:08:50,679 --> 00:08:54,960 Speaker 1: menopause hormone therapy doses actually makes the mental health better 180 00:08:55,040 --> 00:08:55,679 Speaker 1: in these women. 181 00:08:57,400 --> 00:08:58,719 Speaker 4: So would your advice be. 182 00:09:00,480 --> 00:09:04,000 Speaker 3: Erb but also also maybe see a mental health professional 183 00:09:04,080 --> 00:09:04,679 Speaker 3: at the same. 184 00:09:04,520 --> 00:09:07,800 Speaker 1: Time, Yes, I wish though you know mental health professional 185 00:09:08,000 --> 00:09:10,679 Speaker 1: for sure, they are actually seen to be getting up 186 00:09:10,679 --> 00:09:12,920 Speaker 1: to speed on how hormones are affecting this more than 187 00:09:13,000 --> 00:09:17,120 Speaker 1: obiquan Okay, Remember the American College of Obgen has not 188 00:09:17,240 --> 00:09:20,600 Speaker 1: updated their menopause guideline since twenty fourteen. Okay, they have 189 00:09:20,679 --> 00:09:24,160 Speaker 1: not accepted the Menopause Society guidelines, and most OB's are 190 00:09:24,160 --> 00:09:25,680 Speaker 1: not a member of the Menopause Society. 191 00:09:25,760 --> 00:09:27,680 Speaker 2: You have to go outside of your training. 192 00:09:27,920 --> 00:09:31,280 Speaker 1: So your fabulous obigen I was one, right, who delivers 193 00:09:31,280 --> 00:09:33,280 Speaker 1: your babies and digital birth control and you know, held 194 00:09:33,320 --> 00:09:36,280 Speaker 1: your hand at digital palasmears and got your mammograms, probably 195 00:09:36,400 --> 00:09:40,760 Speaker 1: received buckness from menopause training. Okay, they if they haven't 196 00:09:40,800 --> 00:09:42,160 Speaker 1: had the time or the inclination. 197 00:09:42,280 --> 00:09:42,800 Speaker 2: It's hard. 198 00:09:42,840 --> 00:09:45,160 Speaker 1: It is hard to step outside of your busy life 199 00:09:45,760 --> 00:09:46,559 Speaker 1: to go get this. 200 00:09:46,600 --> 00:09:48,880 Speaker 4: Extra train up right. Yeah, yeah so. 201 00:09:49,120 --> 00:09:50,400 Speaker 2: And God bless them when they do. 202 00:09:50,520 --> 00:09:53,560 Speaker 1: But you can't just go to your ob or your interness, 203 00:09:53,600 --> 00:09:56,599 Speaker 1: your family medicine doctor and expect they're going to know 204 00:09:56,640 --> 00:09:56,959 Speaker 1: what to. 205 00:09:56,920 --> 00:09:58,760 Speaker 2: Do or understand the correlation. 206 00:09:58,960 --> 00:10:02,160 Speaker 3: Well, and why why did I expect? Why did I think? Okay, 207 00:10:03,120 --> 00:10:08,360 Speaker 3: when I reach a certain age, my wonderful obie will 208 00:10:08,480 --> 00:10:12,320 Speaker 3: ask about are you having any of these symptoms? And 209 00:10:12,360 --> 00:10:14,600 Speaker 3: they weren't trained, didn't and I've had several of them. 210 00:10:14,800 --> 00:10:15,800 Speaker 3: None of them asked. 211 00:10:16,040 --> 00:10:18,400 Speaker 1: They weren't trained. This is not a part of training. 212 00:10:18,400 --> 00:10:20,840 Speaker 1: We didn't have menopause clinics. Look, I was a residency 213 00:10:20,880 --> 00:10:23,599 Speaker 1: program director. Not only did I complete my residence and 214 00:10:23,640 --> 00:10:26,000 Speaker 1: get board certified, I went back and taught and then 215 00:10:26,040 --> 00:10:28,880 Speaker 1: I was in charge of the curriculum for coming from 216 00:10:28,960 --> 00:10:31,439 Speaker 1: a American Board of OBGEN. What do we need to 217 00:10:31,480 --> 00:10:34,480 Speaker 1: teach the residence. Menopause was included as a topic, but 218 00:10:34,520 --> 00:10:36,880 Speaker 1: it was not like we had a clinic. We spent 219 00:10:36,960 --> 00:10:39,360 Speaker 1: a lot of time. It was just kind of glossed over. Yeah, 220 00:10:39,360 --> 00:10:40,599 Speaker 1: her prayer is going to stop, she may have some 221 00:10:40,640 --> 00:10:44,319 Speaker 1: hot flashes. Avoid HRT because it might be dangerous, you know, right, 222 00:10:44,600 --> 00:10:46,280 Speaker 1: that was it. Her bones are going to get weaker, 223 00:10:46,720 --> 00:10:48,920 Speaker 1: you know, but nothing nothing about mental health. 224 00:10:48,960 --> 00:10:51,839 Speaker 2: Sleep, well, sleep was coming into it a little bit. 225 00:10:51,920 --> 00:10:54,720 Speaker 2: But you know, like this has been going on since 226 00:10:54,760 --> 00:10:56,480 Speaker 2: we've been a species. 227 00:10:56,720 --> 00:10:59,319 Speaker 1: Yeah, and you know, women did make it to menopause, 228 00:10:59,360 --> 00:11:03,640 Speaker 1: not many, but you know, this is just how medicine 229 00:11:03,720 --> 00:11:07,800 Speaker 1: was built, prioritizing men males, studying males, you know, outside 230 00:11:07,800 --> 00:11:12,000 Speaker 1: of our reproduction. It is just disgusting how little money 231 00:11:12,040 --> 00:11:15,679 Speaker 1: is spent on us after we're done reproducing. As far 232 00:11:15,720 --> 00:11:19,160 Speaker 1: as research, training, you know, we're just kind of small men, 233 00:11:19,280 --> 00:11:21,360 Speaker 1: and you know, here we study this and a. 234 00:11:21,280 --> 00:11:22,400 Speaker 2: Bunch of old white guys. 235 00:11:22,559 --> 00:11:25,360 Speaker 1: It'll work for you, and sometimes it does, but you know, 236 00:11:25,480 --> 00:11:26,440 Speaker 1: not for heart disease. 237 00:11:27,520 --> 00:11:28,680 Speaker 4: Right. Yeah. 238 00:11:28,720 --> 00:11:31,800 Speaker 3: Well, and I also think, as we're both saying, it's 239 00:11:31,840 --> 00:11:33,880 Speaker 3: really important to talk to your doctor. I had a 240 00:11:33,920 --> 00:11:38,600 Speaker 3: particularly kind of a painful and scary symptom early on, 241 00:11:38,880 --> 00:11:42,000 Speaker 3: and I heard a colleague of mine, another woman, talking 242 00:11:42,040 --> 00:11:44,560 Speaker 3: about that same thing on television, and she was talking 243 00:11:44,600 --> 00:11:46,160 Speaker 3: about it in a kind of funny way, and she 244 00:11:46,240 --> 00:11:50,880 Speaker 3: attributed it to perimenopause. So I just attributed mine to menopause. 245 00:11:51,000 --> 00:11:54,440 Speaker 3: Turns out, after a couple of years of living with 246 00:11:54,520 --> 00:11:57,680 Speaker 3: this sort of painful symptom, I went to my doctor 247 00:11:58,120 --> 00:12:00,000 Speaker 3: and I told her what was going She said, actually, 248 00:12:00,120 --> 00:12:02,839 Speaker 3: it had nothing to do with perimenopause. It was an 249 00:12:03,000 --> 00:12:07,000 Speaker 3: entirely different thing that we're treating. Now I'm getting help 250 00:12:07,080 --> 00:12:08,800 Speaker 3: for it. But I think, for whatever reason, we're just 251 00:12:08,840 --> 00:12:12,240 Speaker 3: afraid to bring some of this stuff up to our doctors. 252 00:12:12,280 --> 00:12:15,280 Speaker 3: And we listen to our friends. That's fine, that's good, 253 00:12:15,640 --> 00:12:18,360 Speaker 3: But I don't think we should be listening to our 254 00:12:18,400 --> 00:12:21,040 Speaker 3: friends like we do on the phone. 255 00:12:21,760 --> 00:12:22,280 Speaker 4: Oh I have this. 256 00:12:22,360 --> 00:12:24,920 Speaker 3: Are you going through this, it's definitely perimenopause. No, you've 257 00:12:24,920 --> 00:12:27,520 Speaker 3: got to go to your doctor period, right, right. 258 00:12:27,320 --> 00:12:29,720 Speaker 1: So, when like a patient comes to me with her 259 00:12:29,800 --> 00:12:32,440 Speaker 1: laundry list of what's going on in her life, we 260 00:12:32,480 --> 00:12:35,240 Speaker 1: don't just automatically say it's perimenopause. 