Optimizing Hormones Early in Perimenopause

Real quick, before we dive into this episode, I have a little sleep secret I want to tell you about. Look, sleep is crucial for your fitness, but it's crucial for just plain old everyday life and function. And I find I sleep great unless I have a migraine. And I've had more than my fair share since perimenopause all the way through post menopause. My secret weapon was Blue Sky CBD sleep gels. Each gel contains 25mg of CBD and 25mg CBN for deep restorative sleep. Something about it helps to reduce inflammation, which I believe for me was key in helping me get to sleep. But the biggest thing is so many of the over counter solutions, whether for sleep or migraines, can ruin your gut health and liver health. Neither one of those did I want to be problematic for me. So this option is recommended by health care providers worldwide and backed by thousands of happy customers, many of whom come from our flipping 50 community. There is 0thC so it's non habit forming. It's made by a trusted family owned company that we all can feel good about third party tested for purity and potency. And if you're interested, you too can try a sample for just $6. But even better, you can get 30% off forever with discount code. Flipping 50. That's flipping 50. Just go to flipping50.com blueskycbd we'll put that link in the show notes and you'll find it everywhere on flipping 50 at my favorites. What are you waiting for? Good night. Let's talk optimizing hormones and let's talk about doing it early rather than late. Should we? Because many of us I'm 60, I really got on the hormone bandwagon solidly. I actually started prematurely, kind of flirted with it, then was off it and came back on at 56 and probably will not go up. But you know, if I could tell my 35 my 40 year old self something, not that I would have started hormones then necessarily, but I probably would have started and stuck with them sooner. In fact, my last kind of distance triathlon experience might have gone better had I been on them from the very beginning, but I chose not to. So we're here to talk a little bit about perimenopause, about hormones. What is hormone balancing? And I think that although this is not the first rodeo for hormone discussions, here you will find my guess has new insights, new ways of putting it into words that may help you realize what are my choices? What do I need to be asking. And if you're newer on your journey in perimenopause, that it's not too soon. If you want to gain referrals from doctors working with your demographic, whether for bioidentical hormone replacement or using a GLP1 drug, learn how to show them what it is you do. It's not your certifications or your website. It's the art of communicating what you do and how you do it by demonstrating or by testimonials that will win you referrals. I'm Debra Atkinson, and you're listening to. She means fitness business. It's a division of my business, Voice for Fitness, and we now call this division Fitness Marketing Academy. And it's for you primarily, midlife women helping other midlife women. How meta is that? Look, I've been in your shoes at 49 to be a midlife woman literally starting over, having been in a very comfortable position in mid six figures with no debt and a home car environment I loved. And I ditched it and said, I think I need to have a bigger reach. It's something is telling me or calling me. And there I was thinking, oh my goodness, what have I done? I'm starting over. So I know having the knowledge and having the heart and really having to put yourself out there. You see, I had marketed for others for years and worked at a university as well as a private gym. But it's so very easy by comparison anyway, so very easy to market somebody else's business to dozen other trainers, talk about their program, talk them up, write the copy. But suddenly when it's you, there is that moment of, you know, I'm not supposed to brag, I'm not supposed to. Supposed to toot my own horn. I'm not supposed to, you know, all the little things that you learned along the way, maybe as a little girl or I did, came back to me. So I know what it's like to start from scratch, to have to make money, potentially more than some of you listening. I knew that feeling. So it's why I work with women specifically to gain some power, to gain their own ability to make money, be in charge of their lives, whether or not you partner with your love of your life. But to know that you stand your own ground, that you carve your own niche, you create your own future, no matter what you want to do with it. I help you get clients, keep them, and be sure that you're making profit. So. So you're not just by starting your own business or doing this side hustle Creating a job, another job where you work lots of hours and don't get paid very well. And sometimes, dear friend, listening, we tend to do that. We say things like, I do this for free, but I'm crying out to you, don't. Because actually when people pay, they pay attention. And when you charge your worth, the value and how you deliver it goes up. The way you think about yourself and the way you conduct yourself gets an upgrade. Everybody wins. I promise you that there's no bigger growth opportunity than starting your own business. So if you're doing it, cheers to you. And I'd love to help you. No matter where you are, you're needing clients right now. You need to also solve your midlife female clients problems better with more intel or you've had a great business, you have so many clients, you need your time and your freedom back to enjoy the fruits of your labors. We can help you in all three, but what I'd love for you to do first is listen to this very short episode and listen to your guests feeling, really follow it. If you hung this up today and said, I'm just gonna relax, I'm not gonna do this if it's not an urgent thing for you, what would that feel like? Would you be itching to do it in a day, in two weeks, in a week, in a month? And if so, then I would say this is a calling for you. And if that's the way it is for you, as it was for me, I try to walk away several times than I keep keep getting hooked back in. Then go to fitnessmarketingmastery.com Scorecard Download this quick business assessment that I have for you. If you're wondering what do I need? A question someone asked in our well pros group, the mastermind and mentorship hot seats. We do so that all of our trainers know, how do I make an offer? How do I position that? Where do I price things? How do I get clients? Somebody said, what is it that I need to have in place to have a million dollar business? And I said, have you downloaded that free sheet yet? So we were walking them through, teaching them how to do that in the six month program. But you can look at it at a glance and potentially know where you need to start. All right, so without further ado, I want to get into this and I want to give you a recap. You know, this is a blue ocean, what we're about to talk about. Few coaches and trainers are doing this and this outreach to the medical community is something that is yet untapped and much needed. And by the way, this is not an email campaign. You cannot hide behind your keyboard. This is getting to know one doctor at a time and letting them get to know you. What you do and how you do it. You heard it here. To gain referrals, you also might want to consider referring clients to others. My guest today is passionate about making complex hormonal topics accessible and believes that great health starts with happy hormones and a balanced stress response. I want you to listen to this podcast episode and then ideally connect within a perimenopause summit that she is hosting. This is great insight for you. You really want to educate yourself as much as possible, not just on the blanket statements for what's important about menopause, what changes about menopause fitness. But we get down to the nitty gritty you when when we're in the flipping 50 menopause fitness specialist about what is it that women need to do pre menopause versus Perimenopause versus menopause transition and post menopause? And you're going to get a little taste of this today because perimenopause is becoming a thing. So pay attention folks. My guest today, Emily Sadri, is a board certified Women's Health Nurse practitioner, certified nurse midwife and the founder of Aurelia Health, a modern telemedicine practice for women over 35. Aurelia Health provides comprehensive hormone replacement therapy and weight loss support with long visits and unrushed care. How did you hear that? Emily is passionate about making contact complex hormonal topics accessible and believes that great health starts with happy hormones and a balanced stress response. Can't wait to dive into this episode. I'm Deborah Atkinson. You're listening to flipping 50. I started this podcast over a decade ago to answer questions about fitness in menopause and beyond before you knew to ask them. The goal to help accelerate your results with science and the practical application of proven protocols while living your best life. There's no more powerful health influencer in the world than a midlife woman and it's not just about you, but the three generations that you influence my unique 40 year career, including being a university Senior Lecturer in kinesiology, an industry subject matter expert and an international speaker to founder of the first and the only exclusively Made for Menopause and beyond fitness membership in the world. Every week I interview experts behind the scenes and the science of optimal hormone balancing fitness and longevity and share answers to our community's questions so you can have the vitality and the energy that you want, need, and deserve. Emily, thank you so much for being with us today. I can't wait to dive into this topic with you. How are you?

