#265 Help with Menopause Symptoms, Expert Tips from Dr. Doni and Dr. Shilpa Sayana

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Dr. Donnie Wilson struggled for decades to solve her numerous health issues and heal her body. But with focused determination, she healed herself. And in doing so, she discovered the Dr. Donnie stress recovery Protocol. On this show, you're going to hear from doctors, nutritionists and Experts along with Dr. Donnie, who will give practical advice and wisdom to help heal your body. This is how humans heal.

And welcome to how humans heal. I'm Dr. Donnie Wilson and today I'm really excited to introduce you to Dr. Shilpa Sayana. She is board certified in internal medicine as well as functional medicine, and she practices in the LA area, Los Angeles, California. She's here today to talk with us about menopause. She is a menopause expert helping women through perimenopause, menopause, post menopause. And this is something that I help a lot of women with as well. And so we're really excited to talk and share as practitioners helping women through menopause and through decisions about hormone replacement and how to handle both symptoms associated with menopause and prevention of health issues in, in women's lifetime because it's so important to do preventive work during this menopause time of your life. So thanks again so much for joining me today. Dr.

Thank you so much for having me. I'm excited to be here.

Wow, it's, it's so much fun. And here you and I are on opposite sides of the United States and, and at the same time, you know, help seeing what women are going through related to menopausal symptoms. What is it that you observe in the women who are contacting you? What are they saying to you when they reach out to you for help?

You know, a lot of women come to me because they're very frustrated. Like they've gone to their primary care or they've gone to a medical provider and they've complain about symptoms. I have brain fog, I'm gaining weight and nothing has changed. I'm eating the same, my pants don't fit or I can't recall words or I'm just kind of moody and I'm, and I am kind of emotional. And a lot of times I just get discounted that I do want a prescription for Prozac, but this isn't a Prozac deficiency. It's what's happening physiologically in your body. And I think, and some women are like, I'm just going to check my labs on my own. And they go ahead and do that. And it's so frustrating to them because they have to try and figure out up to Google and listening to podcasts or listening to YouTube, how they can actually take care of themselves. But I think women are getting more bold and advocating for themselves and trying to partner with their physician rather than just being told that, you know, nothing is wrong with you, it's all in your head.

Oh my gosh, it's so important. And I think that unfortunately a lot of times women have been told it's all in their head or this kind of gaslighting or dismissing of women's whole hormone related symptoms. And unfortunately that's become kind of the norm. And here you are as a medical doctor, what would you say? I mean, even from someone within the medical, you know, and to be completely.

Honest, like I never got any training about perimenopause, menopause or post menopause in my entirety of medical school or residency. Something I had to seek out on my own because women were in front of me and I knew they what? This wasn't the answer. And that's what led me to go from conventional internal medicine to want that extra degree in functional medicine. I need to understand what's going on and how these hormones are related to each other.

Oh my gosh, I'm so how, how was that for you, by the way? How long ago did you kind of.

Yeah.

Wanted to change what you were offering?

No, it was in my 30s when I was like a busy doctor. I was traveling globally, teaching global medicine to other, other practitioners in other countries. And I had aging parents and I just had a baby and I was juggling all these things and that's when I had my own health issues. And wow, it was really like shocking to be on the other side of medicine and be like, oh, wow, I have to wait for this biopsy result to come back. And it was scary and it was very lonely. And that's something that I never want my patients to be transformed how I approach medicine because my patients, I'm like, I'm here and I'm your partner and we're going to face whatever it is together. And going through that really woke me up to be realized that conventional medicine is just very prescriptive. Like I had a tumor in my neck, was benign, didn't really know what it was. And I was like, why did I even have that? And I remember a good friend and colleague was like, why are you asking why? We don't ask why in conventional medicine. Like which medication can we give you and then which medication can we give you for the side effect of the original medication? And that's when I was like, oh, wow, I need to look for a new body of knowledge. And then I went ahead and got my obesity medicine boards because a lot of my patients were like, I can't lose weight. And then I finally found functional medicine. And through functional medicine, I feel like it really gives you the root cause, but with the same kind of scaffolding that internal medicine gives you. So it's easy to follow. And that's how I found this. And it's been. It's changed my life life that of my families, and that's of my patients.

Oh, my gosh. And so thank you so much for sharing that. And definitely, I want to get to. Because of also your specialty in helping with weight, because weight is one of the common things that women experience with peri and postmenopause. Right. Is this. Tell us more about that.

Yeah. And so you know how I like. And the hormonal cascade is more like the relationships between a family. Think of, like, the adrenal glands, which are like those two tiny glands producing the stress hormone cortisol. That is like the wise grandmother. And then think of the thyroid as a supporting mom, and think of the ovaries as a sensitive grandchild. And the ovaries are going to be sensitive to whatever intragenerational trauma that's happened. So if you've had a ton of stress, anxiety, or inflammation in your life, your adrenals are going to be taxed, and that's going to have an impact on your thyroid, and it's going to have an impact on your adrenals. So a lot of times when patients come to us, they're like, I think I'm in perimenopause. We check their blood, and they're really not. But what they are is the adrenals are shot. Like, they're just not optimal. And that's really why they're gaining weight, because they're craving that sugar. And they're like, I know I shouldn't be having this. I'm so disciplined. But when your body feels like it's being chased by the tiger, because your adrenals are in this fight or flight, you need the sugar now, and it's irrational, and you need to eat it. And that's one of the contributing factors to gaining weight. And also when you're being chased by the tiger, it isn't about. It isn't about burning calories, it's about storing them for future trauma. So a lot of times, if we can help grandma, the wise grandma and impact your adrenals, a lot of times people naturally see weight loss.