261 00:12:34,600 --> 00:12:35,320 Speaker 4: Right right right. 262 00:12:35,440 --> 00:12:38,280 Speaker 1: We do a ton of blood work. I am looking 263 00:12:38,320 --> 00:12:41,360 Speaker 1: at nutrition markers, inflammation markers. I'm looking at you know, 264 00:12:41,400 --> 00:12:44,240 Speaker 1: her blood count, her full anemia panelor her full thyroid 265 00:12:44,280 --> 00:12:46,640 Speaker 1: pane or autoimmune thyroid idis. Because so much of what 266 00:12:46,679 --> 00:12:49,720 Speaker 1: we're going through can mimic other things. We do mental 267 00:12:49,720 --> 00:12:52,719 Speaker 1: health screening, we do sexual desire screening, you know, we 268 00:12:53,280 --> 00:12:57,960 Speaker 1: cover all the bases and so and then we're like, listen, okay, 269 00:12:58,160 --> 00:13:00,120 Speaker 1: looks like you're in perimenopause. We're going to go ahead 270 00:13:00,280 --> 00:13:03,640 Speaker 1: entreat your you know, try to stabilize these hormones through 271 00:13:03,640 --> 00:13:08,120 Speaker 1: this transition. But what's not getting better we have to 272 00:13:08,160 --> 00:13:11,080 Speaker 1: address separately. Yea, So if your mental health is not 273 00:13:11,080 --> 00:13:13,320 Speaker 1: getting better or is not fully controlled, you know, but 274 00:13:13,800 --> 00:13:16,080 Speaker 1: hearing you say that you allowed yourself to suffer for 275 00:13:16,120 --> 00:13:19,319 Speaker 1: a couple of years, it breaks my heart. Yes, we 276 00:13:19,360 --> 00:13:23,280 Speaker 1: should never suffer. We should not suffer things that are fixable. 277 00:13:24,080 --> 00:13:27,560 Speaker 3: Well, I agree, but it's yeah, again, this is part 278 00:13:27,600 --> 00:13:30,800 Speaker 3: of the problem. It isn't talked about enough. So when 279 00:13:30,840 --> 00:13:34,160 Speaker 3: something weird happens, you're like, well, you know, I don't know, 280 00:13:34,200 --> 00:13:36,760 Speaker 3: it's a little too scary maybe, And I didn't associate 281 00:13:36,800 --> 00:13:39,800 Speaker 3: it with perimenopause. My friend did, and I thought, Okay, 282 00:13:40,240 --> 00:13:45,280 Speaker 3: I guess that's just part of being this age. And 283 00:13:45,360 --> 00:13:47,079 Speaker 3: I never thought to like, well, why didn't I ask 284 00:13:47,160 --> 00:13:49,760 Speaker 3: my doctor maybe there is something I can do about this, 285 00:13:50,200 --> 00:13:52,400 Speaker 3: And turns out there was because it was not related 286 00:13:52,600 --> 00:13:56,320 Speaker 3: to perimenopause at all. But that was my fault for 287 00:13:56,640 --> 00:13:59,400 Speaker 3: just living with it and not really wanting to have 288 00:13:59,440 --> 00:14:00,000 Speaker 3: that conversation. 289 00:14:00,640 --> 00:14:02,280 Speaker 2: You don't have to live with it. 290 00:14:02,280 --> 00:14:04,800 Speaker 1: If it's disrupting your life and you're not living your 291 00:14:04,800 --> 00:14:08,600 Speaker 1: best life, then you deserve someone to look into this 292 00:14:08,960 --> 00:14:09,840 Speaker 1: and get some help. 293 00:14:20,640 --> 00:14:22,960 Speaker 4: Talk about the pattern of misdiagnosing. 294 00:14:23,360 --> 00:14:27,400 Speaker 1: Oh god, well, you know, perimenopause was never allowed to 295 00:14:27,440 --> 00:14:32,360 Speaker 1: be a diagnosis for anything, and so we have this, 296 00:14:33,200 --> 00:14:35,040 Speaker 1: you know a lot of so when I talk to 297 00:14:35,120 --> 00:14:38,040 Speaker 1: my orthopedic surgery, who are menopause? 298 00:14:38,200 --> 00:14:38,400 Speaker 2: You know? 299 00:14:38,440 --> 00:14:42,840 Speaker 1: In the menopause world. Vonda Wright J justin Witstein. They 300 00:14:42,880 --> 00:14:47,240 Speaker 1: think a lot of fibromyalgia is actually muscular skeletal syndrome 301 00:14:47,320 --> 00:14:50,440 Speaker 1: of menopause. They think a lot of you know things, 302 00:14:50,840 --> 00:14:54,960 Speaker 1: estrogen dominance is really a misnomer for this is perimenopause. 303 00:14:55,160 --> 00:14:57,360 Speaker 1: You know, this isn't the ovaries doing something on their own. 304 00:14:57,360 --> 00:14:59,840 Speaker 1: The ovaries are just little waiting for instructions from the 305 00:15:00,640 --> 00:15:02,600 Speaker 1: and so all of this is coming from the brain. 306 00:15:03,240 --> 00:15:04,840 Speaker 2: So we are. 307 00:15:04,680 --> 00:15:08,320 Speaker 1: Seeing a lot of things that are mischaracterized or not 308 00:15:08,440 --> 00:15:13,040 Speaker 1: recognizing the hormonal component. Anxiety is anxiety, Depression is depression, right, 309 00:15:13,360 --> 00:15:16,120 Speaker 1: but not recognizing that there could be a hormonal component 310 00:15:16,200 --> 00:15:19,120 Speaker 1: to this, you are hamstringing her for her treatment options. 311 00:15:19,480 --> 00:15:26,800 Speaker 3: Yeah, yeah, And wasn't the hormone replacement treatment. Wasn't that 312 00:15:26,880 --> 00:15:31,320 Speaker 3: sort of isn't the science on that reversing right now? 313 00:15:31,600 --> 00:15:34,480 Speaker 1: So yeah, So it was like a you know, it 314 00:15:34,520 --> 00:15:37,280 Speaker 1: was something that went viral before there was viral, right. 315 00:15:37,720 --> 00:15:41,560 Speaker 1: So in two thousand and two, early study findings were 316 00:15:41,600 --> 00:15:44,480 Speaker 1: released from the Women's Health Initiative and the headlines were 317 00:15:44,480 --> 00:15:45,080 Speaker 1: crazy and. 318 00:15:45,040 --> 00:15:47,840 Speaker 2: Said estrogen causes breast cancer and like that was a 319 00:15:47,880 --> 00:15:49,120 Speaker 2: shot heard around the world. 320 00:15:49,480 --> 00:15:52,360 Speaker 1: People freaked, They threw their estrogen in the trash. 321 00:15:52,760 --> 00:15:54,200 Speaker 2: Doctors were scared to prescribe it. 322 00:15:54,240 --> 00:15:57,240 Speaker 1: They didn't want to get sued, and it turns out 323 00:15:57,280 --> 00:15:58,119 Speaker 1: that data. 324 00:15:57,960 --> 00:15:59,320 Speaker 2: Was never even proven. 325 00:15:59,560 --> 00:16:02,600 Speaker 1: You know, estrogen actually is protective on its own against 326 00:16:02,600 --> 00:16:03,200 Speaker 1: breast cancer. 327 00:16:03,240 --> 00:16:06,640 Speaker 2: It was the progesting component. But literally it took like 328 00:16:07,600 --> 00:16:08,160 Speaker 2: all of the. 329 00:16:08,120 --> 00:16:10,640 Speaker 1: Money, any money, which was not much, was going into 330 00:16:10,640 --> 00:16:15,160 Speaker 1: alternatives to estrogen therapy right and buried in academic journals 331 00:16:15,680 --> 00:16:18,280 Speaker 1: is all of the rebuttals, all of the re analysis, 332 00:16:18,360 --> 00:16:20,240 Speaker 1: all of the stuff that came out improved, but no 333 00:16:20,240 --> 00:16:22,560 Speaker 1: one would pay attention. The drug companies were making tons 334 00:16:22,560 --> 00:16:26,840 Speaker 1: of money on estrogen alternatives, all these fancy osteoporosis medications, 335 00:16:26,880 --> 00:16:30,880 Speaker 1: all these you know, the sale of ambient. 336 00:16:30,600 --> 00:16:31,960 Speaker 2: For sleep triple. 