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00:19There is evidence of loss that is weakening your bones.
00:25The number one thing to do for this is weight-bearing exercises.
00:32When we challenge our bones, then we're strengthening our bones.
00:36We're sending the message to our bones to get stronger.
00:47Hormones, also really important, right?
00:50Estrogen has also been shown to be really beneficial.
00:52I've been on this journey to avoiding the hormones for as long as possible.
00:58Just this sensation or this idea that I have not to put anything that I don't need
01:04in my body.
01:05If something is wrong with my bones, I will start HRT if I need to, if that's going to
01:12help me.
01:12Because I don't want to grow older and have a weak structure.
01:18I have so much work to do in my life.
01:22I have so much ahead of me.
01:24I want to have a strong body that will take me to all the places and the things I want
01:28to do.
01:28So now you're rethinking the hormone replacement?
01:32Yeah.
01:32Understandably.
01:33Yeah, absolutely.
01:37We're about to introduce you to a new universe where women actually feel good.
01:44Menopause has the worst PR campaign in the history of the universe.
01:48The longer your body is without hormones, the less healthy you are.
01:51The research has shown that these things increase the risk of cancer.
01:54Adverse effects were increases in breast cancer and cardiovascular disease.
01:58They're dangerous.
01:59That is just not true.
02:01The men at the top have no idea what happens to a menopausal quality.
02:05We are harming women.
02:07If you don't advocate for yourself, nobody else is going to do it.
02:10I wasn't being listened to.
02:12I had to start fighting for my life right away.
02:15You should begin noticing perimenopausal symptoms between the ages of 35 and 45.
02:20This is like the perfect time to get people all of the tools so the transition is easier
02:25and more pleasant.
02:26I don't think hormone therapy is for everyone, but I think that not even putting it into the
02:31equation is such a disservice.
02:32They think that if they take hormone therapy that that's going to solve everything.
02:35It's not.
02:37You're really defying Mother Nature's plan for you.
02:40We have to look at exercise.
02:41We have to look at diet.
02:43Menopause still is taboo.
02:45There's just not a lot of education.
02:46We have to teach about the journey before it's impacting us.
02:51It's going to take a generation of women that stands up and says, not me.
03:14Sadhvi Anubuthi and I were invited to New York to speak about meditation and share our perimenopause journeys.
03:21I took the opportunity to ask Dr. Suzanne Fenske, a functional and integrative doctor, what
03:27I could do to battle this heavy brain fog.
03:30Since I'm in early peri and still cycling, I learned I may only need a low dose of estrogen.
03:44I think the only way the body knows how to communicate with us is through symptoms.
03:50So if you're feeling good, your body is happy, right?
03:54It's releasing the weight.
03:55It's allowing you to sleep.
03:56You're not having anxiety and depression.
03:58When we talk about hormone imbalance, the things that you're going to notice first are the symptoms
04:03within your body and they're vague symptoms.
04:06It can be, wow, I'm just not thinking clearly or my energy levels have plummeted or I can't
04:12fall asleep or stay asleep at night.
04:14That's your body telling you, hey, something's going on here, right?
04:17Your hormones are not working the way that they're supposed to.
04:20So when we're talking about hormone balance, what we're really talking about is just healing
04:24the body, right?
04:26Just giving your body the things that it needs in order to thrive and give you that vitality
04:31and feel wonderful.
04:38When we look at dosing hormone therapy, it's an art more than a science.
04:42This is a trial and error.
04:44What works for you now?
04:47Perimenopause is a journey.
04:48May not work in six months or a year.
04:50We may kind of hit the sweet spot and then we need to adjust.
04:53So you let me know how you're feeling, what your bleeding's doing, what your mental health
04:57is like, have you seen an improvement?
04:59And then we move on from there.
05:04With approval from my provider, I cut my patch in half and immediately started feeling better.
05:20Meanwhile, we're still uncovering the far-reaching effects of low estrogen.
05:26Whenever estrogen levels are dropping, we know that there's going to be, over time, a correlation
05:31with the deterioration of bone.
05:34Well, that's what holds your teeth in place.
05:36So if your bone is not healthy, but it's deteriorating, now your teeth are not going to be as resilient
05:42over time.
05:43Therefore, they have to start working a little bit harder to make sure they're not getting
05:46cavities or gingivitis or periodontal disease.
05:50Can you explain what periodontal disease is?
05:53Yes.
05:53So periodontal disease is chronic inflammation of the gum tissue and a slow loss of bone in
06:01the jaw.
06:02Over many, many years, we see it progress to the point where teeth start to get loose and
06:08wobbly.
06:08As this process starts to happen, and maybe it does lead to early tooth loss, one or all
06:15of the teeth, the difference that the studies are showing that women who take HRT versus women
06:21who do not take HRT, it's showing that they're losing less bone.
06:26Their bone quality is stronger over the years that they're going into menopause and postmenopause.
06:42Sadhvi Anubuthi has an important decision to make.
06:46Because we covered nutrition, we covered lifting heavy, we covered bashing your bones, we covered
06:52the vitamin support.
06:54But the other things, and I know you're still making your decision about what to do about
06:59this, but we start losing estrogen and testosterone in our 40s, right?
07:04The minute we're around 40 and we have 1% of our eggs left, that's when we get into the
07:10chaos of our hormonal fluctuations that are not cyclical anymore.
07:15And for me, it's not that I don't want to take it, it's not that I oppose taking it, it's
07:22more, do I need it now?
07:24Is it too soon to get started?
07:27You know, I want to make an educated decision, and I want to make sure that it feels good here
07:32inside.
07:34And based on your experience, based on your knowledge, you know, I do want to hear, you
07:40know, what is your recommendation?