Yes. It's, it's, it's so amazing. And thank you for breaking that down. You know, I love talking about stress and the impact of stress, and I love the way you're describing that to really say, hey, we all have stress exposure, but then let's understand how it's impacting us, because ultimately, if we know how it's impacting us, we can do something about it instead of again dismissing it or thinking, oh, there's nothing I can do about the stress because there's a lot of stress in our lives that is just going to be there. We can't. But it's not like we're going to eliminate it all. So how do we help our bodies through the stress so that it doesn't have to go down that cascade, Right. Of going. Hitting the adrenals and then hitting the thyroid and hitting the ovaries and. And then of course, when perimenopause starts to happen and the ovarian function starts to decrease, then it makes it all worse.

Exactly. And that's where I think a lot of times, if you can kind of take care of your adrenals and your thyroid, then you're less likely to just fall into menopause suddenly and you can kind of go into it gracefully without having too many symptoms. We see women going to like, perimenopause in their late 30s just because of all that trauma and stress that they've had. And, you know, usually it's between 45 and 55, but it all depends on how are you managing your stress, which is really your wheelhous, like, how are they managing that. And if they can manage the stress and inflammation, then that transition is just much smoother.

What do you do in terms of helping with stress and helping people to address their stress in order to help with their symptoms?

I think the first thing for a lot of my patients are in their, like, late 30s to 60s, and they just unaware because I'm in Los Angeles, it's a busy city, everybody's on the go. Be traffic, you're dropping your kids, your taking care of your elderly parents. You have a high intensity job and you just got used to this new set of like, I'm ready, I'm ready to react to whatever it's calling me. But I think just telling patients that, you know, you're, you don't have to take so many supplements or so Many pills to manage your stress. It's just about carving the time. You're human. You're not meant to be working like this. How can you carve out the time with some breath work, some just awareness work, sitting in the sun where you don't have to be focused on a gadget or producing all the time. I think women, they intrinsically know this. And there was a study that came out a couple of weeks ago now showing two groups of women with breast cancer, and they were able to kind of show that it's daily stress that actually pushes the cancer to be more aggressive rather than having a sudden stress. I was like, you know, you can be in control of those choices, but it's about the small things that are hard to. To. To choose different, but you can be in control of that. I think making them aware of that first. And when they have some time, like, you know, she's kind of right. I do. This has been a very stressful period. And look, I can see my cortisol went from this to this. And that makes sense. Mm.

And it's. And that's so amazing how, like, to me, I'm always emphasizing that sometimes it's the small amounts of stress recovery we can do on a daily basis that makes the biggest impact, you know, because we assume, oh, I can't take a week or a month off from my life, or I can't be meditating all day. But that's not what's necessary. It can be a small increment.

Yeah, and that's exactly right. Like, some of my patients who are, like, still in the midst of, like, having kids, or the kids are like, middle school or high school, elementary, they're like, I just don't have time on weekends. So I'm like, how can you schedule that during your work week? Since that's the most forgiving, where you could take an hour and just go for a walk. And it doesn't have to be an expensive thing. You don't have to do these expensive classes. But where is this time where you could just be in nature and just walk or.

Get together with girlfriends? Like, I'm really encouraging people to connect because, as you know, in the United States, the biggest suicide in women is between 45 and 55. Wow. Like, women are killing themselves in this age. And this is the age of perimenopause, menopause, post menopause. And you can imagine right there so many things going on in their lives. Their kids are going to college. They might be getting a divorce. They might be reaching their peak in their career, and they're like, is this it? Their parents are aging and they have all these hormonal things happening and can be a very lonely time. So I'm always encouraging my patients, please find community. Reach out to your fellow sisters and friends so you can organize that.

I think this is a really important point, is to emphasize that with menopausal symptoms, or however we want to refer to perimenopausal and menopausal symptoms, one of the most common symptoms is depression. And I think we don't. We hear a lot of times about hot flashes and night sweats and mood changes, but we don't hear depression. And so I'm glad that you're saying, wow, this is a time when actually I heard recently too, that the amount of hormonal flux that happens for women during perimenopause is equivalent or more than what women experience during puberty that way.

And, you know, there isn't much attention given to that. And a lot of times patients don't know, like their mom hasn't talked about it or, you know, there's not. There's not much light and awareness until more recently that like, oh, this is a thing and it happens and you could feel horrible during this time. You don't have to. I do think the mental health piece is something that's very much overlooked. We do know, or at least we can see, that people can get suddenly high cholesterol, high blood sugar, metabolic changes, but the mental health around anxiety, insomnia and depression is very real and can really improve with reducing inflammation and working on hormones. People aren't even aware that this is happening and why.

It'S so important. And I love that you're emphasizing this. And this leads us to. To talk about how it's so important to individualize because I think that we assume that if we're all women and we're all going through perimenopause, that we all are experiencing the same thing or that we all need the same treatment and it's simply not true. We're really finding out that we need to individualize perimenopausal support. Would you say how do you.

