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00:24I was going to the gym and I started to get really sharp pains in my low abdomen.
00:29And my legs started to swell.
00:33So I went to a doctor and she felt a lump on my low right abdomen.
00:38It was discovered that I had an enormous ovarian cyst on my left ovary.
00:44It was so big, it was actually pushing my organs over, which is why she felt the lump on the
00:50low right.
00:51She's like, okay, I'm going to refer you to a local gynecologist.
00:54Depending on how the cyst looked inside of me, he was perhaps going to have to remove more organs.
01:04He was talking about a hysterectomy.
01:06And that brief conversation with him is like, you know, you're 38, you know, are you really going to have
01:11kids anyway?
01:11I had the surgery and came out, was in recovery.
01:16And he informed me that he, indeed, he had to perform a hysterectomy.
01:25And that hit me, that my choices were gone.
01:36You can't leave the hospital until you urinate on your own or have a bowel movement on your own.
01:42And, uh, I couldn't do it.
01:46And for the next five days, it was quite torturous.
01:52Menopause has the worst PR campaign in the history of the universe.
01:56The longer your body is without hormones, the less healthy you are.
01:59The research has shown that these things increase the risk of cancer.
02:02Adverse effects were increases in breast cancer and cardiovascular disease.
02:06They're dangerous.
02:07That is just not true.
02:09The men at the top have no idea what happens to a menopausal body.
02:13We are harming women.
02:15If you don't advocate for yourself, nobody else is going to do it.
02:19I wasn't being listened to.
02:20I had to start fighting for my life right away.
02:23You should begin noticing perimenopausal symptoms between the ages of 35 and 45.
02:28This is like the perfect time to get people all of the tools so the transition is easier and more
02:34pleasant.
02:35I don't think hormone therapy is for everyone,
02:37but I think that not even putting it into the equation is such a disservice.
02:40They think that if they take hormone therapy that that's going to solve everything.
02:44It's not.
02:45You're really defying Mother Nature's plan for you.
02:48We have to look at exercise.
02:49We have to look at diet.
02:51Menopause still is taboo.
02:53There's just not a lot of education.
02:54We have to teach about the journey before it's impacting us.
02:59It's going to take a generation of women that stands up and says, not me.
03:22I wasn't being listened to.
03:24I was complaining of pain.
03:26And on the fifth day, a doctor, not my own doctor, just a doctor, walked by.
03:33And when he saw me, he came back.
03:36And he ordered a CT scan.
03:40And when they read the results, it was a doctor and a nurse,
03:43and they read the results in front of me, and they both gasped.
03:48I had a hole in my intestine.
03:51So for those five days of me begging for my life, begging to be heard,
03:58what might have been just a nick, and if they had believed me that first day,
04:03maybe they could have sewn it up, and then my life would be different.
04:07But because I wasn't believed, it was ripping.
04:20While I was recovering at home, I started to have terrible night sweats,
04:27like dumping water on me.
04:30I started to get chin hair.
04:33I had acne.
04:35I was feeling depressed.
04:39All of these things were happening to me,
04:42and it wasn't until, I'm going to say years later,
04:47that I was like, I went through menopause.
04:52No one told me.
04:59I had a patient who had surgical removal of her uterus and her ovaries.
05:05She came to see me complaining of all sorts of symptoms,
05:09hot flashes, night sweats.
05:10She was about 55.
05:13And when I was asking her if she had ovaries or not,
05:17she wasn't really sure.
05:19And we'd ended up doing an ultrasound and some lab work,
05:22and she didn't have her ovaries.
05:24They were surgically removed,
05:25but the doctor who took them out did not tell her,
05:29or maybe did,
05:31but not in a way that either there was the right bedside manner
05:35or enough education for her to understand that she was castrated.
05:39That's what actually taking her ovaries out is.
05:43She was walking around for many years,
05:45never knowing that she was in surgical menopause.
05:47And this actually happens all the time.
06:09I've been on progesterone for six months
06:12and have just recently started taking estrogen and testosterone.
06:16Have you thought about HRT?
06:19Not yet.
06:19I want to put all the effort into addressing the things that, like, I'm deficient on.
06:26I like that idea that, you know, you go one step before,
06:30like, you know, maybe I'm also deficient on those vitamins,
06:33and maybe that's why I'm not producing as much progesterone or estrogen or testosterone.
06:39So I like that idea.
06:40Let's see if that helps, if that helps to build up my levels.
06:44I mean, I did natural a little bit, but it didn't work for me.
06:47Maybe it required patience, but it's like I can't afford not to sleep.
06:52If I have to do it, I will do it.
06:53Like, now I'm taking all these supplements.
06:55Right, and you wouldn't have taken supplements, so.
06:58Right.
06:59So I'm doing it.
06:59I'm already breaking my ideas.
07:01Are you okay?
07:03Yeah.
07:17Ugh, now I'm having a half-wash.
07:19Holy shit.
07:20Okay.
07:22Oh, sorry.
07:28I am board-certified in obstetrics and gynecology.
