- 6 hours ago
Balance: A Perimenopause Journey - Season 1 Episode 1 - Unbalanced
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00:00I haven't felt like myself lately.
00:30I got my hormones checked and found out I'm low in progesterone.
00:44Perimenopause?
00:46I thought there was only menopause.
00:57Maybe that's why I haven't been sleeping.
01:06My name is Sadhvi Sadali Sri, I'm a Jain monk, and apparently, I'm in perimenopause.
01:13The scary thing is, I don't know what comes next.
01:22This is the worst PR campaign in the history of the universe.
01:25The longer your body is without hormones, the less healthy you are.
01:28The research has shown that these things increase the risk of cancer.
01:31Adverse effects were increases in breast cancer and cardiovascular disease.
01:35They're dangerous.
01:36That is just not true.
01:38The men at the top have no idea what happens to a menopausal body.
01:42We are harming women.
01:44If you don't advocate for yourself, nobody else is going to do it.
01:47I wasn't being listened to.
01:49I had to start fighting for my life right away.
01:51You should begin noticing perimenopausal symptoms between the ages of 35 and 45.
01:57This is like the perfect time to get people all of the tools so the transition is easier and more pleasant.
02:03I don't think hormone therapy is for everyone, but I think that not even putting it into the equation is such a disservice.
02:09They think that if they take hormone therapy that that's going to solve everything. It's not.
02:14You're really defying Mother Nature's plan for you.
02:17We have to look at exercise. We have to look at diet.
02:20Menopause still is taboo.
02:22There's just not a lot of education.
02:24We have to teach about the journey before it's impacting us.
02:29It's going to take a generation of women that stands up and says, not me.
02:39Oh my God! How are you?
02:57So I thought we would have lunch.
03:01And then Jason, our appointment with Jason is this afternoon.
03:05Okay, cool.
03:06All of a sudden I'm starting to feel disconnected and I'm like, who am I?
03:10I know I'm not lost because I feel steady in my soul.
03:13I feel peaceful in my soul.
03:15But why is my body, why is my mind becoming an enemy to me?
03:19People think we already achieved the peace and the calmness and the balance, right?
03:24But we're actually signing up to go through the process of achieving the balance.
03:30It's my kind of inspiration in South BC Valley Street.
03:33You know, she's so strong.
03:34She's so dedicated.
03:36It's scary, you know, that like, uh-oh, you know, I'm trying to achieve what she has achieved.
03:40But, you know, it can be lost almost in like a second.
03:44What does a treatment plan look like to help me achieve some kind of balance inside of me?
03:51You're mentioning that you had those high levels of stress and all those factors beating down on you, which can throw things out.
04:04You're sleeping out as well, not going so well for you.
04:08Right.
04:09And so one of the things that I really want to start treating you on right now is very simple.
04:14It's going to be just some progesterone.
04:16Okay.
04:17And that's going to be done orally.
04:22All you're going to do is take one capsule by mouth at the time of sleep.
04:26Okay.
04:27And that's going to, you're going to notice a huge increase in your ability to just sleep nicely.
04:32That sounds like a great gift.
04:33And you're going to be able to stay asleep.
04:35Do I have to be on hormones for the rest of my life?
04:38Or is this something that I can do for a year or something and then I can come off of it?
04:45Do you have to stay on these for the rest of your life?
04:48Not at all.
04:49But I have a feeling you're going to notice an extreme difference and it's something that you're going to want to be on.
04:55Well, I'm excited.
04:56Let's see.
04:57Let's see what comes of it.
04:58I don't know how I'm doing with my hormones.
05:01We sent you the test and I have your results right here.
05:04As you can see, there is practically no estrogen in your system right here.
05:11Um, having as low...
05:14I just kept thinking like, what's wrong with me?
05:17Why am I going through all these changes or why am I so depleted?
05:22I mean, I was not expecting like a perfect result, but to see the numbers just so skewed to the left, like the low levels, it was just so eye-opening to me.
05:35In a way, it kind of gives me hope.
05:37Like if I do change and if my hormones get balanced, it gives me hope that maybe I actually might be able to do more work and feel more energized.
05:45Things are going to change now.
05:46Things are going to change and we can't go back.
05:52Things are going to change now.
05:53Things are going to change now.
05:58I'm narrowing McCormick and I'm so tied up.
06:03We're monks.
06:07We strive for a balance and peace in our lives.
06:10lives. We tried to keep our bodies pure through fasting, breathing, and eating vegetarian.