Absolutely. Yeah, I would say you absolutely need to individualize it and know. And so what I think when any patient we ever considering hormones or come to see us with perimenopause menopause symptoms, we measuring all their genetics, how do they. How do they detoxify, how do they process their cortisol do and why that's so important. Is that when we give them hormones, their liver needs to be in a good place to. For tomorrow's prescription. So we know, okay, genetically, they're not wired to detoxify. Then what are. What is their gut health like? So every patient, we give hormones, do we measure their gut health? So, and all these patients are like, why? My gut feels fine. But when we do measure it, we see a ton of inflammation. And so we really have to eliminate that inflammation and reduce it. So they're again ready to receive hormones. And we. Exactly what you said. We don't give the same prescription to all women. It's like, where are your hormones now? Which hormone do you need the most? And a lot of times we starting with testosterone. And we might give women a tiny amount of testosterone to help because that's low, but the others look okay. And it's about giving a little bit of hormone one at a time and layering it in so they actually can start to feel like themselves again. It doesn't have to be all these mega doses at one time. And if you're inflamed, you can't process it. And then some people feel much worse with hormones.

It's such an important point. Like our. We have to keep in mind it's not just what we put in, it's how our body can process and metabolize it. And I love that you're talking about how you repair the body. So here we are talking about, like, because what's on a lot of women's minds is hormone replacement. You know, hormone therapy, however you want to refer to it, using estrogen and progesterone. Because as the ovaries decrease their functioning, we can decrease in progesterone and estrogen as well as. As you're mentioning testosterone, dhea. So these hormones that the ovaries make start to decrease. And it can be a little different for different women. Like you're saying sometimes the testosterone drops first or sometimes it's a progesterone or, you know, it's usually all of them that drop at once, unless you have a surgical or. Or ovarian failure or something where they might all drop at once. But usually it's more like a. It's like a moving target over. Over time. And for some women it might be over months and some women over years that it's shifting. Right. And so what you're emphasizing is like, hey, we're not going to just jump right in and give everybody the same hormone dose or the same treatment for menopause. Although we know as We've been saying it's so important to help women. This because so many women have not been getting helped. So we want to be able to help them, and yet we want to do it in a very strategic and careful way. We want to say, hey, before we just put hormones in, let's make sure your body can metabolize the hormones, maybe sometimes even. Right. Would you. And I want to hear your thoughts on all of this. But I completely agree. Like, we want to see if you. Sometimes women's symptoms resolve without needing a lot of hormones.

Exactly. Yeah. That's what I was exactly going to say is that 80% of my patients who come to me and which is a high number, don't even get to hormones because they're like, we're just working on the adrenals, the thyroid and the gut. They're like, I feel 80% better. I don't know if I even want them. Like, my distant cousin had breast cancer. I don't know if I even want to try hormones. And a lot of times we use a lot of herbs. So just to help with that perimenopause to menopause transition, we use things like chaste berry to increase their progesterone, magnesium, B6, just herbs and vitamins to help them maintain some levels without needing actual bioidentical hormones. So it's really. You can treat, you can get a lot of improvement with just good holistic medicine.

And so I really find, as a naturopathic doctor, of course, and this is a thing was for I've been in practice for 25 years now, and I was trained in. As a naturopathic doctor, I was trained in herbs, nutrients, natural approaches to menopausal symptoms. But I was also trained in bioidentical hormone replacement therapy back more than 25 years ago. This is something that I've had in my toolbox and been helping patients with over the years. And the thing was, is that the women's health study that came out three decades ago, or I think it's about 23 years ago now, it's. The media really scared everyone into thinking that hormone therapy was going to cause breast cancer. Like, there was a. Right. The media really made it seem like if you do hormone replacement, you're increasing your risk of breast cancer. And now that's really shifted. Yeah, let's talk about that.

And I think, you know, for anybody above, like, 40, that that whole. Those generations have all been traumatized because it's been kind of pounded into our brains that, you know, hormones equal breast cancer and are bad for your health. And so it would happen so abruptly. Like all these doctors took their hormones off women and women really suffered during that, that decade and only until recently are we. You're hearing it more on social media or doctors speaking out that, you know, breast cancer hor hormones don't equal breast cancer. And the kinds of hormones they use, there were more like synthetic hormones and not bioidentical hormones. And the kinds of populations they were looking at were who had more breast cancer risk, were those who already did have breast cancer risk. So to make those causative statements was misleading. But I had, I have a lot of patients in their 50s, 60s who are like, I don't know, I'm confused. And maybe now the pendulum is swung the other way. I am too scared for hormones. So a lot of that is like, you know, at least can you take vaginal estrogen? Estrogen, Because a lot of women are getting UTIs without any vaginal estrogen. And we know that's safe because we also give it to our breast cancer patients. So at least start there. What natural herbs can you take? Maybe fenugreek, the testosterone, maybe Chase Berry stuff to just make you feel a little better. Because some of my patients are very, very scared and rightfully so because we've been just, you know, impounded by the media.

Really. Really. And, and the thing to know is that they've now reevaluated those studies and there's been more studies because it's been a couple dec. Luckily they've been. There still is not enough research, I don't think, on menopause and how to help women through menopause. But at least we do have some new information as well. And so we've been able to re evaluate it. And practitioners are now saying, hey, let's sit down with the current research and say, what do we know at this point now? It's probably going to change in a year. It's probably going to shift again in another five or 10 years. I'm hoping that it's going to just, just become more and mean more and more help for women through menopause. Because again, it's, it's about helping women with the symptoms we've been talking about. Like, because what can happen is women are getting not only hot flashes, but night sweats and not sleeping well. Then they're not sleeping well, they're more tired, they're more susceptible to so many more health issues also with the weight gain, with the mood changes. And so it's like this snowball effect. This snowballs on women. And, and it shouldn't have to be first of all. So Jeff definitely listening in be like, okay, please know that we're here to help. We in helping women. There are solutions everywhere from diet, nutrients, herbs. As Dr. Shilpa has been saying. We can start with gut health, we can start with so many other things and then we work our way to the point of saying does it make sense for you to try some hormone replacement or hormone therapy and to then individualize it and to really know that you're working with is a, a doctor, a practitioner who understands all of this and will individualize it for you. If would you say? I mean my thinking, Dr. Shilpa is I would say if you're, if you walk in and the doctor just gives you the same prescription they're given to everybody and they're not talking about stress or diet or digestion, that's a red flag.