07:41And especially now, knowing that I am osteopenic.
07:45So I think the two approaches are just do everything now, including HRT, for all the reasons, and
07:51in fact, it may help your energy level.
07:55Okay.
07:55Or do everything, be conscientious, diligent, accept it, and retest your DEXA scan in six months
08:04to a year, and see where we are.
08:10So what are you thinking now?
08:13I'm definitely, definitely strongly thinking about starting my HRT sooner than later.
08:27Yeah.
08:43We have to teach about the journey of our hormones before it's impacting us, so that we're adequately
08:53prepared for the ups and downs of what's to come.
09:02I used to think that because my mom passed away, I missed out on being taught about these
09:07things.
09:08But then again, every family dynamic is different.
09:13Mama Mai, as a Vietnamese mother, God bless her soul, she was way overly strict.
09:19There was never a talk about puberty.
09:20There was never a talk about having sex.
09:21There was never a talk about my boobs or my first bra.
09:25Like, I did most of that myself.
09:26And not because my mom didn't understand it.
09:30Actually, no.
09:31I think, I think, I don't think she understands it.
09:33I've never talked to my mom about menopause.
09:35When I say menopause, what does it make you think of?
09:39Thinking about, like, um, you stop, period.
09:43No more period.
09:44I go to the doctor.
09:46I'm asking for my, my skin is wrinkled.
09:49My neck and my face.
09:50See the difference?
09:52I need the skincare.
09:53And she told me, okay, I give you.
09:55And she doesn't give me skincare.
09:56I look at, that's the vagina cream.
10:00And I told her, I'm talking to my, my skincare, my wrinkle here.
10:05My vagina, very smooth.
10:07No wrinkle.
10:08My butterfly, I'm talking about my butterfly, very smooth.
10:11But why, why you give me the wrinkle cream like that?
10:14She said, no, no, no, no.
10:16I give you this one.
10:17When you have sex, you know, you need to use it.
10:20Because menopause, your butterfly will be dry, not wet.
10:25I say, really?
10:26I didn't know that.
10:27Because, you know, I've divorced.
10:28I never have any men.
10:29I never have sex.
10:30So I don't know.
10:30But if you give it for me for free, I'll take it.
10:33I will try it later, you know.
10:35But I don't know how to try it anyway.
10:36Show me how to use it.
10:38Beginning, I thought she, you know, cuckoo.
10:40You know what I mean?
10:41You can't ask one thing, she give me another thing.
10:43You need to have it.
10:45Otherwise, you're going to get hurt.
10:46You know what I mean?
10:47That's what she told me.
10:48I said, when you have...
10:49That was your first introduction to menopause.
10:51Menopause, that's the one.
10:52So your memory of menopause was vagina cream?
10:58Yes.
10:58Depression.
10:59Depression, yeah.
11:00And moodiness.
11:01Right.
11:02And another thing, forgetful.
11:04Sometimes when you talk to something, just like I'm talking to you,
11:07suddenly I forget what I'm talking about.
11:08I'm actually really surprised, because you know a lot more about menopause than I thought.
11:14Yeah.
11:14This is the first time in my entire 46 years of my life that you have ever mentioned menopause.
11:21How come...
11:21But you never asked.
11:23Why wouldn't you tell me?
11:25If nobody didn't...
11:25If you didn't know about menopause, and you didn't have anybody telling you about it,
11:30why wouldn't you tell me?
11:30Because I'm right around the age where you had menopause.
11:33Don't you want to prepare me so that I don't have to worry about being confused?
11:37Yeah.
11:38You are very busy, and I'm busy, too.
11:39I forgot to tell you.
11:40Yeah.
11:40Right now, I can actually be experiencing perimenopause, which I am.
11:45Okay.
11:45I have experienced brain fog.
11:48I have lack of self-confidence.
11:49Sometimes, all of a sudden, I'm nervous and I'm insecure, like I was when I was a teenager.
11:53Come to me.
11:54I have confidence a lot.
11:55I will teach you more confidence.
11:57Yes, I need to, yes.
11:58Yeah, I will show you that.
11:59This is a conversation that I wish we had more of, Mom.
12:03Well...
12:06Can you say hi, everybody?
12:08Hi.
12:08I say hi, Siddalli.
12:10Hi, Siddalli.
12:11Aw.
12:13Hi.
12:13That's so nice of you, Ka.
12:15Nice to meet you, Coco, again.
12:19How cute are you, Coco?
12:20Coco?
12:21Coco, are you ready for perimenopause?
12:23Coco, are you ready for perimenopause?
12:26One thing that I made a promise to myself about being a mother
12:29is that I am never going to let Monaco experience growing up
12:34and becoming a woman the way I did,
12:35which was secretive, shameful.
12:41Really?
12:43Are you sure?
12:45Are you sure?
12:46I don't look down.
12:46I don't look down.
12:47I don't look down.
12:48Okay?
12:49Mom, I might sit down, Coco.
13:03So, menopause is not talked about in Mexico and Latin America.
13:07Women are viewed as a reproductive entity, right?
13:13So, the value of a woman starts with menstruation,
13:16because she can actually get pregnant,
13:18but it ends when a woman cannot get pregnant anymore.
13:22And I think that represents a barrier for us to access health
13:28and care and knowledge about it.
13:31We feel ashamed about talking about menopause,
13:34because menopause equals, you know, being old
13:38and not being able to function as you were before.
13:42So, women do not like to be associated with the term menopause.
13:48I'm Muslim.
13:49I'm Pakistani.
13:49We have a culture that I think has historically had a lot of taboo
13:54and stigmas attached to talking about menses,
13:58talking about women's health issues,
13:59talking about sexual health issues.