06:17We prefer to do things naturally. So what will our spiritual teacher think about my
06:23desire to try hormone therapy?
06:25I am really not pro progesterone or any hormones. But I don't condemn it.
06:35Do you think it's okay for me to go the natural way and try the other alternatives first?
06:42You try it. If it works for you, then maybe you go in that route. If it doesn't work,
06:53then there is no other choice. So maybe you have to take that HRT.
06:59I will definitely start with the natural and then let's see what happens.
07:04Go HRT!
07:05Yeah, yeah, yeah, yeah, yeah.
07:11I need this to work. I have books to write, films to make, workshops to teach. My biggest
07:20year and I can't fall apart. Sadhvi Anabhuti is in a similar boat. Her energy is depleted.
07:29She's unable to focus. How can we find the right solution when everything online is so confusing
07:36contradictory?
07:37I'm so excited you guys came all this way to come and see me. It's an honor for us to be
07:51here with you. Yes. All right. Are we ready? Yes. Should we do this? Yes. Let's go learn.
07:55I have a million questions. So each month in a normal menstrual cycle, you're living your
08:01best life, you're having your monthly periods in a healthy woman. You have this feedback cycle
08:06of hormones that are happening from the brain, the hypothalamus gland to the pituitary, the
08:10pituitary to the ovaries. As we go through perimenopause, as we reach a critical threshold
08:17in the amount of eggs we have left, that process gets harder and harder and harder to do each
08:23month, requiring more stimulating hormone and producing less hormones from the ovary.
08:28This leads to, in perimenopause, this zone of hormonal chaos. You start getting these wild
08:34fluctuations. It's a downward trend over time, but you're having massive high levels of estradiol,
08:40then dropping to very, very low, and this leads to the perimenopausal symptoms.
08:49What do you think perimenopause is? Perimenopause. Ooh. I can't say I'm familiar with that phrase.
08:59I never heard that, though. Could it be menopause that is early onset? The stage or time prior
09:09to menopause. When did you find out about the word perimenopause? I still don't even fully
09:24know what it means. I'm thinking it's before the full-on menopause happens, and I really
09:31just thought that would happen, like, closer to 50 and older. Once I started doing a little
09:36research, I'm like, this is totally me. What would you say were, like, the check marks
09:41saying it's totally you? Mm. I sweat a lot now. Even normal tasks, like getting dressed
09:48during the day, I'm sweating. I can't sleep at night. Mood swings, which I would attribute
09:56to just my cycle, but it's just really extreme. I'm just feeling, um, fighting depression sometimes,
10:04and I gained a lot of weight. I met my husband in 2012. From there to now, I gained 75 pounds,
10:11not doing anything extra. Oh, I have chin hair growing in. I never had chin hair, but now, like, once a month,
10:21I have a cluster, and I started counting. Okay, six. It's over six now. I'm plucking out, like, ten a month.
10:28So, that was major, too. Like, I hope I don't get a beard.
10:40What are some statistics about perimenopause that we should know?
10:43It happens to 100% of women. The average age of menopause is 51 in the U.S. If you're African American,
10:50that goes down to 49. Perimenopause symptoms typically begin 7 to 10 years before your period stops.
10:5995% of women will go through menopause between the ages of 45 to 55. Let's do the math.
11:06Minus 10. You should begin noticing perimenopausal symptoms between the ages of 35 and 45.
11:15I'm not limiting this to hot flashes. When, as medical providers, we are simply utilizing the cliché symptoms
11:22of hot flashes and night sweats, as menopausal, we are harming women.
11:26Recognizing the mental health changes, the cognition changes, the musculoskeletal changes,
11:31the gastrointestinal changes, the cardiovascular changes is key.
11:35What do you think are the symptoms that women experience during perimenopause or menopause?
11:40There might be some negative effects.
11:43Sometimes mood swings or irritability.
11:45I honestly have no idea.
11:46Changes in appetite.
11:48Have you heard anything about it?
11:49No, actually, the first time.
11:52Heat flashes.
11:53Hot flashes.
11:54Hot flashes.
11:55Hot flashes.
11:56Hot flashes.
11:57Menopause has the worst PR campaign in the history of the universe, right?
12:00The idea that it's just hot flashes and night sweats and they only last for a short period of time
12:05is the biggest crock of shit that's ever been delivered to people.
12:08It's a huge problem because you have hormone receptors in all of your body.
12:12And so menopause affects your whole body.
12:15And actually, the genital and urinary symptoms that happen with the loss of hormones
12:20are some of the most severe and life-threatening issues surrounding menopause.