07:31That means that I did medical school,
07:33and then I did a four-year accredited residency in OB-GYN.
07:36I do, you know, gynecologic surgeries.
07:39I delivered babies for 22 years.
07:42Office gynecology, infections, birth control, and menopause.
07:47I look at the person, and I figure out what's going on with them.
07:49So they're coming to me, and I try to assess with them what are the real pain points?
07:55What's bothering them the most?
07:56What are the things we can accomplish right now?
07:58And what's the best way to do that?
08:00So for some people, hormone replacement therapy, that's what they want.
08:04That's what they need.
08:05Some people aren't ready to use hormones or may never want to use hormones.
08:10I happen to have other things I can do.
08:12So I have a lot of herbal medicines that I really, really like.
08:15I really like Siberian rhubarb.
08:17I really like black cohosh.
08:19I really like, Vitex is probably my favorite.
08:21I love jujubee for sleep.
08:22There's a lot of phytonutrients out there,
08:25plant-based, you know, minerals and vitamins that we can't get any other way.
08:28The thing with perimenopause is it is change.
08:31It is constant change.
08:32It's unpredictable change.
08:34That is what the problem is,
08:35is that it's not the same from day to day, from week to week.
08:38Somebody's coming in, maybe their cycles are still regular.
08:41Get this a lot.
08:43Their PMS, they never had PMS.
08:45It's out of control.
08:46I mean, they're getting divorced every three and a half weeks.
08:49They are in a dark hole.
08:51They're picking fights.
08:52They're getting in trouble at work.
08:54They can't sleep.
08:55Chase Berry works really well for that.
09:00It will be 11 years on April 3rd.
09:03Still no one has told me about menopause.
09:05And I've seen the doctors who lead departments.
09:28Essentially, I went into menopause
09:32when I had the partial hysterectomy in 2013.
09:35I believe I did.
09:36Okay.
09:36I'm wondering, am I going to go through it again with one ovary?
09:40Mm-hmm.
09:41Because I'm starting to see some signs.
09:45A lot of facial hair, some heat, a lot of sweating, brain fog.
09:50I'm suspicious that you just were, like, super sick.
09:54Yeah.
09:54Because let's say you did have an ovary that was there.
09:56You were so sick that there was no way
09:59that ovary was going to function properly anyways.
10:01The bodily body was going to...
10:03Right.
10:03Your body's like, mm, ovulation, really not important right now.
10:06Like, we are shutting that shit down.
10:07Yeah.
10:07Because right now we are trying to be alive.
10:09Yes.
10:10We're not trying to get pregnant.
10:11Yeah.
10:12But the fact that there's been, like,
10:13this big change in the last, like, eight or nine months,
10:17like, that tracks and that sounds like perimenopause to me.
10:22And I think it's an important time for you to start to look at how do you want to proceed.
10:29Mm-hmm.
10:29So here are the way I think we can deal with this.
10:33There's enough data on some of these herbs that are out there
10:36for some of the specific issues that you might have
10:39that that is a reasonable way to start.
10:42And then there's just kind of basic nutrition.
10:44You know, we're talking a little bit about magnesium,
10:46making sure your vitamin D level is adequate.
10:50Vitamin D.
10:51Yeah, D3, really important.
10:53And then there's hormone therapy.
10:55You're a good candidate.
10:56And I think it's something to seriously consider.
10:57So what I would normally offer someone like you is transdermal estradiol.
11:02Mm-hmm.
11:03That would probably be a great place to start for you.
11:06Technically, because you don't have a uterus, you don't need progesterone.
11:10Okay.
11:11And progesterone really needs to be taken orally in order to be absorbed appropriately.
11:15You have these long-term sleep issues.
11:17Yeah.
11:18I mean, but progesterone can help people sleep.
11:20The whole point of this is to help you feel better.
11:23Yes.
11:24Yes.
11:24Right?
11:25And that's what I would love.
11:26I usually tell you guys two to four weeks to see where you're at.
11:29If it's really horrible or you're scared, you call me.
11:32You know what I mean?
11:32Mm-hmm.
11:33But try to, like, get through the four weeks, and then we'll see where you are.
11:38Cindy has finally found menopausal support.
11:41But what about all the women who aren't getting the proper care?
11:45Why is it so difficult?
11:52The biggest challenge that women face is getting the right information.
11:55I mean, let's face it.
11:57Most doctors do not know anything about hormone therapy.
11:59They don't know anything about menopause.
12:01And so women go to their doctor thinking, well, he or she's an OB-GYN.
12:05This is their world.
12:06Of course they're going to know.
12:08And when they're told no hormone therapy isn't a good idea or they're not offered it at all,
12:12it never occurs to them to say, well, gee, maybe I should get another opinion.
12:16Because they trust that doctor.
12:18That doctor delivered their babies.
12:19That doctor did their hysterectomy.
12:21That doctor's been there for them for the last 20 years.
12:23So we have all of these women who are not getting the right information.
12:29There was a study that was done by the Mayo Clinic.