I'm so good. I'm so excited to be here. As you know, I'm a huge fan, so I'm thrilled. Thank you for having me.

Well, back at you. And just this common denominator of topics, we keep coming back to you here because it's so interesting. And tell me if you feel this from people coming to you as well. We've gone through this period of time where, like, nobody wanted to consider hormones. And this is over 11 years nobody wanted to consider hormones. And if you were doing hormone replacement, you were an anomaly. And now I think the tide has turned and more women are realizing, oh, my gosh, this might be my solution. And this isn't just about symptoms and wondering, is it too late for me now that I'm postmenopause? So many question have come up. I mean, are you seeing this whole thing, like, turn around? I am.

I think that people are still in kind of what we call, like, pre contemplation and contemplation phase around it because there is so much sort of poisoning of the well that even though for us, because we're in it every single day, it doesn't feel this way. But for the public, like, they've just been steeped in the fears for so, so long that even if really reliable sources are saying, hey, you know, we don't associate this with an increased risk of cancer, people are just feeling really unresolved. But they're so curious. And to your point, they do feel like, okay, so I used to sort of understand this as something that was potentially good for symptoms. And it's very possible that people in your audience, especially, who are very health conscious, are saying, I don't really have symptoms. And now I think there's so much information that's making people go, oh, it may be it's actually like a health thing and not just a symptom thing. And that's the piece where I think it's really cool, and I'm hoping that just continues to swell.

Totally agree. Okay, so what about you? My audience likes to know the dirt on all the guests we have here. So why this? First of all, did you always know you wanted to be in health? You're a nurse practitioner. Did you know you wanted to go there? And then how did it evolve for you that it was hormone replacement therapy and weight loss support specifically?

Yeah, no. I think that 20 years ago, my 20 year ago self would be, would die if she saw me now. Even the 10 year ago person would be like, what? Because, well, I came to this, I didn't always know I wanted to be in health. I think I was always interested in it because like so many people who choose this profession, I had my own issues. I, you know, was a kid that was just really sick and allergies and gut issues and all the things. So I was very preoccupied with like this system and these solutions being offered to me are not working. So that was sort of my origin story. And then I actually have a Bachelor's of fine arts from nyu, so I was in performing arts of all things. But you know, the interesting thing about that is that I love stories. I love the stories of people, I love human connection. And I understood in a very physical way from a young age, like how we can feel transformed based on our experiences. And then I was as a sort of survival job after college teaching music to moms and babies in walk up buildings in New York City.