12:25As you age and you lose hormone receptors in that very hormone-sensitive tissue,
12:30all these genital and urinary symptoms start to happen, including urinary tract infections,
12:35which can kill people and do kill people and cost the healthcare system quite a lot of money.
12:40And so urologists who deal with sexual health and quality of life,
12:44we are constantly talking about issues like incontinence, pain with intercourse, pelvic pain, urinary frequency, urinary urgency,
12:52and urinary tract infections. So a lot of the menopause issues are not even sexual-related, right?
12:57It's just urinary-related. So it's okay if you're a monk.
13:00You will still be affected by the genital and urinary symptoms in menopause.
13:04You can't escape those even if, you know, sex is not a priority.
13:07And then menopause itself, what is that?
13:11So menopause is one day in your life, medically. It is the day one year after your last menstrual period.
13:18That is your menopause. And from that day forward till you die, you are postmenopausal.
13:24So we have premenopause, perimenopause, menopause one day, postmenopause.
13:32So why do we call everything menopause? If it's just one day, why do we put so much emphasis on that word?
13:38So I do that a lot. I just say menopausal, meaning I'm trying to, like, let people know that, you know,
13:45we're going to spend a third or more of our lives, up to 40% of our lives, in our menopausal journey,
13:53through perimenopause, menopause, and postmenopause. And that things are irrevocably changed for the rest of our lives
14:01as those hormone levels get disrupted and decline.
14:04And what do the hormones look like, or the hormone levels, when you're postmenopausal?
14:10Postmenopausal. Estradiol is less than 1% of its premenopausal levels. It's basically gone.
14:15Progesterone is gone. And testosterone levels have decreased 50% or more.
14:20Forever. Until HRT. Unless you replace them.
14:33We have to remember what hormones are. And hormones are chemical messengers.
14:38And actually, we're only talking about three main hormones.
14:41So oestrogen, or even oestradiol, which is a really good form of oestrogen, progesterone and testosterone.
14:48And every woman and every man produce them. And they're biologically active.
14:53And they have receptors for these three hormones on every single cell in our body.
14:57So they work with cell processes. So that's what's been forgotten somehow.
15:02Because if I said to you, you're deficient in vitamin D, I think the first thing you'd say is,
15:07well, where's the vitamin D? What dose do I need? How do I take it?
15:11So if I say you're low in a natural hormone, which is called oestrogen,
15:14then you'd probably say, well, how do I increase my oestrogen?
15:17Like, it's not rocket science, is it?
15:27We're not being validated by going to doctors. You're too young.
15:30Like, we could have been ahead of this when I was 37.
15:33I know. I know. It's frustrating.
15:35I know. I know. I know. I know.
15:37That's usually the first response when you feel better, right, is, like, anger.
15:40Like, seriously? Someone could have given me this patch, like, five years ago?
15:47It's such a disservice to call oestrogen, progesterone, testosterone sex hormones.
15:51They're impacting receptors in our brain that can trigger or worsen anxiety,
15:57major depression, even things like bipolar.
16:01Now, maybe it's just hormones and it's not those diagnoses.
16:05Maybe it's both. Maybe one is causing the other.
16:08But this impact that the hormone decline has on mental health is so significant.
16:16I would think mental health mood changes is on 60 to 70% of my patient intake forms.
16:25How many women's shoulders are hurting them?
16:34Did you know that that was your hormones?
16:36I was doing the exercises with the bands and all of the things.
16:40And it wasn't getting any better.
16:42I had no idea that it had anything to do with perimenopause until I got some testosterone.
16:48And guess what?
16:49A couple weeks later, my shoulder didn't hurt.
16:52It's like a freaking miracle.
16:54It's a frozen shoulder.
16:55It's your hormones.
17:00I had no plan in becoming a perimenopause advocate or an influencer.
17:06I'm like your neighbor that's like, hey, I did hormone therapy.
17:09It helps with inflammation and joint pain.
17:12Women everywhere are finding out.
17:14I don't know what happened, but my story of having experienced all of the symptoms of perimenopause
17:21without knowing about perimenopause and then finding hormone therapy and how my body all of a sudden turned back on.
17:27That whole story fell out in three minutes on a TikTok video.
17:32And the next day I woke up and it was at 9 million views.
17:36Zero sex drive for years.
17:39But it was the comments, comment after comment, women across the world saying, hey, I have every single symptom and I also went to my doctor.
17:49My doctor also said everything was normal.
17:52Where are we going?
