396: Navigating Menopause: Insights and Strategies with Dr. Anna Cabeca

Take out your uterus. And while we're there, since you're over age 35, let's just take out your ovaries, too, and then we'll, you know, just put you on estrogen. You'll be fine. And it's just such a problem. And then I always joke, I say, then the patient comes back and says, you know, I have no sex drive. I'm not feeling better, I'm moody, I'm forgetful and can't sleep, and, you know, I'm having relationship issues. Hi.

I want to welcome you to Midlife Conversations. I'm Natalie Jill, your host, and I help midlife women redefine and rebrand aging. On this podcast, I do what I do best, taking complicated information and conversations around aging that are relevant to us now and breaking it all down simply with actionable steps that you can implement.

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Menopause have to suck. And if we think it sucks, what can we actually do about it? Like, what can we actually do about it to start shifting and not be caught up in all of the. The negative talk, the negative feelings, the downside, the midlife sickening, the hair thinning, the mood, the. All the things, the memory wrinkles, the.

Eyelid swings, the forgetfulness.

They're not being able to read anything.

What did you just say? Not being able to.

I get what you just did there. Today I've got Anna Kabeca, my very dear friend, who is going to be talking with us all about menopause. What we need to be aware of, what we can actually shift, how we can truly thrive through it, sail through it without it taking us down. She's known as the girlfriend doctor. We have had her on midlife conversations before, but it was time to bring her back on because this is a hot topic.

A hot topic.

So, Anna, thanks for jumping in again to midlife conversations because this is important. You know, you scroll social media, you talk with your friends at lunch or coffee, you turn on the media anywhere, and all you hear is the negatives about menopause. The doomsday. Right, right, the doomsday.

Yep, I totally. I completely want to shift it. I have to shift it for myself, for my own mental strength and health. And I really want to celebrate menopause. If we Think that we celebrate puberty. We, you know, and we go through life, and then menopause is another rewiring. It's a transition period, and we have another half of our life, maybe more, second 50 to live. So this should be a celebration, a time of celebration. But it can be hard to celebrate when you're like, no, oh, wait, I got these. You know, I could. No, literally right before this and before.

We started recording, I was pulling up my eyelids and I said, what's happening here? This is new. I asked if I was allergic to Arizona or if it's menopause.

I'm like, what?

What's going on? So there's a lot of things that actually do shift. So before we even dive into that, because there's a lot I want to ask you. There's a lot I want to share and talk about and open up the discussion around. But let's define what is perimenopause? What is menopause? What is post menopause? Because it's my understanding that menopause is actually a day. It's the day that you. It's been a full 12 months since you've had a cycle, and that's your menopause day. Is that accurate?

Yeah, that is. So the technically, the terminology we use, we have terms pre menopause, perimenopause, menopause, and then post menopause. So we use menopause to really encompass menopause and perimenopause. So we kind of are using the term inaccurately. But when we say you have gone, you are menopausal, you've been 12 months without a period, now you're designated menopausal.

Okay. And perimenopause is pretty much that decade leading up to that. So if you've. And that's. I'll say that's really where I am. I'm not fully menopause. I thought I was, but then I got a surprise period out of nowhere. Like, surprise, here we are. So that's a good thing.

And that is a good thing. That's ovarian regeneration. That is a marker for longevity.

So perimenopause is those years. It's usually about 10 years leading up to it, where you have a wonky cycle, where your hormones start declining, where you start noticing these different things. Accurate?

Yes, absolutely.

Okay. And then postmenopause is everything after that one day, that incident of menopause.

Yep, exactly.

Got it. Okay, so let's talk about what actually happens. Like, what can we not control and what can we start to control. Let's talk about, like, what actually happens biologically.

So physiologically, like one of the things that mark menopause is the decline in ovarian function. So what's physically, physically happening is our, the number of eggs we have. So we are born with the eggs that we have for a lifetime. And so as we, as we hit puberty now, we start ov, we start releasing an egg or two every month that's part of ovulation and our hormone production. And when that's happening, our hor. To get to that ovulation, we have a spike mid cycle of, of hormones called LH and fsh. So LH to stimulate the ovulation as well as fsh, then we get an increase in progesterone, the second half of the cycle to help with, you know, essentially for fertility reasons. And so we get this, this nice monthly hormonal transition. Well, in our mid-30s, we have less than 15% of the eggs that we were born with. And so less functional ovarian eggs, less functional follicles that are being produced to support the second half of the cycle, less progesterone being produced. So we start to see mid-30s, typically a decline in progesterone levels. And with that we get irregular menstrual cycle, breakthrough bleeding, PMS symptoms, anxiety, difficulty sleeping, brain fog. Because progesterone is more than a reproductive hormone. It's a neurologic hormone, it's a neuropeptide. And it really works with our neurotransmitter. So it's very neuroprotective. So it's good for our brain, it's good for our memory, it's good for our thought processes. It's kind of our calm, cool, chill hormone.

So all of the changes that we start to see in menopause or leading up to it during perimenopause are, Is that all related to hormone decline?

Well, no, it's also relating to an increase in insulin and an increase in cortisol. So as we're aging, we're also seeing a shift in. We start to get more insulin resistant, increase in our fasting insulins, our, our glucose levels. So we become more insulin resistant as we age, and glucose also increases as we age, as well as some other metabolic hormones that work against us.

So it's not just sex hormones, it's not just your insulin, it's your cortisone. And then what happens with our thyroid.

