Menopause Q&A: Top 10 Questions and Expert Answers to Common Concerns |

All right. So you probably have done this and maybe you're doing it today and you know your girlfriends are doing it. We are Googling questions or actually you're probably not even Googling anymore. You're probably ChatGPTing your symptoms and your questions about your body, looking for answers. And I know this because women bring this up with the women they trust. They have questions about what's happening with them., and we do it in community and in groups. And then often we don't go talk to doctors about it because we feel dismissed, and it's kind of a crowdsourced conversation. So today we're going to talk about the top 10 questions women ask about perimenopause and menopause. And some of these are actually coming from the Minerva Lounge. So Minerva is my company that, uh, that provides telemedicine services all across all 50 states., and it's also a technology company. And we implemented about a month and a half ago a Minerva Lounge Monday. And so Monday afternoons we have this, you know, basically open mic Q&A. I call it the karaoke bar with real information. And so a bunch of these questions came out of conversations from our last several episodes. And when you really look at it, these are also the questions that are most asked on ChatGPT, plaud, perplexity, all of your language models, your AI. And so, what I want to help you with is the gap between what you're asking and maybe the message that you're getting from your doctors, because we know that gap is like cavernous. And, you know, women know there's something wrong. Your intuition is 100% right. And this episode is really gonna bridge the gap between some of those really large questions. And I'm also gonna give you episodes that you can go back to, to listen for more information. And this is the perfect episode to share with your girlfriends when they're like, I just don't understand what's going on. And I understand the confusion. I understand the fears and the shared sort of mistrust and also just misunderstanding that every woman has. And we're going to talk a lot about the science. As you know, everything's always grounded in the research. So, you know, I've been doing this for 21 years and, and, you know, the questions and concerns have always been there. But, I think the growing understanding online of women looking up hormone replacement therapy, perimenopause, menopause, other individuals writing books in this space, the documentaries, I've been in a couple and there's a couple more coming out, even the conferences. There's so many conferences about women's health today just around perimenopause and menopause. And, I always get women that kind of sneak to the back and ask these questions. And it usually starts with this: I know this is a stupid question. So first off, there is never ever a stupid question. The questions you are asking are always asked by millions of women. And again, like I said, they're the ones that you're up at night when you wake up in the middle of the night and you're Googling and/or asking chat. So let's really get into this, right? So here's the first question: perimenopause. Right. So menopause has gotten a lot of attention, but perimenopause is still very much misunderstood. And you're not losing your mind. But what I want you to do is validate and understand that 87% of women are actually blindsided by the fact that they are in perimenopause. And if we look at recent research, they did a survey, a very large survey of a large population of women. I can't remember the exact number. And they found that 60% of women were symptomatic with symptoms of the menopause transition, but had no idea that's what's really happening. So if you're like, I, maybe I'm still cycling, maybe it's kind of wonky, or maybe they're totally normal, but I'm having a bunch of other symptoms. You're not going crazy. You're not going crazy at all. And really, like I've said before, if you listen to my episode before and many, many episodes, menopause is technically one day in your life. Which is one full year from the last time you had a menstrual cycle. Now you are then menopausal for the rest of your life. There's nothing magical going on there. Basically, the ovary egg carton has run out. You are completely outta eggs, and those ovaries have shriveled up and they are not doing anything anymore. But 87% of women are symptomatic for 8 years, and that's that perimenopausal transition. That's the average. Right. So I'm going to talk about myself. So I started having hormonal problems when I went off birth control. I was put on birth control at 18, stayed on it because I wanted to control my, my fertility future. And I got off of it and then I had my tubes tied. And so it's really interesting because I never went a long period without having something that might have altered my hormonal trajectory. And so birth control works by suppressing your hormones and your natural ovulation. It irreversibly binds to the estrogen receptors in your ovaries and basically puts you in this sort of pseudo-menopausal state as a woman, which is probably why we see more depression and anxiety in women on birth control. Now, I went through that, so I was on that. A matter of fact, I was actually in the study. So early on, they were trying to understand PMS and PMDD. So this is in the early '90s, and I was in the human clinical study that was trying to approve SeroPharm as a drug, which is basically an SSRI drug that they were trying to promote for that kind of second phase mood issue. And, you know, I used to tell my friends, I was like, man, if I said what actually was going on in my brain, the thoughts I was having, the feelings I was having, if I said those out loud, no one would believe what I was saying. And then it was weird, you know, I'd have my period and then all of a sudden I'd feel fine. And then about 2 to 3 weeks later, it'd start kicking in again. At the time, I was young. I had no idea what was really going on. I didn't know. I, you know, had just entered into— when I got my tubes tied, I had just come out of my master's program