17:54I'm 38.
17:58This is a conversation for when I'm 50.
18:01Like what's going on?
18:02Yeah, 50.
18:03We all think like 50.
18:04Right.
18:05Like it's not even on the radar.
18:07Yeah.
18:08I kind of fell in love with myself.
18:10And then the hard thing was that my body was not matching that.
18:15Right.
18:16My body hurt.
18:17It didn't want to get out of bed.
18:20I felt kind of numb.
18:22It was very strange to have found my soul and then have my body falling apart.
18:28My doctor said, you look normal.
18:31You know, I was going through all these horrible things, not sleeping, no sex drive.
18:36My body was itching.
18:37My bones hurt.
18:38I couldn't run anymore.
18:40I just thought, what's happening?
18:42Like I must be sick or depressed or something.
18:45And at 41, I got lucky.
18:48And a friend said, it sounds like you should start hormone therapy.
18:52And I didn't even know what that was.
18:54And she goes, oh, you should just go to this clinic.
18:57They do Botox.
18:59And I thought, are you insane?
19:01That sounds very strange.
19:03And I went and it was about a week later that I started feeling like me.
19:09Like my body matched my soul.
19:11Did you know you were going through perimenopause?
19:14I had never heard that word.
19:15When you started doing HRT, did you know already by then?
19:19No.
19:20The only, I think the first time I heard the word perimenopause was after I had shared my story on TikTok.
19:26And somebody mentioned perimenopause in a comment.
19:30Progress.
19:31The gift of sleep returns thanks to hormone therapy.
19:44But Sadviana Bhuthi searches for a natural path.
19:47I think we should probably give you a little bit of DHEA and a little bit of Pregnatalum both.
19:53Now, those are supplements.
19:56They're not medications.
19:57They are supplements.
19:58They're derived from plants.
19:59With your levels as low as they are, I don't think we want to go with food as medicine here
20:03because it's going to be really hard to get what you need.
20:06But I do think that a replenishing protocol where we're using those building blocks could be really beneficial for you.
20:25After learning about our journey, Alyssa Milano, who we worked with before, was eager to share her own experience.
20:31I mean, what can I say?
20:39Perimenopause was no fun.
20:41And originally, I went on bioidentical creams.
20:46And I was doing testosterone, progesterone, and estrogen.
20:51And it helped for a little bit.
20:54And then they just stopped working.
20:57Around the same time, I started getting chronically ill.
21:00And I remember just being in total pain throughout my whole entire body.
21:05My ANA panel came back positive.
21:07And the diagnosis, I have a working diagnosis of Sjogren's syndrome, which is an autoimmune disease that impacts all the parts of your body that get moist.
21:21So your eyes, your nose, the insides of your mouth, you know, down there, everything.
21:28I think because I went so long without hormone replacement therapy that my body just started attacking itself and thinking that I had an autoimmune disease.
21:40I am on progesterone pills and an estrogen patch and an estrogen suppository.
22:01So, wow.
22:02But perfectly healthy until perimenopause.
22:07And my only wish was that I started treating it with hormones earlier because, honestly, it could have been a totally different last five years for me.
22:22In Washington, D.C., the Bipartisan Menopause Research and Equity Act was going to be introduced.
22:38Sadly, things didn't go as planned.
22:41But when one door closes, another one opens.
22:44So they decided to postpone the press conference and we don't know, you know, when it's going to be rescheduled.
22:50But fortunately, Dr. Sharon Malone, who's one of the top menopause specialists in the States, she's like, I'm available to meet with you.
22:59And she's like really close friends with Michelle Obama.
23:02I think she knows Oprah.
23:04So we get to interview her tomorrow and learn so much.
23:07We have gone full circle on the hormone issue, even though it was in widespread use in the 60s.
23:17It kind of dipped down in the 70s and 80s.
23:20It came back with full force in the 80s because we had now long-term longitudinal data on women who had taken estrogen.
23:31And what they found was that women who had been on estrogen long-term had a lower risk of heart disease than women who did not take estrogen.
23:40So this is in addition to all of the symptomatic relief.
23:43And when they found that estrogen decreased the risk of heart disease, that was the magic bullet.
23:49And that is how the Women's Health Initiative was born.
23:52The Women's Health Initiative really set the stage here.
23:55They were hoping that these hormones, they were seeing a lot of studies that showed improvement in cardiovascular disease.
24:00And they said, oh, we want to study this in a big way.
24:02We want to see if it reduces the risk of cardiovascular disease in women.