As we age and as our thyroid too, and especially during perimenopause, Menopause, there can be a lot of thyroid disruption because thyroid works, interacts with our other hormones. So with estrogen, with testosterone, with progesterone, I mean, there's a interaction with all our hormones. As you know, our thyroid's a regulator. So it often can be also dysfunctional or less functional as we go through perimenopause and menopause. So that's also a problem too. We tend to produce less thyroid hormones.

Okay, so I'm team Replenish. Like, yes, let's, let's replenish lost hormones. Whether that's with your thyroid, with whether that's your sex hormones. Replenish it, bring it back up. There's a lot of people that feel very against that and they'll say, well, I want to do it naturally or I don't. Can you speak into that?

Some, yeah. And I think like this is where I mean, it really has to do. You have to do what feels right for you. But again, you want, you have to do it for the right reasons. Sometimes it's fear. Like I don't want to do the fear of estrogen is going to cause, or hormones are going to cause breast cancer. But you don't think about that when you replace your thyroid or you replace insulin levels. If you're diabetic, we just replace it.

Right.

You don't think, oh well, that's going to cause all these other issues. Now it's important to think about the whole consequence, but you also have to say, okay, what in my life, what can I manage and where do I need support? So I like to say I do hormone replenishment, not replacement. I don't want to suppress what your body's producing or capable of producing. I want to support a natural transition. I mean, there's blessings to aging. We want to do it healthfully with strong bone, strong mind, reduce the dementia. So for my clients that are like, I want to do it naturally, let's do it for the right reasons and how natural is your life? Are you outside every day? Are you in a non toxic environment? How's your spiritual life? How's your stress? And those issues come to work against us in our current environment.

I want to debunk some of the things that come up though. Like there's a, a lot of people will say I don't want to do it because they're scared of breast cancer. Can you speak into that? Some.

So the research consistently has shown that estrogen in and of itself in the studies that from the Women's Health Initiative Studies that have been done does not cause breast cancer. So estrogen, whether it's oral or transdermal, is not associated with an increase risk of breast cancer. And that's really important. Now, oral estrogens, and I don't like to give oral estrogen over age 45 or 50 because oral estrogen, like in the birth control pill or in some hormone replacement can increase your risk of stroke and can increase inflammatory markers. So try to avoid oral estrogens for those reasons. So there's, there's that piece that's really important to understand. If we're going to do something, we want to do it safely. What has shown consistently to cause breast cancer are synthetic progestins. So it's not progesterone. It's not a bioidentical progesterone, although it's often called progesterone. It's progestins. These are synthetic. They're not the same molecule as progesterone. These are the progestins in birth control pills. These are the progestins in many combination prescription hormone replacement therapies like Provera, Medroxy. This is a really important to understand. I told my clients and Magic, when we're talking about hormones, I said, only use bioidentical progesterone. And one of my clients, she wrote in and she said, well, I'm on medroxyprogesterone. It has progesterone in it, so it must be natural. I said, that is the worst one. That's the generic name. The trade name is Provera. And Medroxyprogesterone is toxic. Mp, you know, it's really toxic progestin. And so that is associated in the Women's Health Initiative study and in the, the Dr. Fournier did the epic trial with over 100,000 women, shows an increased risk of breast cancer. So synthetic progestins, whether they're in your birth control pill or they're Provera or Norithindrone or Combi Patch, those are synthetic. So unless it's bioidentical progesterone, really important to make that difference. And that has been shown to be safe in the, you know, in the studies by Dr. Fournier published in. I mean, we have this research from, oh my gosh, back to 20, you know, trying to think 2011, where he published research looking at over 55,000 women and looked at the different forms of progesterone. So oral micronized progesterone, which is the bioidentical compared to progestins whether they were Provera, which is called a pregnant derivative, or nor pregnant derivative like noranthendrone. So these are different names for these progestins. Progesterone did not increase risk of breast cancer, but every one of the progestins did, including the Provera, the medroxyprogesterone or pregnant derivative, had a three to four times increased risk of breast cancer.

How did estrogen get so villainized? Where did that get go wrong? Like I know that there was a study that's. But was it the progestins that they were just concluding with estrogen and they blamed estrogen.

They just blamed the estrogen for it. They just blamed. I think this anti estrogen talk is really misogynistic, to be honest.

And what's interesting, we were walking this morning before we recorded this and we were talking about breast cancer in general and people that we know that have, that have had that. And Dr. Anna said something that really stuck with me. She said, you know, it's really sad because these women that go through breast cancer treatment, they've been through the wringer and now it's almost like they just get thrown out with the bathwater where they now are healed, they're healthy, they recovering, and no doctor will prescribe them hormones to help them because they think that's a, it's going to cause a cancer reoccurrence. And there's no link to that?

No, no, not with, especially with vaginal estrogens. And DHEA especially is very, very safe and has been studied in women with history of breast cancer. And so we can feel very confident in that. And yet doctors are reluctant to prescribe because of, really we in America, we have such a litiginous society. Yeah.

Wow. Okay, so let's. I want to ask about the birth control question because this routinely comes up in a number of ways where somebody, one of you listening, this has probably happened to you. You go to your doctor for your checkup and you say, I'm experiencing menopausal stuff, perimenopause, all this stuff. You list all those things we listed at the beginning. The brain fog, the dry skin, the painful, all just all of the things. And they say take birth control pills. That's their lazy medicine answer. Let's talk about that. Why do doctors still so many of them do that? And then my second part of the question is, if you've been given that and you're on that and you're over 45, what do they do?

