Health
The New Science of Women's Health with Tamsen Fadal & Dr. Amy Killen
In this episode of the Communic Podcast, host Jeff Krasno engages with Tamsen Fadal and Dr. Amy Killen to explore the often-overlooked aspects of women's hormonal health, particularly during peri...
The New Science of Women's Health with Tamsen Fadal & Dr. Amy Killen
Health •
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Interactive Transcript
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Welcome to the Communic Podcast.
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My name is Jeff Krasno.
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In this episode, we're gonna dive deep into women's
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hormonal health from perimenopause through menopause
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and unpack one of the biggest medical mistakes
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of the 21st century.
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So for decades, we celebrated the onset of womanhood,
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but we've pathologized its evolution.
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What my friend Dr. Marisa Snyder
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calls women's second puberty.
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We whisper about hot flashes and mood swings,
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but rarely do we talk about the deeper biological
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and emotional transformations taking place.
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Or the way modern medicine has systematically failed
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to meet women where they are.
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In today's episode, you'll hear from two remarkable women
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who are at the forefront of the movement
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to address women's health head-on.
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Dr. Amy Killing, a board-certified emergency physician
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who's now revolutionizing women's longevity medicine
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and tamson Fadal and Emmy-winning journalist
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and author of How To Menopause,
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who experienced firsthand what happens
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when our healthcare system fails women at midlife.
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Together, they're helping rewrite the narrative
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from silence and shame to empowerment and science.
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So let's start with a story that might sound familiar.
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So tamson Fadal is at the top of her game,
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a seasoned journalist anchoring a major news station
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in New York City, then one night in the middle of a broadcast,
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her body sent her a message that she couldn't ignore.
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I was in my 40s.
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I'd gone through a divorce early in my 40s.
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I had gone through some odd things that were happening,
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but I had never looked at them as a whole.
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One night in 2019, I was on the air
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and I had had some problems earlier in the broadcast
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and like look at a word on the teleprompter,
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you know, the words as a news journalist would scroll across,
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you'd read an hour and you'd be done with your newscast
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and I do that every night, live television,
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for 20 plus years.
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And this one particular night, I would look at a word.
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I knew the word, but it wouldn't come out of my mouth.
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I just kind of skipped it.
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If you were listening closely enough,
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what did she say?
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Maybe I misunderstood her.
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We were in a commercial break and I got what now I realized
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was a hot flash, really intense.
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And it just kind of comes in the inner core of your body
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and it's sweat just kind of breaks out instantly everywhere.
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My head, my underarms, everywhere.
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And my heart started racing and I thought,
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oh my gosh, I'm not gonna make it through this next,
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iteration of what goes on.
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So I said something allowed and a coworker of mine
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said, I think you should get off the news set
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and he came to me and we walked to the bathroom.
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He later said to me, I didn't know if you're having a heart attack.
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I didn't know what was happening to you.
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It was scary.
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And I just went down to the bathroom floor
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and another coworker, both men came in,
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putting ice on my neck and I never had anything like that before.
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Certainly it was never nervous around camera.
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It was the only job I've ever had.
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And I left the studio and then I went on a kind of a quest
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to figure out what was going on.
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I didn't go to an OBGYN right away.
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It wasn't any part of what I thought was happening.
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I ended up eventually going to an endocrinologist
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and then an OBGYN and I got a note inside my patient portal
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that you get from the doctor and there's an alert
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and I opened it up and it says in menopause.
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Dot, dot, dot, any questions?
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As if here's your diagnosis, let me know
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but this is kind of where you're at and good luck to you.
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That dismissive message from her doctor
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became the title of Tamson's book
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and a rallying cry for millions of women
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who felt invisible in the healthcare system.
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But here's what's truly shocking.
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It didn't have to be this way.
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For decades, we had safe effective treatments
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for menopause symptoms.
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Then in 2002, everything changed.
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The Women's Health Initiative study is one
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of the most consequential and arguably botched studies
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of our time.
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Here's Dr. Amy Killan explaining what went wrong.
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So the Women's Health Initiative came out in 2002
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and it was essentially the wrong hormones
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being sent into the wrong population of women.
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They essentially released their results to the media
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before they even had a published and peer reviewed.
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So they essentially came out to the media,
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they stopped the study, they said,
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oh my gosh, these hormones caused breast cancer
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and what's lots and hard to see is in strokes.