14:01We're 25% of the world population,
14:03but we carry close to 67% of the world heart disease, you know?
14:07And so, we carry a big burden of heart disease.
14:09Pakistan has the highest rate of diabetes in the world.
14:11So, if you think about these medical conditions
14:14that we know get worse in menopause,
14:16when I see a patient who is South Asian in my practice,
14:20I definitely, like, make them aware of what our genetics predispose us to.
14:26If they're considering hormone therapy,
14:27I tell them the cardiovascular benefits.
14:30I tell them, you know, the benefits of their bones
14:32and their brain and everything else.
14:35When we look at our patients
14:37and we look at the difference in ethnicity,
14:38being able to give the foresight and education
14:41behind here's what you may experience,
14:45I think that creates more of an understanding of who you are
14:50and not having shame behind it.
14:54I was taught that black women tended to not have
14:58as many menopausal symptoms as white women did.
15:01Now, where that came from, I don't know,
15:03but that's what we were told,
15:04just as we're told that black women
15:06are not at risk for osteoporosis.
15:08It makes physicians not be curious
15:12about the experience of black women.
15:15And when we have done the studies,
15:17there's a study called
15:18The Study of Women Across the Nation,
15:21which is a long-term study
15:23where they just observed women over time,
15:25and they found that black women
15:27tend to have earlier menopauses,
15:29their symptoms are more severe,
15:31and their symptoms last longer,
15:34as long as a decade.
15:36These are women who are most at risk
15:39and are least likely to bring it up
15:42because we don't talk about it amongst ourselves.
15:44Your physician is least likely to ask you about it.
15:47And even when the women come in
15:50and complain about the symptoms of menopause,
15:53they are only half as likely to leave
15:55with the prescription for hormones.
15:57So we've got a major perception problem,
16:00and I think that this is going to be combated
16:03on both ends, educating women,
16:06to know that, again,
16:07this is not something that you have to suffer through,
16:10but also making you understand
16:12what the long-term health implications are
16:15of those hot flashes and sleeplessness
16:18and all of the other symptoms that you have.
16:21These are things that are harbingers
16:23of cardiovascular disease.
16:25So treating, and particularly for women of color
16:29who are at risk,
16:30is even more of a vital conversation
16:33that needs to be had.
16:38Sadhvi Anabuthi makes the leap.
16:42She has found a bioidentical hormone treatment
16:45that she feels comfortable with.
16:54At the same time,
16:55I feel so much better
16:56on my reduced dose of estrogen.
16:59I'm so close to feeling whole again.
17:02I'd like to revisit my testosterone options.
17:06The brain fog is just...
17:09I think it would be a great idea,
17:10if you're willing to try it,
17:12is to use an FDA-approved preparation,
17:14although FDA-approved for men.
17:16We'll use it in about a tenth of the amount,
17:18and we'll use it on a daily basis.
17:21You'll just use a very small pea-sized amount.
17:24This would be an off-label use
17:25of topical testosterone.
17:28In terms of risk factors,
17:30very low that we're going to face
17:32an adverse event,
17:33given the dosage that you're going to be on.
17:35So in my opinion,
17:37a very, very safe
17:38and very reasonable option for you to try
17:41that is, yes, off-label,
17:43but might be very, very effective
17:45in relieving a lot of your symptoms.
17:53I think testosterone is really a really important topic
17:57about not having an FDA-approved testosterone for women
17:59is really hurting women.
18:01The idea, most of the data that we have
18:02is on low libido,
18:04but there is definitely more to testosterone
18:06than just low libido,
18:07and one of them is urinary and bladder
18:09and vaginal health.
18:10And so we need a lot more data
18:12and research on testosterone therapy in women,
18:14and we have to stop saying to people,
18:16oh, well, there's just no data for that,
18:17so it doesn't work.
18:18Well, there's no data for that
18:20because there's no money in women's health care,
18:22and there's no money in this,
18:23and there's, oh, nobody does any research on this,
18:25and there's no product that's coming out there,
18:27so nobody's even doing the research.
18:28So I get really frustrated with people
18:30who just say, well, you can't do this
18:32because there's no data,
18:32and you're like, where's, like, let's get the data.
18:35Let's figure this part out.
18:39It doesn't make sense
18:40that we don't have an FDA-approved testosterone
18:43or an MHRA.
18:45Most countries don't have testosterone available,
18:48and I think it's because of misunderstanding
18:52and ignorance, actually,
18:53because people think testosterone is for men,
18:57and then you talk to some clinicians
18:59who aren't experienced in prescribing testosterone,
19:01and they'll be so worried about the side effects,
19:04they'll be so scared that they will retreat
19:06and not prescribe it,
19:08so they'll be worried about facial hair,
19:10acne, deepening of the voice,
19:12enlargement of the clitoris.
19:13You speak to women who are on testosterone,
19:15they don't have those side effects
19:16because you're just giving them the right dose.
19:18And also, if people are only talking about it improving libido,
19:23then people will say,
19:24well, we have got other things to think about.
19:26But even our clinic data shows that mood improves,
19:30energy improves, joint pain improves, sleep improves.
19:33If we're giving people the right dose and type of hormones,
19:36often with testosterone,
19:37people then are coming off their antipsychotics,
19:40their antidepressants.
19:44There's a woman called Professor Susan Davis in Australia
19:47who's done a lot of work.
19:49I was going back into her research,
19:51and there it is in 1995,
19:54and it's about testosterone improving libido,
19:57but it's also about testosterone improving bone density in women.
20:02And we just haven't been thinking about that,
20:05but, of course, if it improves bone density in men,
20:08what do you think it might do in women, everybody?
20:12But, yeah, here we are.