Yeah, yeah. So this is, this is the issue. And it's almost like, okay, you're having these symptoms and you're a doctor. I mean, what. Where. You know, initially, when I've been practicing medicine for 30 years now, and I'd like to say a lot has changed, but really, a lot has not changed. And so, you know, you have someone coming in with these symptoms and their periods irregular. They have PMS, etc. You put them on the birth control pill. It doesn't matter if they. If they've had their tubes tied or whatever. Right. They're not using it for birth control. We're using it for hormone suppression. And so, okay, that'll, you know, keep them out of your office for another few months. But then the often. So here's the first thing. Let's put you on birth control pills. The next thing is they come back home. Anxiety. I'm having PMS symptoms. I'm irritable. I'm feeling moody, I'm depressed. Well, let's give you an ssri. So then you get put on Prozac or one of those o loft or one of them. And then you come back again. You're like, well, I'm breaking through, bleeding. I'm not feeling good. And then the doctor's like, okay, well, let's just take out your uterus. And while we're there, since you're over age 35, let's just take out your ovaries, too. And then we'll, you know, just put you on estrogen and you'll be fine. And it's just such a problem. And then I always joke, I said, then the patient comes back, back in. So them, you know, I have no sex drive. I'm not feeling better. I'm moody, I'm forgetful and can't sleep. And the, you know, I'm having relationship issues. So the next thing you know, the physicians like writing you a referral to a psychiatrist. Oh, my God. And by the way, here's a good divorce attorney. So.

Wow.

It's. I mean, that's like. That is a sad but not unusual. And. And some people are probably listening, say, oh, my God, I went through that.

Yeah.

And. And. And honestly, I mean, that's what I had coming out of one of the best training programs in the world at. To help my patients with. And. And I thought, you know, well, if we do surgery, that's the answer. Then we just put them on estrogen. But wait, then they're not sleeping. They need progesterone. They say, don't give you progesterone. If you don't have a uterus. But why? The progesterone's neuroprotective. So started using progesterone. Then I started doing progesterone before and supporting the adrenals and my mighty Maca supplement and detoxing before I put them on, you know, course to hysterectomy, let's say. And all their symptoms resolved. All their symptoms resolved. So I went from doing. And this is humbling to me. Yeah. And I have so many people. Patients to apologize to early on in my career. But I went from doing two to three surgeries per week to needing to do two to three major surgeries per year.

That's crazy.

Crazy. So reversing them, not completely eliminating. Sometimes there's no way I can get around needing to do a hysterectomy or incontinent procedure or something like that, but reduce 90% of them.

And that's just years of you practicing and seeing and experimenting and seeing this trend. But unfortunately I think too many doctors, that's just the ghost you still is. This something they learn in medical school. Like here, menopause give birth control pill. Like where does that even.

Well, perimenopause symptoms, the irregular cycle, the mood swings, the PMS, birth control pills and SSRIs.

Okay. Which is exactly what my OB GYN had told me before I did my own research and learned. When I said any symptoms, it was birth control and ssri. No.

Yeah. No. And then it's at a young age too. I mean, we're going to talk menopause and go more into that. But it's important when women are starting young girls or starting their periods a 13, 14, and they're having acne and irregular, you know, cycles or whatever, they're being put on birth control pills. And that increases risk of breast cancer significantly and also causes a lot of hormone disruption later in life. So no more should we be 20 years. Yeah. No more should we suppress puberty than we should suppress menopause.

Interesting.

So that's how I strongly I feel about it. There is a rewiring that has to happen in these young girls and boys. Boys, boys. Not to suppress their puberty. And no longer should we suppress menopause. Like with that birth control pill, that high dose suppression, we should enhance and support and optimize, but not suppress.

Okay, I want to ask about the IUD in a minute, the hormonal one, but I don't want to forget that. That's why I'm bringing it up. But I Still want to ask more about birth control right now for a second? Because if somebody is listening to this and they're on birth control, there's a couple things that they need to be aware of. Like you can't actually do your hormone testing while you're on birth control pills. Can you speak into that? And what if they want to go off birth control pills? What is the process?

Yeah, yeah. I mean, sometimes physicians will test you while you're on birth control pills. I don't recommend it. I don't ever test on birth control pills. I have a client. You're going to get a false number. You're going to, you're not really going to understand what's happening with the individual's own hormones. So I have a client stay off the birth control pill for two to three cycles before I do their hormone testing.

Okay. If you're on birth control and you want to go off it because it is suppressing, it's not. What, do you just stop cold turkey? What, how, what's the proper way to do that?

Yeah, I mean, because with birth control pills you have that placebo week and then your body resets. It's just about stopping. Okay, but when you, you know, you're, you are stopping when you're on birth control pills. You have to understand that the, you know, the ingredients of birth control pills, the combination of ingredients, the progestin and the estrogen, high dose pregnancy level hormones, are.

Depleting other important nutrients like magnesium and B vitamins and iodine. And so you want to supplement that before, you know, as you're coming off the birth control pills or as you're thinking of coming off the birth control pills, or even if you're on birth control pills, you need a good multivitamin B complex and a good magnesium supplement so that you can.

Hormones can be.

Balanced and that makes for an easier transition off.

Okay, if you're on birth control pills and you like being on birth control pills, what are some of the things they need to be aware of? Especially if they're over 45 and they bid on it, they're like, I feel consistent, I feel good. What do they need to know here?

So you are continuing to suppress your ovaries and that's a synthetic progestin. So we know those increase your risk of breast cancer. So you have to really be aware of the risk risks. And I really do recommend if you don't need birth control pills for birth control, that you're off of them.

We'll talk about IUD for a Minute iud, there's two different types. There's the copper and then there's the one that has the hormones in it. Is the one with the hormones creating the same issues as birth control pills.