You should run out of there because they're not understanding who you are. Like you're not an, you're just not, not an average, you're not an average human. It's your. You based on all your trauma that you've had, your hue, you based on your past medical history, the medications and supplements you're taking and your you based on your genetics and where your and how your gut processes things. So that's in a complex conversation and you need to speak to somebody like a provider who understands how to interpret that conversation. So if your practitioner is just ready to give you a prescription and walk out the door in a couple of minutes, you should look for someone else. I just mean to make sure you're feeling heard. I can't tell you how many women feel really dismissed. And you know this whole concept of like the 1.0 medicine was like more of our parents generation where the doctors told you what to do. And then the 2.0 is this pharmaceutical companies that have all these medications and tell you which medication to prescribe. And medicine 3.0 is really patient centered. She decides what she's willing to do and partner with who for her health. Like that's where we need to be and we need to empower women to be like you're in control. We just your guides and you pick and choose and tell us what's right for you.

I love that medicine 3.0 where women can get the information they need to make decisions for themselves, informed decisions and to. And to know that it's not like you, you're going to make this decision and it's this going to stay the same for the rest of your life? Likely you're going to need to see how your body shifts and, and then change your, your treatment based on that. Right. Like most women that I've worked with over the years, it's, you know, we're like, hey, let's see. As your, you were mentioning cortisol is a stress hormone. Maybe cortisol is high. When you, when we first start working with you, we get the cortisol to optimal, but then at some point it might end up going low and we need to shift things or we need, as your ovary function decreases, we may need to shift gears or add something or do something differently. And we do. I love how you were talking about monitoring along the way because most practitioners, most providers who are even offering hormones, hormone therapy.

Yes.

Are not monitoring.

No. And it's so important. And we, we, I tell patients that cortisol is like your fifth vital sign. Like we measure your blood pressure, your respirations, your pulse, we need to know where it is. And in a three month span, a lot could have changed. You could have lost a job, got a promotion, which I'm always like, oh no, that's a good and bad thing. You know, you could have lost a friend or family member. A lot could have happened that could have impacted your cortisol. You have to monitor because it's not like we're living in some static silos. We are humans that are, you know, organisms and relating to the environment and that is going to impact how we process any hormones or herbs. It's important to just monitor. And most women actually appreciate the numbers and once they empowered to understand them, they're like, oh look, my numbers look good.

And we can monitor some through blood work, like doing. And even then I'm sure as, as with me as a functional practitioner, we're looking, looking at, not just, I mean, yes, we're going to do a CBC and metabolic panel and we can run a lipid panel, but there's more that we're looking at in regular blood work. You know, we go to the, say the standard lab and have your blood drawn each year. Right. We want to look also, we want.

To look at things deeper. Want to look at your, not only as an internal medicine, we look at two thyroid hormones, we don't want to look at all five. We want to look at how your vitamins are your, how are you absorbing vitamin D and B12. And you know, sometimes the women are just taking so many supplements and then when we check their Labs, they're not absorbing any of it. So they're just kind of making expensive poop. And we're like, let's try and improve your gut health so you can absorb all these nutrients. But it's important to do a full panel of labs. And also the number one reason women are dying above 50 is from heart disease. It's important to work even sometimes. A lot of times patients are like, oh, I saw my doctor and they said, you know, you should be fine. You have no family history. But we live in a different world. We know that lead toxicity increases coronary artery disease. We do know that stress increases the likelihood of having a heart attack. So we tell all our women above 50 to do a coronary calcium score. And you don't have to go through your insurance here in LA, it's about $200. But it'll tell you, like, what's your plaque here? So you can actually make informed decisions. So it's important to look for somebody who is not going to just be like, they'll be very reactive and say, come to me when you're having issues, but let's be proactive because you are. In this decade where things happen.

I know how scary it is to test positive for HPV virus, virus. And I know it's even more concerning when your gynecologist tells you that all you can do is wait and see if it continues and if it causes abnormal cells. That's exactly why, as a naturopathic doctor and midwife, that I feel so passionate about helping women to be proactive about protecting themselves from HPV virus. I've been helping thousands of women for the past 23 years to do exactly that and to get HPV to negative and stay negative. And that's why I developed the say Goodbye to HPV online program where you can get access to my proven protocol from wherever you are in the world. So I hope you will come check out the say Goodbye to HPV program, review the success cases and see if this is going to be a good fit to help you get your life back from hpv. It's such an important time to, I think, for. Because a lot of times women have been so busy by the time you get to like, let's say, because the average age of menopause is 51, so we kind of get to the 51 and we're like, okay, where am I now in this lifetime? And. And the ovaries are kind of letting us know that it's time to check, check in. And what the studies are Showing is if we can start taking action in your 40s and 50s and 60s, we can be preventing heart disease. We can be preventing also dementia, dementia and osteoporosis and so much at this, when we start at this time frame. So that's why I agree with you. It's so important to say, hey, let's not just look at cholesterol levels, let's look at other parameters, even cardio crp. Right. The high risk inflammation levels. You've been talking about inflammation, how much it impacts. So we can test for that in lab work. We can look at these other factors that give us a better sense of your heart disease risk. And, and, and amazingly, some of the same things that help with fatigue and sleep and other symptoms in the moment actually also end up helping with preventing heart disease and dementia. Right. We. So it's not like you have to do different things. It ends up the same things. Help all of it.