Wow.

Yeah. And I.

Wait a minute, I have to stop you at performing art. So what kind of performing?

I was a musical theater major. So I. Yep. Was dancing, singing, acting, the whole thing like in. Yeah. And in the late 90s, early 2000s. And that was my dream was like to move to New York and be on Broadway. And I loved watching these brand new moms with tiny babies like and the personal transition that they underwent as they became mothers. I was just really fascinated by that. And the place where I taught music to moms and babies, also taught childbirth education. So after my class, all these pregnant ladies would roll in with their pillows just like in the movies. And I was like that something was tugging at me around that. And I remember reading the Red Tent, which is an amazing novel, several years before that and thinking to myself, you know, if I wasn't going to be an actress, I could totally be a midwife. And that sort of creeped up again. And I just sort of decided one day I think I need to be a midwife. So I went to Penn, to the University of Pennsylvania because they seem to be the most kind of diverse in their education, meaning that I was a women's health nurse practitioner being trained to do that and midwifery at the same time. And the director of their WHNP program was an herbalist and had co authored books with Aviva Ram and you know, felt like the type of place where I could get a more well rounded education. And the interesting thing about that was I got A very well rounded education in terms of birth. Midwives are very focused on supporting physiology when it comes to pregnancy, labor and birth. And postpartum, like, don't intervene the physiologic patterns that our body participates in, especially labor, right, That's a hormonal feedback loop that just kind of grows and grows and grows until it, you know, results in the expulsion of a baby in a placenta. And so it was very confusing to me that we were so good about that physiologic focus in birth, but when it came to gynecologic health and hormonal health, we were just following the same algorithms that the American College of Obstetricians and Gynecologists used. Like, we weren't coming up with anything unique or. Or that upheld physiology in that space. And it was just very disappointing, upsetting. And I was in school right after the WHI was released, so I was being taught by all of these people who were Perry and postmenopausal themselves. And we were like, no hormones ever. We will never prescribe them because there's so many other good solutions for symptoms. And really they're only supposed to be used for people with hot flashes and only for five years or less, and only the lowest dose. And I was like, I'm going to wear Eileen Fisher and Birkenstocks and prescribe maca and red clover for the rest of my life. Like, that was my vision. I was like, that is going to be me.

Black coa shoot. Yeah, yeah, yes, totally.

I was like, I am that. And it's so funny that only less than a decade into my practice as a midwife, I really felt called to leave the practice because, well, lots of reasons. It was burnout and all the things. You know, working in the hospital is just really, really hard on the body. And I wanted to do functional medicine. And I started my practice and, you know, I understood the menstrual cycle and I respected it. But functional medicine doesn't really have a respect for the menstrual cycle and the way that I think sort of the hormone movement does. And what I found was that I was sitting in my office and all of my patients were Perry and postmenopausal, and they were coming to me for functional medicine, and I was doing all the things that functional medicine taught me to do, and they weren't getting better. Like, they did not need another elimination diet. They did not need, like, to cut out a million foods and take a million supplements. They really were falling apart because estrogen and progesterone were. Were rapidly on the decline and it was affecting every body system. And that really couldn't be repaired with this sort of herbal functional medicine approach. And so I just got interested and was like on a mission to figure out what it was. And, you know, it was hormones.

Wow, what a story. Okay, I'm gonna back way up for anybody if we skipped over this. I'm really sorry. For you who are listening, you'll know immediately, like, oh my gosh, of course. So whi. Women's Health Initiative, in case we lost you, and you're out there on a trail somewhere wondering, wait a minute, what was that? That's what she's talking about. So now I know. You know, right? But just in case.

Thank you.

Where do you think people are right now? I mean, are we still taking sides? Hormones good, hormones bad? Are we doing this or where are we?

Unfortunately, yes, unfortunately. Primary care providers, and especially specialists, breast specialists, these sort of breast surveillance programs that women get put into where they should be followed up closely. And I think we're doing a really good job of detecting breast cancer, but they're still very much in the space of estrogen is bad. You know, telling people who in, you know, have maybe an elevated risk for breast cancer that they should take tamoxifen. And this is for preventive care. I mean, this is happening for preventive care. They're telling them that they should take an estrogen blocking drug to reduce their risk of breast cancer. And it's okay to offer that and have a conversation as long as you're also having a conversation about how deleterious it is to the body to restrict it from estrogen exposure for basically half of a lifetime. So I.

No, I absolutely love that you said that, because I. This has come up another time. And I love it that we're kind of being bombarded or railroaded with whoever the practitioner in front of you might be and the strong opinion that they might have based on the information that they've been given or been open to consuming up until this point. But we're not hearing both sides. We're not being presented with all the options and educated so we can make the informed consent were kind of like, this is who I work with. This is what my practitioner says and kind of blindly following.

Well, that's because the entire practice of medicine is based on how well you can convince your patient to comply with what you think is best. No, I mean, that's why so much of the language is around that. So it's. They may talk about shared decision making and throw that term around, but it's not really shared. If you can't present things and say, this is sort of my understanding. There are other people who think this and then really say, I'm not even gonna go into more until you tell me what your personal goals are. Like, that would be the best way to start a conversation.