Yes, because it's a progestin. Not as significantly as the birth control pill because the birth control pill is high dose estrogen as well, but it is a progestin. So you'll see the weight gain, you can see the hair loss, you can see the mood swings, et cetera. It's not suppressing the ovaries. It's really working on the lining, but it's still getting absorbed herbs systemically. So nutrient depletion as well. I like, you know, if we need birth control and you know, the paraguard iud, the non hormonal proper iud, I think it's great. It's safe. And though, you know, I was taught how to do it painlessly there, you know, you have to get, you know, again. It's nice that there's some news around this. Actually. There's been some news about how IUD causes a lot of pain. And I remember training at Emory and saying, well, we need to use a vaginal suppository and ripen the cervix before we put in IUD in.

So I think putting a copper IUD in, I'll put it on the level of. It was hard. It hurt more than doing a, Than having contractions in labor. Yeah, it was pretty bad.

Yeah.

No, because I, I know they've changed it. It's been years since I've done that. But that was pretty darn.

Yeah, because they used to not do any sometimes and people do they train not to just, oh, well, it's just gonna hurt for a minute. But that's terrible. I was like, there's no reason to do that.

Yeah, it felt pretty, pretty awful. So.

And I've had an IUD three times, so first time after I had one, I became a very symp. Athletic gynecologist.

It's not a.

There's no reason to experience pain.

Okay. I want to shift a little bit into menopause in general. And, and I'm talking perimenopause and menopause and what's changing and how rapidly things change after two.

I just want to say too, I had my daughters do IUDs too. So like that's in the, the Paraguard IUD. And the same thing I lidocaine, vaginal suppository. I leave the, you know, starting 48 hours before to a leave every 12 hours for 48 hours before the procedure and after. And the LIDOC suppository and then the IUD was inserted. And they did really well. They did really well. It's never painless completely, but they did really, really well. So, I mean, I think that's important for me as a mother. I don't want them to have.

So there seems to be a rapid decline once you stop menstruating regularly. So not even full menopause. But I, I noticed even in myself when my period started skipping months and spreading out, that's when you start having the accelerated aging in a lot of different areas. Why does that seem to happen so fast? Like, I feel like. And I've heard this overnight, right? Yeah, it's overnight. Like all of a sudden your skin's way drier or your hair is there.

Or the age spots pop up all of a sudden.

Yeah.

You know, how.

Why is, what is that correlation? Yeah.

That is just so unfair. Right. And it has to. I mean, there's a lot to this. And when we look at the rapid aging, there's a stem cell link, right. So our stem cells were aging rapidly because now we're going from reproductive level hormones to post menopausal level hormones. So there is that, there's that biologic clock. And you know, I wouldn't get off tangent, but there's that, that shift. And so we're less, we have less regeneration, less repair in, in so many instances. And so you start thinking of, okay, well how do I reverse this? How do I reverse these changes? And yeah, so they're not so terrible. But it is, that relates to stem cells and our biologic clock, which I will just say that women a hysterectomy and their ovaries removed. And I want to hear from you because if you've had it like before age 40, there's something that happens age 45 to 55, that's another. Even though you don't have your ovaries, there's another menopause happening here. And so there's very little research in this population. But there's another, I mean, that relates to our other biologic clocks. So the, the insulin clock, the metabolic clock, the aging clock. So even so, it's especially important to be on progesterone during this time. Okay.

How much of this stu can be prevented or slowed down with hormone replacement?

So with hormone replacement is again with the ovarian, I'm going to say we do much better job at preventing with supporting nutrition and healthy lifestyles than we do with hormone replacement. Hormone replacement is the 10%. It's important, but the 90% is the lifestyle. Yeah, you're the way you think. Positive mindset, getting out in nature, sunrises, sunset, avoiding hormone disruptors. All those things are very supportive to supporting your body's own natural hormone production and detoxification.

Okay, I'll, I'll go with that. The 10. She said 10%. But this is what I want people to hear and what I'm hoping you agree with. You can tell me if you don't. Without that 10%, though, it makes it a lot harder to do those other things.

Oh, absolutely, absolutely.

So even if hormone replacement is only that small percent, your drive, your motivation to want to work out, your drive, your motivation to get on with life. Life goes way down when you're that depleted of hormones.

And especially during a rapid transition. Especially during a rapid transition. So it can help. So almost like I say, you know, hormone replacement is like filling the whole hormone replenishment. Adding what we need is like filling the holes in the bucket. And then you're, you know, everything you do with your lifestyle fills the bucket.

Now, this could get confusing, Anna. So I'm gonna, I'm gonna ask this. And I don't. I'm not trying to start a controversy here. I just really, I'm. I'm trying to figure this out. I'm sure, sure my audience here is trying to figure this out. There's a lot of different opinions about levels of hormone replenishment or hormone replacement. You'll talk to somebody that will say, you need to have extremely optimal levels. You've got to have these like, the same levels you were when you were in your 30s. And then you talked. I know when I've talked to you, you say, well, why would you want. You don't need to go this over extreme. You just want to get you back to getting out of symptoms. How did you come up with that versus the optimal. And where do you, where do you stand on. On teachers and doctors that want people at these extreme optimal levels? And I don't know the answer, even for me. So that's why I'm asking.

Yeah, yeah. And. And I have, like, I've been doing this now for. In the hormone replenishment. I've been physician for over 30 years. And in really specific with hormone bioidentical hormone management for over 20 and age management and longevity clinics for. For this long too. So when we look at the longevity model, I want to look at, you know, what is the science showing and what's, you know, what who's doing it really, really well. And also because part of the experiment, you know, experimentation is on my, you know, my clients and me.

And me. I'm weird.