20:13We are plagued in our countries by osteoporosis.
20:18One in two women get an osteoporotic break after the age of 50.
20:22We know that giving them their oestrogen back
20:25increases bone density and helps with kind of flexibility as well.
20:29And what about testosterone?
20:32Why aren't we researching that?
20:34Why aren't we asking those questions?
20:36Why aren't we studying people like me in three years' time
20:38who've been taking testosterone and oestrogen together
20:41and looking at what's happening to our bone density?
20:45That's when we met Stephanie,
20:47whose work is paving the way in the United States
20:50for the first FDA-approved testosterone product
20:52designed just for women.
20:55We wanted to be designing products
20:58with these gaps and unmet needs in mind
21:00that were designed by women for women.
21:02We knew that transdermal delivery
21:04is probably one of the most powerful ways
21:06to deliver testosterone,
21:08especially since women only need one-tenth a dose.
21:12And so that's how we identified a therapeutic asset,
21:17a transdermal patch,
21:18that delivers just that right amount of testosterone
21:22that women need.
21:23And really the goal with testosterone therapy
21:25is just to put a woman back in that reproductive age.
21:29What's happened,
21:30because there are no FDA-approved products
21:33for women with testosterone,
21:35compounding pharmacies and the pellet industry
21:38has grown exponentially,
21:40which when you're desperate
21:43and there's nothing that fills that void,
21:45you're willing to do anything.
21:47And I was one of them.
21:48I currently take pellets.
21:51Those are not FDA-approved.
21:53But at the time,
21:55that's really all that was available to me,
21:58and I was so desperate,
21:59I was willing to do anything.
22:01I have had a lot of patients who come to me
22:03and they have tried other forms of HRT
22:05and it just has not worked for them.
22:07And then they have probably converted
22:10to a form of a compounded or a pellet
22:12and they feel much better.
22:14Do I think it has work to do?
22:15Yes.
22:16Do I think that FDA-approved, you know,
22:18compositions of HRT have work to do as well?
22:21Yes.
22:22So I think that me really paying attention
22:26to understanding the patient,
22:28utilizing my education and background
22:30in hormones in general, just as a GYN,
22:34I think that also gives me,
22:36I would say, a lot more validity.
22:38There are some people,
22:39very few that I've put on pellets
22:41who are just like,
22:41you know what, didn't work out for me,
22:43don't love it.
22:43But I'm not going to force you to stay on it.
22:46I will find you other recommendations
22:48and solutions and alternatives,
22:50vice versa, the same way
22:51that someone might be on
22:52a FDA-approved patch or oral form,
22:56who those didn't work for them as well.
22:58So now here's another alternative too.
23:06Riddhika is a long-time retreat student
23:08from Canada.
23:09She has complained for years about symptoms.
23:14I got pellets because I was on this forum
23:18where all these women were talking about pellets
23:21and this is all in the States.
23:22Pellets, pellets, pellets, pellets, pellets, pellets.
23:25Pellets because it brought their libido up
23:27and their sex lives were amazing
23:30and they just love it.
23:32And you introduced me to Dr. Shepard.
23:34I was like, I want the pellets.
23:36Give me the pellets.
23:36I want to try the pellets.
23:37You can also do what we call a pellet.
23:40So a pellet is basically a little,
23:44it's like a rice grain size
23:45and we insert that into the buttocks,
23:48into the skin of the buttocks
23:50and that lasts a little bit longer
23:53than some of the other forms that we discussed.
23:58I was really like, I want to try these pellets.
24:01I don't want to see how everybody else is feeling.
24:05Did it improve?
24:06So that was the result.
24:08So that was the truth.
24:09Why she went with the pellet.
24:10Yeah.
24:11Oh, also actually.
24:13Those conversations are not comfortable with months.
24:15Yeah, yeah, yeah.
24:15Well, because that's what everybody was like
24:17advertising them as, right?
24:19But really, I wanted my brain to function properly.
24:23So pellets are also for brain fog.
24:25And that's what Dr. Shepard also mentioned.
24:34The first time I didn't really see a difference
24:37like in my libido.
24:39I did see a difference in my brain and my energy.
24:44So that was good.
24:45I did feel different.
24:46I did feel better.
24:48And then I came back.
24:50I got some more pellets.
24:52And then definitely the libido thing.
24:56Kicked in.
24:57Yeah, I was like, oh, that's how men feel all the time.
25:05All righty then.
25:06Now I know how he feels.
25:08So I had a lot of sympathy for my husband.
25:15There's nothing inherently wrong with a pellet.
25:17They just, the way that they're being utilized, at least in the U.S., is very problematic.
25:24Pellets are the way for a health care provider to make the most money because they physically
25:28put them in your body.
25:30If you and your health care provider decide, after a full discussion of all of your options,
25:34including the FDA-regulated options, and you and she decide together that this is your best mode
25:41and you don't mind paying the extreme premium and you're fine with that, go for it.
25:45Okay?
25:46So that's one problem.
25:47The second, there's a certain company that makes a testosterone-laden product.
25:51So I signed up to be a provider because I wanted the literature.
25:54I wanted to see what they were teaching because I was seeing patients, and this is across the
25:59board amongst all my health care providers who do what I do.
26:02These women are coming in with male-level testosterone levels.
26:06Sure, their libido is going up.
26:08Sure, they feel great initially.
26:10They're also, the higher your testosterone levels, the more likely you are to have hair
26:14loss, acne, liver issues, toxicity issues, okay?
26:19Clitoromegaly, deepening voice, all the things.
26:21So I looked at their paperwork.
26:23Why is this happening?