337 00:16:32,560 --> 00:16:36,040 Speaker 1: We doubled the prescription amount of antidepressants like when we 338 00:16:36,040 --> 00:16:37,800 Speaker 1: took estrogen away, and. 339 00:16:37,720 --> 00:16:41,040 Speaker 2: So wow, you're like, oh my god. 340 00:16:41,080 --> 00:16:43,080 Speaker 1: When you look at the drug patterns and everything with 341 00:16:43,200 --> 00:16:46,680 Speaker 1: there was no economic incentive to like share this knowledge 342 00:16:46,720 --> 00:16:50,160 Speaker 1: with the world, you know, because everybody's making money doing 343 00:16:50,200 --> 00:16:51,600 Speaker 1: alternatives to things. 344 00:16:52,000 --> 00:16:55,600 Speaker 2: I mean, oral extra dial is two dollars. No one 345 00:16:55,600 --> 00:16:57,600 Speaker 2: makes money on it. You know, it's the cheapest. It's 346 00:16:57,640 --> 00:16:58,280 Speaker 2: like dirt. 347 00:16:58,280 --> 00:17:01,160 Speaker 3: It's like asprin and meanwhile, women, we're being denied something 348 00:17:01,160 --> 00:17:03,720 Speaker 3: that was really that could have really helped them. 349 00:17:03,920 --> 00:17:05,680 Speaker 2: Yeah, yeah, could have really helped them. 350 00:17:05,720 --> 00:17:09,080 Speaker 1: So now the boomers are pissed because they kind of 351 00:17:09,119 --> 00:17:12,480 Speaker 1: missed that sweet spot of opportunity for cardiovascular disease protection. 352 00:17:13,040 --> 00:17:15,480 Speaker 1: Gen xers aren't putting up with us, and who comes 353 00:17:15,520 --> 00:17:16,400 Speaker 1: behind this millennial? 354 00:17:16,440 --> 00:17:18,640 Speaker 2: I can't keep up my kids. 355 00:17:18,920 --> 00:17:21,359 Speaker 1: Yeah, the millennials are like, I fucking live with this, 356 00:17:21,560 --> 00:17:25,080 Speaker 1: like no care to say, give me all the all 357 00:17:25,119 --> 00:17:28,560 Speaker 1: the options, all the things. So what I love about 358 00:17:28,560 --> 00:17:31,399 Speaker 1: my clinic is that we put out the fires, we 359 00:17:31,440 --> 00:17:34,119 Speaker 1: get the symptoms under control. We give her her life back, 360 00:17:34,600 --> 00:17:38,600 Speaker 1: right through whatever combination of lifestyle and pharmacology and supplements 361 00:17:38,680 --> 00:17:38,960 Speaker 1: or whatever. 362 00:17:39,040 --> 00:17:41,760 Speaker 2: Okay, we give her her ability to like that life 363 00:17:41,800 --> 00:17:42,160 Speaker 2: she built. 364 00:17:42,200 --> 00:17:45,080 Speaker 1: She can manage it again. Then we start building a 365 00:17:45,160 --> 00:17:48,720 Speaker 1: roadmap for the next thirty years. Right, how did your 366 00:17:48,760 --> 00:17:51,400 Speaker 1: mom suffer and die? How did your grandmother suffer die? 367 00:17:51,400 --> 00:17:53,239 Speaker 1: What are your aunts doing? How are they aging? Are 368 00:17:53,240 --> 00:17:56,920 Speaker 1: they independent? Are they happy? Are they or are they 369 00:17:56,920 --> 00:17:58,840 Speaker 1: in nursing homes requiring long term care? 370 00:17:58,960 --> 00:18:01,760 Speaker 2: Lost their independence? Do it frail to your dementia? Your 371 00:18:01,800 --> 00:18:04,240 Speaker 2: heart disease, like like, how are. 372 00:18:04,160 --> 00:18:06,639 Speaker 1: The people aging in your family? And we start looking 373 00:18:06,680 --> 00:18:09,120 Speaker 1: at what we can do to decrease those. 374 00:18:09,000 --> 00:18:10,879 Speaker 2: Risks for her. And that's the most exciting part of 375 00:18:10,920 --> 00:18:13,360 Speaker 2: my job is that I get to help. 376 00:18:13,400 --> 00:18:16,280 Speaker 1: You know, this is like a roadmap to get you started, 377 00:18:16,280 --> 00:18:19,639 Speaker 1: because if you do the lifestyle stuff now, you're going 378 00:18:19,720 --> 00:18:20,920 Speaker 1: to be so much better off. 379 00:18:20,960 --> 00:18:23,919 Speaker 2: You're building your eight year old body right now. Yeah, 380 00:18:23,920 --> 00:18:24,400 Speaker 2: and brain. 381 00:18:25,440 --> 00:18:32,280 Speaker 3: That's interesting because I've always wondered if the way perimenopause 382 00:18:32,280 --> 00:18:35,600 Speaker 3: and menopause will affect you is closely related to the 383 00:18:35,600 --> 00:18:39,320 Speaker 3: way it affected your mom and aigh grandmother. And when 384 00:18:39,359 --> 00:18:44,560 Speaker 3: I was pregnant and my like pregnancy journey, it matched 385 00:18:44,640 --> 00:18:48,320 Speaker 3: my mom's almost to a te like all of my 386 00:18:48,480 --> 00:18:52,159 Speaker 3: reproductive stuff, like how I was gonna end up conceiving 387 00:18:53,280 --> 00:18:55,800 Speaker 3: all those things, really, whether I was able to breastfeed, 388 00:18:55,840 --> 00:18:58,359 Speaker 3: whether I was you know, it really matched up with 389 00:18:58,400 --> 00:19:04,840 Speaker 3: my mom's experience. How related is it genetically? Menopause and perimenopause. 390 00:19:04,080 --> 00:19:07,719 Speaker 1: About fifty percent, so you know, especially age of menopause, 391 00:19:07,840 --> 00:19:10,000 Speaker 1: we see a big correlation. If your mom went through 392 00:19:10,040 --> 00:19:12,760 Speaker 1: really young, you most likely will go through on the 393 00:19:12,840 --> 00:19:15,280 Speaker 1: younger end. I'm always asking that in the history, how 394 00:19:15,320 --> 00:19:19,520 Speaker 1: old was your mom? She doesn't know, Okay, so yes, 395 00:19:19,720 --> 00:19:22,480 Speaker 1: And there's definitely things we can do to like speed 396 00:19:22,560 --> 00:19:27,480 Speaker 1: up menopause, like smoke, have surgery, abdominal surgery, any any 397 00:19:27,560 --> 00:19:29,640 Speaker 1: kind of ovarian surgery, stress trauma. 398 00:19:30,240 --> 00:19:33,200 Speaker 2: You know, women who have who were sexually abused, whose. 399 00:19:33,119 --> 00:19:36,199 Speaker 1: Kids then were sexually abused, go through menopause like eight 400 00:19:36,240 --> 00:19:41,480 Speaker 1: years sooner versus their counterparts. Also, like your postpartum experience, 401 00:19:41,640 --> 00:19:44,280 Speaker 1: that's a time of low estrogen. So if you had 402 00:19:44,359 --> 00:19:48,240 Speaker 1: horrible postpartum depression or anxiety, or like I had intrusive 403 00:19:48,280 --> 00:19:51,280 Speaker 1: thoughts a little bit, I could manage them, but like 404 00:19:51,760 --> 00:19:54,440 Speaker 1: I would see my daughter drowning, like I couldn't stop. 405 00:19:54,760 --> 00:19:57,040 Speaker 2: Yeah, so and thank god it But I knew. 406 00:19:56,840 --> 00:19:59,000 Speaker 1: What was happening because I was educated. But you know, 407 00:19:59,760 --> 00:20:02,600 Speaker 1: so so that kind of should have told me that 408 00:20:02,760 --> 00:20:06,840 Speaker 1: my perimenopause and menopause I would have some mental health issues. 409 00:20:07,359 --> 00:20:10,000 Speaker 2: I was so ragy. 410 00:20:10,160 --> 00:20:12,879 Speaker 1: I think about my kids were young, young, like middle 411 00:20:12,880 --> 00:20:15,919 Speaker 1: school teenagery, and I just think of me flying off 412 00:20:15,960 --> 00:20:18,200 Speaker 1: the handle at the littlest thing and yelling at them. 413 00:20:18,240 --> 00:20:19,960 Speaker 2: And again, my life was very stressful. 414 00:20:19,960 --> 00:20:21,880 Speaker 1: My husband was working overseas, Like, yeah, I had all 415 00:20:21,880 --> 00:20:25,960 Speaker 1: the life stuff too, but like I look back at her, 416 00:20:26,040 --> 00:20:27,560 Speaker 1: at Mary Claire at thirty five and. 417 00:20:27,440 --> 00:20:32,399 Speaker 2: Forty, and I'm like, who is she? How do my 418 00:20:32,480 --> 00:20:34,440 Speaker 2: kids survive? That? You know intact? 