Yeah. And again, we're not like, we're not like a siloed human. We're not with the heart and the lungs and the stomach. We're one holistic organism. And yes, we address a root cause. It has multitudes of impacts, be it the heart, the brain, the gut, your mood and your energy. So, yeah, treating root cause is really the only way to go because you can see so many improvements as opposed to just treating by symptom.

Yeah, I completely agree and, and completely love doing that too, because then we're like. It gets exciting to me especially too when I look at cases, you know, women that I've been helping for more than 20 years and now I'm getting to see what a difference it can make when we've been paying attention to these things over time. It's almost like a, a study in itself in, in a, you know, within a clinical practice to be able to see, wow, when we pay attention to these tests, like you're saying the beyond regular blood work and things like cortisol and calcium scores and, and, and paying attention to, to things like stress and sleep and exercise. And when we do that, it does play out in the end. And the research is really showing that, that when women do that, they can lower risk of heart disease, dementia, osteoporosis. And if you don't mind, I want to touch a little bit more on dementia because it is, I think, a lot more women. Yes, as you pointed out, heart disease is way more common. And I know we're all tend to be afraid of breast cancer, but actually heart disease is, is way higher and Dementia is becoming higher for women.

Yeah. So in our practice, everybody who comes to us in that same genetic panel gets the APOE gene to see even other risk for dementia. I have one APOE gene and so what I know I can do now is really cut out the gluten, make sure that I'm really lowering my toxic burden and make sure that I'm moving and exercising and improving my nutrition. So. And a lot of times women are like, I think I am getting dementia and I'm 52 do. But. And they like, they have so much on their plate, like they have no more adrenal reserve. They're always in this fight or flight state that sometimes when you just improve some of those hormones and optimize hormones like testosterone and estrogen, they're like, oh, I'm back to myself again. And they get reassured. And that's what's important to know. What are your risk factors but what you can do to prevent dementia. Like you were saying, it has to happen in your 30s and 40s in terms of diet, nutrition and anti inflammatory lifestyle practices.

And then there's recent research showing that when women in additionally start estrogen replacement within 10 years of their period, stopping that, that can also help reduce risk of Alzheimer's disease. So we're starting to. This I think is opening our eyes and, and also causing us to relook at what we thought we knew about estrogen. In that estrogen, first of all was not associated with increased breast cancer risk estrogen alone. It was when they combined this equine estrogen with, as you mentioned, the synthetic progestin that it had, it was increased, but it was only increased by one woman out of every 1,000 women per year. So it was a very small increase in breast cancer risk. And what we're seeing now is, is we could just change the progesterone. We can use a bioidentical natural progesterone and not have that risk. And then women can have estrogen like a natural bio. What we call natural bioidentical, meaning it matches with the estrogen that our bodies make in the, usually in the form of estradiol. When we can give women estradiol all. And usually if you have a uterus, you're going to need to combine that with a progesterone. When we do that, it can reduce risk of Alzheimer's disease, but also osteoporosis and heart disease and so much more. Right. So we're like starting to relook at this and go, wait a minute. If women are not using hormones. They're missing out on some protection here.

They absolutely are. And I think, you know, they just kind of piggyback on what you're saying is that we only thought estrogen receptors when they open ovaries, but there's only in the brain. And so by taking estrogen, it can really help memory and mood. But another big important thing that you brought up is bone health and loss of muscle. We see so many women in their 40s and 50s just lose a ton of muscle. And a lot of times they're like super athletic and were super athletic. And now they're like, I still am exercising the same weightlifting, the same, but nothing is happening. And that's where I think hormones like testosterone can really play a big, big impact. Because we just know, at least in male studies, testosterone increases bone density and trabecular growth and bone, but in women it should probably do the same. So it's important to really increase your testosterone levels a bit naturally and with some sort of supplementation so you can preserve your muscle and your bone health.

Oh, my gosh, it's so, it's so true. It's so important. And testosterone often gets missed, skipped over. And so because we put so much focus on estrogen and progesterone, and now there's much more information. You're right. About how, how. And with women, when we prescribe testosterone, we're talking about tiny doses. Go a long ways.

Exactly. We're not trying to make you a little. A big man or a little man. We're just trying to optimize you get to kind of you back to where you were in your 30s or even early 40s, where we can just increase the testosterone level. One thing I think I commonly see with women who come in on testosterone from another provider, and I'm like, I just don't feel, I don't feel any different, is we check the sex hormone binding globulin, and this is a protein that binds up all your testosterone. So sometimes your testosterone levels can be nice and robust, but your free testosterone is so low that you're not able to actually feel it. And that sex on binding organ is a protein that's the culprit. And in doing that, and you can lower that by either taking minerals, reducing gut inflammation, putting yourself on a detox. So it's important to like, look at the whole picture. And testosterone, yes, you have great testosterone, but can you actually make use of, of it?

And I love that earlier you mentioned the vaginal estrogen. So I want to come back to that because this is, this is such an important distinction. A lot of times when women are thinking, well, I, I'm not having hot flashes, I'm sleeping well, I'm feeling okay, so I don't feel like I need any hormones. And yet we know that with menopause, estrogen drops vaginally. And when estrogen drops vaginally, we become more susceptible to vaginal infections. And including yeast, BV and hpv. I see a lot of women high risk HPV and abnormal Pap smears after menopause. And I think a lot of it is because of the estrogen drop. And you mentioned earlier bladder infections. It's so common. Women, as soon as someone starts getting bladder infections, I'm like, we need some estrogen because it really affects, let alone just pain with sex and discomfort in general. General.