Yeah. It's like it's part of. We are always so unique and individual. So it really does depend on that. But also the pendulum swings initially especially with functional medicine hormones. I'm like oh, more is better. Right. And then it's like wait, this is. Can this not. That's not true. True. It's not good for the pocketbook necessarily. You're on like so many supplements. Not good for the digestive tract. It's not good for your body because all of a sudden you're giving your body things that it needs, right? I mean needs it. But now your body's not making what it needs to make. Okay. So what I've seen in these high dose replacements, for whatever reason you can stay on it long term, but if you don't then all of a sudden you stop you physiology and physiologically into chaos. This is where depression. You've seen su sides happening like say from high dose testosterone and then stopping it. Your body is out of sync and it hasn't you somehow suppress its innate ability to do what it needs to do. And I think that's never good. I want to work with mother Nature, not against her.

That makes sense.

And also because high dose physiology affects our behavior. So when you're on these higher dose, how are you thinking? How are. Maybe, maybe it is better. But I've seen also increase it. Say for example again with testosterone being the culprit, we'll say testosterone first increase anger, increase.

Increase adultery, let's say increase relationship mean those distractions, right? And so that's with higher testosterone with higher too too high progesterone estrogen, mood swings.

Also like there's a bell curve depression, anxiety. So and then you have to relate to you know, what's, you know, what do we know for our decade in life and the best science we have and take into account, okay, what helps your body keep doing what it needs to do. You never want to like if you had to take out your, if you take out your ovaries, we've got to replace. Right. But like you know, ovaries are still producing hormones into our 60s over age 65. We know we're still. Our ovaries are still producing some hormone. But if you're completely suppressing the cycle, what is that doing and what's it doing to our nervous system, our vascular system, etcetera I'm more on the conservative. I'm like a happy medium. But it depends on the individual, what the individual wants. I often. I do the start low, go slow, and then we keep tightering from there to get you feeling good, and then sometimes taking breaks to just remind your body, look, I got to keep functioning.

That's what we've been doing. With me, we'll share, because my doctor for my hormones, and when I first came to her, I was definitely not on enough. I was on by, and it was a. Not a great combination. And my estrogen was extremely low. Like my labs, it was like a 20. Estradiol, I think it was. It was like postmenopausal, like fsh.

And LH was really high. And that means bone loss and more conversion from white fat to brown, from brown fat to white fat.

Super scared me. Yeah. So we gradually bumped it up. I'm on the patch now, and all my hot flashes stopped. Everything. But I'm not. When I looked at my numbers, my estradiol, I think, was like at an 80 or something like that 60 or to 80 something or that. And I was concerned because I said, well, I hear these other doctors talking about having these optimal levels. I need to be at 200. And you explained that that is going to have a pendulum effect the other way. Possibly.

Yeah, absolutely. And I think so. I mean, it's. It's something you can play with as an individual, but too much, too long. And this is what I hear now, again, because I'm, you know, I see clients from all over, but also more people have been on, say, for example, testosterone pellets for a few years now, and they. It's like, it's good for the first. First year, two years, and often. And then now at a year four, all of a sudden, they're not feeling good. They're like, you know, they definitely feel a shift. Their mood, their memory, their, you know, get up and go, their drive. This is. It's. It's changed. It's depressed. They're not feeling as good as they did initially. And, you know, you've interrupted an HPA access process. Interesting. You've interrupted it. So instead of supporting it. So I think that's the problem with the long term. And with pellets specifically. We get high levels. I mean, we'll see estrogens in the. In the, you know, 200s. We'll see testosterone in the 3, 400 levels in women. And that is. That is really high.

Yeah, I know at one point years ago, before I was Working with you. I was doing the troches. Troche, I call it troche.

And it was way too high. It was like, ridiculous. And there was side effects over that. So now I keep mine on the lower side. But you said it's actually good for my age group, so. So it's not the optimal that some people talk about, but it's. It's that level where you don't have the. The negative side effects. You don't have any of the negatives going along with menopause, but you have. You're supporting your body with a little bit.

Yeah, yeah. Because side effects of too much testosterone can be hair loss, can be hoarsening of the voice, can be enlarged enlargement of the clitoris. I mean, there, there's certain side effects with that. And again, physiology affects behavior. So, you know, how's your mood, how's your tolerance, how's your relationship? All those good stuff. And that's really important stuff. That's really important stuff. And the other thing, too, when we're using a topical cream, like, say for testosterone cream, we're not going to see it in the blood, so we can't really rely. We're not going to see it in the blood as much, so we're not going to rely on those levels. That's where I say treat the patient, not the lab. When we do a Dutch test looking at urinary metabolites of testosterone, if you're using it on a cream, we will see. We will see it in the. In the urine. We'll have a good representation. But it's this. It's a complex legs. Because hormones are energetic molecules. There's no perfect way to test them.

Now, what about. I've heard from women, they'll say that they were taking testosterone and it was. But it was converting to estrogen. Is that even a thing?

Yeah.

And why does that happen?

And especially in men, you can see it in men who have moobs. Male boobs, right. They are converted. They have a lot of aromatase converting testosterone to estrogen. So we make estrogen from testosterone and from testosterone, we also will convert to dihydrotestosterone.

Okay.

So I'm a rapid converter to dihydrotestosterone. And cortisol enhances that conversion. So testosterone to dihydrotestosterone. So when I'm stressed, I make my testosterone goes to dihydrotestosterone instead of estrogen, and I start getting hair loss. I get breakouts, you know, and so that is. I'm like, oh, wait, okay, I'm too stressed. I'm converting. So you have to interrupt that conversion with zinc and also decreasing cortisol, managing my stress, stress levels and supplementing to support that. And then otherwise you're going testosterone via aromatase to estrogens and then estrogens. Because there's not just one estrogen in our body. We have over 30 different estrogens in our body.