Yeah. You know what flashes before my eyes? And this is not related to hormone therapy. But I remember just a few years ago, I was at a doctor's appointment and I was having some skin issues that just did not make sense. Like, nothing previous to pointed to what. What was happening. So I went into this office and I was in there, and the doctor literally was in there for maybe five seconds and said, oh, this is what you have. And he had his hand on the door. He was out the door. I said, well, wait a minute. I don't. How could that be? Why? What would cause that? How do you know that? Didn't even ask me. Because I'm the doctor, was his answer. And I was like, not mine. Yeah. Bye. Bye.

Yeah. I think we really forget that we are consumers. I'm sure you've talked about this with other guests, but it's probably because, you know, in order to have a consumer culture, you have to have really good supply. Right. And it's. There's not a great supply. Access is a huge problem. It's why there's so many telemedicine companies now, because access is a huge issue for most of the population, especially around, you know, time. Like, time is a commodity within the medical system. And so if you're looking for someone who's going to have a fair and balanced approach, involve you in decision making, and give you time, you have very few options, especially if you are still relying on your insurance to pay for your care. And so doctors, you know, are in this position where they're the only product on the market. So it's like, take it or leave it, you know?

Yeah. Yeah. I would ask you one thing, because I think you. You suggest there's a downside and an upside to testing hormones. So I'm curious why you'd say there's a downside. Hey, this is Debra Atkinson. And there is one thing you can't do in the gym at your age, and that's get all the protein that you need. You've got to do that in the kitchen. Kitchen. To make it easy for myself, not only to get the protein, but the fiber, the fruits and vegetables. I want daily, I started drinking a smoothie a day 30 years ago. But when I realized all the junk, the sugar and the extras that you don't want that I don't want hiding in most protein powders, that's when I finally caved in. After years of saying I will never add, ever, ever sell supplements. Stop skipping, skimping and sabotaging yourself in the morning after workouts by always being prepared. Look, yep, I agree, real food first, but it's just not convenient to carry a turkey sandwich Sometimes the protein, and don't forget the fiber, they kill cravings and they boost satiety. And you've got to make it easy to do the right thing. You can use code podcast for 10% off your first order at flipping50.com today.

Oh, did I say there was a downside?

Yeah, not so much. Okay.

No, I mean, I don't, I don't think that I, I rely heavily on testing in my practice, you know, for a few different reasons. One, because I am extremely interested in replacing hormones for optimization and for health span and health jevity. Right. For just really good lifespan and outcomes and not just to alleviate symptoms. So we don't have robust data on levels and associated, you know, sort of positive outcomes, but we have some. And we also know kind of what were physiologic levels at certain times of cycles. And so we have an idea of, you know, we need about this much to stimulate bone activity or about this much. So I'm very interested in testing especially. We treat a lot of women in perimenopause and I think it's awesome to test if you have an understanding of the 28 day ish menstrual cycle, which a lot of people don't. So one of the biggest arguments against testing is, well, it's, it's too unreliable. It changes all the time. So does blood sugar. Changes all day long.

Right.

You would never tell a diabetic that it changes before and after meals. And you know, estrogen is no different, it changes. But if you know how to track that and track it sensibly. Right. It can give you a lot of information.

You mentioned that some believe testing estrogen and progesterone is not necessary. I find that shocking.

That is really what the North American Menopause society sort of states and its guidelines is that testing isn't necessary, shouldn't be relied upon for HRT planning, meaning hormone replacement therapy, prescription planning. Right. We shouldn't be deciding our dosage, but we should just be basing how we dose and what kind of replacement we use. Based on how the patient feels alone.

Oh, my gosh, that sounds wrong. I mean. I mean, I love both. I don't like the idea of we get the lab test back and here's what it says, so never mind. We're not going to ask you how you feel or how it's going. I think that's also wrong.

Yeah. And I think it just comes down to this idea that we can't, because they don't think they can standardize. They don't know how to standardize. So a medical sort of consortium is not going to make a recommendation unless they can really back it up with high quality data that says if we follow it this way, it improves outcomes. So until we have that much data that says, like, you know, it really is prudent to have this level in order to achieve this outcome, they're not going to change their stance. And I think it's sort of like, it's like that first step. It's like we're getting better because at least we're not saying only treat for vasomotor symptoms, which are hot flashes like that used to be where we were. So we're kind of a little closer by saying, hey, there's all these things that you can treat for. We're not quite to the level where we're recommending that women treat just for, say, prevention of cardiovascular disease, although I think we have enough research to say that is truly the case at this point. But we're inching our way closer. So I'm hopeful that eventually we'll get to the place where we realize that it's not so much just symptoms and it's not so much just one level. I really think that the future lies in, you know, replacing hrt, depending on, again, a person's goals, but if their goal is really to live the longest, healthiest life that we consider, you know, rhythmic dosing of hormones and actually achieving physiologic levels, because we know that like stem cell regeneration and certain physiologic processes don't occur if we don't hit peaks of estrogen and progesterone. But that's really tricky to manage. Right. So it's very advanced stuff, and that's kind of how things always go in health. It's like a little niche is pop practicing this one way. And eventually, you know, as we make it more standardized and figure out more and can back it up better, then everybody gets there eventually.