24:06In order to prove that a woman would develop heart disease or not, women don't get heart disease until they're in their 60s and 70s.
24:13So the average age in the WHI was 62 years old.
24:17They had younger patients.
24:18They had older patients.
24:19So remember, we're dealing with a much older population than would be the ones who start hormone therapy.
24:24They recruited for this study and it went on and we thought, oh my goodness, now we've got this amazing double blind randomized control study that is going to prove for us that not only does estrogen relieve the symptoms of menopause,
24:39but we were also going to do something long term for women's health, decrease their risk of cardiovascular disease, which is the number one killer of women in this country to this day.
24:50And all was well until that fateful day in July of 2002 when the study was abruptly halted.
24:59The trial has been stopped early due to the increased risk of invasive breast cancer.
25:06There was this big fear, oh my gosh, hormones cause cancer.
25:09The NIH, which spent a billion dollars on this study, did a press conference before the papers were even released saying hormones cause cancer,
25:18hormones cause blood clots.
25:20These are terrible.
25:21Everyone must stop these immediately.
25:23And while much remains to be learned, today we can finally begin to offer some guidance.
25:29The key adverse effects were increases in breast cancer and of cardiovascular disease.
25:35The entire industry tanked.
25:37Everyone said, oh my God, you can't take these hormones.
25:40You must stop it.
25:41You must throw everyone through their hormones in the garbage.
25:43The US prescriptions immediately, like 80% for hormone therapy stopped immediately.
25:48About 40% of women were on hormone therapy at the time.
25:51And that dropped to, right now it's 4%.
25:544% of women in the United States right now who are menopausal are enjoying the benefits of hormone therapy.
26:00That is really the legacy of that study and how those results were presented to the public.
26:07We've had 20 years of that negative impression of hormones really sticking.
26:14And so a generation of women has been disadvantaged by not being offered hormone therapy.
26:21I have an insomnia problem.
26:38I need to find a way to help me.
26:41The doctors always have tried to help me with treatments for depression.
26:50And I can't take medications to sleep because I have a reaction allergic to everything that is to sleep.
27:00The other day you were telling me that you had to go to your ginecologist.
27:04Yes.
27:05Yes.
27:06I went to my review annual review with the ginecologist.
27:10And, well, a year ago I told you about some treatment based on hormones for me
27:17to see if I could resolve or compose a little bit the situation to be able to sleep.
27:23And he told me that no.
27:26But why?
27:27He said that recently in the studies that have been released,
27:32that the hormone treatment causes problems in the heart and the brain.
27:39You have an entire generation of doctors who never learned how to prescribe hormone therapy
27:46because they read the same headlines as patients.
27:48So you have patients who think hormones cause cancer.
27:50And you have doctors who think hormones cause cancer.
27:53And no one bothered to explain to them in a very loud way that it's more nuanced than that.
27:58That it's not black and white.
28:00And that there's so much benefit.
28:02Women can be strong and healthy whether they take HRT or not.
28:05But we have to remember that our hormones work throughout our body.
28:09And actually our cell processes work better.
28:12You only need to look at pictures of the brain before and after having hormones.
28:16And you'll see that it lights up.
28:18You know, it works.
28:20Our hormones reduce inflammation.
28:22They improve our cardiovascular system.
28:24You know, they work in so many different ways because they affect every single cell.
28:28But it's not about having to need to have it or not.
28:31It's about choice.
28:32It's about understanding.
28:34And it's also...
28:35It's just hormones, but there are different types and there are different doses.
28:39So some people will say,
28:41Oh, I've been on HRT and it did nothing for me or I felt dreadful.
28:44Well, they weren't on the right dose and type for them.
28:47So it's not a binary decision either.
28:49I mean, I've been told off for even telling people that I'm on HRT by other healthcare professionals.
28:54I don't really understand why it's a problem.
28:56But it's all about choice.
28:58And this is the biggest problem.
29:00Women have this choice taken away from them.
29:02This wouldn't be a discussion if every woman who wanted hormones could have them.
29:07If you came to me with raised blood pressure, I would not say to you,
29:11Sorry, you can't have that blood pressure lowering treatment.
29:14I'm not going to reduce your risk of a heart attack.
29:17But day in, day out, women are being told you can't have HRT.
29:21I feel bad for your mom, I mean, just hearing her story and her struggle.
29:41I don't want to end up in her place.
29:44At least right now we're educating ourselves and trying to find alternatives through these changes with our body.
29:51But your mom's been suffering a lot.