And it's such a tragedy, I think, for conventional medicine to not emphasize that enough because I've had women come to me who are older, who are now resistant to all kinds of antibiotics, and they got in such a bad shape because they've been getting multiple antibiotics for UTIs, whereas if one provider had just offered them vaginal estrogen, they would have probably got no more UTIs and could have saved their gut and also their mental health was the gut's inflamed, it's going to impact your mental health. So if they could have prevented the, that just by offering that option. And again, it's conventional regular medicine, it's studied, it's understood, but they just didn't have the time or didn't go to a practitioner who was willing to do that.

So just to be clear, when, when a woman uses estradiol or estriol for that matter, there's two different estrogen use vaginally, E2 or E3. And when we use estrogen vaginally, it mostly stays vaginally.

It.

It's not considered systemic. So when you put in estrogen vaginal vaginally, most of it stays vaginally and helps with the vaginal area and the urinary area. And only a small amount goes around your body. So it's not considered systemic. And it doesn't require that you add progesterone. You could just use some vaginal estrogen. You also don't use it daily. Usually it's. You use it for a few days in a row and then maybe you're using it once or twice a week ongoing. But essentially, essentially what I'm hearing is that this is. Women need to be thinking about vaginal estrogen Postmenopausally as something that's just they're going to keep using it some consistent way through the rest of their life in order to, as you're saying, prevent infections and the need for antibiotics.

Absolutely. I think being on vaginal estrogen is really a no brainer. I wish it was less messy though because it can be kind of messy to apply but it's so important to lubricate that tissue. Especially when women tell me how painful sex can be be and you know, having lubricating gels and vaginal estrogen is just something that it needs to happen. We need to educate the younger generation so that it's something they can advocate for as they get older.

I love that because a lot of times in the past women didn't talk about menopause. They didn't. And even now women don't tend to talk about vaginal symptoms or what they're low libido.

Like it's just not something that we, we're talking, we're talking a little bit more about it now. But testosterone can really help that. And there's one prescription that I tend to use I guess most the one the, the pharmaceutical rep was like you're the most the biggest prescriber of this medication in your multiple zip codes. And it's just unfortunate that sometimes women have never heard of it. It's ib, A D D Y I and it's a medication that works on your amygdala and increases libido and the likelihood of you orgasming. So it's an important medication. And it's kind of sad right, in terms of medicine because for about multiple years you couldn't prescribe it. As a physician, you had to watch a webinar because it could cause dizziness and maybe sleepiness. But Viagra can cause death and none of us had to watch a webinar. So finally that's not a requirement anymore. But it can really help with libido and interest. The only side effect is you do get sleepy. So plan around that. But things you can do that maybe you know, not if you're scared of hormones or if hormones are not any us.

And also maca, there's some amazing forms of maca that can be have research has shown has helped with various symptoms including libido. And so when women are like, oh my gosh, what, what? Because I'm so glad you're mentioning libido. It's another important symptom that women deal with and they're like what can I do? And there definitely are natural approaches. There's the testosterone we mentioned. And. But it's also like, we have to be so careful because we don't want to just be like, okay, testosterone's the magic pill for this. Right. We have to be like, let's look at full health. Let's make sure the vaginal area is supported. And then we can even try, you know, herbs like maca, which could be helpful for libido. And sometimes we do these things in combination. Right. Like you might be using estrogen, progesterone, testosterone, and maca or eggplant. Exactly. And the medication.

And I think a big thing also is just to remind women also that it's about the human connection. Right. If your partner is, you know, that you need to go on date nights, he needs to help you with the dishes, all that stuff is sexy. Like, you need to get all that in play. And it may just be not just like a physical thing, but you need that connection to even be attracted to him or her.

And there, there again, too, I think, think that relationships are shifting. I don't know if you're noticing this too. The way, you know, women are communicating their needs in a relationship and how men and women are working together in relationship is. Is shifting. And so, you know, just noticing that and being open to that and, and to know that, you know, it's more important, like you're saying, to know yourself and, and your relationship and to communicate and. And that that's all possible.

And then also, then going back to your statement about a practitioner who's just going to give you the same dose for everybody, it's also important that they ask you, like, what is your. How is your libido? Are you having pain with sex? Like, if it's, if they're going to open up those doors, that's important because it allows you the space to speak. But sometimes when your practitioners aren't even asking, you might feel shy to share.

Yeah, that's so important. I love this that we, Dr. Shilpa, we've essentially, in. In this interview, we've essentially come up with what you should be looking for in your doctor who's helping you with menopause. What should they be asking you? What could you be asking them? I'm. I'm loving this because I think maybe from in the notes, I might be able to even consolidate what we're talking about into a list for women to say, yeah, what. What to look. Is there anything you would add? Like, Yeah, I would probably quickly say.

And I'm happy to share with you our to share with your listeners, our hormone longevity panel. Like, it just goes beyond hormones. It's looking at do you have ana, which is a common autoimmune marker that kind of creeps up in perimenopause menopause. And once you have one autoimmune, you're more likely three times more likely to get the second. But you can reverse that with good functional medicine. So asking your provider to be like, this is a list of labs I want. Here are some diagnoses that usually work with it and usually insurance covers it. Ask your provider and just be aware of what those labs are. So that I think when patients advocate for themselves, even the practitioner is like, okay, I need to take her seriously. I shouldn't need to. But sometimes it helps. I don't have to.