Okay, listener, I have an assignment for you because I would love for you to answer this and if you're walking or you're in the gym, just feel free to say a hell yes out loud. I don't care who's around you, but would any of us answer, no. No, thank you. I don't want that. I don't want to live as long as possible as healthy as possible. Are you going to turn that down? I mean, it has no calories, so I don't know what your second thoughts would be, but I think, isn't that what we all want? That's a crazy thing to think. We wouldn't. I do want to ask you something that is very, probably very remedial. And is this even the right term? We use this all the time, like balancing my hormones or I have an imbalance of hormones. What does that mean to you? Like, are we balanced? Do we get balanced? What does that mean?

Yeah, I mean, I think it sounds nice, but I mean, as somebody who's been, you know, talking about hormones for so long and studying them, I don't. I don't really know what it means. So I see. I'm, like, stumbling because I'm like, yeah, because it, you know, to me, I'm like, what, are we achieving optimal levels is kind of the way that I would think about it. Or are we supporting the body so that the body can support the hormones? So I. I mean, I guess people could describe that as balanced, but balance insinuates a concept that I really don't like, which is say, like, something's too high and something else is too low. And I don't think that really is what is happening pathophysiologically when people are, quote, unquote, not feeling well, or, dare I say, unbalanced, which, again, I really don't like that term.

I know, Yep.

Right. It's more about, like, optimizing the functionality. So if you've heard the term estrogen dominance, I really hate that term because we typically don't make too much of a hormone. Like, the body's not making too much estrogen. Right. You may have elimination issues. You may not be detoxifying. Well, relative. But even this concept that. And you've probably heard this, and people may have even talked about it on this show, so, you know, feel free to censor this part. But, you know, you may have heard this idea that in perimenopause, progesterone is the first hormone to decline and estrogen can be too high in the luteal phase, meaning, like, after you ovulate, when you're supposed to have robust exposure to progesterone, because we only produce that for half of the month in a menstrual cycle that in perimenopause, progesterone secretion decreases and you have can have estrogen dominance. I don't even like this concept because to me, the ovaries are. Are glands, right? It's a singular. Well, there's two, but singular gland that produces and has lots of functions. It responds to follicle stimulating hormone from the brain. Fsh, you know, signals the ovaries to recruit a dominant follicle. But part of that recruitment of the dominant follicle, which is like the egg, right, is also raising estrogen levels. So estradiol needs to peak around somewhere day 10 to like day 13, somewhere in that range. And when estrogen peaks, that's the highest it ever gets in the whole month. Then it triggers luteinizing hormone LH to come out of the brain, which then triggers the release of an egg. So what I see happen, because I test a lot and I follow and I see these women in perimenopause, is that the ovary is aging. You could argue that there's also undernourishment and other reasons that can speed up ovarian aging. You can have early onset ovarian aging, but the ovaries aging, and it's not responding in general to FSH the way that it used to. And so you're not hitting that peak of estrogen on day 12. And then you're also not getting the best follicle that's not going to produce robust progesterone in the corpus luteum, which is like a gland that gets left over in the ovary. And so then once you do ovulate, the ovaries, like, kind of trying to catch up to this stimulus of FSH from the brain because it knows it never hit that peak. Right? And so then in the luteal phase, the second half of the cycle, you get this situation where, again, you've got sort of underproduction of progesterone because you never got good recruitment in the first half. And then you've got kind of irregular patterning of estrogen because it's still trying to catch up from not hitting its peak in the first half. And so that may look like symptoms, like people may have the onset of PMS for the first time in their life. They never had painful periods. All of a sudden they do, but it still starts with a decline in estrogen, which I don't think we're talking about enough. And Part of that is because we're just not raised as women to really understand our cycle and that it's not just a period. The cycle is like every day of our life, we're somewhere in a cycle, and that's breaking down as we age. And so this idea that we're only replacing progesterone until someone. This is a major thing in practice and just something that I would encourage listeners to question when they're seeking out a hormone provider. Many providers are only prescribing progesterone as long as someone is still getting a period. Oh, this is. I know, I know. This is happening all the time. Or they're testing a random estradiol level. Random. So they're not, you know, maybe this person's only ovulating four times a year. Right. So they're testing a random estradiol, and it's over a hundred. Because, again, it's like Chitty Chitty Bang Bang if you're, you know, if you know that movie or it's like. Right. So this, like, sputtering of the ovaries in its production of estradiol, it's not this organized, two peaks and valleys. Right. Like it is for most of our life until it starts to break down. And so they're saying, oh, your estrogen's very high. It's high. We're just going to give you progesterone. You're going to take it 12 or 14 days a month. And, like, they're completely negating or forgetting the fact that there's breakdown in all hormone production. Right. And I think we can get away with this sometimes because they're not afraid to prescribe testosterone in perimenopause. And testosterone, to some extent may convert to estrogen depending on the person and kind of what's going on in their system, but it also just gives women a little bit more of a feeling of resilience, which they're losing as estrogen is declined. So. So let me know if that felt like too much. But I just think that it's important to understand because we have to be really discerning when we're looking to feel better and to optimize, because so many of the health benefits really come from estrogen. And I know people will talk about the fact that women make more testosterone than they even make estrogen. That may be true, but estrogen is still, in my opinion, the primary driver of health optimization for women.