in human nutrition science. So I'd been in tech before that, and that was kind of what I did in my free time, probably like you. And so, you know, they didn't go into hormones in my nutrition and biochemistry school, you know, classes. They just didn't do that. And so I had no idea. And so I didn't want to be on birth control anymore. So I decided to get my tubes tied because that would make sure— and actually what they did was cauterize them, so they fried them. And that way I wouldn't, wouldn't mistakenly have children and I could then get off the birth control pill. But what I didn't realize, this is about 36, 37 years old, is when you do that, when you damage the, the fallopian tubes, the, you know, basically the tubes that the egg goes down to get into the uterus, You can actually damage the blood supply and nerves going to the ovaries. And I started having all kinds of weird hormonal symptoms. My hair started falling out. I got big old cystic acne and acne on my face, on my chin, and across my cheeks. Um, pretty big fatigue, hair loss, loss of the outer eyebrow. So everybody thought it was thyroid, and I had probably some thyroid stuff going on, but your sex hormones and your thyroid are tied together. And so, also over the course of about a year, I gained about 35 pounds doing nothing different than what I did the day before, right? My workouts and everything were the same and I just started gaining weight. The other thing that happened is my period started coming closer together. And so, you know, within a couple years, my periods then were almost every 21 days, right? So, what it means is, is I had something that changed my hormone trajectory. I had a tubal, right? But I was in my late 30s, mid to late 30s, and I was really already having symptoms of perimenopause. So when you look at that 8-year window, some people have 16 years or 15 years or 14 years, and then some people sail through with very little. So if you're 36, 37, 38 and you're listening to this, or you happen to be somebody who might be older and you know somebody going through these kind of symptoms, It is not you being crazy. It is truly part of the thing that can happen. And it's really often that first hormone that drops, progesterone, right? Progesterone declines as we come out of our 30s and into our 40s. And that's where we start to see fertility problems. But the symptoms that show up at that time are things that we normally associate with neurological function, brain fatigue, right? Brain fog. Anxiety, depression, insomnia, bitchiness and rage, right? So heart palpitations, loss of libido, even those are all actually more neurological than they are reproductive symptoms. And so the reality is, is you may be experiencing all of those and it could go into your late 30s. And a lot of times you're going to get dismissed because your doctors are like, oh, you're stressed out. Maybe you need an antidepressant. Or a sleep medication. But the reality is your estrogen, your hormone, FSH, follicular stimulating hormone, and luteinizing hormone may very well look normal at this point. And so perimenopause is that window of chaos that you're experiencing that is leading up to things like bone loss and early aging of the arteries and risk for dementia., but those symptoms can last a long time and they can show up early. And so if you feel like you're having those symptoms, it does warrant exploration. Um, Flo, the Flo app that tracks for fertility, did a study on their, their customers. And of the ones that answered the survey in that second half of their 30s, 30% of their users that responded were having symptoms that are associated with perimenopause. In their mid to late 30s. So the important thing here is it doesn't matter your age. You could already be showing symptoms of the egg carton starting to become empty, or that the eggs aren't actually going through maturation and ovulating. You're not ovulating every time, which is where we start to see those symptoms. Um, and here's the thing, your labs could look normal at this point, right? They could, but You're absolutely not fine if you're symptomatic like this. You're in perimenopause and the fluctuation is what matters. The loss of progesterone signaling matters. It's the one that gets highest in the second half of your cycle. So, guess what? When I was doing that study, I— my progesterone levels were not peaking to the level they should have been. And so, I wasn't getting the protective calming effects of progesterone. Now, I'm summarizing and assuming that because no one while I was in the middle of a clinical study ever actually did blood work. They just took my symptoms and either raised or reduced the drug that I was on, which was an SSRI, to test it. And to be honest, I actually took myself and removed myself from that study because the symptoms on the medication were so bad that I couldn't continue. That was my first foray into like, hey, do I want to be part of the science experiment? And I was like, well, I kind of do, but I kind of want more control of it, which is how I ended up really going and doing what I do now with my PhD and everything else. So the reality is, is if you're feeling not fine, you may not be. And yes, you could be in perimenopause even if it seems early. And if you're asking questions about this, if you go back to my October 6th podcast called Giving 100% But Seeing No Results, it's a perimenopause hack podcast where I go into a bunch of different tips of how to actually handle That perimenopause transition, and that one again came out October 6th, 2025. All right, question number 2: Is hormone therapy actually safe? I heard it causes breast cancer. Okay, you— if you've listened to me at all, you know that this question was so absurdly overblown by the Women's Health Initiative and the assertions that they made that it's just, it's just almost farcical. And it's so frustrating that it still the thing that women care about the most, and it haunts women the most. And I want to tell you the truth, and this is where the fear comes from, because you really deserve that clarity. In 2002, the Women's Health Initiative