26:24They recommend getting a woman therapeutic with no data to support this, not a single
26:30study of 150 to 250, two to three to four times what the natural hormone level would
26:37have been in a woman who is perfectly healthy and functional.
26:40They don't make pellets in low enough testosterone doses to get a woman to physiologic range.
26:47They just put the low-dose men's pellets in the women and called it good and said, hey,
26:51no one died.
26:51They're safe.
26:52If you can't get a hormone, you know, you want to get it in different ways, don't you?
26:56And it's harder in some countries when there isn't any regulated products.
27:01Pellets or implants have been around for a long time.
27:04And actually, before we had the transdermal, the patches or gels, it was really common for
27:09people to have pellets.
27:10And 20, 30 years ago, lots of people in the UK were given sort of pellets or implants after
27:16having a hysterectomy.
27:17And actually, that was a really good thing, just to help their recovery, start them to
27:21feel better.
27:21And then people would often continue it.
27:24One of the reasons that I don't personally, and we don't in our clinic provide pellets,
27:28is because I really like women to be in control.
27:31I like women to be able to change the dose if they need to.
27:34And then the other thing is that the absorption can be unreliable.
27:36Some people find that they do really well, and then they come off quite quickly.
27:41And then it's harder, because then they might need to get them inserted closer together.
27:45And then it's more expensive.
27:47They've got to find the doctor, everything else as well.
27:49And it's quite hard to source them in the UK as well.
27:52So I always try and find a sort of cheaper, easier alternative, if possible.
27:58But if there's not an alternative, it's just another way of having hormones, which is fine.
28:06Three, two, one, switch, go.
28:10Double one, double one.
28:16Sadhvi Anabuthi is determined to reverse her osteopenia.
28:21Though my bones are fortunately very strong,
28:24I'm proactively turning to weights and resistance training.
28:28All right.
28:29Can you go heavier?
28:31I can try it.
28:31I can put a 45 on it.
28:33It's okay.
28:34Just for fun.
28:35Let's try it.
28:36You got it.
28:37I would have laughed if you told me I'd ever be lifting weights.
28:41I'm changing my waist.
28:46My life has changed between finding the right balance of hormones, lifestyle changes, and eating better.
28:53My mood has stabilized, and my energy has increased.
28:57My brain feels activated and crystal clear again.
29:03Sadhvi Anabuthi has made a complete turnaround.
29:10How long have you been wanting to make bagels for?
29:13Years?
29:14Yeah.
29:15And then what did it take?
29:17Two things.
29:18What is that?
29:19Stephanie gave me a starter, a sourdough starter, and energy.
29:24So now I have more energy to cook or bake.
29:27Yeah.
29:28Yeah.
29:28Well, you've always wanted to do that.
29:30Yes, for sure.
29:31I'm excited.
29:32And happy.
29:33Yeah.
29:35I'm happy.
29:36I'm happy.
29:39Charyashree, I have a few questions for you.
29:43I've been on hormone therapy for two years, and so I wanted to get your observations on what
29:51you've seen throughout the two years.
29:54What have you noticed change?
29:56Well, it's absolutely stunning, the result.
30:03I have seen that you have more active.
30:10I notice also that your memory is increased.
30:16The best thing is you used to forget.
30:23So hormone therapy, even though in the beginning I was not in favor of it, but when I found out
30:33this is more natural product, so I favored it.
30:39And it works.
30:42Why it works, why not to accept it?
30:48We're still trying to answer one of our early questions.
30:51Why is it so difficult for women to get proper menopausal care?
30:56I've been on hormones for 15 years, and I went to a new doctor, you know, just in the intake
31:03process, you know, what do you take, whatever, and I told her I take hormones.
31:06She looked at me and she said, you know, I'm not a fan.
31:11And I just remember thinking, you know what I do for a living, right?
31:15I pretty much, I got this.
31:17But that sort of underscores what is happening in doctor's offices all across the country
31:24every day.
31:26Women are coming in, they've had thoughtful conversations with their doctors, they're
31:32on hormones, and then they go to see another doctor who will actively discourage them and
31:38tell them how dangerous, how much this is going to, you know, again, give them cancer.
31:43That's powerful.
31:45That's where that debate is going on, not in the public square, but in the very private
31:51rooms of doctor's offices all across this country.
31:53Women are going to doctors saying, I have low sex drive.
31:57And that doctor is saying, go drink wine and watch porn.
32:02And that is insane.
32:05And now that we have a platform and we're all in one place sharing notes, we can say, wait,
32:11your doctor said that?
32:12Your doctor said that?
32:13Hundreds of doctors are saying this?
32:19Like many physicians, Dr. Barnard has voiced concerns about hormone therapy.
32:25Yet he empathizes with the frustration and distrust many women experience when navigating the health
32:30care system.
32:31Oh, no, women have been treated really well by medical, organized medicine.
32:37No, it's been a disaster.
32:40First of all, a woman will go into the doctor and say, I'm having unusual symptoms.
32:45And doctors have often poo-pooed it.
32:48They thought they were described as being hysterics.
32:51Doctors have not taken women's conditions and complaints and issues seriously enough.
32:58Secondly, they have not provided them the treatments that are healthful and natural for them.
33:02What is it that caused the hot flashes in the first place?
33:04And often it's something natural that a woman can control herself, but she cannot exercise her right to make decisions
33:11over her own body if she's not given the information to make choices.
33:20Here's the thing with patient advocacy.
33:23We say this all the time, what patients need to advocate for themselves.
33:27Well, it's difficult to advocate for yourself if you don't know the information or how to actually have those conversations
33:36with your physicians.
33:38Most women don't know that they should seek out expert help.
33:41And then even if someone does know that, yeah, my doctor is clearly clueless.