Mm, agree. I mean, with heart health, but with muscle, with bone, I mean, it's key. Not that we don't need testosterone to help with that too. It's just, it's such an integrated process. But we've had people here, like clients and participants, members, you know, suggest that they were on HRT but report they're only on one, not on the other. And I'm like, but wait, there's a relationship here. And we seem to be ignoring it. I think you should go back and ask about that. What, so what are your thoughts? You touched on testosterone. Do you think all women benefit from some testosterone?

I don't think every woman doesn't need it. I mean, I think this is one that's really important to test in serum. Some women are just genetically more adept at making testosterone and you know, it's influenced by so many things. If you're someone who's kind of been chronically ill throughout your life, you've just, you know, struggled with that. You're, you're more likely to have lower testosterone. And just in my sort of very clinical observation, but that's one that you really want to test in. This idea that like everybody just needs it is it's really not the same as estrogen. Like I've seen 70 year old women with robust testosterone levels without it being replaced. So really, really important to test for that one.

What else do you see that you do either even before prescribing HRT or to help women once they have it, be successful with it, to have it its best efficacy for them.

Yeah, it's such a good question. So indigestion for sure. Because we need to recycle and excrete our estrogen every day. Right. That's why you wouldn't take it once a week. You have to take it usually if you're doing a transdermally twice a day or you're doing by a patch. Right. It's continuous. So you want to make sure that you're eliminating. Well, that you are. Your liver is working well. So if we're kind of assessing that we see a lot of chronic constipation in women and that would be something that I'd want to resolve. Yeah. But forced or concomitantly at the same time that we start estrogen. So whether or not do you want

to unpack that at all? Why do women tolerate constipation and assume it's their normal. Why is that?

I think it's just so pervasive that they don't question it. I think that it's, you know, taboo for women to talk about poop. I think that pediatricians should Be bringing it up more. I mean, my kids, they know I'm going to ask them every day if they pooped. But that is like part of our family culture that's good for you. And they know if I'm not feeling well. Let me think about, did I poop today? Like, because they start, you know, if you had kids and you're probably, you know, this, that they, they don't act the same if they are constipated. But I think a lot of families don't talk about it. And so a lot of women are raised just kind of like keeping it to themselves and not saying anything. And obviously, if you're not working hard to diversify your diet, if you're eating a standard American diet, even 80% of the time. Right. It's impossible to have regular bowel movements. It just is. But then there's so many other reasons why women, emotionally and socially and for, you know, a variety of reasons, hormonally may be prone to slower bowel movements and, you know, just magnesium deficiency in the food sources and our food source is a big one. So, I mean, that's just like level one, right?

Right now. Yeah, I just. And it's certainly not the first time we've talked about that, but I keep coming back to that. And I remember starting when I was working with people, we didn't collect this as fitness professionals. I mean, for 30 years, and I taught a university, I taught students how to work with individuals, I taught trainers, we didn't ask them that. And when I started, as soon as I started, because I realized there was such a connection with where they were hormonally, even if they've never done lab tests yet, or they didn't realize they were in perimenopause. But when I started to look at, just even informally, the percentage of them that felt like, oh, that's my normal, and just passed it off as that, I was like, oh, oh, no, no, no.

There is no you can do better. Anything less than daily, even though you, it may be too typical for you, but it is definitely not normal and not optimal by any means. And I would add to that that I, I tend to believe that any new onset of GI disturbance sort of over 35 or a new onset mental health disturbance over 35 should be considered and ruled out as hormones first, because we're really just not considering this. Like, we have no problem chalking things up with kids to like, oh, they're just going through a developmental change or whatever. But with adults and women in perimenopause and heading into menopause, there's such seismic shifts happening and it translates to every function of the body. Palpitations. Right. Any case of palpitations in a woman over 35, hormones have to be included in that decision tree. Like, sure, work them up. But nine times out of ten, this is hormones hormone related. So I just, I think that if we would start to think about all of our health issues sort of through this lens of like, where am I on the hormone hormonal trajectory and not making the mistake that hormones are to blame for all of our problems, because that's certainly not true. They're more a reflection. However, like with ovarian aging and with hormone decline, there are so many sequelae across the body. And because medicine is so good at putting everything in a silo, we forget especially it's also not a system designed for the female body. So they haven't been looking at, at things through this lens of like, where are they right. Hormonally, like, you know, pelvic pain. Right. I mean, you go into the ER if you have pelvic pain, the first thing they're going to ask you is when was your last menstrual period? Like, they have to identify sort of where you are. So, like, we do do this in certain areas, but we're not thinking about it when it translates to kind of everyday things. And all these little kind of concerns and symptoms that women have should be worked up from a hormone perspective first, in my opinion.