12:31Only about 20% of medical students had had any formal training in either menopause,
12:37and this is not just OB-GYNs, but internal medicine and family practice doctors as well.
12:42And only about 7% of doctors, as they are finishing up, felt as if they had the capacity to
12:50treat women in menopause.
12:52Urologists get no training about menopause, and yet we deal with issues like incontinence and genitourinary syndrome of menopause
12:59and bladder pain and pelvic pain.
13:01And so we're really trying to change that.
13:03This is a urological condition.
13:05Menopause is a urologic disease, right, and probably the most dangerous, the one that will kill our patients the quickest,
13:11is urinary tract infections.
13:13And so urologists must take on menopause as part of their advocacy and their work.
13:18Listen, I had a gynecologist in my office shadowing me today, and I asked her in front of a patient.
13:24I had done a hormone therapy consult and talked to all of this patient all about hormone therapy.
13:27And I looked at her and I said, how much training did you get on this in your residency training
13:31program?
13:31You went to a top-tier place, she said, maybe a one-hour lecture at most.
13:36She never saw it in action.
13:38She never saw it done.
13:39She never saw prescriptions written.
13:41And I said, what would it get for me to get you to write a prescription of testosterone?
13:44And she said, I never, I have no idea how testosterone works.
13:48I don't even know what it means.
13:49I don't know what it does.
13:50And this is a gynecologist who then did a fellowship in urogynecology, right?
13:55So no one is teaching people how to do this, why they need to do this.
14:00Why is education on HRT so important?
14:03Because we don't have any, even amongst our health care providers.
14:06The effects of the Women's Health Initiative basically stopped all meaningful education
14:10around menopause care because we took most therapeutic options off the table.
14:14I think the disaster was that women now had, like, no options.
14:19That's it.
14:20You're just going to suffer.
14:24When the Women's Health Initiative was published, first of all, it wasn't even published before
14:29the press came out.
14:30But it was very clear, very quickly, in the academic community, this was a massive misinterpretation
14:37of the data.
14:39I saw the study before everyone else.
14:42These studies are generally embargoed, meaning that the press gets them before the general
14:46public.
14:46But because I was in the media, I saw this study in advance, which gave me the opportunity
14:52to read it carefully and also to talk to my staff.
14:55I mean, I knew.
14:56I knew that this was going to be enormous.
14:57Because at that time, we were very routinely prescribing hormone therapy for women, not
15:04just for symptoms like hot flashes and vaginal dryness and insomnia.
15:07We were prescribing hormone therapy to prevent long-term problems like cardiovascular disease
15:13and bone health.
15:14So when this came out and the WHOI said, no, it increases the risk of breast cancer.
15:21It increases the risk of blood clots.
15:23It increases the risk of dementia.
15:26We all kind of went, whoa, we weren't expecting that.
15:33So what happened on the day that it was released, I was on, I think, probably somewhere between
15:38five and seven different media outlets.
15:40I was everywhere talking about it and, quite frankly, trying to calm people down.
15:49There were two arms of the study.
15:51If you had a uterus, you got a synthetic estrogen pill combined with a synthetic progestin,
15:57because if you have a uterus, you need progesterone to balance out the estrogen effects,
16:03because you don't want uterine cancer.
16:04So if you had a uterus, you had estrogen and progestin in a pill form.
16:07If you didn't have a uterus, you just got the synthetic estrogen.
16:12They stopped the arm of the study that had estrogen and progestin because they found,
16:17oh, we don't see this improvement in cardiovascular disease in women.
16:22And we also see a slight uptick in the risk of breast cancer.
16:26There's a big difference between relative risk and absolute risk, and that's hard for
16:31a layperson to understand.
16:32I can terrify you with percentages of relative risk.
16:36It doesn't mean they're invalid.
16:38It just means you really don't know how to take that and digest it.
16:41Can I tell you what 26% increase in breast cancer meant for the WHI?
16:46If you're on placebo, taking a sugar pill, and you put 1,000 women on that, four will
16:52get breast cancer.
16:53That's just the underlying drumbeat of breast cancer incidence at the time.
16:59If you were on conjugated equine estrogen, right, Premrin, plus medroxyprogesterone acetate,
17:07MPA, five out of 1,000.
17:11That's not to negate that that one out of 1,000 people sure wishes she didn't have breast
17:16cancer, but if you are a woman hot flashing your way to a divorce right now, wouldn't you
17:21like to know that there is just a 0.1% chance, actually, one out of 1,000 chance?
17:30You are not talking about a significant number of breast cancers, and in fact, it did not reach
17:35statistical significance.
17:36What's fascinating is that that happened in the study where women were taking an estrogen
17:42plus a progesterone, but the women who are taking estrogen only because they didn't have
17:47a uterus, so they didn't need a progesterone for safety, were getting reductions in breast
17:52cancer.
17:55The hormones that we used back then were kind of like birth control pills, so they were a
18:01synthetic pill of hormone that was kind of a high dose, and you take it, goes through your
18:06liver, and it can pump out some proteins, and we found out that it can pump, just like
18:11birth control can cause blood clots.