promoted a statistic that wasn't even significant. Now, I'm a nerd, I know what that means. So when you look at a mathematical equation or a statistical analysis, there's a very simple stat— statement. You don't ever use significance in a paper, in a scientific paper, except for this particular statement, because it has a very particular meaning. Statistical significance means it actually is meaningful. If it does not have statistical significance, it's not meaningful, and the number that they're promoting could have easily been chance. Now, the breast cancer thing they're promoting from that particular study, the Women's Health Initiative in 2002, was that breast cancer risk was 26% increased compared to the women who did nothing at all in the older women in the study that were on Prempro, synthetic medroxyprogesterone, and Premarin, right? However, that was not statistically significant, so it shouldn't have even been written up. Instead, they promoted that all through the media, all through the entire— the world grabbed a hold of that statistic and ran with it. And so that's where that whole story came from. No study prior to that showed risk for breast cancer and dying. And really no studies since then, act— if you remove the Women's Health Initiative data and the preposterous recommendations they made, none of the data shows that. And actually, even to this day, we don't show any increased mortality risk with women on hormone therapy or not and breast cancer. So we keep getting told that. And the synthetic progestins were the ones that actually caused that little tiny, not statistically significant increase, which was actually, it went from 3 in 1,000, which is the risk they found in the women that didn't do any hormones at all. It went to 4 in 1,000. Could have easily been chance, actually not even important. Now, 40 in 1,000 would've been huge, but it wasn't that, right? And so every woman still hand rings about the risk around breast cancer when the reality is 310,000 women in 2023 died of stroke and heart attack. 380,000 men did, right? We die at the same rate. Hormone replacement therapy started in the menopause transition is probably one of the most protective things we can do for our artery, heart, and stroke risk. And the reality is, even women who have breast cancer are more likely to buy— die from cardiovascular disease than they will from the breast cancer itself. And it's because the treatments that we use are so damn harsh, they destroy the arteries in the heart. And so heart disease is the greatest killer of women, either through stroke or heart attack. And so the truth is, is more recent evidence shows that women who start hormone replacement therapy have no greater risk than women who do nothing at all. However, it's actually reduced because even in the Women's Health Initiative, the women that were on Premarin showed a 23% reduced risk compared to the women who did nothing at all. Estrogen does not cause breast cancer. And here's, here's another way to think about it. So I'm a logical person, obviously. I'm a scientist, mathematician. Well, math I kind of hate, but I'm gonna be honest, I'm a scientist. So things that aren't logical bother me, especially when it's got, you know, mathematical things that we can look at, science we can look at. So your hormones are totally fine. Until menopause. The synthetic hormones that irreversibly bind to our receptors that they give out like candy to young girls to, you know, reduce the painful periods, acne, everything else. We hand those out like candy, no questions asked. But something crazy magical happens at 50, like this magical dividing line, and the hormones that you have that your body makes itself are deadly. And any hormone that's bioidentical to it, meaning it's exactly chemically the same, automatically is deadly. And the synthetic hormones are okay in certain instances, like an IUD to help you get through it, but automatically your hormones are dangerous. That doesn't work because the average age of diagnosis in the United States for breast cancer is 62. That is a good decade after women have had hormones. So if your hormones are zero, right, your estradiol is zero, your ovaries are out of eggs, where is that risk coming from? You're more likely to have it without hormone replacement therapy than you are with it, and that's what recent research shows. So, all right, now let's go to question number 3: Why am I gaining weight when nothing in my life has changed? So I know this intimately. As a matter of fact, from about 39 to about 48, I'm a nutrition professional. Biochemistry and nutrition is my jam, right? Women's research, nutrition, how to manipulate the body with, with biochemistry is my jam. I have medical people that have worked with me for 21 years in my clinic. I have medical people who work with me in my telemedicine company that works across all 50 states. And I can tell you, for almost a decade, I did not work with people individually with weight loss. I worked with people who had autoimmune conditions, complex biochemical problems, other more complex health problems, but I wouldn't take on weight loss. Why? Because I was 35 pounds overweight for almost a decade because I couldn't figure out what was happening in my body because the things that normally work, high protein, low carb, muscle, you know, kind of focusing on weight training and high-intensity intervals and stress and sleep and all these other things weren't working the way they should, right? So, my toolbox didn't work. And it wasn't until I went back for my PhD that I really started digging into these hormone pathways in metabolism, especially, and how our body gets rid of those hormones and how we process them and how they work on your powerhouses of your cells and how they make a difference on how you burn fat or sugar. That's when I figured it out. And actually, I lost all the weight I gained and got back to my pre, you know, kind of fighting weight before perimenopause. Actually fairly easily once we got everything dialed in on my hormones and I was able to sort of reset that metabolic rate. But this is almost