Estrel, estradiol, est.

And those are the biggest ones. And then metabolites of those, like 2 hydroxy estrone, 4 hydroxy estrone. And so when we see, so we look at those, those, the pathways of the metabolic breakdown of estrogen within our body. And, and so it's important to look at, it's important to look at how your body's using that estrogen once we make it from testosterone. So testosterone does convert to estrogen. So if we're supplementing, you know, high levels of testosterone, well, that'll be converting to estrogen. If we're also supplementing with estrogen, you know, we're getting it from two different, different roots. And then, you know, what are your adrenals and ovaries have to do? Totally.

And okay, I want to ask you a lot. I have a lot more questions about hormones, but I want to, I want to shift a little bit into a little bit about the mindset piece, which sounds funny, but we've got a little bit of a story to share about what you just went through and how the world reacts to our aging. So I want to, I want to shift into that, but I don't want to stop the hormone conversation. So what I want to invite you all to do right now while you're listening to this, you can can bookmark this for later or you can even screenshot from the show notes. If you're watching this on YouTube, it's in the description or if you're listening to this on Midlife Conversations, the podcast, it's in the show notes. We are going to be doing a live masterclass again. We've done these before. We usually super fun like once or twice a year, but we're doing it one date. I think we're doing on the 23rd.

Monday, 23rd Monday at, at 3 Pacific Time and 5 Central Times.

So and if you go to midlifeconversations.com forward slash magic. So midlifeconversations.Com forward SL magic. The reason I'm telling you about this is we're doing a deeper dive specifically on hormones, hormone myths, what you need and I know that when you come to the class, not only are you going to learn and get your questions answered, but you're also giving away optimal. Oh, this is. This is killer. Everyone asked for this. Like, if you've ever wondered, like, what lab ranges should actually be, like, what should you have your doctor test for? And what are the ranges that are optimal versus what they just learned in medical school that aren't helping. You're getting that guide for free, just for attending. You can't just sign up. You got to show up. It's free.

Got to show up.

You got to show up because we want you to learn this stuff and.

Beyond and ask questions. Yeah.

Yeah. So that's Midlife Conversation.com/magic. I just didn't want to pivot the subject without mentioning that. The reason I want to pivot the subject right now is there's a whole other conversation we were having when we were walking this morning about the idea of aging and menopause and how. How we make that as a limiter for ourselves and want to share just a few examples of that. One of the examples was Anna was not. Last time I was out to visit you, you were not walking at all.

No, she made. We walked around the lake that day, and I'm like, oh, I should keep doing this. And I did.

Talking about the bed. Because two of the really important things in aging that I stand for are movement, moving daily, and strength training. You have to do both those things. It's so critical. We lose muscle mass as we age, and we're also too sedentary. So those things, and they get harder and harder. By the way, if you do not keep up or start now, like, it gets harder, your knees start hurting you, you have problems by not doing that. So I. We were talking about that. She was in agreeance, but she wasn't doing it. You were not walking at all?

No, I was. I was strength training and boxing, but I was not walking.

So when we looked at your whoop or my aura, when we looked at your phone steps, she was like 2,000, 3,000 steps a day, maybe. Yeah, by accident. Like going to the bathroom, running an errand, not seeing. Going rooms. Room to see a patient, but not. Not intentional. So I said, well, I walk every day, so let's go walk. So we, we. She's like, oh, I have a lake right down the street. Like, you have a lake down the street and you're not walking. So we went and walked this lake, and it was like the first three miles she had walked in a long Time, right? We did great. You weren't complaining. It was nice. And she said, okay, I'm committed to walking. Well, she didn't start. You literally didn't start. So you decided to sign up for. What was it called?

Camino de Santiago. The Camino de Santiago is a pilgrimage, and it is this. The pilgrimage of many different routes, but they end at the Santiago de Compostela, which is a cathedral in Spain, where The bones of St. James, one of the original 12 apostles of Jesus, was originally was thought to be. That's where they're buried. And so it's a very spiritual holy pilgrimage site. And the Camino de Santiago, it's very famous for the French route through the Pyrenees mountains and the Portuguese coastal route. So my, you know, I wanted to do. I was going to Portugal anyway in this summer, and so I was like. I was just burying. I was called, and all of a sudden, like, everything happened that said, okay, you are going to do this Camino. And it.

Which meant about 40,000 steps a day for a week straight just to give.

You 100 miles in seven days.

Hundred miles. So, Anna, this is.

This is.

This is real life.

This.

Y'. All. Y' all get this. This is real life stuff. She started sharing with some friends, some colleagues. Oh, boy.

Before we say that, you know, like, you know, the whole concept of walking and being able to do this walk and everything is that really, like. I would tell Natalie, I just don't have time to walk.

So she. She's telling people she's going to do this. And what she was instantly met with is what you all are met with sometimes people going, well, you don't walk. You can't do that, or you're not. That's a lot. A little aggressive. You can't.

Because it was like in two weeks, two and a half weeks that I was going once I decided.

So she was met with why she can't. Or why she shouldn't have that vision or why that's not possible, or she.

Shouldn'T go by herself.

It's going to be dangerous, whatever. All the. All couple of reasons. So she called me and she said, I'm gonna do this. I never once said any negative. She said, what do I do to get ready? And I said, you start walking twice a day. You start wearing a weighted vest. I gave you things to do. Y. I wasn't the only one. You had a few other people that. You had a trainer that said something similar, right?

They said, well, let's work on your knees. Let's work on Your hips. Yeah.