18:14These kind of pills that you take also can increase the risk of blood clots, and as you
18:18get older, those risks go up.
18:19Even those hormones, which we don't really prescribe anymore because of the increased
18:23risk of blood clots, had a lot of benefit.
18:26The decrease in fracture risk was huge.
18:28There was a decrease in overall mortality.
18:30There was a decrease in getting diabetes.
18:32There was a decrease in all cancer deaths.
18:35There were all these benefits, which didn't make any headlines, not a single headline.
18:39There was real anger on the part of women that they had been misled, and I will never forget
18:44one of the interviews that I did was on PBS, Nightly News, when the anchor turned to me
18:50and said, don't you feel guilty?
18:53And I said, what?
18:54She said, don't you feel guilty?
18:56And I said, guilty for what?
18:57And she said, for prescribing hormone therapy that's going to harm women.
19:02What she said was really indicative of how the whole country felt that they had been misled.
19:09But what I saw as far as impact on a day-to-day level, I mean, keep in mind, I
19:13had a busy practice,
19:14right?
19:14So I have all these women who have suddenly stopped their hormone therapy.
19:19So as expected, women who are having terrible hot flashes, brain fog, they can't sleep, they're
19:26having sexual problems.
19:28And one of the things that I didn't expect, because I didn't know enough about it at the
19:33time, was the number of women who came in and said, my joints are killing me.
19:38And honestly, that was not something I was aware of.
19:41At that time, I wasn't a menopause expert.
19:43I want to be clear about that.
19:44I was a general OBGYN.
19:45And I actually said to people, oh, I don't think that has anything to do with your hormone
19:49therapy, which of course, now I know it absolutely has to do with hormone therapy, because part
19:54of the thing that we see with estrogen deprivation is a real impact on stiff joints and arthritis.
20:01We need to be thinking about what are the risks of not having those hormones.
20:06So rather than we've been fiddle-faffing around for 20 years thinking, what are the risks?
20:10What are the risks of having HRT?
20:12We need to spin it on its head and say, what are the risks of not having HRT?
20:17What does estrogen do for improving health for women as they age?
20:21It turns out, well, yes, we know that it does decrease the risk of osteoporosis.
20:26It turns out that that risk of cardiovascular disease that we thought was non-existent was
20:33there, but we found out that it matters when you take estrogen.
20:37When those results came out, what they were looking at was not the same population of women
20:44who routinely start on hormone therapy.
20:47How we normally would give estrogen to women would be around the time of the natural menopause.
20:53Average age was 63.3.
20:56When you know that menopause happens between 45 and 55, we had zero people under 50.
21:0210% of their participants were 50 to 54.
21:05And 67% were over 60.
21:0950% of them were current or former smokers.
21:1236% of them were actively being treated for hypertension.
21:1714% of them had already had a bone fracture after the age of 55.
21:22And my personal favorite is that the average BMI, the body mass index, was 28.5.
21:28Specifically, 35% of all participants were overweight and 34% were obese.
21:36You have to realize, back in the 1990s, only 12% of American women were obese.
21:41But somehow you managed to triple that number and put them in this study.
21:44I don't think that the results of the WHI are universally invalid.
21:51You're just telling me what an overweight, hypertensive former smoker does in response to being on estrogen or estrogen plus
22:00progesterone somewhere like 8 to 17 years after her body's never seen a molecule of it.
22:08So, you can't take that data, extrapolate it to the rest of every woman.
22:15It just doesn't apply.
22:17I think it's fair to say that if you're trying to do a study to prove the prevention aspect of
22:24hormones,
22:25then you should probably give it to women before they get the disease, not afterwards.
22:30And a significant number of the women in that study already were much older and already had significant heart disease.
22:37It was the wrong type of HRT in the wrong type of woman, given at the wrong time as well.
22:47When we look at hormone therapy as a group, we have estrogens, we have progestogens, and we have androgens, which
22:56includes testosterone.
22:57Estrogens are easier, right?
22:58So, we have estradiol, that our ovaries made.
23:01We have estrone, which is made in fat cells, which is not as biologically active.
23:05And we have estriol, which is made in the placenta for women who are pregnant.
23:10And then there's esterotrol, which is now available pharmaceutically, which was the fetal estrogen that is created.
23:16So, all of those can be synthesized in some form.
23:20Some have plant-based, some come completely out of the lab.
23:24When we say body identical, like in the UK, they use that term a lot.
23:27That means estradiol, giving your body back what the ovaries used to make.
23:33Then we have conjugated equine estrogens, which was the most popular form of estrogen therapy given to patients for decades.
23:40That comes from pregnant meriurine, Premarin, easy to make.
23:45I don't love it ethically.
23:46I don't love what they do to the horses to get it, and I don't prescribe it.
23:49But it is where most of the data we have on the safety and efficacy of HRT comes from.
23:53The WHI study was only done with Premarin, and that's where all that data comes from.
24:01When they stopped the WHI, they actually did not stop the whole study.