29:54For too long, I think.
29:56I mean, I think that's stressful maybe for you.
29:59It is.
30:00She's been suffering for too long and I really, really wish that I could do something for her
30:06and that I could find her the right help.
30:08It's a worry for me.
30:09I worry about her.
30:10I worry about her health.
30:12My hope is that maybe at least I can find the right doctor who can check her hormones
30:18and can give her some advice and guidance with treatment.
30:22I wondered, you know, if she had the right doctor.
30:25She got on HRT.
30:27She mentioned that she has and she's dealing with arthritis and, of course, her sleep issues.
30:32If she had treatment, maybe all of that could have been prevented.
30:37And that's so sad.
30:55I really think that menopause has to be viewed as Mother Nature's way of protecting women.
30:59Let's face it, reproduction is a little bit dangerous.
31:02It means you've got a lot of estrogen in your system and it's there to promote fertility.
31:07And that is risky.
31:10Too much estrogen can drive breast cancer and all kinds of other problems.
31:13So nature says, all right, I'm going to give it to you only between menarche,
31:18when you're in your late teens, say, and up to about 50.
31:22And apart from that, no, we're not going to fool around with estrogen because this is dynamite.
31:26And so the idea of, no, no, no, menopause, now that I don't have estrogen anymore,
31:31I should keep taking it as a medicine.
31:34You're really defying Mother Nature's plan for you.
31:38And we're putting ourselves at risk.
31:40You know you're going to get a lot of controversy and maybe a pushback against this statement
31:46because we have a lot of women and doctors promoting HRT for women in post-menopause as well.
31:54Yeah.
31:55What's your opinion on that?
31:57For reasons I cannot explain, there is sort of a near religious allegiance to certain pharmaceuticals.
32:06And we've seen it with hormone replacement therapy where people get angry.
32:10If you point out the research has shown that these things increase the risk of cancer.
32:14They really do.
32:16We don't make up the results.
32:18We just simply report the results and people get all upset.
32:21Perhaps it's because they thought they had a fountain of youth that they could prescribe for women.
32:26Perhaps they're taking money from the pharmaceutical industry for whatever reason.
32:29People do get upset when you point out there are problems with hormone replacement therapy.
32:34But they're real.
32:36There's such a number.
32:52What's the answer?
32:54How's the interview?
32:55It went great.
32:56It was good.
32:57I mean the interview was great.
32:59He gave great information.
33:01I am so...confused.
33:04what happened? I mean I thought I would be getting closer to understanding all of this but
33:11honestly I'm still like just kind of confused. I think this is going to be controversial because
33:15he fully opposes HRT like 100 percent. 100 percent not like no room. He says that there is really
33:24nothing that states that HRT is safe for women. That's interesting because we have a bunch of
33:33doctors that are going on social media citing and showing us the papers that are saying it is safe.
33:38So that's why I think this conversation needs to be had because there is one so much confusing and
33:45conflicting information and you know I'm taking HRT. I'm on progesterone only right now. It's made
33:51a huge impact on my life and I'm feeling good about it. Trusting you know the information of our
33:58of our doctors so I mean I still feel strong in in my stance only because I'm taking it and I feel
34:06better and I feel the difference but I know your journey is the natural path.
34:11naturopathic medicine we try to use lifestyle we try to use herbs we try to use mindset meditation
34:30all things that are not pharmaceutical first if possible. So I used to view hormone replacement
34:37therapy as medication right as something that was unnatural to be put in the body. So for many years
34:45I would try to alleviate menopause symptoms just using lifestyle practices and you can get pretty
34:52far doing that for the day-to-day frustrations of menopause the hot flashes and night sweats the
34:59vaginal dryness. However as I got deeper into the research I realized that estrogen and particularly
35:05estradiol this hormone is so essential for so many systems in our body for our bone health for our
35:13brain health the flexibility of our joints for the collagen in our skin. So as I start to understand
35:18these things I'm like well from really treating the root cause actually the decline in the absence of
35:24estrogen and progesterone and in some cases testosterone but mostly estrogen and why would I not put back in
35:32estrogen if it's available.
35:36There's lots of things that happen due to nature due to us becoming older. I keep talking about raised blood pressure
35:43because I think it's a good analogy because most people with raised blood pressure don't have any symptoms but we still
35:48treat it and screen for it and make sure the blood pressure is normal. And there's lots of reasons why people can have
35:53raised blood pressure of course but it is a disease of aging. It's a natural process that occurs but we still treat it. So why is it
36:01menopause that's associated with disease risks we just say oh it's nature.