419 00:20:35,119 --> 00:20:40,320 Speaker 1: So damn I needed you know, no wonder they sedated 420 00:20:40,320 --> 00:20:44,760 Speaker 1: my mother in perimenopause. You know, they gave her something beautisoul, which. 421 00:20:44,600 --> 00:20:46,760 Speaker 2: Is a derivative of penal fucking barbital. 422 00:20:47,240 --> 00:20:50,160 Speaker 1: You know, that was that was beautasol was like given 423 00:20:50,200 --> 00:20:53,480 Speaker 1: to like get your wife back, and it's a woman 424 00:20:53,600 --> 00:20:56,600 Speaker 1: like cooking, She'll cook breakfast again. In the fifties and 425 00:20:56,600 --> 00:21:01,440 Speaker 1: the sixties and seventies, yeaheah, Oh. 426 00:21:01,440 --> 00:21:04,119 Speaker 3: You mentioned this earlier brain fog and stuff. Talk about 427 00:21:04,119 --> 00:21:07,879 Speaker 3: what happens to the brain during this time. And you know, 428 00:21:07,920 --> 00:21:12,520 Speaker 3: you hit your forties around and you're feeling on top 429 00:21:12,560 --> 00:21:16,400 Speaker 3: of your game, and then suddenly, yeah, you're not anymore. 430 00:21:16,520 --> 00:21:19,280 Speaker 1: Okay, So now you go into the zone of hormonal 431 00:21:19,359 --> 00:21:20,800 Speaker 1: chaos that is perimenopause. 432 00:21:21,040 --> 00:21:24,679 Speaker 2: Your neurotransmitters stop working the way that they used to. 433 00:21:25,200 --> 00:21:28,720 Speaker 1: Also, your ability to uptake glucose in certain areas of 434 00:21:28,760 --> 00:21:31,800 Speaker 1: your process glucose and certain areas of your brain changes 435 00:21:32,200 --> 00:21:35,520 Speaker 1: beautiful work done by Lisamasconi at Walkernell in New York, 436 00:21:36,200 --> 00:21:40,000 Speaker 1: taking women through brain scans looking at estrogen tracers and 437 00:21:40,000 --> 00:21:43,119 Speaker 1: glucose uptake and where the estrogen receptors. 438 00:21:42,760 --> 00:21:43,240 Speaker 2: Are in the brain. 439 00:21:43,320 --> 00:21:46,640 Speaker 1: What they saw was in premenopause, here's what the brain 440 00:21:46,680 --> 00:21:48,760 Speaker 1: looks like, and like the frontal cortex is lighting up 441 00:21:48,760 --> 00:21:51,359 Speaker 1: for memory and coordination and all these parts. Then you 442 00:21:51,400 --> 00:21:54,439 Speaker 1: get through Perry and it's like the brain is on 443 00:21:54,600 --> 00:21:58,159 Speaker 1: the struggle bus for where we consolidate memory, where we 444 00:21:58,400 --> 00:22:01,520 Speaker 1: make so like an and then some of our executive 445 00:22:01,560 --> 00:22:06,399 Speaker 1: processing areas tank. They do come back in postmenopause. Some 446 00:22:06,560 --> 00:22:07,480 Speaker 1: most of them come back. 447 00:22:07,560 --> 00:22:09,399 Speaker 2: Okay, like this is the time. 448 00:22:10,080 --> 00:22:12,960 Speaker 1: So not only are your neurotransmitters and how we coordinate 449 00:22:13,000 --> 00:22:16,640 Speaker 1: signals going across neurons in our brain changes directly related 450 00:22:16,640 --> 00:22:20,359 Speaker 1: to hormones. The way our brain uses energy changes because 451 00:22:20,400 --> 00:22:25,199 Speaker 1: it's freaking out because of the hormone fluctuations. So fortunately 452 00:22:25,400 --> 00:22:27,680 Speaker 1: that is not a sign of impending dementia. A lot 453 00:22:27,680 --> 00:22:29,480 Speaker 1: of women think it is. It's so bad for them, 454 00:22:29,520 --> 00:22:32,119 Speaker 1: but it does tend to get better. But hormone therapy 455 00:22:32,119 --> 00:22:33,280 Speaker 1: can be really helpful here. 456 00:22:34,800 --> 00:22:38,119 Speaker 3: Okay, good to know what about physical aging symptoms. I 457 00:22:38,119 --> 00:22:42,440 Speaker 3: think you mentioned some of these, like osteoporosis our greatest cyclopaedia. 458 00:22:42,600 --> 00:22:47,960 Speaker 1: Yeah, the greatest rate of bone loss starts six seven 459 00:22:48,040 --> 00:22:49,800 Speaker 1: years before your period stops. 460 00:22:49,840 --> 00:22:50,680 Speaker 2: So you're like. 461 00:22:50,680 --> 00:22:54,200 Speaker 1: In the thick of perimenopause and your bones are tanking. 462 00:22:54,280 --> 00:22:57,480 Speaker 1: I literally today a study came out and looked at 463 00:22:57,920 --> 00:22:59,200 Speaker 1: fracture rates. 464 00:22:59,480 --> 00:23:02,680 Speaker 2: Versus a gender. So women before thirty five fracture less 465 00:23:02,680 --> 00:23:05,960 Speaker 2: than men, okay, and then the minute from. 466 00:23:05,800 --> 00:23:07,879 Speaker 1: Thirty five to forty five we even up, and after 467 00:23:07,920 --> 00:23:10,919 Speaker 1: forty five it's skyrockets. Now for these women it's usually 468 00:23:10,960 --> 00:23:13,480 Speaker 1: a risk fracture, but they're like, this has got to 469 00:23:13,520 --> 00:23:15,919 Speaker 1: be hormonal, Like this is the difference these women are 470 00:23:15,920 --> 00:23:18,800 Speaker 1: in perimenopause and these are not. And so waiting till 471 00:23:18,840 --> 00:23:21,159 Speaker 1: sixty five to have a bone density scan when the 472 00:23:21,200 --> 00:23:24,520 Speaker 1: cow's out the barn. When we're fracturing in our forties, 473 00:23:25,080 --> 00:23:28,080 Speaker 1: you know, at much higher levels than men. I really 474 00:23:28,119 --> 00:23:31,520 Speaker 1: think we should be getting scans much much earlier to 475 00:23:31,800 --> 00:23:32,960 Speaker 1: you know, see where you're at. 476 00:23:33,080 --> 00:23:35,000 Speaker 4: Can we just ask for that as a patient? 477 00:23:35,320 --> 00:23:38,840 Speaker 1: You can now it might be covered by insurance if 478 00:23:38,880 --> 00:23:42,840 Speaker 1: you have high risk conditions like your mom had. Family history, smoker, thin, 479 00:23:43,400 --> 00:23:47,320 Speaker 1: Caucasian blue eyes. There's lots of things you have, like 480 00:23:47,359 --> 00:23:50,399 Speaker 1: an autoimmune disease that causes inflammation, you're on steroids for 481 00:23:50,440 --> 00:23:51,040 Speaker 1: a long time. 482 00:23:51,440 --> 00:23:53,200 Speaker 2: Those are reasons insurance will pay. 483 00:23:53,240 --> 00:23:55,280 Speaker 1: But like in Houston, like I live outside of Houston, 484 00:23:56,040 --> 00:24:00,480 Speaker 1: this is ninety nine dollars. I'm like, listen, if you're 485 00:24:00,480 --> 00:24:02,560 Speaker 1: going to pick something to spend money on for your health, 486 00:24:03,480 --> 00:24:05,479 Speaker 1: I would do this before a Dutch test, you know, 487 00:24:05,760 --> 00:24:09,080 Speaker 1: like this is the one test you want to get 488 00:24:09,119 --> 00:24:10,600 Speaker 1: because when those patients. 489 00:24:10,240 --> 00:24:13,000 Speaker 2: See, holy shit, I'm forty and I have osteopenia. 490 00:24:13,359 --> 00:24:16,120 Speaker 1: I've never seen a more motivated to do the lifestyle 491 00:24:16,200 --> 00:24:18,680 Speaker 1: changes because who wants to fracture right? 492 00:24:19,240 --> 00:24:19,760 Speaker 4: Nobody? 493 00:24:20,400 --> 00:24:25,160 Speaker 1: And most women are not diagnosed with osteoporosis until they fracture, right. 494 00:24:25,280 --> 00:24:28,240 Speaker 4: But so what do you do preventatively? What are the changes? 495 00:24:28,359 --> 00:24:29,399 Speaker 2: Yeah, no, great question. 496 00:24:29,960 --> 00:24:34,520 Speaker 1: So strong muscles equals strong bones, so lifting lifting heavy. 