24:05They stopped the estrogen and progestogen group.
24:09The estrogen-only group went for another two years.
24:12And when that study was released, it was very positive.
24:17The estrogen-only group, particularly in the 50- to 60-year-old group, showed that there was a decrease
24:22in breast cancer,
24:24that there was a decrease in cardiovascular events, that there was a 30% decrease in all-cause mortality.
24:29I mean, think about this.
24:30We have a study that showed people who took estrogen alone had a 30% decreased risk of dying.
24:37So, again, I got it embargoed, so I had my hair done, I waxed my eyebrows, I had my nails
24:43done.
24:43I'm thinking, there's going to be another media flurry.
24:45Not one interview.
24:48Not one.
24:49Nobody cared about the positive.
24:52They only cared about the negative.
24:54So when we talk about the long-term implications of WHI, why is it still rearing its ugly head today?
25:01It's because it was an ugly head.
25:03It was because it said bad things.
25:15Mom!
25:17Mom!
25:19Mom!
25:19When did you go through menopause?
25:21What?
25:22When did you go through menopause?
25:2445!
25:25Oh, shit.
25:29Jeannie is a friend of ours who we've worked with on two documentaries.
25:33She's also in her 40s.
25:35Was it showing up in her life, too?
25:42We're heading out to interview Jeannie now.
25:46Okay.
25:47See you soon.
25:48California.
25:50Remember that song from the OC?
25:52I have no idea.
25:58The first thing I noticed was not being able to sleep at night.
26:02I sleep really, really well.
26:04I would sleep a nice, good, solid, like, seven, eight hours, no problem.
26:08All of a sudden, out of nowhere, I woke up around 2 o'clock, and I would stay awake all
26:13the way till, like, 4 or 4.30.
26:15And then it would mess up my day.
26:16I would not be functional the next day.
26:20Then I also noticed, like, this deep-rooted anxiety.
26:24I have a very front-facing job, you know?
26:26I love the stage.
26:28I love camera.
26:29I'm really comfortable with it.
26:30But then I started noticing, questioning myself, going into, like, spaces.
26:34I've had more talks in the car than I've had on the phone with my family.
26:38Like, I've had to sit in cars or sit in bathroom stalls, talking to myself, working my way through things.
26:44Like, that feels like high school for me.
26:46How come nobody told me that perimenopause feels like puberty going backwards?
26:50When you go through puberty, it feels like this stage so that you can cocoon and turn into a woman
26:55and blossom, and it's all beautiful.
26:58Where's the cocoon after this?
27:00Where's the blossoming?
27:02You know?
27:03Where's the...
27:04Because it's feeling real ugly up in here.
27:12Everybody, if you can gather over here, please.
27:16Happy birthday to you.
27:22Happy birthday, dear Sammi Sidali Sri.
27:30Happy birthday to you.
27:36Woo!
27:37Woo!
27:37Woo!
27:37Woo!
27:40Woo!
27:54I realized that my symptoms began at 35.
27:58My friend, Andri, reminded me that my sleep trouble started years ago.
28:02I was getting hot at night, and I was complaining that my brain wasn't working.
28:08I wish I had known about perimenopause earlier.
28:29People don't realize how difficult it is to get pregnant.
28:34Rosie is a yoga and meditation teacher who suffered from multiple miscarriages in her
28:39mid-30s and didn't get the full support from her doctors.
28:44The other thing that happens when your body, you know, gets pregnant, like, you're going
28:49through all the hormonal changes, right?
28:52There's so much grief and so much sadness.
28:55You just feel like you're such a failure, you know?
28:59You feel like, oh, my body is just, like, what is wrong with my body?
29:06I found a new doctor.
29:08She said that I was in perimenopause.
29:11I came home and I did a bunch of research.
29:14What is perimenopause?
29:15What does this mean?
29:16Can I still get pregnant?
29:18Can I still have a child?
29:20And that was my first main concern.
29:23Shortly thereafter, all the symptoms I was having were making sense.
29:28The depression, the weight gain, the brain fog, the not feeling like myself in my body.
29:52The lack of education and awareness that I find in perimenopause is they've made it this scary entry point of
29:58menopause.
29:59If these changes start to happen, oh, my God, it's coming closer.
30:02It's coming closer.
30:03People are, like, trying to fight it.
30:05They're like, no!
30:05And they're, like, running the other way to run away from menopause during the perimenopausal phase.
30:11This is, like, the perfect time to get people all of the tools that they will need during the menopausal
30:18phase so the transition is not harder, but it's actually easier and more pleasant.
30:22Hi, Rosie!
30:24Welcome to Lexington!
30:27As you know, I was diagnosed with perimenopause when I was about 37.
30:33And I do believe that I'm postmenopausal now.
30:38I do not have periods anymore.
30:40I actually stopped very shortly after I was diagnosed with perimenopause.
30:45And that was as much information as I got from my doctor at that time.
30:49We focus so much on menopause that most people are like, I'm not there yet, right?
30:54And so that's the emotional aspect that maybe you went through.