one of the most common questions. So when you're, when you're going through perimenopause, 80% of women will gain 15% of their body weight. So just to do some math for you, if you're 150 pounds going into perimenopause, the average weight gain will be almost 20 pounds to 22 pounds, right? If 80% of us experience that. So that— and it doesn't come on usually suddenly. Most of the time, it's kind of a slow thing. But how many dress sizes is that on you? I can tell you 5, 10 pounds is a good dress size automatically because I'm a Smurf. I'm only 5'3", and so any, any weight gain shows up everywhere, right? Things get too tight. And here's how it happens. When estrogen declines, your body loses efficiency at multiple metabolic checkpoints. So think your body was a Lamborghini and now it is a total, total like 1980s Pacer or something. Your insulin sensitivity drops. Your ability to burn fat and sugar at the cell drops. You can't push glucose into the cells efficiently. Your fat burning mechanisms come to an end and even the nerves that go to your fat cells in your subcutaneous fat, the jiggly bits that we don't like, they take a nap. And so you can't even mobilize fat to get it used. And everything slows down at a cellular level. And here's the thing. The other thing is, is we start losing muscle mass, a slow drizzle, right? So we lose a little bit each year. And our muscles is actually where we burn our fuel, right? They help build your metabolic rate. So we keep losing a little bit of muscle at the same time, unless we're actively looking at trying to build it. And so that means you're going to burn less calories at rest. And when your sleep's screwed up, you will not burn fat. So whether you have insomnia and you can't get to sleep, or you pass out on the couch only to wake up at 2, 3 AM and stay awake for 3 hours or 2 hours and then fall asleep right before the alarm goes on, or if you have upper airway resistance or breathing problems or snoring, all of those things disrupt your deep sleep and your REM sleep. And your circadian rhythm, which makes you more insulin resistant, raises your cortisol, and slows down metabolic rate. So all of that then causes sort of the opportunity for issues. Then as estrogen declines, literally the engine inside your cells, the mitochondria, start to downregulate. So instead of burning all this fuel, you're burning it like half speed, and your fat burning also becomes impaired.. And this is why we're likely to gain weight doing the same things that used to work for us before. Right? So I went into this like a big old deep dive, right? At the beginning of this year, January 26th, it's the podcast called The Real Reason Why You Can't Lose Weight. So if you go back to Menopause Mastery Podcast, go back to the January 26th show. I like, if you wanna understand it at an intimate level, go check out that, that podcast. And share it with your friends, share it with your doctor. They, they probably don't have a damn clue on why you can't lose weight. All right, question number 4: Am I losing my mind? My memory stinks. When will my brain come back? Right? So here's the thing, so many women contact us, come to our Minerva Lounge, come to my lives when I'm, I'm doing live webinars, come to the speaking engagements, and they're like, oh my God, I think I have dementia. Right? Here's the reality. You're not getting dementia, but your brain is changing in perimenopause. And I wanna explain what's really happening cuz it's completely reversible. Right? So estrogen, that hormone is neuroprotective. It's not just a hormone that affects your ovaries, it powers your brain. It specifically helps your prefrontal cortex. So this is that area up here. It's what makes humans humans. It's where we do all of our executive function, computations, memory. You know, planning and protraction. Executive function lives there. Concentration, focus, and planning. That's where it happens. When estrogen declines, that part of the brain literally, like, dims. So, like, I imagine you're in this room and the light keeps going dimmer and dimmer, and you're like, oh my God, where's my readers? Oh my God, hold on, I can't see what I'm looking at. And it's— and it's literally what the brain is doing. We have that on MRIs. We know That's what's happening, right? Your hippocampus, which is the part of the brain that actually consolidates memory. So it puts it together and imagine opens a filing cabinet and puts those memories in and says, this memory was kind of like that one. And so I'm gonna remember this. It's massive amount of estrogen receptors in there, right? So think every file has an estrogen receptor, every drawer, all of a sudden thousands of them. And then when the estrogen drops, that short-term memory turning into long-term memory goes away. It's like the filing cabinet gets wiped. Right. And so that's why you, you know, walk into a room and you're like, oh my God, I gotta do this thing right here. And then you walk into another room and you're like, why is this in my hand? I don't, I don't understand what I'm doing. And the reality is, is because the brain isn't really getting what it needs. So the other thing is, is your brain actually regulates neurotransmitters like serotonin, dopamine, acetylcholine. And acetylcholine is really important to storage of brain function, right? Memory function. These chemical helps you— help you feel good. They help you stay motivated and remember things. And when the estrogen fluctuate, these neurotransmitters become very unbalanced. We often see that serotonin levels may fluctuate, and acetylcholine, which helps us kind of seal in those memories, and acetylcholine has been associated with Alzheimer's risk. Right? All of those things start to be affected by estrogen. So Alzheimer's today, 3 out of 4 Alzheimer's patients are women. And here's the thing, yes, we live an average of 4.5 years longer than men, but our age does not account for that difference because the average length of time somebody has the disease is longer than that. So the reality is, is Alzheimer's is predominantly a female-related disease. It has a hormonal component. What's interesting is things like ALS and Parkinson's don't have as much of one. Doesn't mean that it won't happen in women, but it's considerably less than Alzheimer's. And here's the thing, the hopeful part: research shows that cognitive symptoms that peak during perimenopause and through menopause can improve with hormone therapy. And actually, Dr. Lisa Mosconi's group has already shown that the brain won't go through turning down the engine here or changing the neurons and supports actual hippocampal growth when you do hormone replacement therapy as you start that transition and onward. And so, the reality is that risk for your brain isn't as great if you start and keep on hormone replacement therapy through your perimenopause, menopause, and beyond. Now, I went into a lot of conversations about kind of the brain and the busy brain too. 