So good. Yeah, and I'm glad you added that second part because it's like, oh, it's hormones, you know, has become kind of an umbrella statement. But then it implies almost, it's like throw the hands up and oh, it's hormones. But knowing that it is, you need to know now you have answers. You can get to the bottom of what and what are your choices and options? And you have put together really a whole kind of arsenal and library to help people with this in an upcoming summit. So talk a little bit about that, tease a little bit about why. I mean, I know from having hosted this is a major project, it's like, gotta be a labor of love. But what is your hope in hosting and tease a little content if you can?

Yeah, no, I mean, I think that I'm such a learner and I wish that I could have people kind of walk around with me on my shoulder all day long and like consume the information and talk to my mentors in the same way that I am. Right. Because we're only one person and we want to get all the things across, but we have our very specific way that we talk about things. And it's so enlightening when you can hear different voices and experts who have each, you know, been in their respective fields for decades. And so my hope with the summit, which is called the Perimenopause Revolution Summit, was just that there could be some different and more in depth information to kind of bring clarity in this sort of. We're seeing like a menopause revolution really happening on social media. Like people are talking about it like they never have, but I think that it deserves so much more nuance. Like there's sort of this message out there that like if you slap a patch on and take oral progesterone, like you've. So you're going to solve all your problems and like that's the only thing that's out there and that's the only barrier. And once you get that, like your whole life is going to be good. Oh, and like also maybe eat protein and lift weights. Like that's kind of the extent in the general messaging, but it's really so much more than that. And I think after, you know, in your late 30s, early 40s and then into your 50s and 60s, like there's such an opportunity to make really informed, intelligent decisions so that your whole life looks different. And so that's really my, my hope for the summit. We have over 40 speakers. Most of them are people who are just very near and dear to me, who I learned so much from and have informed my practice. And so I'm so excited to just share them with the world.

So love it. Yeah. And you're so eloquent in terms of interviewing and I thank you so much for being here today because I really wanted you to bring a little nugget of that inside. So if you're listening and got some value of this, I mean, this is just a drop in the bucket. So Emily knows how to interview and how to pull out all the golden nuggets that you want out of someone else. So you heard her, she's a lifelong learner, so she has an ulterior motive too. But she's got your back in doing that, exactly what you wanted, an interviewer. So the link to join the summit will be in the show notes. It happens to be, if you have a mind like a steel trap, you're a better woman than I am. But it's flipping50.com forward/revolution and we'll point you to that. And Emily, you're also on social media. Where can they follow or stalk you there?

Yeah, I'd love that. So I'm lysadrinp can see lots of put out, try to put out lots of educational content and sometimes dancing in the kitchen with my kids. You know, if that's your thing.

Well, you always have to use the puppies, kitties and kids.

Yes, absolutely, 100%.

Thank you so much for being here.

Oh, Deborah, that was. You have me blushing at the end. I'm speechless. It's really such an honor and I could talk about this stuff with you all day. So thank you for having me and I can't wait to share you with my world as well.

Thanks so much. Thank you for listening. To listen to a decade of episodes and to get the show notes, visit flipping50.com where you'll be able to find all the previous episodes. And I made it super easy to make the most of your listening time and get exactly what you want to listen to as top priority by getting the top 10 episodes in the areas you most care about. Like how much protein do you need? Weight loss and other three, three ultra important topics we've identified as our community's top five. There's no more powerful health influencer in the world than you, midlife woman. So go and listen right now. Emily, thank you so much for coming over here. You didn't know we were going to double dip and double work you, but we are. So this is seriously like behind the scenes. So pulling back the curtain for our fitness professionals, our health coaches, practitioners who are working with women generally in midlife. So we really have a meta meta group. They too are in midlife themselves and working with women in midlife. But because of that, you know, it's one to three hours a week. Maybe, you know, on average a trainer, that's quite a bit of time somebody spending with them. And having worked with people for, you know, 40 years, people share everything. Once you establish a relationship, I mean, and they're moving, there's something about flowing out of you when you're in movement. You end up sharing a lot. It's a really a great opportunity. What would you suggest their role is? If they're observing things like women are weight loss resistant even though they're doing all the right things. Women are tired, canceling, have insomnia, so they're not wanting to show up to their appointments in midlife. What suggestions do you think is within scope of practice for a health and fitness pro?

So many good things. First, I would say being Someone who's been on the other side of that. I had never heard anyone say it that way before, but yes, when I work with my trainer, I definitely overshare. Thank you for that insight. And then I would say that the lovely thing about having that drawn out time and it's sort of like that experience of when you're driving in the car and your kids are behind you and they share more with you because you're not staring right at them.