33:47I need to go see someone who knows something about this.
33:50Well, that's not so easy because, first of all, there are not that many menopause experts.
33:55If there are menopause experts, quite frankly, there's very limited access.
34:00Number one, many of them don't take insurance.
34:03Why?
34:03Because to do a really thorough menopause evaluation takes about an hour.
34:10Insurance isn't going to cover that.
34:12It's not going to pay for that.
34:14So true menopause experts often find that the only way that they can give the kind of care that women
34:19deserve and that they want to give is to go concierge, to not take insurance.
34:24And then if someone does find someone who does take insurance, it might be an eight- or nine-month
34:29wait.
34:29And particularly if someone's in a small town, there's just not going to be access.
34:34When you look at what's going on in the telemedicine world, I used to be dead set against telemedicine.
34:40Not anymore.
34:42Now I appreciate the fact that for a lot of women, that is the only way that they are going
34:47to get access.
34:48What kind of doctor is supposed to treat menopause?
34:52There's a lot of different doctors that can treat menopause.
34:56There's actually no one doctor that's supposed to.
34:59I think that because menopause, perimenopause falls in womenly things or women's health, there's sort of this historical idea that
35:09that's for the OBGYNs.
35:10But truthfully, I'm an internist and internist family medicine doctors are really well-versed in chronic conditions, chronic health.
35:20We don't need to call perimenopause or menopause a disease or a condition, but it is something that once your
35:26body changes, it always changes.
35:28So in a way, it's chronic.
35:30So doctors who are trained in internal medicine, family medicine, should really know how to treat and manage perimenopause and
35:38menopause.
35:38We really should be educating clinicians, no matter what specialty they're in, what are some of the things that you
35:45might see a woman coming in with.
35:47Cardiologist needs to know about heart palpitations.
35:49The endocrinologist needs to know about hair loss and insomnia.
35:53The mental health providers need to know about anxiety and depression and, you know, ADHD.
35:59And then our internal medicine docs, they need to know about the effects that menopause has on blood pressure and
36:05sugars and weight.
36:06We all need to be in this together.
36:13Drive, drive, drive.
36:14Pop your knee, pop your knee.
36:15Up, drive, drive.
36:16Even.
36:17One more time.
36:17Abs tight.
36:18Use your legs and hips.
36:18Drive, drive.
36:19Pop your knee.
36:20Push, push, push, push, push.
36:21And done.
36:22That's a good job.
36:24Up, three.
36:25Power.
36:25Up, four.
36:26Down.
36:27Up, five.
36:28Up, six.
36:29Ten, twelve.
36:30Up, seven.
36:31Down.
36:31Up, ten.
36:33Two more.
36:33I got you.
36:34Up.
36:36Eleven.
36:37One more for the day.
36:37Always get up.
36:39Up, up, up.
36:40I'm kidding.
36:41And down.
36:43There you go.
36:46Oh.
36:47There you go.
36:47We like to approach hormones holistically.
36:50So there's many things we can do lifestyle.
36:53Then we also do have very safe and effective ways to replace our hormones that we're no longer making.
36:59You know, what we really are looking at is the program.
37:02It's a big picture.
37:03You know, if someone comes to me and says, I am really having a hard time in terms of my
37:09menopause symptoms.
37:10I'm not sleeping.
37:11And they go through the whole list and think that if they take hormone therapy that that's going to solve
37:16everything.
37:17It's not.
37:18You know, we have to look at exercise.
37:19We have to look at diet.
37:22So in my clinic, I talk about the menopause toolkit.
37:24And so when you open up your toolbox, you've got multiple boxes.
37:28The first most important box, I think, is nutrition, really.
37:31No matter what amount of hormones you replace, if your nutrition is not on point, you're not going to do
37:36as well.
37:36And the nutrition I really focus on is around keeping your bones and muscles healthy, keeping your diabetes and your
37:44insulin resistance under control.
37:45Anti-inflammatory nutrition, high fiber, making sure you're hitting your micronutrient goals, shoring up your vitamin D, your magnesium, things
37:51we know that women tend to run low in.
37:53Eating a whole food plant-based diet is critical.
37:57The phytoestrogens in foods are anti-inflammatory.
38:02They're anti-proliferative.
38:03So they really calm everything inside of us.
38:06And it just brings a world of peace, literally.
38:09In Japan, for example, in the post-World War II period, women had hot flashes, but not that frequently.
38:16And when they had them, they were pretty mild.
38:18In the United States, hot flashes were much more common, much more severe.
38:22Japan started changing its diet.
38:25It westernized more cheese, more meat, more grease.
38:29And that was pushing the traditional, more plant-based diet to the side.
38:33And hot flashes went up from about 15% up to, oh, about 40 or 45% by the year
38:402000.
38:40Breast cancer went up.
38:41Diabetes went up.
38:42Obesity went up.
38:43All these problems reflected westernization of the diet.
38:46And to that list, menopausal symptoms should be added.
38:49When you're spending that time on exercise, making sure you're including resistance training to keep your bones and muscles strong.
38:55The holy grail would be five hours of cardio a week and three 20-minute sessions of lifting weights and
39:04lifting heavy.
39:05We want muscle strength.
39:06We want those bones to be a little traumatized, to have good stress put on them so they maintain and
39:13they even build.
39:14Anytime you are putting a stress against the bone, so you are lifting something heavy, the bone is realizing, oh,
39:21she might lift something heavy again, so I must build stronger.
39:24We talk about stress reduction.
39:26For some people, prayer, meditation, journaling, yoga, calling your girlfriend, going out for dinner.
39:31You know, whatever that looks like for you, carving out time for yourself where you can shut out the world
39:36and just focus.