'Cause the other thing we have to remember is the busier you are, the more stressed out you are, the more it's like your brain gets scattered, right? It's hard to turn on parasympathetic drive, which is rest, restore, and relax. The brain just feels like it's running on empty. So, I had a really great, great conversation with Dr. Romy Mustag about this, and particularly if you happen to be a working woman. And, it's the December 31st conversation, December 31st, 2025. And it was titled The Workplace Crisis No One Is Talking About. Because the reason is, is women, when we get into this state, right, where our brain doesn't seem to work as well, we often start to not take promotions, step back from responsibilities, maybe leave the workforce, have more absenteeism, presenteeism. And actually, if you talk to executives across the United States, We have a brain drain going on in women of— in high-powered positions and that are in a position to also move up because they don't recognize their body in this state, right? The brain is kind of going haywire. And she and I had a really good conversation around her book, The Busy Brain. And so that is a great, great resource to go back to. All right. Another neurological and brain symptom. Why am I so anxious? I was never anxious before. Right. This is a neurological response to hormones and changes in hormones. It's not a mental health crisis. We bucket these things into mental health. And I think because we have so much stigma about those words and, and mental health, that a lot of times people don't want to acknowledge they're having symptoms because they don't want it to be seen as a failure, right. Or a moral failing. Right. Mental health and changes in your body chemistry that affect the way your moods and, and the way you handle things are chemical. They're not failings. Our body has a physiology and, and a chemistry that actually supersede your own experiences and thoughts, right? Your mitochondria respond before your thoughts are there. Right? And they actually respond before your nervous system. So the reality is when our hormones start to go sideways, progesterone first declining— progesterone's job is to help the GABA receptor. So think of GABA as your body's kind of natural Xanax. It's, it's calming, it's relaxing, it helps get to sleep and core body temperature drop, all of that. GABA calms you down. Progesterone helps that work. So when my progesterone levels are abnormal or they're fluctuating or they're starting to decline, it is not uncommon to start feeling more anxious, right? When it's high and functioning normally, you feel calm, you feel relaxed, you feel grounded. Your ability to handle stress works better. And when it drops or loses its power, all of a sudden your nervous system stays in this sort of higher state of activation, wired, right? And if we add to that cortisol, our stress hormone, and the responsibilities of a midlife woman, I don't know, taking care of kids, taking care of probably, you know, other people in her house like a spouse or a partner, potentially taking care of elderly parents, maybe one or two or more, managing a job, managing other people's schedules, managing the emotional load and toil and all those other things. That's a recipe for feeling awful. Right. And all of those hormonal changes will drive that stress response into a much, like, more severe experience. So hormone replacement therapy helps you recalibrate and at least put progesterone, in most cases, back in. And hey, guess what? Estrogen plays a role here too. And testosterone, right? They all do, but progesterone is the one that shows up first in that perimenopausal transition, and then when estrogen declines too, it gets ratcheted up, right? So this is not you, it's not a moral failing, it's your hormones and it's biochemical. And we can also look at how our body gets well in an environment that may very well make us sick. So I've talked about this before on the podcast. For the last 2 and a half, almost 3 years, I helped take care of my mom who had been living alone, doing her own thing, And at 89, she had a heart attack that brought on a catastrophic stroke. And that day, within 24 hours, she went from doing her own taxes, managing her own investments, to a 100% assistance on every activity of daily living and went into an assisted living home that luckily was right down the street from me. And I was very involved in her care daily. And the reality is I was running my company, finishing a PhD. My husband had had a catastrophic leg break On the same day, my mom had her heart attack and stroke, and he was in surgery. And I was— had started Minerva up at the same time. All those plates had to keep spinning, right? I couldn't let go of anything right now. I could take my attention off some of them and recalibrate how much I was spending time on them, but I couldn't walk away from the day-to-day stuff. The reality is, is a lot of times that anxiety and stress and everything else are things that we can't get past. We're gonna have to get well in an environment that may very well be triggering us to be sick. And then your chemistry changing, like hormone changing, just makes it worth— worse. And so, the other things that can help too on top of hormone replacement