497 00:24:34,840 --> 00:24:36,720 Speaker 1: So there was a trial lift more and they took 498 00:24:36,760 --> 00:24:39,679 Speaker 1: women with osteopenia osteoporosis and put them through a workout 499 00:24:39,680 --> 00:24:42,800 Speaker 1: protocol of like squats and lunges and jumping. You have 500 00:24:42,840 --> 00:24:44,240 Speaker 1: to jump up to a pull up and then let 501 00:24:44,320 --> 00:24:47,320 Speaker 1: go and fall. So the jumping process like eight inches 502 00:24:47,400 --> 00:24:49,800 Speaker 1: is all you need. Jumping like two three times a 503 00:24:49,800 --> 00:24:52,800 Speaker 1: week for a few minutes. That will send a stimulation 504 00:24:53,119 --> 00:24:56,560 Speaker 1: to the osteoblast to start laying down more bones. So 505 00:24:56,560 --> 00:24:59,639 Speaker 1: there's ways to stimulate those little So what happens is 506 00:24:59,680 --> 00:25:02,040 Speaker 1: both muscle and bone we're chewing up old stuff and 507 00:25:02,119 --> 00:25:07,440 Speaker 1: laying down new Okay, and in menopause perimenopause, we starting 508 00:25:07,720 --> 00:25:10,160 Speaker 1: the chewing up part speeds up and the laying down 509 00:25:10,240 --> 00:25:12,640 Speaker 1: kind of slows down a little bit. So we want 510 00:25:12,640 --> 00:25:15,480 Speaker 1: to reverse that process, go back to where we're in 511 00:25:15,520 --> 00:25:17,320 Speaker 1: a bone neutral or bone building phase. 512 00:25:17,359 --> 00:25:19,680 Speaker 2: And estrogen's directly related to that. 513 00:25:19,760 --> 00:25:22,600 Speaker 1: But lifestyle, make sure you're eating enough protein, make sure 514 00:25:22,600 --> 00:25:24,760 Speaker 1: you're doing the heavy lifting, make sure you're. 515 00:25:24,600 --> 00:25:25,399 Speaker 2: Getting vitamin D. 516 00:25:25,760 --> 00:25:28,280 Speaker 1: Adequate vitamin D, get that vitamin D level checked, and 517 00:25:28,320 --> 00:25:31,440 Speaker 1: make sure you're getting enough calcium from your diet. Calcium 518 00:25:31,480 --> 00:25:35,160 Speaker 1: supplements do not prevent osteoporosis, but high calcium diets food 519 00:25:35,320 --> 00:25:36,520 Speaker 1: rich in calcium do. 520 00:25:36,560 --> 00:25:37,760 Speaker 2: Seem to turn the needle. 521 00:25:51,280 --> 00:25:56,520 Speaker 3: Talk about sleep during PERIMENOPAUSEO. 522 00:25:55,520 --> 00:25:57,880 Speaker 2: So fifty percent of us we'll have a sleep disorder. 523 00:25:59,320 --> 00:25:59,920 Speaker 4: How about that? 524 00:26:00,240 --> 00:26:02,399 Speaker 1: Wouldn't that be nice to know when you're waking up 525 00:26:02,480 --> 00:26:04,960 Speaker 1: lending yourself at two in the morning, so we have 526 00:26:05,080 --> 00:26:07,600 Speaker 1: you know, there's many reasons why women don't sleep. Okay, 527 00:26:07,760 --> 00:26:10,399 Speaker 1: if you're having hot flashes, they will wake you up typically, Okay, 528 00:26:10,520 --> 00:26:12,760 Speaker 1: that's fixable. We get rid of the hot flashes and 529 00:26:12,800 --> 00:26:13,840 Speaker 1: you'll sleep through that. 530 00:26:14,480 --> 00:26:15,760 Speaker 2: There's many other reasons. 531 00:26:15,760 --> 00:26:18,520 Speaker 1: So there's women who struggle to fall asleep, and there's 532 00:26:18,560 --> 00:26:21,520 Speaker 1: women who struggle to stay asleep. Go to bed fine, 533 00:26:21,600 --> 00:26:24,040 Speaker 1: but then they're getting that two, three, three, seventeen am 534 00:26:24,080 --> 00:26:26,399 Speaker 1: wake up right, and then they sit there and toss 535 00:26:26,400 --> 00:26:30,439 Speaker 1: and turn. So talking to sleep medicine specialists like people 536 00:26:30,440 --> 00:26:33,440 Speaker 1: who are usually internists who then did a sleep medicine fellowship, 537 00:26:33,760 --> 00:26:36,040 Speaker 1: that's a learned like three am wake up can be 538 00:26:36,080 --> 00:26:39,119 Speaker 1: a learned response, a cortisol drop, blood glucose, something going on, 539 00:26:39,160 --> 00:26:40,480 Speaker 1: so we have to do a deeper dive. It could 540 00:26:40,480 --> 00:26:43,800 Speaker 1: also be sleep apnea, and that is massively underdiagnosed in 541 00:26:43,920 --> 00:26:45,320 Speaker 1: women because we don't snore. 542 00:26:45,119 --> 00:26:46,320 Speaker 2: As much, but we still have it. 543 00:26:46,920 --> 00:26:49,680 Speaker 1: So you can try magnesium, some of the different sleep 544 00:26:49,680 --> 00:26:52,720 Speaker 1: supplements to see if that helps. Progesterone works wonders for 545 00:26:52,760 --> 00:26:56,440 Speaker 1: these patients in a lot of cases, sometimes just cognitive 546 00:26:56,440 --> 00:26:57,160 Speaker 1: behavioral therapy. 547 00:26:57,200 --> 00:26:57,760 Speaker 2: I have to do this. 548 00:26:57,800 --> 00:26:59,320 Speaker 1: If I have a three am wake up, I have 549 00:26:59,520 --> 00:27:03,760 Speaker 1: to go through like breathing exercises, box breathing meditation to turn. 550 00:27:03,600 --> 00:27:05,280 Speaker 2: My brain off. If it's really bad, I just get 551 00:27:05,320 --> 00:27:05,800 Speaker 2: out of bed. 552 00:27:06,119 --> 00:27:09,959 Speaker 1: Sleep bed should be intimacy and sleep. Nothing else, no reading, 553 00:27:10,119 --> 00:27:13,159 Speaker 1: no TV, no you know. And so I get up, 554 00:27:13,200 --> 00:27:14,720 Speaker 1: go in the other room where it's dark, and I 555 00:27:14,800 --> 00:27:17,440 Speaker 1: read on my backlick Kindle until I feel sleepy again. 556 00:27:17,480 --> 00:27:18,480 Speaker 2: Then I go and lay back down. 557 00:27:20,840 --> 00:27:21,920 Speaker 4: I mean, this is exhausting. 558 00:27:22,000 --> 00:27:26,440 Speaker 1: It's exhausting, but like sleep is everything, Like you must 559 00:27:26,520 --> 00:27:28,760 Speaker 1: prioritize your sleep if you want to live a long 560 00:27:28,800 --> 00:27:29,679 Speaker 1: time and live healthy. 561 00:27:30,280 --> 00:27:32,280 Speaker 3: I think one of the areas that everyone's afraid to 562 00:27:32,320 --> 00:27:35,880 Speaker 3: talk about is sex during menopause or very menopause. 563 00:27:35,920 --> 00:27:36,480 Speaker 4: What happens. 564 00:27:37,000 --> 00:27:40,639 Speaker 1: We have body changes, we have brain changes. So you 565 00:27:40,720 --> 00:27:43,400 Speaker 1: really have to meet patients where they are. And if 566 00:27:43,440 --> 00:27:45,160 Speaker 1: she's like, I don't care if I never sex again 567 00:27:45,160 --> 00:27:48,879 Speaker 1: and I don't care, I'm like, okay, fine, yeah, if 568 00:27:48,920 --> 00:27:51,120 Speaker 1: you want to live like that, there's nothing wrong with that. 569 00:27:51,640 --> 00:27:53,879 Speaker 1: Where I can be helpful is when a patient says, 570 00:27:54,359 --> 00:27:54,959 Speaker 1: I miss it. 571 00:27:55,520 --> 00:27:57,959 Speaker 2: I had it. I want it back, okay. 572 00:27:58,800 --> 00:28:01,000 Speaker 1: So when we look at the domain of sexual functioning 573 00:28:01,080 --> 00:28:05,600 Speaker 1: in a woman, okay, we have relationship disorders, So how's 574 00:28:05,600 --> 00:28:08,080 Speaker 1: your partner, what's going on there? You know, we talk 575 00:28:08,119 --> 00:28:09,960 Speaker 1: about that, all right. I can't I send them to 576 00:28:09,960 --> 00:28:13,560 Speaker 1: a therapist. That's not my jam, right, you know, or 577 00:28:13,600 --> 00:28:16,760 Speaker 1: get a new partner, you know. Okay, Then we have 578 00:28:16,960 --> 00:28:21,160 Speaker 1: arousal disorder. Arousal is the physical response on what happens, 579 00:28:21,840 --> 00:28:25,560 Speaker 1: So blood flow, lubrication, blah blah, blah, blah blah, same 580 00:28:25,600 --> 00:28:26,640 Speaker 1: as a direction and a man. 581 00:28:26,800 --> 00:28:29,640 Speaker 2: Okay, that is arousal. Viagra helps arousal. 