The reason I'm sharing that. Well, she did it. Not only she do it and having a mass. A major amazing time doing this us, but that was. She made a decision. She got clear on the vision of it and she did not allow anyone's limiting beliefs, anyone's what I call false assumed truth stop her. And I wanted to bring this up because so many times we say in midlife, oh, you know, it would be nice if I could feel better or it would be nice if I could do this or I, I maybe I want to what, insert whatever. And then we get mad met with the limiters. And I think this is an important part of what we need to discuss with aging.

I think, I mean that's such an important topic because how many dreams have we buried within ourselves like that we just say, well, you know, it's not realistic and don't even worry about that. I mean, I say like really go for it and, and trust. Like plan big, like aim big. It's not like, okay, you know, I could have just said, I'll just hike one day or two days. Like, no. And the next time I go, I'm going to more two weeks or four weeks or whatever, I'm going to walk every day and just keep going. And I think that's, I mean it's. And since I've been back, I've been keeping up with my walking and I really committed to do 10,000 steps a day, at least five days a week to make sure I get that in.

But help with some helpful advice there to people listening because you literally. I said I have no time. You said, I have zero time. How did you all of a sudden find time? Because you didn't all of a sudden get an extra day each week, right?

I know. I just like, somehow I got up a little earlier. I just walked out the door where I would have been sitting at my desk starting work. I'm like, that work will still be there. Let me go walk first. And then I took calls while I was walking sometimes. So I found a way. I found the time and I found the way. And then you were just like, okay, you've got to get this amount of time and just walk twice a day. And so that was like, okay, in the evening. I've always wanted to go for an evening stroll at sunset and I just wasn't. And so like that as part of the training was, was somehow I had time.

You ran into another glitch and you ended up buying a purchase. Tell them about that.

Oh, yeah. So just because. Trying to get in those 10,000 steps. So I bought a walking. The walking pad. The walking pad, and I put it in my living room because my daughter, like, we like to watch a movie or something. So I'm like, okay, if I haven't got my 10,000 steps in, I'm going to get on this pad. Or if I'm going to watch a movie and I don't have 10,000 steps in, I'm going to get on this pad while I'm watching the movie or folding clothes or whatever it may be to get in my 10,000 steps.

And you don't love doing that. But it doesn't. It's not. But it gets you committed to your goal.

Yeah. And then I just see that 10,000 steps and I see that nice bar on my. I, you know, my app. It makes me happy.

Yes. So. Okay, so the reason I wanted to bring that up is a lot of reasons. We, I think we have limiting beliefs our whole life. Like, and I call them false esteem truths, which fat. That's the kind of fat I like to kill.

Yes.

But we, we have those our whole life. I feel like they start compounding in midlife.

Well, and, you know, I remember having a patient coming to see me and I had just done. I was for. At. I was 43 at the time. And at 42, I had done a sprint marathon. I had done, you know, bike ride, swim or so bike run. Swim, bike, swim, bike run. That's what it is. Swim, bike, run. So I had just done a sprint marathon. I had the picture up on my wall and she said, oh, my God, you know, I'm just too old to do that. And I looked at her age and she was 38 years old. She was four years younger than I was, five years younger than I was. And I was like, there's no reason you can't. I just did this last year after having a baby at age 41. So. So there's no reason you can't do it. Just one step at a time to train yourself into doing something like that. And I think that's where our just say, I'm too old. And those were the thoughts when, by opposition for me, walking alone for, you know, that for a week or so, you know, in this, in the, in Europe was, well, you know, shouldn't go alone or, you know, you're too old or, you know, that's. You'll. You think, okay, well, there's going to be all these young hikers on the road. And let me tell you you got to do things that push your limits. Yeah. But there were 70 year olds, 80 year olds walking and hiking and carrying 2030 pound packs. Yeah. So like that's limiting. Belief has shattered that, like it is shattered. And I, I just loved, I love seeing that. And I think when there's, you know, like having a purpose, having a challenge, having a personal dream and accomplishing it is the best gift you can give yourself. And there's no age limit. There's no age limit. And expose yourself to people that are older than you, that are doing things. And if there aren't, you be person for those that are coming around you.

And I don't want to sound doomsday, but I'm going to say this anyways because I think we, sometimes we use doomsday to stop us from our goals, but I want us to be aware of doomsday to empower us because we all in our 50s, we're. You're 57, 58. 58. I'm almost 53 right now. I'll be 53, I think when this airs. But we, we tend to know, we all know people that don't have the privacy privilege of aging.

Right.

And we see more diseases pop up more, more just horrible things that start happening. So it to my question is if not now, when?

Right. If not now, when? Yeah, Yep. And then the aspects in our lives, like how do we, you know, I, I have strong faith and I think that God gives us a certain number of days on this earth. It's up to us how we want to live them. There's so much I had, you know, my father, you know, after he was almost, he was dying at age 79, you know, I was able to step into his medical management. But take him off three prescription drugs, put him on testosterone, get rid of his insulin, etc. And he lived to 91 good years. 91 good years. He was the oldest brother of four. He outlived all his younger brothers, not just in the number of years, but by quality of years. One of his brother was on disability for back issues for over 20 years. And the other brother, his youngest brother, was over.

14 years younger than my father. He, he was bedridden for the last eight years of his life till he died. Bedridden. And so I think that, you know, my dad was jet setting and traveling. You know, he could have been that same 79 to 91. If God was giving him that time, he could have been in bed that time. The changes that we make, no matter what our age is so Powerful. I see that over and over again. I have a client in my office right now who's going to be celebrating her 70th birthday. And she, you know, she's lost the same hundred pounds five times in her life. She feels defeated, she's been depressed. She's like, you know, desperate. She knows this isn't the way. So to come to our clinic, you really are taking a step. It's cash pay. You're going to be determined. You're going to be faced with functional medicine testing and, and me and, and supplements and things like that that I want you to do IV maybe, you know, if I really want to move the needle, I'm going to put you on some IVs, like I did for Natalie. Just like, okay, let's give you.