therapy, because I know you're all about, you know, like, how do I take care of this? Hormones are great, but what other things can I do? Part of it is helping your brain learn how to be more flexible, right? As those hormones change, as we get more stressed out, we start to get more rigid, more black and white in our thinking. We start to lose neuroplasticity, which is the ability for the brain to sort of shift and mold and rebalance itself, which can make us have more fatigue, more pain, more anxiety. I had a really cool conversation with Ashok Gupta about this and their product. And so, if you wanna listen more about this and how to have some activity that you can help sort of drive changes, home here. It was the January 14th, 2026 episode called How Neuroplasticity Can Reverse Chronic Fatigue, Pain, and Anxiety. Great, great conversation because a lot of it is within your power and control. Even if you're not on hormones, we can help our body learn how to control stress when we have the right tools. Alright, now this one, this one is often said kind of, you know, on the down low after somebody gets to know you, sort of behind the scenes, because nobody really wants to talk about it. But it's real. And it's the question of why I don't want to have sex anymore. And is my marriage going to survive this? Because this is real, right? This is really real. I've had so many women over the 21 years I was seeing patients in our clinic, along with our medical providers. And especially now that I sit in talking to the providers for Minerva and the ones that are still working in the clinic, working with people every day. And so many women, this is like a huge deal. And here's the other thing is if their husbands are getting testosterone and they're finally at levels like where they were at 20 and 30, it's not really fair for a woman to be at levels that are about what you were when you were 8 years old. A woman in menopause has the estrogen level of an 8-year-old. A man at the same age has more estrogen than the woman does. And estrogen is one of the many hormones that affects libido, and desire. And it is the main sort of health and sensitivity of your vaginal tissue. So let's talk about the anatomical activity, right? Your, your vaginal tissue needs to stay moist and supple and flexible, right? When we lose estrogen, it gets dry, it gets brittle, and it gets— it's like sandpaper, right? So sex becomes painful and there's nothing we can do about it. You can put lube in there, you can stimulate, you can help blood flow.. But the reality is estrogen helps keep that tissue safe. And it also supports arousal and arousal's interest, right? And, and starting to have those feelings, right? Testosterone does too. Testosterone helps with libido, arousal, and, and also sexual pleasure. So being able to orgasm. And testosterone works mostly on libido between your two ears, right? Between your two ears. Testosterone helps with libido because it helps your brain be more motivated, right? So here's the other thing that most people don't think, right? Testosterone absolutely can help sexual desire. Estrogen can help sexual desire and also make sure that it's not painful to do so. But women's sexual desire comes from their experience, not the physicality. And what do I mean by that? In most cases, we will warm up like a pot of water, but we're not showing up boiling. Right. And I think it's really interesting, you know, talking to men because men don't understand this transition and all they feel is I'm not close to my wife. I'm not getting what I want, you know, and always, almost always in a very loving thing. Like I want to have this passion or whatever. And they don't realize that we could watch paint dry and it would be about as exciting or that it's so painful. We want to do it, but it's so painful that it's uncomfortable. And so, you know, it's, it's all of this, right? All of those things. I'm going to go into a much deeper dive into, you know, sex and libido and hormones. But the reality is you're not broken. Your body has changed. Your partner, if you happen to be partnered with a male, has more hormone estrogen than you do at the same age. And your testosterone has cratered also. Now, relative to your estrogen, it's better, but they're still pro— potentially low, and progesterone plays a role, but less so, you know. And so the reality is you feel like a stranger in your own body, and it does feel hard. Now, there's also other things than just hormone replacement therapy. You know, all of us have heard about Viagra or Cialis for men. Now, it's important to note that those are drugs that were actually created for blood pressure, because erectile dysfunction is more of a vascular problem than it is a hormone problem. When you get vascular disease, what it starts to do is it affects the extremities, right, where your blood flows down to these much smaller capillaries. And so, for men, advancing heart disease, cardiovascular disease, vessel disease, hypertension, diabetes risk, all cause erectile dysfunction. And how those drugs work is they improve blood draw— blood flow. And nitric oxide. And so the other thing is we have to remember that women's physical anatomy, things like the clitoris and the vulva and all of the sexual parts of a woman, also are affected by blood flow and, and arousal too, but very much by blood flow. And had a really cool conversation about this with Dr. with Susan Bratton, and was a story and a conversation about how to revive your sex life. And that one was, uh, quite a while ago. It was back May, uh, 31st, 2023. So, if you're wanting to kind of deep dive and understand it more, and maybe understand a little bit more about the non-hormonal activities that can help with sexual desire, sexual function, and enjoyment, that would be the episode of Menopause Mastery that you want to go back to. And again, that's May 31st, 2023, How to Revive Your Sex Life with Susan Bratton. Alright, question number 7: My periods are all over the place. When do I officially have menopause? Alright, this confusion exists partially by what I was talking about before. You know, some