I do that all the time too with patients. Like, you know, go. Because when you have a provider that's under insurance, right? Because a lot of times as much as we can, if you can get good work done under insurance, then it's like, okay, but you just need to know which test to ask for. Because your doctor might not know as you. You're saying you didn't learn these tests in medical school?

No, I didn't. So we active in medical. The whole conventional medicine.

So don't be surprised if you go. If you're going to your medical doctor, they may not be familiar with some of the things we're talking about here. This is. And you.

And you can just say, you know, I'm curious about these tests and, you know, could you partner with me in ordering them and just really. So you can really try and work with them because they're just another human trying to do their job. So if you could just kind of approach them with kindness, I think they would approach you with the same environment return and you could help them. Like, you have the diagnosis codes, a lot of those covered through insurance. But I'm happy to share that with any. All the listeners and they could advocate for themselves.

And it's so true. Because sometimes that's what stops a provider is if they don't know which code to use. It can be something so simple as that. Like, but if we can go, here's the test, here's the code so that it can be submitted under insurance so that you can get the information. And then once you have that information, then you might be finding, hey, my provider doesn't have the information about how to help me. But that's when working with a functional practitioner sometimes then can help you get more information because it's true. So many, as you mentioned, so many women are googling and searching, what about this? And you can get some good information online. But at a certain point you, especially if you're wanting hormones by prescription, you're going to need a provider who can help you do that.

And don't go to provider, like kind of coming back to what you're saying, who's going to prescribe everything and say come back in a year for your refills. Like you need to be monitored and that's just important. And you need to, you know, be comfortable with the practice, practice the provider you're going to. And you feel like they hear you and that they're going to order the right test and then not make you into another provider. Like they should be able to guide you and take things off your plate as opposed to telling you to like go research these labs and you know, do more things. Which I know as women we have so many things that we juggling already.

Absolutely, absolutely. So it becomes a partnership. And then that's how I look at it. And with, with my patients, I find too that it works where it's like you can go. Then you, if something comes up, patients call us and say, hey, this is what I'm noticing. What can I do? Sometimes we need to adjust a dose. Sometimes we need to come down on a certain hormone dose and add something else to help with the symptom. Like if. Right. If some sometimes experience breast tenderness, for example, then we go, okay, let's decrease the estrogen and let's increase something else to help with this so that we can fine tune. It does take some fine tuning until we go, oh, this is perfect for your body. But that's all possible. Maybe we can just touch on. Because I'm, I'm so grateful for having you here, Dr. Shilpa. And all this information, it the difference between. Because I think for some women the concept of a compounding pharmacy may be like. So when we're talking about hormones like estrogen, progesterone, testosterone, some of them are available through pharmaceutical companies, which means they would be. You could likely get them at a standard pharmacy like a national pharmacy. And then some of them are not available through national pharmacy. We're going to need to have them, what's called compounded and pharmacy or sometimes we might want to use a compounding pharmacy because they can make more individualized dosing of more natural ingredients.

Exactly.

Yeah.

So we, we try as much as we can to use stuff that people can get covered through the insurance. So we use bioidentical estrogen like the Vivel patch and the bioidentical progesterone like Prometrium. But a lot of times we might have to look at a compounding pharmacy because people might be allergic to peanuts and peanut oil is in that progesterone. So we might to do a peanut free oil or the progesterone orally, or we might need a sustained release progesterone because the regular progesterone is just not enough to keep them sleeping. And for testosterone, there isn't an actual commercially available testosterone for women. So that one is always compounding pharmacy. And it's important to go to a practitioner who does this a lot because the price difference can be huge. And so the practitioner should tell you that, you know, this is this compounding pharmacy we use often and they price it. I think in the LA area you can get progesterone or testosterone for like 100 bucks for three months. And that should be something that you should ask a practitioner because it doesn't matter if they give you the prescription, but if it's completely unaffordable, then you can't use it.

Then you're like, I can't keep up with this anyway.

Exactly.

Oh my gosh, thank you for that. Yeah, it's. And so just know that when you're talking to a provider, they're going to be thinking this through. Okay. There's different options. We can go with this one if we want to try to get as much of a cover covered. And then if we want these options, we're going to need to go to a compounding pharmacy, which is going to be out of pocket. But it allows you to get oftentimes that the doses that really match your body. So sometimes women are making that decision, hey, I want to look at my budget and figure out how I can. You know, I think another thing, you.

Know, you were saying that a lot of women in perimenopause about 40s are getting abnormal pap smears and having HPV. And I think a lot of my patients are like, I, I'm done with the Pap smear time and not thinking about hpv. How do you approach your patients who end up coming to you with hpv? And what do you do that really reverses that?