36:06Just to protect you if women you know will be like angry that you're not supporting them that they feel like you're not
36:14hearing them they're suffering because you're against HRT which is being you know promoted as a way to help women. Can you talk about your intention? I mean is your intention to prevent them from feeling great?
36:25Okay. First of all when I raise an alarm that hormone replacement therapy is related to breast cancer and to dementia and so forth I understand that some people may have strong feelings about that as if we're preventing them from taking a treatment that makes them feel better in many ways. Let me be clear. It's a woman's body and it's her decision what she chooses to do. But my job as a doctor is to look at the literature and to share those risks. Let's be honest.
36:44And let her go forward making the choices for herself.
36:51Estrogen causes breast cancer. However, it does it with low frequency. When it manages to make a breast cancer, it is almost
36:58uniformly a less aggressive, more curable subtype. And women on hormone
37:28replacement who get a breast cancer almost uniformly have a 50% decrease in mortality from that breast cancer versus a woman who was not on hormone replacement.
37:44No one can argue that you become less healthy simply by removing estrogen. This is proven in multiple organ systems. Estrogen is a powerful anti-inflammatory hormone.
37:55And it's a powerful regulator of mental health. It's a powerful regulator of our kidneys, our bladder, our gut. And when those levels decline, then you become less healthy.
38:05You have a significant gap of time without hormone therapy. We can continue benefits if you had, if you had had the opportunity to be on hormones for a long time.
38:20But while you're off hormones, we see an acceleration of certain disease processes. So there's two things that are, we need to address. One is the strokes. So we know that estrogen therapy in any form, oral or transdermal, is going to be on hormones.
38:36Mm-hmm.
38:38Does increase the risk of stroke, especially in an older patient, especially with a history of strokes. So that probably in and of itself is going to rule out an estrogen option for her because of the risk of causing another stroke.
38:52Wow. So that's one thing. That doesn't mean you can't take progesterone. That doesn't mean, and that might be helpful for sleep. It doesn't mean testosterone is off the table either.
39:12Oh, she's asking, yes. Thank you for reminding me. Vaginal cream. She's asking, is that something she should consider taking and having?
39:22Yes, absolutely. Even though she's not sexually active, the vaginal estrogen, which is very safe, will not increase her risk of stroke, will protect her against bladder infections and sepsis as she continues to age. So I would recommend it at least once a week.
39:36Is that over the counter? Is that something? No, it's a prescription. Is that something you can prescribe to her? Absolutely. We'll do it today.
39:41We'll do it today. Excellent. And so what would be, is it like a daily thing?
39:45So when we, yeah, well for her, because she's not sexually active, it's going to be once a week.
39:50Okay. Once a week. Just to kind of help that tissue stay healthy so she doesn't make her more prone to UTIs.
39:56Okay. Perfect. So urinary tract.
40:02She's never, she's not, she doesn't have like a history of it. Is that still good to do?
40:06She's not been sexually active for, you know, definitely if she be, if you get a boyfriend and become sexually active, this is mandatory.
40:15What I'm trying to do. If you have a boyfriend, it's going to be mandatory to take him.
40:20But it can be protective for potential UTIs and keeping that tissue health.
40:27I'm recording.
40:37This is going to be great. This is an awesome day.
40:39It is. It is. It's happening.
40:41For 15 years, we've been dreaming of our inauguration day to open our meditation park and temples.
40:48Years of planning, coordinating and strategizing have gone into making this day possible.
40:55The last three months have been very intense for us and perimenopause didn't help.
41:01What are you doing?
41:11Um, I'm just reviewing the souvenir.
41:15Why are you crying?
41:18We just had like the big celebration. Why are you crying?
41:22It's like, um, a mixture of emotions and feelings and accomplishment and it's done.
41:33I mean, you have to think we've been, I've been dreaming of this day for like 15, 15 years, right?
41:39Being on progesterone, I think fortunately that helped because it helped me to sleep.
41:45But like, it was just so much, so much pressure, so much, cause you want everything to go right.
41:50And I just remember just, I don't know. I've had, I had moments of snapping.
41:56Um, and that I, I felt bad about. I actually made somebody cry.
42:01I don't even know if I told you that. Yeah. Um, Riddika was helping me with some wire.
42:06And then I just, I don't know. I just, not that I lost it, but it was just maybe my tone or I'm just so stressed out.
42:13And I just feel like, yeah, I got some sleep the last week cause just energy's catching up.