I came to visit and I said, I'm getting over a sinus infection. She's like, you're getting an IV today?

Yeah. So we did a good immune boost iv. And so anyway, so for this client, you know, there's mold toxicity, there's hormone disruption, there's all these things. And also this long, long period of chronic depression and defeat. And Demoral, like, so such negative thoughts about herself. And it really broke my heart. And so, you know, really. And she's not alone. I have so other clients, so many CL clients, like, in the same situation. And so to changing the mindset. Like, okay, so you're. So you're going to be 70, but what do you want to live this way to your 80? Knowing that you have the. Our body is constantly regenerating and repairing, so you have to feed it with positive thoughts, positive energy, the right nutrients, and you have to eliminate. And we're going to talk about endocrine disruptors in our masterclass, but you have to eliminate the things that are working against you, that are weighing you down, that are burdening you. And, you know, a few interventions and she's doing amazingly better. Yeah.

What do you want listeners to know about menopause? How do you want them to approach it? What are the things? If you were to pick, like, I need you to know these five things before, because they're entering into it or they're there and they're suffering. What do you want them to know?

First of all, you know, while menopause is natural and mandatory, suffering is optional. So you don't have to suffer, you don't have to power through. And so it doesn't have to be painful. Right. Does not have to be. That's number one. Number two, there's also Always something you can do to improve your health. There's always one next right step. And number three, understanding. When you're, you feel like, you know, there's.

You'Re on this downward spiral, just know that you can pull yourself out of it and it comes with, oftentimes with force, you know, increasing oxytocin. So remembering that, you know, like we are best gift we can give ourselves is happiness and we are designed for pleasure. So do things that bring you joy, that bring a smile to your face. And then the fourth thing is don't be afraid of hormone optimizing your hormones. Don't be afraid. Get the facts, get the knowledge, get the information. When you have that knowledge, you can make the best decision for yourself better than anyone. And, and that with that, don't give your power away. Don't give your power away to a prescription, to a, you know, insurance company, to anyone else. You are that powerful individual. So nourishment is key. So you know, focusing on like, for me it's always the keto Green way, the keto green lifestyle, focusing on, you know, the, the nutritional aspects, the lifestyle aspects that really make the biggest difference in our lives. It's powerful.

So good. And I would add to that, surround yourself with education because to me, if we just rely on our one doctor's opinion and our five minute appointment that is going to leave us hungry for answers and confused, you might luck out and have an amazing doctor. You might. I just think it's very hard in 5 minutes or 10 minutes or 15 even to really get the full grasp of your health and what you're navigating. So I would say surround yourself the way that I do, which has helped me hugely. Listening, learning, reading as much information as you can get. Be hungry to be your own health detective. I know that's what's changed for me and that's changed for my clients because we have to learn on our own. I know that sounds annoying to some people, like I want to go to medical school or I didn't want to do this right. But we have to be hungry for that information and be open to opinions that maybe are different. I'll tell you, I've had lots of hormone experts on my show and they don't all agree on all the things, but they do have a lot of commonalities, like being open to a hrt, like being open to, to replacement to a lot of things. But they might differ on numbers and things like that. But that's where we have to step in and learn for ourselves.

I believe. Yep. And you have to. You're your own again. Be your own best advocate for yourself.

I will say Dr. Anna is my own personal doctor. She helps me with my hormones and all the things. So. So I'm very fortunate to have some of my friends that are my doctors, which I absolutely love. I've had some of my other doctors on, like my peptide, my favorite peptide doctor on that, you know, too you so. But I want you to be able to join in with us and learn more without having to necessarily go change your doctor. Right now. You can just be a fly on the wall. Actually, more than a fly on the wall. Be interactive with us and learn more. We are doing that free class coming up on the 23rd. Depending on when you're listening to this, it might have already passed, but if it's before September 23rd, you're in total good luck. So if you just go to midlife conversations.com midlifeconversations.com magic or check the show notes or if you're watching this on YouTube, look below and you can make sure to save your spot. The class is totally free. And when you do attend the class, not only you're gonna have fun because we're fun. I think we're fine.

I think we're fine.

We're fine.

Yeah. And we, we won't. Won't hesitate. We'll entertain every question. I mean, that's right. There's no layer, you know, no barriers. So you can ask us anything.

She's a teach a lot. You're gonna. There's gonna be an interactive time to ask us any questions. Mostly Anna. I'll be more listening. You might have a question for me. But mostly they'll be for Anna and you'll be able to try on more of what she does. And then she's also going to give anyone that attends your list of labs and how to test for optimal like how do you what you can actually start being your own health detective. So that's midlife conversations.com forward slash magic. I hope to see you there.

I hope to see y'. All.

Thank you.

Bye.

I hope you enjoyed the episode. Thanks for taking time out of your day to listen. Listen in as my guest. If you found this episode valuable, please share it with friends and on social media. Be sure to tag me and our guests so that we can find you and share the love. I'm Natalie Jill fit on all social media platforms and the biggest thank you that you can give me is leaving a review and hopefully a nice one at that. This will help others find these episodes so we can help and reach more people. If you do leave me a review, please message us at subscribers support@nataliejillfitness.com with a screenshot of your review, and we would love to send you a free digital download of my DSR journal as a thank you.