Ah, thank you for asking. Well, and this is the thing. I think it is really important for women to know that it is still important to do, and I would say even more now it's becoming important to do the HPV test. So yes, we're used to thinking of the pattern test, but what's becoming more standard is to go in on a regular basis and have a vaginal test for high risk hpv. You can also often get them from a, like a home test, like a provider, like I can, we can order a HPV test without even having to do a Pap smear. But the point is, especially if you have new sexual partner, especially if you've ever tested positive for HPV in the past or had an abnormal partner Pap smear in the past, but really, I would say in general, women should still be thinking about doing an HPV test even if you've had a hysterectomy, because you could get high risk HPV happening, especially if you've not been using vaginal estrogen. So then the HPV comes in and it starts to cause abnormal cells after menopause. And I would say even for women into 65 and beyond, especially if you're still sexually active, you're going to want to be monitoring for high, high risk hpv. Because if high risk HPV is positive, then we can do a Pap smear, then we can do a colposcopy if necessary to look for abnormal cells. And there's so much we can do to help prevent this. And number one for anyone postmenopausal is going to be making sure you have vaginal estrogen and that we address the vaginal microbiome. You were talking, we were talking about the gas, the gut microbiome. And that's so important too, because the gut microbiome influences the vaginal, vaginal microbiome. And there's so much now we know we can do with both oral and vaginal probiotics to get those. Because we, I think about the vaginal bacteria as like the bouncers, right? They're like our protectors. And if we have estrogen and we have our, our bacteria, healthy bacteria, vaginally, that's going to just make it so the HPV can't come even if you get exposed to it, it's going to bounce it right out of there and you're going to be protecting, protected. But unfortunately, if we're not being told that we need vaginal estrogen and we've been on antibiotics and the vaginal microbiome gets disrupted, now we're susceptible. And so those are some of the first steps I take with helping women to, because it's important to know that you can get HPV to go to negative, you can prevent certain Cancer. And we also go through some of these same things we were talking about today. Everything from stress helping because we know that stress makes us more susceptible to HPV as well. And diet nutrients. We do some of this same specialty blood work to say, hey, are there nutrients that are depleted? I see that very often. And we want to help with the hormone balance and the hormone detoxification, reduce toxin exposure. Those same buckets, so to speak, things that make the same root causes that make us susceptible to other health issues also make us susceptible to cervical cancer and hpv. So we go through that process and we go. And I see amazing, amazing things, amazing turnarounds. Women have been often unfortunately told that they are not going to be able to clear HPV or that they're going to have it forever or they're just going to have to deal with more biopsies and procedures. And lo and behold, all we had to do was go through this process that you and I are talking about and optimizing levels. And all of a sudden, then their body clears the virus, it goes away. No more abnormal cells, and they're free of that situation.

Wow.

And. And so it's. It. I'm. Yes. I'm just so passionate about health.

That's so amazing. And then in terms of, you know, self collecting, I'm sure some of your listeners are curious, is that painful? They can do it themselves.

Yeah, it's like a, just a swab. Like it's almost like a Q tip. But you put it in there definitely. So you can. Yeah, there's, you know, the, there's a company called Microgen and there's a couple others as well, but I like theirs because they also run a vaginal microbiome panel. And they run a vaginal HPV panel. And it's something.

Yeah.

Women can collect as simple as a little vaginal swab at home.

Amazing.

And so it's putting that power back in women's hands, right?

Yeah. And I think a lot of my post menopausal women are terrified of getting Pap smears because they're like, they especially. They're not vaginal progesterone, but it's just like the. Taking the ease out of. You don't have to even do the Pap smear. You can just collect the fluid and send it and send it to the lab. I think that's so.

It makes it so easy, makes it so much easier. And then if it's negative, the likelihood of cervical. Because 99% of cervical cancer is caused by HPV. So we just go all way the. Okay. Then you can just be like, I cross that off my list and I can keep going with, you know, my other things. Oh my gosh. I'm so glad we got to talk this through today. Thank you so much.

Yeah, thanks for having me. This is always just fun to talk about passionate things like menopause, women's health and advocating for yourself, especially with like a fellow practitioner like yourself.

I thank you so much and I've enjoyed it too. I know that women are going to get so much out of this. Make sure that if you're listening in to check out the notes below, we're going to make some, some compilation of our, of our discussion so that you can use this as a tool as you're navigating menopause and to know that Dr. Shilpa and I are here to help you. I'll make sure to put your information or clinic information so we may find you. I love what you're doing out in LA to help women and you're having women come, come from far away to Canada.

Yeah. We had a woman come to just today from Florida with one come from Utah. So I think people are finally just wanting to just take care of themselves and they're like, I just need to know and figure it out. And since I'm only licensed in California, they have to come and physically see me once and then I can, I can take care of them. But it's just nice to know that women are, you know, not, not accepting, mediocre anymore. They need answers and they're partnering and that's medicine three point out.

Oh, I love it. It's so important. I'm so glad for other women to know that, like if you're feeling like I need something else here. You're not the only one thinking that many women are realizing, hey, not only do we need more help with Perry and postmenopausal, we deserve it. And, and it's possible it exists.

Yeah, you just shouldn't be discounted by your provider. And all those red, you know, flags we talked about, like pay attention to them and listen to your intuition because, you know, we as women have a lot of great intuition, but we easy discount it. So don't discount it. Listen to intuition. If you don't feel comfortable, find the next one.

Absolutely. Oh my gosh. Thanks again so much for joining us.

Thank you so much for having me.

Yes, I look forward to talking to you again soon. Thanks again so much for joining me here at How Humans heal and with Dr. Shilpa on this episode about menopause and helping to guide you through menopause. If you are new to how human seal, I welcome welcome you to subscribe and join me for the next episode. You can also find a link down below to come to my website and sign on to my email list so that you receive an email when each new episode comes out. I look forward to being in touch with you and if you need more help with your health, especially related to Perry and postmenopause, don't hesitate to reach out. I'm here too. I'm happy to help guide you you and help you to be feeling your best and living your best life, because that's absolutely possible. All right, talk to you all very soon.

Thanks for listening to how Humans Heal. If you liked this episode, leave a rating and a review. And for more resources, visit drdani.com.