30:58And I hope that you were able to have someone kind of guide you through that.
31:01But no, we can we can do that today, too.
31:04I know we could do we could do all the things today.
31:07If I wanted to still have a child, could I still have now that I'm post?
31:12Yeah. Yeah. And that that's why that conversation was so like crucial and critical at that time frame,
31:19because menopause, by its definition, means that the ovaries are not giving off enough
31:25estrogen in order to ovulate. The perimenopausal phase, which we were talking about before,
31:30is when your estrogen is just starting to decline, it can take seven to 11 years or less.
31:36So that is that critical time frame in which the conversation should have been had.
31:41And now at this point, being postmenopausal, ovaries are not able to give off enough estrogen.
31:47So naturally, you wouldn't have the ability to give the estrogen to have a follicle.
31:52But if this is something you truly desire, having the option of having a donor egg,
31:57having the option of having a surrogate, and that can come in different forms as well.
32:01And at the end of the day, what is that outcome?
32:03And that's what we were talking about before.
32:05Like, what is your actual desire for an outcome?
32:07And can that be obtained?
32:09Yeah.
32:09Maybe not through the route in which traditionally or, you know,
32:12how you thought before, but still can be accomplished.
32:15Yeah.
32:26I was 13 years old when my mom died of cancer.
32:40She was only 43.
32:45I wonder if she experienced any of what I'm going through now.
32:50I wish she was here to guide me.
32:53Would she have even talked to me about it?
32:56It's just a nice day today.
32:58I will never know.
33:14My name is Dr. Corinne Men.
33:16I'm a board-certified OB-GYN.
33:18I'm certified by the Menopause Society as a certified menopause practitioner.
33:22I'm also a long-term breast cancer survivor.
33:26This year will be 23 years.
33:28I was diagnosed when I was 28.
33:30I was ignored.
33:32I was gaslit about my own symptoms.
33:33I was also ignored, not offered any support from my oncology team or my GYN team
33:40on how to deal with premature menopause or surgical menopause.
33:44I had no warning, nothing.
33:47So that experience has really informed how I practice medicine and how I live my life.
34:00I'm going to go out on a limb on here and I'd say, no, there's nobody who absolutely couldn't
34:06if they were counseled on risks, benefits, alternatives.
34:11But the ones who we are the absolute most careful with and would not recommend it in that present moment
34:20would be active liver disease, active estrogen-dependent breast cancer,
34:27ovarian cancer, uterine cancer, a serious cardiovascular disease like a heart attack,
34:34or an unprovoked blood clot or an unprovoked pulmonary embolus.
34:40If you had a history of any of those things, that's where the nuance comes in.
34:44And that's where we must, we must be respectful of balancing patients' symptoms, risks versus benefits,
34:55their treatment goals, and what the current evidence shows.
34:59The vast majority of breast cancer cases are in women who are not taking hormone therapy,
35:06they're menopausal women, and they don't have much estrogen.
35:11Yeah, huh.
35:13Huh.
35:13Really?
35:14Really, yeah.
35:15So I'll just leave it at that.
35:26My anxiety and brain fog have worsened recently.
35:29I feel like I'm going backwards.
35:33Sadhviana Bhuthi wants to meet with her naturopathic doctor to explore her brain and hormone health.
35:41Maybe her doctor can help me too.
35:48Yeah, thank you.
35:52Yeah.
36:16Yeah, and then, let me fill it at the highly worm.
36:16Yeah, thank you.
36:20let's start with your goals um you had stated that you would like to improve your health and
36:25hormone balance and you would like to understand the impact of past physical and emotional trauma
36:31on your brain is there anything else you want to add to that i want to understand my anxiety and
36:35where it came from i really want to optimize my health like i want to be healthy i want to
36:41be
36:41strong but not only healthy but optimal i want to be healthy i want to be have the same energy
36:48when
36:48i'm 80 years old i want to just mention that the first thing that i notice is this is overall
36:53very
36:53healthy looking skin okay okay so here's this part of your brain sending you some negative thoughts
36:58ah the world might not be a safe place here's this part of your brain sending you some anxious
37:02thoughts this is actually a ptsd pattern it's a diamond pattern oh my goodness you see it very
37:08commonly in people who have ptsd so at rest your brain looks like you have ptsd that actually
37:17makes me sad wow i thought i got past it was it the loss of my mom was it going
37:27to war i've experienced
37:30so much pain in my life is perimenopause triggering my past and that stress response then we see it
37:39right body response right so it's not gone it's still there we know that with support we can see
37:47a healthier balanced brain over time we also know that really early childhood trauma can create a very
37:54high set point on this stress response so there's a lot of aspects here and it's hard to say oh
38:01it
38:01was that or it was that most likely it was accumulation over time is there anything else that i need
38:07to do
38:07as i shift into this new phase of life to maybe navigate through those symptoms a lot easier getting
38:14your system stronger getting your system in better balance is going to help with that what we'll do is
38:19for the first half of your cycle so from day one to day 13 try to eat one to two
38:25tablespoons of ground
38:26flax seeds or raw pumpkin seeds plus you'll take the vegan omega and then for the second half of your
38:33cycle you're going to take evening primrose oil plus some sesame seeds or sunflower seeds every day
38:39cerebellum activation do something every day that activates your cerebellum and i highly encourage this
38:46this is the perfect time of life to add a little bit of weight bearing exercise which is the number