39:37Bringing joy into your life, bringing creativity into your life is so, so important.
39:40Laughing is really good for you.
39:43We release hormones, oxytocin, being around people that we care about, that care about us.
39:48And we talk about sleep optimization, you know, both hygiene, where hormone therapy may be helpful if your menopause is
39:54disrupting your sleep, and really finding ways to prioritize your sleep.
39:59For some women, they have to cut out alcohol.
40:01Alcohol.
40:02Oof.
40:03It has so many ill effects inside your body.
40:06I wish it weren't so.
40:07It messes with your sleep, for sure.
40:09A decision to drink is a decision not to sleep well tonight.
40:12In addition, alcohol is a flat-out carcinogen.
40:16It causes breast cancer.
40:19A drink a day in premenopausal women increases breast cancer by 7%.
40:23Two drinks a day, 14%, and so on.
40:26Post-menopausal, a drink a day increases breast cancer by 13%.
40:30It is neurotoxic.
40:32It literally shrinks your brain.
40:34It makes you stupid.
40:35It decreases white and gray cortical matter.
40:37It elevates cortisol, which elevates a lot of that menopause-induced insanity that we feel.
40:45And if you're drinking to take the edge off, bad news.
40:49That cortisol elevation stays elevated the entire next day.
40:53So now when you come home from work the next day after your drink, you need two drinks to take
40:57the edge off because of the cortisol.
40:59We talk about pharmacology, hormonal and non-hormonal.
41:03Estrogen, progesterone, and testosterone.
41:06There's oral tablets, there's patches, there's sprays, there's gels.
41:11Sometimes people think it's either hormones or nothing else.
41:14And that's just wrong because, you know, I take hormones.
41:17But if I didn't do yoga, my brain would be all over the place.
41:21My body would not be as strong.
41:23My sleep would not be as good.
41:24My mood would probably be a lot worse.
41:26And that's the same with all of us, isn't it?
41:28We've got, you know, multiple tools in our toolkit.
41:30It's not just hormones.
41:53It's not just hormones.
42:02One year.
42:03One year, yes.
42:04Yes, I think I'm going to go for one year.
42:06Wow.
42:06And how do you feel?
42:07Platicame.
42:07Me siento bien.
42:10Siento que la piel se me ha compuesto bastante, dirÃa.
42:16Me siento con energÃa, contenta, sobre todo.
42:21Tienes energÃa para hacer ejercicio.
42:23¿Qué has hecho?
42:24¿Cómo ha cambiado tu vida?
42:25No sé.
42:26Bueno, es que ya ves que realmente yo sà he estado activa.
42:30Me gusta estar activa.
42:33Y sigo igual.
42:34O sea, sigo teniendo energÃa para hacer las cosas que tengo que hacer.
42:38Para salir a caminar, que es algo que disfruto muchÃsimo.
42:42Y el gimnasio.
42:43O sea, me gusta.
42:45Me siento llena de energÃa.
42:47Me siento bien.
42:52Que conociste a la doctora Heber y...
42:55Ay, sÃ.
42:56No sabes qué gusto me da haberla conocido.
43:00Le estoy muy agradecida por la consulta que me dio, por el tratamiento que me puso.
43:06Estoy contenta.
43:08Muchas gracias, muchas gracias.
43:10Qué bueno.
43:11SÃ, realmente a raÃz de lo que ustedes están haciendo, de su trabajo, bueno, pues empecé yo a tener esta
43:21inquietud, a conocer un poquito.
43:23Y estoy muy agradecida, estoy muy contenta.
43:26Súper bien.
43:27Qué bueno, mamá.
43:28Me da gusto.
43:29SÃ, muchas gracias.
43:30Muchas gracias.
43:31Gracias.
43:38La vejez es parte de nuestra vida y es realmente un privilegio.
43:44Llegar, yo hablo por mÃ, llegar a la edad que yo tengo, que tengo la oportunidad de seguir disfrutando de
43:50mi familia, de mis nietas.
43:53Para mà es un privilegio.
43:54Y, bueno, estar ahora con el tratamiento hormonal, pues todavÃa más.
43:59Porque me siento muy bien, muy bien.
44:01Y no, no le tengo miedo al envejecimiento.
44:04Me siento, me siento contenta, me siento bien.
44:14La ruta de spartan es un test de gruelo en el cuerpo, la mente y el grito.
44:19Sadvi Anabuthi llegó con una cámara en la mano, lista para filmar, no para correr.
44:24Pero cuando Dr. Wright inspiró ella, ella no podÃa resistir.
44:27Ella fue a la carrera.
44:29White shawl y all.
44:30All right, let's go, go, go, go.
44:34Go, wow.
44:36See you later.
44:38I can't believe I just did that whole race.
44:41I am proud of myself.
44:43I mean, six, eight months ago, honestly, I don't think I could have done this, like, not even in my
44:49dreams,
44:49because I had no energy at all.
44:52It was hard, it was so hot, and I'm wearing, like, all my layers.
44:57But, you know, I got the medal, so that was really cool.
45:01Good job.
45:05Let's do about 23 miles and 20 obstacles and 97-degree weather, and it was harder than last year.
45:13But nobody that finished thinks they just finished a race.
45:17They feel an accomplishment, like they can brag to their people that they did something bigger than they would ever
45:24think they would do.
45:25And that's the point of bringing women that I serve to Spartan races, because it's not on every person's bucket
45:33list.
45:34But if you can get over the obstacles, carry the weights like you carry your children,
45:41if you can keep breathing through the hard things, that is the point of this race,
45:45to prove that midlife women are not done yet, we've always done hard things, and we still do hard things.
46:13What do you think it's the biggest thing you've learned?