42:18But I like, this can't be our normal.
42:23And I'm, I'm thinking of asking and asking Jason, like maybe the next step for me is maybe estrogen or testosterone
42:31because sure progesterone has helped me to sleep, but I still don't feel like myself.
42:36And just the fact that I made someone cry like that, that's not me.
42:43Think about physiology. What do these hormones do in our body?
42:49They're independent hormones, but we also know that they work together in the pathway.
42:53In fact, our hormones come from cholesterol. Cholesterol gets converted to progesterone.
42:58Progesterone gets converted to testosterone. And then testosterone gets converted to estrogen.
43:05So they're all linked. They're a family.
43:07But increasingly I see women who haven't been given the right dose and type and balance of those hormones together.
43:13And it makes sense because if we're putting too much strain on one hormone and ignoring the other,
43:19the body doesn't quite know how to work.
43:21But we also need to remember that these three hormones,
43:23oestradiol, progesterone, testosterone work with other hormones,
43:27especially in our brain, such as dopamine, serotonin, noradrenaline, adrenaline,
43:32really important melatonin, our sleep hormone.
43:35But they all interact. So if you've got low oestrogen or low testosterone,
43:39you're going to have low dopamine, low serotonin, low melatonin.
43:43And then if you take a step back and think, why was my sleep not good?
43:47Why is my mood not good? Why is my feeling of pleasure in life not good?
43:52Oh, it's not just the effect of those three hormones.
43:55It's the effect they have on other hormones as well.
43:58And then the gynaecologists are saying, we look after menopause.
44:01Well, they look after ovaries.
44:03They're not trained to look after the brain and the bones and the heart.
44:07And thinking in this whole way of how our endocrine system works.
44:23So I'm excited to meet Dr. Hirsch.
44:26Yeah, finally.
44:28The biggest thing, it's...
44:31I really just want her to answer why this is so complicated.
44:35Like, why this is just so confusing.
44:38Which part?
44:39Just the whole thing with hormone replacement therapy,
44:42the information on social media,
44:45the different opinions with the doctors.
44:48You know, we hear one doctor saying they support one thing,
44:53the other one doesn't.
44:54We have to be careful because we don't want people to get hurt in this process.
44:59I mean, they've already been hurt enough.
45:01We respect everybody.
45:02Right, right.
45:03By not having any kind of treatment.
45:04Right.
45:05But making sure that they get the right information.
45:07Yeah.
45:08I feel like I just jumped in.
45:10I'm like, HRT, let me sleep.
45:13Well, I mean, I can understand.
45:14Like, I know how much my mom suffers from not sleeping.
45:17Yeah.
45:18So I can, you know, understand if somebody chooses to jump straight into HRT
45:23to just get some good sleep or just to start feeling good or better.
45:27For sure.
45:29When we started researching the topic, we came across a lot of fear around HRT,
45:40hormone replacement therapy.
45:42Yeah.
45:43Why is there so much fear around it?
45:45The fear is, so I pause because I understand it.
45:51As a female myself, I understand why women have fears.
45:56And a lot of the fears about hormone therapy are really an emotional reaction.
46:03They're actually not logical.
46:04It's just this emotional reaction.
46:06In the early 2000s, the Women's Health Initiative closed.
46:11And there was a big media day.
46:13And, you know, clinicians, researchers, doctors came out on social media and said,
46:16oh my gosh, for all these years we thought estrogen was so good
46:20and it actually causes breast cancer.
46:22That wasn't the whole story.
46:24It had to do with the dose of hormone therapy used in that study.
46:28The age of women that were enrolled in that study.
46:31The route in which it was administered.
46:33The timing of menopause.
46:35And so there were so many things that in 2002, when that first came out,
46:40those researchers, scientists, clinicians didn't yet know.
46:43But that message stuck.
46:46The more we've learned about perimenopause and hormones,
46:51the more we realize this is just one piece of a bigger conversation.
46:56A conversation about the medical injustice, dismissal and inequality women have been facing forever.
47:02I do fully believe that this happened to me so that I could share this story.
47:25It was such a big thing that happened.
47:32Maybe my bad experience can help someone else advocate for themselves.
47:39I'm trying to figure out the way to sell it.
47:41What I did was this and the words as a person is turning in this.
47:42Is that the word feeling?
47:43I was just trying to say the word feeling.
47:44I was trying to say the word feeling.
47:45I was trying to say the word feeling.
47:46It's kind of a different feeling.
47:47I was trying to say the word feeling.
47:48So I think you are wrong.
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