38:50one recommendation that helps to improve bone density bone strength your adrenal hormones really
38:55low your sex hormones really low going into the beginnings of pyramid perimenopause with those
39:02deficiencies is likely to make that a very rough transition for you so now we're going to rebuild and
39:10get you nice and strong as you go into that transition time in your life i'd like to listen to
39:15the body like
39:16you were feeling and functioning much better getting better sleep which is going to help with
39:20everything right when you added the progesterone and then that sleep got disrupted when you put the
39:24estrogen and testosterone maybe we can step back from the estrogen and testosterone continue with
39:31the dhea because that's a really good adrenal support stress support and continue with the progesterone
39:39which made a mark of difference for you when you started it
39:49i'm switching back to just taking progesterone and adding vitamin supplements hopefully this new
39:55combination will help me savi anabuti is eager to try her new natural treatment plan but will it yield the
40:03right results the thing is and i really do understand and appreciate the sort of idea about
40:09the natural approach i have been living in both worlds for my entire adult life the only problem i
40:14have with the quote with being again being married to your natural approach is that if you have not been
40:19properly educated about the risk benefits and alternatives i'm concerned that you're saying no to
40:25something that you don't really understand so again i'm not here to tell everybody they need to be in
40:29hormone therapy but i think if they've just shut down like hormones are not natural to me they're not
40:35they're synthetic so they're not good and that's not part of my life view i'm concerned that you don't
40:43really understand the decision that you're making things like meditating and good diet and exercise
40:49they are helpful but for many women because this is a physiologic process which means it is mostly out of
40:58your control oftentimes treatment specifically with hormone therapy which to me is the most natural
41:06type of treatment because you're replacing the hormones that you're losing can be really immensely
41:13life-changing beneficial safe and effective there's a whole school of the naturopath world not i think
41:20there's some great naturopaths out there i love them but there's there's this you know there's always
41:23factions right that are saying that you don't need hormone therapy we just need to give you stuff to
41:29support your hormones when the factory's broken where the hormones are created no amount of precursors
41:37and and help is is going to lift your levels that's not happening and trying to sell miracle cures and
41:44supplements that are claiming to do that are outrageous and you're just taking people's money
41:49i tried several different vitamins i even tried smoothies where you're supposed to mix these
41:53different like drops of some some some really strong tonic-y stuff to like lots of overload of
42:01herbs like at one point i was having shakes with like extra cilantro in it because it was supposed to
42:06help with brain memory it would be meditation pills smoothies i subscribed to this like juice thing that
42:12promises better brain health and juices none of it worked and that was a lot of money spent
42:18there's a couple things that drive me crazy this idea that women need to just suck it up and just
42:26um
42:27do more breathing do more yoga do more meditation do more stretching be more inner peace
42:32eat more pro you know just it's all fixable if you just try hard enough and we do this we
42:38think
42:38natural is somehow better like oh if i do nothing that's the way i'm supposed to age it's kind of
42:44um
42:46bullshit if you again like hemorrhoids are aging um eyeglasses right i can't see anything without
42:52my contact lenses and i choose to use technology to wear contact lenses so i can see and be a
42:57productive
42:58member of society and so it's really we we tell women that like there's not trying hard enough
43:03there's not working hard enough they can figure out their brain fog if only they eat cleanly enough and
43:09it's just not nice and it's not fair and the other side drives me crazy too the every supplement that's
43:15being peddled that this supplement is absolutely going to cure this problem we peddle so much snake
43:19oil to women and women take it because they're desperate and they want to feel better and they
43:24don't care how much money they have to spend and they don't care what they have to do and they'll
43:28do
43:28anything to feel better and we don't hold those people up to the scientific rigor that we should and
43:33we don't say to them hey snake oil salesman if you think this works so well show me the data
43:41patients don't like to take medication as someone who does clinical research studies i can tell you
43:47that compliance is one of the number one problems in terms of getting people better it's not just women
43:54but i see it more in women because from a societal standpoint we're just expected to suffer you know
44:02we go through our periods and told that everyone goes through your periods but then if you look at
44:06the period simulators when men experience the cramps they're like what you walk around with this and i
44:12tell you we go to work with a smile on our face and we are suffering we just push through
44:17so much pain
44:18as women because we're told that well that's what your mom did that's what everyone does it's the same
44:23for menopause all women go through it so why are you complaining just because we all go through something
44:28doesn't mean that the pain is diminished it doesn't mean that the pain isn't real so i do think there's
44:33that pressure on women from our societal standpoint to just get through it because all women go through
44:39it and it's completely incorrect but most patients don't want to take medication they want to do it