582 00:28:30,119 --> 00:28:32,520 Speaker 1: Women don't tend to have as much arousal issues, but 583 00:28:32,560 --> 00:28:34,680 Speaker 1: they can. So you have to really help tease that out, 584 00:28:34,800 --> 00:28:37,560 Speaker 1: you know, listening to their history and what's lacking. There's 585 00:28:37,760 --> 00:28:41,680 Speaker 1: desire disorder, that's the brain. That is what most of 586 00:28:41,680 --> 00:28:46,680 Speaker 1: my patients complain of. I love my partner, and usually it. 587 00:28:46,640 --> 00:28:49,200 Speaker 2: Is heterosexual couples that this happens in. 588 00:28:49,240 --> 00:28:52,000 Speaker 1: There tends to not be a mismatch in same sex couples, 589 00:28:52,000 --> 00:28:55,280 Speaker 1: so I don't want to exclude, you know. And then 590 00:28:55,320 --> 00:28:57,600 Speaker 1: there's patients who just love to masturbate, and I don't 591 00:28:57,600 --> 00:28:59,680 Speaker 1: want to anymore, you know, but they miss it, so 592 00:29:00,240 --> 00:29:01,360 Speaker 1: part they're fine with that. 593 00:29:01,880 --> 00:29:03,480 Speaker 2: So in the desire, we. 594 00:29:03,440 --> 00:29:07,960 Speaker 1: Have medications that can testosterone, vy Lesi and Addie have 595 00:29:08,120 --> 00:29:11,760 Speaker 1: all been studied in women and shown to improve the brain. 596 00:29:11,640 --> 00:29:14,760 Speaker 2: Aspect of the sexual response. And then there's pain. 597 00:29:15,160 --> 00:29:18,520 Speaker 1: So if you're having pain from activity, right, you're having 598 00:29:18,720 --> 00:29:22,000 Speaker 1: whatever reason. Usually it's GSM, jenner uniar is symdrome, and menopause, 599 00:29:22,040 --> 00:29:24,720 Speaker 1: but not all and that requires a physical exam and 600 00:29:24,760 --> 00:29:27,080 Speaker 1: a long discussion, you know. But if a patient comes 601 00:29:27,120 --> 00:29:29,560 Speaker 1: in she's like, I'm having dryness. It really hurts. It 602 00:29:29,560 --> 00:29:32,120 Speaker 1: feels like glass. You know, I'm fifty five of my period. 603 00:29:32,200 --> 00:29:32,440 Speaker 4: Stop. 604 00:29:32,480 --> 00:29:34,680 Speaker 1: I'm like, okay, let's go ahead and treat for GSM 605 00:29:34,720 --> 00:29:38,120 Speaker 1: based on your history. If this isn't working within three months, 606 00:29:38,160 --> 00:29:40,080 Speaker 1: we need to get you into a specialist to see 607 00:29:40,120 --> 00:29:40,680 Speaker 1: what's going on. 608 00:29:41,960 --> 00:29:44,680 Speaker 3: So a lot can happen around sex at this age. 609 00:29:45,080 --> 00:29:47,200 Speaker 2: So but you know, we have to normalize. Do you 610 00:29:47,240 --> 00:29:49,520 Speaker 2: want to have sex again? Is that important to you? Right? Okay? 611 00:29:49,600 --> 00:29:49,719 Speaker 1: Right? 612 00:29:49,760 --> 00:29:53,040 Speaker 2: So then are do you have pain? Do you have whatever? 613 00:29:53,200 --> 00:29:55,480 Speaker 1: You know, sex should never be in service of someone 614 00:29:55,520 --> 00:29:59,080 Speaker 1: else ever, right, if you gifted to someone that is 615 00:29:59,120 --> 00:30:02,800 Speaker 1: your decision, but like one hundred percent of the time, 616 00:30:02,880 --> 00:30:04,440 Speaker 1: you just doing it to stay married. 617 00:30:04,640 --> 00:30:05,240 Speaker 2: Bless your heart. 618 00:30:06,080 --> 00:30:07,840 Speaker 4: That's when you need a partner ectomy. 619 00:30:08,440 --> 00:30:11,320 Speaker 3: What about fertility, Women are having babies later and later, 620 00:30:11,520 --> 00:30:12,840 Speaker 3: Is that getting riskier? 621 00:30:14,800 --> 00:30:14,920 Speaker 2: So? 622 00:30:15,600 --> 00:30:19,920 Speaker 1: Yes, and no, we are having more women over forty 623 00:30:19,960 --> 00:30:22,840 Speaker 1: now having babies than under twenty first time in history. 624 00:30:22,920 --> 00:30:23,120 Speaker 4: Wow. 625 00:30:23,120 --> 00:30:26,600 Speaker 1: So and women are sliding right from postpartum in to perimenopause. 626 00:30:27,200 --> 00:30:29,360 Speaker 2: That's a whole nother discussion. 627 00:30:30,840 --> 00:30:35,360 Speaker 1: Artificially being able to increase someone's fertility. The older you 628 00:30:35,400 --> 00:30:37,440 Speaker 1: are and you have a baby, the more likely you 629 00:30:37,520 --> 00:30:41,360 Speaker 1: are to have underlying disease, starting right cardio and I'm 630 00:30:41,360 --> 00:30:45,760 Speaker 1: talking about cardiovascular disease hypertension. So the danger in having 631 00:30:46,440 --> 00:30:49,360 Speaker 1: a baby when you're older is that your body is 632 00:30:49,400 --> 00:30:51,560 Speaker 1: not as healthy as it was at twenty, and the 633 00:30:51,760 --> 00:30:55,120 Speaker 1: pregnancy becomes a stress test to the body. So we 634 00:30:55,160 --> 00:31:00,000 Speaker 1: see much higher levels of preeclansia, gestational hypertension, gestational diabetes, 635 00:31:00,160 --> 00:31:02,160 Speaker 1: and these things all carry risks to the fetus and 636 00:31:02,200 --> 00:31:02,480 Speaker 1: the mom. 637 00:31:02,800 --> 00:31:06,160 Speaker 2: Okay, so just being with age and. 638 00:31:06,120 --> 00:31:09,239 Speaker 1: There's nothing magic about thirty five, this horrible term of 639 00:31:09,280 --> 00:31:09,920 Speaker 1: you know, elderly. 640 00:31:10,000 --> 00:31:12,760 Speaker 2: Primogravita. I had a baby. I was an AMA baby, 641 00:31:13,000 --> 00:31:14,240 Speaker 2: advanced maternal age. 642 00:31:14,320 --> 00:31:16,160 Speaker 4: I was a geriatric pregnancy as. 643 00:31:16,080 --> 00:31:17,640 Speaker 2: Well, geriatric pregnancy. 644 00:31:17,720 --> 00:31:17,960 Speaker 4: Yeah. 645 00:31:18,440 --> 00:31:21,200 Speaker 2: So so rue's twenty two now she's fine. 646 00:31:21,480 --> 00:31:26,080 Speaker 1: Yeah, but you know, just we're older, our cardiovascular systems 647 00:31:26,080 --> 00:31:26,960 Speaker 1: are not as healthy. 648 00:31:27,080 --> 00:31:29,440 Speaker 2: Our you know, intecrine system is not as healthy just 649 00:31:29,520 --> 00:31:30,640 Speaker 2: due to the aging process. 650 00:31:30,960 --> 00:31:33,360 Speaker 1: And then if you add on obesity and smoking and 651 00:31:33,680 --> 00:31:36,520 Speaker 1: all the things, you know, it becomes a lot more risky. 652 00:31:37,080 --> 00:31:40,200 Speaker 2: But we can usually navigate that. You know, that's why 653 00:31:40,240 --> 00:31:41,360 Speaker 2: we go to doctors. 