46:19Not to give up on my hormone treatment journey.
46:22I started with a little bit of progesterone, so that helped me to sleep.
46:26But then I started to explore estrogen and testosterone maybe a little bit too early.
46:31And then I started experiencing symptoms, and then I made it worse by adding more estrogen.
46:37I was still always trying to find the sweet spot, and I believed in it.
46:41I didn't give up on it.
46:42Just because it didn't work, yeah, it didn't work for, like, a year and a half, and I felt really
46:46bad.
46:46Yeah.
46:47But I knew that with the doctor's insight and the information they're sharing, that I have to land sometime.
46:55So I would say, like, patience was the biggest thing.
46:59Patience to, and not to give up.
47:01For me, like, the learning that I think, like, impacted me the most was really understanding that hormones are as
47:10natural as they can be.
47:13You know, it's like that misunderstanding or the way we perceive hormones as, like, taking a medication versus, like, it
47:21is something that you already produce.
47:23I think that's the biggest lesson for me.
47:31With progress in D.C. for research and funding towards menopausal health, we must not give up.
47:39I believe that all of this advocacy has caused even our government to think, oh my gosh, something's going on
47:48here.
47:52My hope is that women are listened to, that women are taken seriously, that hormones are thought about in a
47:58different way.
47:59And every woman who wants hormone treatment has it without a fight.
48:04And if that happened, it would be amazing.
48:07I don't know why, but I feel that I have the weight of this entire field sitting on my chest.
48:12And that is my responsibility to teach both patients and clinicians how to do this better.
48:18I don't know why, but I do find that people are listening to me in a certain way, and I
48:23have a voice that people can hear.
48:25And so I yell loudly.
48:32What's your why?
48:34So if you look over there, I have my dad and three of my brothers who have all passed away.
48:40I have two daughters, and I may not have, my genetics are not great.
48:45I just had another doctor comment on one of my posts.
48:47You're a cute doctor, a combination of good genetics and lifestyle choices.
48:50And I had to write her a DM and be like, if you knew my genetics, you wouldn't say that.
48:54My mother's one of seven kids.
48:56Five of her siblings have had cancer.
48:59Of my dad, all of them except for my father had cancer.
49:02You know, when you go through the family history thing, I am checking boxes left and right.
49:05We don't have so much heart disease.
49:07For us, it's really cancer-focused, and I've lost two brothers to cancer and a third to liver failure.
49:13I may not get the chance to watch my kids become the women they're meant to be.
49:18And I'm stacking every card in my favor, every card.
49:22And I refuse to let menopause increase those risks for me to not be here and be with them as
49:27I get older.
49:29Thank you so much.
49:37It's such a powerful message that women need to be educated on menopause, what's happening in their bodies, so that
49:43they don't feel like they're alone, right?
49:45They don't feel like they're going crazy.
49:46And so I think being part of this, being part of a movement, helping women know that they're not alone,
49:52and then give them the answers that they're looking for so that they can go through perimenopause and menopause and
49:56feel amazing.
49:57With proper treatment, it is, like, the best time in life.
50:02Life is great when you don't have periods.
50:04No PMS, no cramps, no pads, no tampons, wear white whenever you want, and you're going to continue to have
50:12great sex and think clearly and live longer.
50:14I always say that menopause comes with a superpower, and I don't know if I'm allowed to say this on
50:19this documentary, but it comes with a superpower that you have no fucks left to give, okay?
50:24You are just not putting up with anything from anybody.
50:28So someone comes at you, and you have opinions, and you don't care who hears your opinions, and that is
50:33magical about menopause.
50:35And I really want women to know that they don't have to suffer.
50:39And if you take the suffering part out of it with confidence, with knowledge, and with empowerment, like, it is
50:45the best time.
50:50It's been two years since my perimenopause journey began.
50:54I slipped into a dark place, feeling isolated, yet pretending everything was fine.
51:00It felt like all my inner work disappeared overnight.
51:04When I discovered it was perimenopause, everything made sense.
51:09I realized so many women are silently suffering.
51:14That's when Sardviana Bhuthi and I began searching for answers.
51:17We sat with some of the world's top menopause experts determined to understand perimenopause,
51:23not just as a physiological condition, but as a profound life transition that deserves more than a quick fix.
51:30Along the way, we found community.
51:33Sharing our stories encouraged others to share theirs.
51:36When women are informed, they make better choices.
51:40And that's how the suffering ends.
51:43There is no one-size-fits-all solution.
51:46What matters most is having the freedom to make informed choices about our health.
51:52Now that I feel like myself again, even stronger than before, I'm finishing what I once put on hold.
52:00The conversation is shifting.
52:03More women are speaking up.
52:05More experts are listening.
52:07But we can't stop here.
52:09Together, we must push for better research, better education, better care, and better support.
52:16For a future where every woman can live fully, in her best health, and on her own terms.
53:01I just wanted to come to you and give you an update.
53:04I feel like a rose that just blossomed.
53:08I'm sleeping at night.
53:09I'm feeling so much better.
53:11And I'm telling all my friends about it.
53:13I'm talking to all my friends about perimenopause and about hormones.
53:17I can't say thank you enough.
53:18I feel like, you know, I'm coming back to myself.
53:22I'm always hesitant to begin something new.
53:26But that doesn't mean that I'm not leaning in.
53:29The next video I make could very well be,
53:31hey, I'm on HRT and I feel amazing.
53:33But for now, I'm in the research phase.
53:37I feel like a brand new me.
53:41A better version.
53:43A version of myself that I could get emotional.
53:47A version of myself that I didn't think I would see again.
53:51And I'm just so grateful.
53:54A version of myself that I can't see myself composition is really wonderful.
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