44:44the natural way even what when natural means unstudied and dangerous so most people would rather try
44:52a supplement that's never been studied that's you know could potentially be harmful but if it's you know
44:58if you put a picture of a plant on the cover and you call it natural they'll take it versus
45:02something
45:02that is fda studied like hormone replacement replacement therapy is there a natural way to replace
45:08hormones no i mean if you want to replace hormones you need to use hormones are there are there herbs
45:18that
45:19occupy those receptors that can have similar impacts in terms of symptoms yeah there are do we know that
45:27they're going to do the same thing long term no we don't can i tell you that your bone density
45:33is
45:33going to improve and your fracture risk is going to be reduced i can't i can't so they're not the
45:37same
45:38i will tell you that a lot of my patients will start with herbs and they'll wind up on hormones
45:48estrogen when it declines it increases inflammation but there's so much we can do
45:53to decrease inflammation through nutrition through exercise through mindset through breath work through
46:02meditation there's so many things we can do just in our day-to-day lives to combat the symptoms of
46:10perimenopause and menopause and then also we can add in bioidentical natural hormones that can actually
46:17support our body systems and increase longevity and prevent disease so we can have both we can
46:23look good we can feel good and we can have a long life so as soon as you detect the
46:29hormones dropping
46:30then test your hormones see if you're in the right because i do have i have low estrogen and low
46:35progesterone yeah and i am working with a naturopathic doctor yeah so they should just give you a little
46:40that's and so what she's doing right now we're doing the supplements first like kind of like
46:44fix all my deficiencies right and we just added vitex i don't know yeah just to kind of see if
46:50it's
46:51yeah i can sometimes bring your progesterone up a little bit that's the one we're trying to
46:53cycling yeah we're trying to boost the progesterone yeah i have very low level of progesterone okay and
46:58so um if it doesn't work then uh i'm starting to not understand you're still cycling you'd still make
47:04hormones right right so you don't need to take a whole bunch but just a little bit will help so
47:08i don't
47:09have to wait to have severe symptoms to start taking hrt i can start yeah yeah so you never
47:15have the city why would you want to wait to have severe symptoms my worry is that dependency like
47:22that idea that i'm gonna depend on something for the rest of my life we depend on a lot of
47:28things for
47:28the rest of our lives and i think the thyroid example is a helpful one for my patients of if
47:33you
47:34god forbid get cancer of your thyroid and we have to take the whole thing out we're going to give
47:38you
47:38thyroid hormone forever and i think when you make a decision to potentially try hormone therapy
47:43you can use it forever and you probably should use it forever but you don't have to use it forever
47:48like you can try something and see if it's right for you and then decide to kind of change what
47:53you do
47:53it's just giving you back what you're not even in the same doses but giving you back just a little
47:58we're just filling that gas tank to like a quarter tank or a half a tank and so numbers kind
48:03of matter
48:04here i kind of like numbers here depending on where i am in my cycle my estrogen at its low
48:08is probably
48:0950 and goes to about 150 when i ovulate and then comes back down when i was pregnant with my
48:14children
48:15my estrogen was probably 3000 my husband's estrogen is probably 25 so a man's estrogen is 25 menopausal
48:23estrogen zero right pregnancy 3000 reproductive age you know between 50 and 150 so when we give you back
48:31say we give you estrogen in a patch form we're looking to get your estrogen between like 25 and
48:3650. oh i actually my hot flashes are gone i'm sleeping better my brain fog is gone maybe my libido
48:42is low
48:43and maybe now we take that testosterone and we move it up to like 30 or 50 and then all
48:47of a sudden no
48:47my libido's back i actually responded i actually initiated i had a patient the other day
48:53uh she said i was at thanksgiving and i told my sister i initiated sex and we all went nuts
48:59we
48:59couldn't believe it it's been years since i've done that right these things actually help and actually
49:05can work to make you feel like you again right so that's all we're trying to do does that does
49:09that
49:09make sense yes and i'm starting to change to the way i i'm viewing the hormones so it's been a
49:16lot of
49:16learning and unlearning too but i want to stress how much time you have spent deep diving into this
49:24and the process that it has been imagine your mom in a 10-minute visit once a year with a
49:32gynecologist
49:33where are we supposed to teach women this information where are we supposed to get the
49:37nuances across where are we supposed to undo all the crap that's given to us on instagram how do we
49:42fix
49:42this how do we dig out from this giant mess that we're in it's clear to us that women have
49:49been
49:49hurt by the misinformation and lack of education around perimenopause treatment where do we go from
49:56here lives are at stake our current topic today is menopause
50:12it becomes even very difficult for the female because they don't understand why
50:19my energy is so low why i'm so tired why there is no harmony there is no peace
50:30first we need to understand female's body
50:35every single woman on the planet has to know what is going on with their bodies
50:44i woke up and i just felt like i don't have my edge anymore i don't even have like clear
50:49thinking what is going on and all of a sudden this feeling of you don't matter
51:01so i got in my car and i drove
51:05so
51:17so
51:35Transcription by CastingWords
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