654 00:31:41,560 --> 00:31:45,920 Speaker 3: Right, What are some good leading questions to give women 655 00:31:46,080 --> 00:31:48,360 Speaker 3: so that when they go to their doctor and decide 656 00:31:48,360 --> 00:31:52,000 Speaker 3: they want to talk about perimenopause, okay, they know exactly 657 00:31:52,080 --> 00:31:53,200 Speaker 3: what to ask. 658 00:31:53,760 --> 00:31:57,080 Speaker 1: On our website, there's something called the lab checklist. And 659 00:31:57,120 --> 00:31:59,440 Speaker 1: if you just go to the Pause Life website and 660 00:31:59,480 --> 00:32:02,240 Speaker 1: you serve and put in checklist, it'll come up and well, 661 00:32:02,280 --> 00:32:04,600 Speaker 1: it's like an eight page document will send to you. 662 00:32:05,280 --> 00:32:08,960 Speaker 1: We have scripts what to say if my doctor says, 663 00:32:09,040 --> 00:32:12,640 Speaker 1: I don't believe in hormone therapy, you're too young. You know, 664 00:32:12,800 --> 00:32:15,880 Speaker 1: all the common cliche things that patients have told us 665 00:32:15,880 --> 00:32:18,800 Speaker 1: they hear in their doctor's office. These are ways for 666 00:32:18,880 --> 00:32:22,560 Speaker 1: you to tactfully say this is what I need, and 667 00:32:22,600 --> 00:32:25,680 Speaker 1: we have a whole page of them, so you know, 668 00:32:27,280 --> 00:32:31,720 Speaker 1: call ahead. If they're not Menopause Society certified, this probably 669 00:32:31,760 --> 00:32:33,960 Speaker 1: isn't your best bets. You can go to menopause dot org, 670 00:32:34,080 --> 00:32:36,960 Speaker 1: which is the website of the Menopause Society, and look 671 00:32:37,000 --> 00:32:39,320 Speaker 1: for a certified provider, not just a member. You want 672 00:32:39,360 --> 00:32:42,560 Speaker 1: the certified provider. They'll be a little star and find 673 00:32:42,560 --> 00:32:45,720 Speaker 1: one in your area. Call ahead, Are they taking new patients? 674 00:32:45,800 --> 00:32:47,920 Speaker 1: Do they take your insurance? Are you willing to pay 675 00:32:47,920 --> 00:32:51,920 Speaker 1: out of pocket? You know, and then that is probably 676 00:32:52,000 --> 00:32:54,680 Speaker 1: your best bet. Also on our website again Pause Life, 677 00:32:55,160 --> 00:32:58,840 Speaker 1: The Pause Life, you can go to we have probably 678 00:32:59,160 --> 00:33:01,520 Speaker 1: two thousand testimonials. 679 00:33:00,840 --> 00:33:04,280 Speaker 2: From our followers on doctors that they loved, and we've 680 00:33:04,360 --> 00:33:05,680 Speaker 2: organized them by city and state. 681 00:33:07,040 --> 00:33:07,280 Speaker 4: Great. 682 00:33:08,320 --> 00:33:12,880 Speaker 3: Uh okay, I want to do sort of a rapid 683 00:33:13,160 --> 00:33:22,680 Speaker 3: lightning round of questions. What is something no one would 684 00:33:22,680 --> 00:33:25,200 Speaker 3: think to associate with perimenopause but could be. 685 00:33:26,800 --> 00:33:27,640 Speaker 2: Palpitations? 686 00:33:28,480 --> 00:33:29,880 Speaker 4: Heart palpitations. M hmm. 687 00:33:30,680 --> 00:33:35,080 Speaker 3: You said one earlier that I definitely have too itchy fingers, 688 00:33:35,200 --> 00:33:36,560 Speaker 3: itchy feet, itchy skin. 689 00:33:37,040 --> 00:33:38,520 Speaker 4: I would never have known. 690 00:33:38,840 --> 00:33:41,760 Speaker 1: Right, So we lose thirty percent of our collagen in 691 00:33:41,800 --> 00:33:45,920 Speaker 1: the first five years. During menopause, we lose transfer drumal 692 00:33:45,960 --> 00:33:49,360 Speaker 1: water loss increases, so the skin becomes drier, so we 693 00:33:49,400 --> 00:33:52,840 Speaker 1: have thinner, drier skin. We also have more nerve inflammation, 694 00:33:53,040 --> 00:33:58,040 Speaker 1: so that magical combination can lead to intractable itching and 695 00:33:58,080 --> 00:34:00,200 Speaker 1: some patients and the ear is a little more or 696 00:34:01,000 --> 00:34:02,840 Speaker 1: the ears because you can't get in there, you know, 697 00:34:03,120 --> 00:34:05,240 Speaker 1: and so you see the ear itching. 698 00:34:05,320 --> 00:34:06,520 Speaker 2: I mean, patients are like. 699 00:34:06,920 --> 00:34:11,239 Speaker 3: Yes, you know, I'm very much into skincare and I 700 00:34:11,320 --> 00:34:14,480 Speaker 3: like to know what I'm using. And the thing that 701 00:34:14,520 --> 00:34:17,800 Speaker 3: bothers me a lot is this idea that like topical 702 00:34:17,880 --> 00:34:23,279 Speaker 3: collagen is actually going to start boosting your collagen. You're 703 00:34:23,520 --> 00:34:26,160 Speaker 3: the molecule is too big to be absorbed by. 704 00:34:26,000 --> 00:34:28,520 Speaker 2: This thanse you need it or a huge molecule. 705 00:34:28,719 --> 00:34:31,239 Speaker 1: And then even orally, I mean, I have collegen in 706 00:34:31,239 --> 00:34:33,120 Speaker 1: my shape right now. But it brings down to the 707 00:34:33,120 --> 00:34:36,239 Speaker 1: component amino acids, you know, so in. 708 00:34:36,160 --> 00:34:40,040 Speaker 2: The digestive process. So if you're going to. 709 00:34:40,080 --> 00:34:42,520 Speaker 1: Do anything, I would just do the amino acids. But again, 710 00:34:42,719 --> 00:34:45,440 Speaker 1: the skin is a barrier, right, It's meant to protectice. 711 00:34:45,480 --> 00:34:48,040 Speaker 2: It's hard to get things in there that are that big. 712 00:34:48,520 --> 00:34:50,759 Speaker 3: It is, and it bothers me that there's so much 713 00:34:50,800 --> 00:34:54,440 Speaker 3: misleading sort of marketing. Of course, of course in the 714 00:34:54,440 --> 00:34:59,120 Speaker 3: cosmetic and you know industry, but all of these creams 715 00:34:59,239 --> 00:35:03,239 Speaker 3: that are topical hologen and they are everywhere. They might 716 00:35:03,719 --> 00:35:06,000 Speaker 3: make you look a little bit better for like five 717 00:35:06,000 --> 00:35:09,480 Speaker 3: minutes thirty minutes, but you're not actually boosting your collagen 718 00:35:10,040 --> 00:35:11,600 Speaker 3: putting collagen on your face. 719 00:35:12,760 --> 00:35:12,920 Speaker 4: Right. 720 00:35:13,760 --> 00:35:17,560 Speaker 3: What about topical estriol. I started losing that too, do Weah, 721 00:35:17,560 --> 00:35:18,920 Speaker 3: I've read a lot of studies. 722 00:35:20,040 --> 00:35:21,960 Speaker 1: So the studies are small, but they're there, and the 723 00:35:22,080 --> 00:35:23,839 Speaker 1: and the benefit was clearer, but. 724 00:35:23,760 --> 00:35:25,799 Speaker 3: They're there, and there's like two recent ones that are 725 00:35:25,840 --> 00:35:28,960 Speaker 3: pretty good and they both say that it's advantageous. 726 00:35:29,040 --> 00:35:32,200 Speaker 1: Yeah, there's not been one study done on topical they've 727 00:35:32,239 --> 00:35:35,759 Speaker 1: done it on topical estradyle and topical estriol and all 728 00:35:35,800 --> 00:35:36,839 Speaker 1: of them were beneficial. 729 00:35:37,280 --> 00:35:39,880 Speaker 2: So they're small. So like the naysayers will be like, 730 00:35:39,880 --> 00:35:42,920 Speaker 2: the studies are too small and you'll you'll kill yourself. 731 00:35:42,920 --> 00:35:44,040 Speaker 2: I'm like, oh my god. 732 00:35:44,160 --> 00:35:49,880 Speaker 1: Like it's microdosing and it's very very local and it 733 00:35:49,960 --> 00:35:50,640 Speaker 1: is absorbed. 734 00:35:51,160 --> 00:35:52,000 Speaker 2: It is absorbed. 735 00:35:52,200 --> 00:35:56,279 Speaker 1: All my dermatology friends use it, all of them when. 736 00:35:55,840 --> 00:35:57,640 Speaker 4: Well there's no better endorsement. Yeah. 737 00:35:57,680 --> 00:36:02,840 Speaker 3: I started using estrail on my face maybe a year ago, and. 738 00:36:04,120 --> 00:36:05,640 Speaker 4: I really like it. I really love it. 739 00:36:06,160 --> 00:36:11,080 Speaker 3: I see effects of it in elasticity, and yeah, I'm 740 00:36:11,080 --> 00:36:11,640 Speaker 3: a huge fan. 741 00:36:12,200 --> 00:36:13,759 Speaker 4: Good Okay, good to know. 742 00:36:14,080 --> 00:36:16,560 Speaker 1: I also use vitamin C and retinols and you know, 743 00:36:16,840 --> 00:36:17,960 Speaker 1: and put everything on there. 