people, their periods get further apart or get really abnormal or heavy or clotty, or they get painful. And then other people's periods get more spread out, or like mine, they get more close together. You know, so menopause again is that one day in your life and the chaos zone is there, you know. So the reality is, is you can be in this chaos zone for a long time, right? And the other thing that never gets talked about, and we really lack the research here, but we're starting to understand this. We know that bone loss accelerates before you actually hit that menopause day. We know that cognitive changes, structural changes in the brain, arterial aging occur as the chaos zone ensues, right? What we don't know is when are you going to have menopause. We don't know. We kind of guess. There's so many women out there that went like 6 months and then they had this stray period and their doctor's like, well, you gotta wait until you go a whole year. All right, so here's the deal. You could go and it just stops. You could go and it fritters out and it sort of comes and goes. You could have, I don't know, a baby late and go through breastfeeding, and bam, you start perimenopause early. There's all kinds of things, right? So when your periods are all over the place, that's a sign, right? Especially if they were somewhat normal before, and especially if you have any other symptom. This is where you really need to look at it. So menopause is 1 year from the last time you had your cycle. Perimenopause can be, you know, 15, 16 years.. And so you want to address it before you go through menopause. Here's the thing that no one tells you. You could still have a cycle every damn month, and your estrogen compared to what it was when you were really healthy, right? Let's say you're 30, is too low. Let that sink in, right? You don't have to have abnormal periods. You don't have to have the loss of period to actually have relatively low cycling amounts of estrogen compared to you where you were. Before. And a lot of times it can be what I like call the bungee cord. It's up here, it's down here, it's up here, it's down here. But for some of us, it's actually, instead of being that wild, it's like relatively low to my normal high peaks, but then I'm like doing this below the line, right? So I'm either all over the place, like I'm jumping above the line and below the line, or I'm actually at the line and below. So know that. Right? So just, just because your period's all over the place doesn't mean you have to wait to do hormone therapy, but it can last for a while. Right? Uh, number 8, joint pain, aches and pains. Is this, is this part of menopause or am I getting old? So Dr. Vonda Wright and her team published a study back in 2024 called the Musculoskeletal Syndrome of Menopause. It's either right at the end of 2024 or early 2025. So estrogen has an anti-inflammatory effect on baseline inflammation, right? So when you lose your estrogen, your inflammation goes up everywhere including the joints. And we have a loss of collagen production as we go through menopause. So collagen helps make ligaments, tendons, and helps make the, the capsulation around your joints which is the bursa sac that holds the fluid that keeps it lubricated. And lubrication dries up. So if your eyes get dry, your mouth gets dry, and your vajayjay gets dry, so do your joints. Right? So everything sort of dries up and then it gets more brittle. And tendinopathy is really common. Right? And so you start to have pain, particularly in your hips. So if you lay on your side and you're like, I'm hit painful there, or my knees, my elbows, my shoulders, my hips. It's very common. And it's because of the loss of estrogen. It's not because you have arthritis.. And many women report that their joint pain goes away when they start taking hormone replacement therapy. Now, if you're like me, I, I, you know, I was sort of a— you say athlete and people think you're an amazing athlete. I was an athlete in training all the time. But the reality is I was pretty rough on my body. I enjoyed what I enjoy. I like cycling. I like, you know, bodybuilding. I like doing those things. And I did some stuff that, you know, kinda wore out some joints. But the truth is, you know, hormone replacement therapy makes a big difference here. Also an anti-inflammatory diet and targeted supplementation, but it's not in your head. That joint pain is associated to your hormones. Alright. Number 9. Hear this all the time too. I talked to my doctor and they either told me it's in my head or I'm not in menopause or my labs look normal or any version of that. How do you advocate for yourself? So this is probably one of the biggest ones on the list because you need to trust your instincts, right? You gotta remember that the doctors that are practicing today were either in residency or just got outta practice when the Women's Health Initiative study hit the ground and all of that came out. They were not trained in menopause. Only 20% of the medical schools actually have training on menopause. That includes OB-GYN and endocrinology. And we're talking less than an hour, right? A third of your life. No discussion in medical school at all. So they don't know how to deal with it. They don't know what they're doing. They don't know how to assess it. They don't know how to treat it. And they have to go get secondary education on their own that they have to pay for themselves to be trained. Then the question becomes, are they trained and what paradigm are they trained in? Are they using the research that's emerging today, or are they using 18-year-old year research that may be very valid, but it's also way behind the current research. The average clinical changes from research, right? So let's say there's a paper that comes out that really turns everything on its head. It takes an average of 18 years for research to make it into clinical practice. I don't know about you, but I'm 56, so that don't mean that I'm gonna be, you know, basically 73, 74 years old before whatever is being published today might get into practice in conventional medicine. Like, come on. I want