Yep.

I get the same idea. Like if I'm sitting there and I'm doing my weights or whatever and you're kind of behind me, it's like, it's much easier to share. And I can imagine that really good advice would be if I was in that position. I mean, kind of being someone who stood by laboring women for hours and hours. And I have a sense of what that means to kind of be in the room and hold space. Probably the best thing, and I'm sure you've talked about this a lot, is resist the urge to fix everyone and really hone your active listening skills. Sometimes you can get somebody there just by asking genuine, loving questions like, tell me more about that or have you asked your doctor about that? You know, because as soon as you launch into like, oh, well, I had this experience and it was so great, you're gonna lose somebody. And I think just the more questions the better. And have a network of people who you trust, who you know are good in your local area with hormones and with, you know, supporting people from a holistic approach. But don't be doling it out. Yeah.

On that note, I would love to ask on behalf of everybody listening, I think they struggle with this. You know, there was an initiative quite a bit ago between American Medical association and American College of Sports Medicine, and I think all trainers thought, oh, here it comes, it's going to rain referrals from doctors, and guess what, it's a drought, because it doesn't work that way. What's appealing to you when you're thinking about your patients and knowing they need to potentially exercise, but knowing they also have a history of maybe getting hurt or not doing it, Starting and stopping. What's appealing about a health and fitness professional that might make you refer to them or be interested at least in some collaboration?

Yeah, I mean, I think that if you're a good provider, you understand the benefits of relationships. And most providers, even myself, even though we prioritize 30 to 60 minutes in our practice, the reality is it doesn't make sense for me or my other nurse practitioners to be the coach. Doesn't make sense for me to spend time checking in with them every day in messages. That's a better role for someone whose role is to coach. And so if you can lay out, I think for a provider sort of how much of a relationship you can form with a person and also how you work to habit build and start small, small and kind of not push someone like beyond where it's reasonable for them to go. That would be a big buy in for me. Like, yes, this is a person who's going to be in your corner, who's going to be supporting you because ultimately, like, we all, we always knew in birth that like a do, having a duel in the room was a huge asset. Right. Because that person was never going to leave the bedside, whereas the provider might be managing two or three people in labor. And I feel like it's the same thing. It's like that continuity of relationship, someone who's in the corner. I don't know if that answered your question, but for me that would be what I would be looking for is like, who, what kind of coach is great at relationships? And I will tell you locally with my private clients, the coaches I refer to are the ones who are not shoving information down people's throats and are just providing a long term trusting relationship that the patient's going to keep coming back to.

Love that that was, those were golden nuggets. Okay. Knowing you are talking to the majority of our audience, probably we are the meta. Meta. They are women in midlife themselves going through changes and working with women in midlife or beyond. And if there was one thing that you could tell them, you know, because you see patients coming maybe in big need, like they get to you because they're calling uncle, I need help. I probably tried something else to figure this out before coming here. What, if anything, might you say to them?

I think that when you're in the health space, you tend to think that you have all of the answers. And so depending on what your specialty is, if you're a gut person or this person or a trainer person, you may think that like your problem is something that's in your scope. Like, my problem is that I'm exercising too much or I didn't hit the gym enough in. And I think it's really important, especially for people that know a lot, to find a good partner to support them. Like, we always need a person to, like, I need a person that I can go to and be like, I'm feeling all these things. Because even if I would have those answers for somebody else, we kind of have to, like, remember that we need care as well. And I will also say that I strongly believe that our resilience and our capacity to kind of show up with big energy and do a lot of things is highly reliant on our hormone replacement plan in midlife. If we're deep into perimenopause and in menopause. And so if you feel like you're kind of pushing through and like you have to rely on, you know, a lot of tricks to keep your energy up, I would just encourage you. Like, as a high performing person myself, I cannot perform highly without my hormones adequately replaced. And I would imagine that if you're having to be physical in your profession every day, that's even more important.

Thank you so much for being here. Okay, everybody, so I'm going to send you back over to the flipping 50 episode that we just did with Emily. And the reason being is she's actually talking about a lot of things. We got into the nitty gritty about things that may be beneficial for you as the person you are dealing with midlife changes, but also opening you up to new ideas and to kind of what we talked about and see collectively as this is kind of the approach and the moment that we're in and the diverse amount in different thoughts people are having about HRT or about this journey that they're having through menopause. And there is an opportunity to join Emily's summit about perimenopause. And if you don't know, I would say that of three words this year, like the buzzwords are longevity and menopause and perimenopause is having its own moment. People are getting this is different. This is a different ph. And I think it's a really important one because if we can get this one right, you know, the menopause transition itself post menopause and that means like till death do us part all goes so much better. So we'll. You'll find the link to join that in the show notes. It's free, but when you can get information like this from doctors, you're so much more schooled and educated yourself and you'll be better at what it is you're doing. Not necessarily having to be the expert, but knowing where to find them. Emily, thank you again.

Yeah, thank you so much.

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