744 00:36:18,320 --> 00:36:21,279 Speaker 3: Oh, haptides, lipids. We could go down, we could go 745 00:36:21,360 --> 00:36:21,919 Speaker 3: down the list. 746 00:36:21,960 --> 00:36:24,720 Speaker 4: Girl, I'm all over it. Okay. 747 00:36:24,760 --> 00:36:28,880 Speaker 3: What's the biggest mistake men make as their partners go 748 00:36:28,960 --> 00:36:30,000 Speaker 3: through perimenopause? 749 00:36:30,719 --> 00:36:36,319 Speaker 1: Not get educated and just assume she's crazy, you know, right, 750 00:36:37,200 --> 00:36:39,480 Speaker 1: and not pick up the slack while she's trying to 751 00:36:39,480 --> 00:36:40,080 Speaker 1: figure it out. 752 00:36:41,160 --> 00:36:42,600 Speaker 4: Yeah. So you know, on my. 753 00:36:42,600 --> 00:36:45,440 Speaker 1: Instagram it is ninety eight percent women who follow me. 754 00:36:47,080 --> 00:36:49,960 Speaker 3: It's it's almost doctor like half the planet isn't really 755 00:36:50,000 --> 00:36:52,279 Speaker 3: interested in what's happening to us. 756 00:36:52,320 --> 00:36:55,239 Speaker 1: So I don't know the demographics on the podcast, but 757 00:36:55,520 --> 00:36:57,160 Speaker 1: you know, but Instant actually. 758 00:36:56,880 --> 00:36:58,520 Speaker 2: TikTok is a little better because they're young. 759 00:36:58,600 --> 00:37:03,120 Speaker 1: Yeah, so TikTok is like eighty five fifteen, Okay, well we. 760 00:37:03,160 --> 00:37:07,200 Speaker 2: Still out of where we listens is ninety eight percent female. 761 00:37:07,239 --> 00:37:10,479 Speaker 1: I'm like, hey, like I've been asked to speak for 762 00:37:10,640 --> 00:37:13,520 Speaker 1: three major medical systems to go in and do a 763 00:37:13,600 --> 00:37:16,080 Speaker 1: women's health talk right on menopause, and. 764 00:37:16,000 --> 00:37:18,160 Speaker 2: I want all three. I couldn't believe it. I walk 765 00:37:18,200 --> 00:37:18,840 Speaker 2: in the room. 766 00:37:19,040 --> 00:37:21,640 Speaker 1: There is four or five hundred doctors in there and clinicians, 767 00:37:21,640 --> 00:37:25,560 Speaker 1: a lot of nurse practitioners, all women, one hundred percent women. 768 00:37:25,640 --> 00:37:29,200 Speaker 2: I'm like, yeah, where are the men? Where are the men? 769 00:37:29,360 --> 00:37:29,840 Speaker 4: Doctors? 770 00:37:30,680 --> 00:37:33,680 Speaker 2: This was there women's in medicine event. 771 00:37:34,440 --> 00:37:34,760 Speaker 4: Wow? 772 00:37:34,760 --> 00:37:37,440 Speaker 1: And I'm like great, I'm happy to talk to whoever, 773 00:37:37,520 --> 00:37:41,239 Speaker 1: but like, bring me for your medicine event. You know, 774 00:37:41,440 --> 00:37:43,560 Speaker 1: all of us need to know this, not just your 775 00:37:43,600 --> 00:37:44,800 Speaker 1: friend clinicians. 776 00:37:45,000 --> 00:37:48,160 Speaker 4: I was like, wow, yeah. 777 00:37:48,080 --> 00:37:48,960 Speaker 2: No men. 778 00:37:50,320 --> 00:37:54,240 Speaker 3: What's the biggest mistake doctors make when treating perimenopause? 779 00:37:55,360 --> 00:37:59,000 Speaker 2: Oh gosh, Okay, So it's tough out there. 780 00:38:00,600 --> 00:38:03,920 Speaker 1: If an obgyn is willing to even accept that your 781 00:38:03,920 --> 00:38:06,520 Speaker 1: perimenopausal and maybe we can do something, it's usually birth 782 00:38:06,520 --> 00:38:07,960 Speaker 1: control pills is your only option. 783 00:38:08,480 --> 00:38:09,120 Speaker 2: They haven't. 784 00:38:09,200 --> 00:38:12,480 Speaker 1: We've done a terrible job really teaching the nuances around 785 00:38:12,600 --> 00:38:16,120 Speaker 1: treatment and perimenopause. So I think just rushing and look, 786 00:38:16,160 --> 00:38:18,440 Speaker 1: I have patients on birth control pills and they're doing great. 787 00:38:18,520 --> 00:38:19,719 Speaker 2: It depends on what they need. 788 00:38:19,960 --> 00:38:23,360 Speaker 1: But losing the other half of your armamentarium of knowing 789 00:38:23,400 --> 00:38:27,399 Speaker 1: that MHT is okay in perimenopause and when to use 790 00:38:27,600 --> 00:38:28,120 Speaker 1: either one. 791 00:38:28,200 --> 00:38:30,719 Speaker 2: I think, you know, for doctors, you really need to 792 00:38:30,719 --> 00:38:31,440 Speaker 2: get educated. 793 00:38:33,120 --> 00:38:35,680 Speaker 4: H Okay, what is your favorite self care tip? 794 00:38:37,000 --> 00:38:40,920 Speaker 2: Sleep? Put yourself first, Sleep, don't. 795 00:38:40,680 --> 00:38:43,759 Speaker 1: Worry about get a brick for your phone, put your 796 00:38:44,280 --> 00:38:45,879 Speaker 1: you know, I'm bricked out right now. 797 00:38:46,000 --> 00:38:47,600 Speaker 2: You know, like that has been. 798 00:38:47,480 --> 00:38:50,160 Speaker 1: Life changing for me because you know, I work on 799 00:38:50,200 --> 00:38:53,319 Speaker 1: the internet and all this crazy news. 800 00:38:53,080 --> 00:38:54,080 Speaker 2: And all the things. 801 00:38:54,280 --> 00:38:57,279 Speaker 1: You know, it's tough, and it was really affecting my 802 00:38:57,320 --> 00:39:00,600 Speaker 1: mental health. So like taking that step to like turn 803 00:39:00,680 --> 00:39:02,719 Speaker 1: it off and walk away. And I can't change what 804 00:39:02,800 --> 00:39:04,960 Speaker 1: I can't change, and I'm going to do the things 805 00:39:04,960 --> 00:39:06,719 Speaker 1: that I can control. I had a video about that 806 00:39:06,760 --> 00:39:10,600 Speaker 1: today and so I think is key and women are 807 00:39:10,640 --> 00:39:13,120 Speaker 1: realizing if I don't do these things, I'm not gonna 808 00:39:13,160 --> 00:39:13,440 Speaker 1: make it. 809 00:39:14,480 --> 00:39:16,640 Speaker 4: Yeah. Oh, and also just like I don't want to 810 00:39:16,680 --> 00:39:17,920 Speaker 4: live like this for years. 811 00:39:18,280 --> 00:39:18,960 Speaker 2: Yeah. 812 00:39:19,000 --> 00:39:21,320 Speaker 4: This isn't like half a year long phase. 813 00:39:21,400 --> 00:39:25,320 Speaker 2: This is years, years and years and years. 814 00:39:25,400 --> 00:39:26,120 Speaker 4: Who wants to. 815 00:39:26,080 --> 00:39:34,640 Speaker 3: Live suffering in confusion, panicked, enraged all the thing, tired, exhausted, 816 00:39:34,640 --> 00:39:36,400 Speaker 3: anxious for years? 817 00:39:37,719 --> 00:39:42,200 Speaker 4: Yeah, Yeah, nobody wants that. The book is the new Perimenopause. 818 00:39:42,280 --> 00:39:44,960 Speaker 3: Doctor Mary Claarhor thank you so much for coming on 819 00:39:45,040 --> 00:39:46,560 Speaker 3: Off the Cup and talking about all this stuff with 820 00:39:46,640 --> 00:39:51,640 Speaker 3: us happy to do it. Off the Cup is a 821 00:39:51,680 --> 00:39:54,920 Speaker 3: production of iHeart Podcasts as part of the Reason Choice Network. 822 00:39:55,080 --> 00:39:56,840 Speaker 4: If you want more, check out the other. 823 00:39:56,719 --> 00:40:01,200 Speaker 3: Reason Choice podcasts, Politics with Jamel Hill and Native Land pod. 824 00:40:01,600 --> 00:40:03,680 Speaker 3: For Off the Cup, I am your host, Se Cup. 825 00:40:03,960 --> 00:40:07,400 Speaker 3: Editing and sound design by Derek Clements. Our executive producers 826 00:40:07,440 --> 00:40:11,359 Speaker 3: are me Se Cup, Lauren Hanson, and Lindsay Hoffman. Rate 827 00:40:11,360 --> 00:40:14,960 Speaker 3: and review wherever you get your podcasts, follow or subscribe 828 00:40:15,200 --> 00:40:22,400 Speaker 3: for new episodes every Wednesday.