those changes now, right? I want somebody on the kind of bleeding edge, but also very grounded in the evidence when they're doing hormone replacement therapy. So when you talk to your doctors, do not let them dismiss you. Do not let them gaslight you. And be really specific. So number one, right? Trust your instincts. If your instincts are screaming at you because this person's dismissive, fire them. Just, just fire them. You can fire a doctor, right? It's just like a hairdresser, except a hairdresser is probably nicer to you and has a better relationship with you and much better bedside manner. Second, be specific when you're talking to them. Don't just say, I'm tired. Be very specific about your symptoms. Whatever they may be. I am sleeping by 10 PM, but I wake up at 3 AM and I'm up for 2.5 hours and then I fall back asleep right before my alarm. I can't fall back asleep. I'm, you know, I have, you know, anxiety that shows up out of nowhere. I get my heart rapidly beating, but I go, you know, I'm not doing anything. Maybe I snap at my kids. Be really specific because if you're not, they're gonna dismiss it. And you wanna also be specific about timeframe. I never felt like this before. I didn't have this until X time period, right? You have to be specific cuz that may help them. And then third, if they, they aren't listening, right? Again, that's like, go back to number 1 and repeat. Find a new one, right? There's plenty out there. That's why Minerva exists. That's why my clinic exists. It's why we treat people all across 50 states. We were having a hard time finding people to refer to, so I said, okay, let's build it. We need people who actually understand women's health and want to help move women's health forward. Okay, last time, number 10: do I have to suffer through this, or are there really options? Right, so here's the, here's the deal. Absolutely, you don't have to suffer. There are options for hormone replacement therapy with bioidentical hormones. If there's thyroid problems, thyroid support, adrenal support. Nutrition targeted to your own body's needs and what's going on metabolically, lifestyle modifications, even support for mental health and stress and community. I don't know about you, but most of us are really damn lonely, right? Most of us are really damn lonely. And community is really important. And so women seeking out other women and having the support of our community is great. And community doesn't have to be in person. Most of my community is all across the United States, and we're meeting on Zoom and WhatsApp and all kinds of stuff, and we try and get together. But the reality is, is we can make community wherever we can, right? We don't have to have it built in. And what matters most if you're struggling in this environment is to have a clinician that's working with you that understands menopause and perimenopause and actually can work with you. It's having a community of women that can help support you and, you, you know, help you understand what's going on and know that you have shared experience and you don't have to white-knuckle it. And I would say the other part is understanding how your body works. You know, I always thought this was funny because I'd meet conventional clinicians, whether they were nutritionists or doctors, and they would always be really dismissive, you know, because if you look on every drug insert, like, go look at a statin drug, it'll say right on the top, like in the very top, uh, paragraph, when diet and lifestyle don't work, take blank. And you know, I had doctors say, oh, nobody follows your recommendations or the diet and lifestyle you do. People won't do that. And I was like, that's interesting because people do do that. And when we do that, it's because we understand when a recommendation is given or a diet is given or a lifestyle or supplement or medication when somebody sits down with you and says, here's your body, how it's acting, here's what it's doing in your body, and here's how this intervention is going to change your body and your outcome because this data from this lab shows it, and this is what we're looking to change, and we can test it again. When you have that kind of information, what normal conventional doctors call compliance, I like to call it actually understanding your own body. Becomes really easy. So the other thing I would say, if you're in this situation, I would expect that level of experience. I don't, I don't know about you, but I don't take things just because somebody in a white coat told me to take it. I want to know why. I want to know what's good about it, what's bad about it, what happens if I don't do anything, and what happens if I do do it long-term, right? And what other things I could do that either can do the same thing that aren't medications or that make it work better. And if you can't get that out of your medical experience, you're just being given a pill, right, for an ill, really. You deserve to feel better and feel like yourself again, and you definitely deserve a future of, you know, 20, 30, 40 years that rocks. That rocks. So I've covered a lot of ground here, and I also gave you several episodes you could go back and look at or listen to. And I want to thank you for spending time. And I know time is such a, such a narrow margin that we have. And if you have any questions, you want to know something more, I want you to know you're not crazy and you're not broken. And if you're in perimenopause, menopause, or you're postmenopausal, right, your body is probably asking for support. And we're here to help you understand and, and not only understand what's going on in your body, but figure that out., and we'd love to help you get there. And if this episode gave you something useful, a piece of understanding, a moment of validation, a question to ask your doctor, your best girlfriend, please share it. Share it with friends because we don't need to suffer in silence, and we don't need to just get together and talk about how bad it is. We need solutions, right? So I wanna thank you so much for listening to Menopause Mastery, and I'll be back with you next week.