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We got to get everyone off of them
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and they hadn't even gone through the peer review process
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which we know is really important for studies.
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And so in the last 20 years, we realized that they did
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some things that weren't ideal.
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We know how to do it better.
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But unfortunately, the fear that came out of that study
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has still, it's still around today.
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Doctors are afraid, women are afraid.
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And so less than 5% of women over age 50
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are currently taking hormone therapy
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even though we know it's super beneficial.
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How did that data emerge from that study
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and how was it misconceived?
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So the breast cancer piece was, it turned out
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it wasn't the estrogen that caused an increase in breast cancer.
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It was the progestin, this synthetic progestin
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called the Medjotsy Progesterone Acetate
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which is not one that most of us use anymore.
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That caused a slight increase risk of breast cancer.
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I mean, it really ended up being just a couple of extra people
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per 10,000 women years.
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It wasn't even a very big difference
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but it was a slight increase risk.
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However, the estrogen, when you use estrogen alone
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in that study resulted in a 20 something
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29% reduced risk of breast cancer.
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So again, if they'd waited a little while
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to publish their results, get a peer review
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before the media statement,
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I think we would have caught that.
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So that was one thing.
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And then for the heart disease,
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it has to do with using a synthetic estrogen
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and starting it late in menopause.
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So when women lose their estrogen at menopause,
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estrogen drops, you kind of have this invisible shield
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that was protecting your cardiovascular system.
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It's gone away now.
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And so all of a sudden your plaque builds up
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in your arteries, you get aphrosylrosis
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and it happens pretty quickly after you lose estrogen.
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And so those women in the NAHI,
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they were 13 years out from menopause on says
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that they had plaque in their blood vessels.
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And then we gave them an estrogen, this primarine,
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which actually has a simaptivity that ends up
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breaking up the plaque a little bit,
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which we know then can increase stroke risk
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and heart attack risk.
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And it increases what they call MMP and enzyme.
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So essentially wrong hormones,
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you know, wrong population of women.
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That's the lingering legacy of the women's health initiative,
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a generation of fear of silence
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and misinformation.
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Here's Tamsin again, describing how that fear
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shaped her own choices.
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I went into the doctor when they said,
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hormone therapy and she took out a little calculator
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and was like, okay, your mom was this age
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when she had breast cancer.
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And I was like, is that how we're deciding this?
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And so I was very scared.
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And I think that sadly, you know,
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because we know doctors really stop learning about this
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in school, when you have a woman standing
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in front of a doctor going, are you sure?
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Am I sure what, I don't know what to do?
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What it did learn though,
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with one research after another,
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and one doctor after another,
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and one piece of, and one study after another,
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is that if you have a family history of breast cancer,
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that does not mean you're excluded
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from taking hormone therapy.
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And even if you've gone through breast cancer,
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there is some guidance and some doctors
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that will talk to you about what your options are.
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So I think we have a lot to teach
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and a lot to share with women.
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So they're not going through that suffering.
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It's a long term.
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They're not in any danger health wise.
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This is crucial information.
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Having a family history of breast cancer
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doesn't automatically exclude you from hormone therapy.
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But because of the WHO's flawed messaging,
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countless women have suffered unnecessarily.
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So what are the actual stages of menopause?
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And when should you start thinking about your options?
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But, tamson breaks down the three phases
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that most women do not understand.
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Where are the stages, the main stages,
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that I think are important to know?
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So there's perimenopause, which is basically anything
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that happens prior to menopause,
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which can last anywhere from four to seven to 10 years.
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Every woman goes by this individually.
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So I could have started my perimenopause journey at 46
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and hit menopause by 51, and that could have been it.
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I could have had very mild symptoms.
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Somebody else could have very severe debilitating symptoms.
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So that's the perimenopause area,
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which I think is a very important one to discuss
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because when you're in your late 30s,
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you could already start looking at these hormone fluctuations,
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which is essentially what's going on.
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And they could start in your mid to late 30s
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and go right up through your 40s and on.
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Menopause is one day after you have an enter cycle
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for 12 months, and that is on average age 51
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in the US for women.
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I started, mine was 48, so I didn't, you know,
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mine's a few years earlier, so you can see it either way.
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I know women that are 54 that are still getting their period.
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And then anything after that is referred
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to as post-menopausal, a woman is post-menopausal,
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which we start to see some of those symptoms kind of level out.
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But I, for the sake of the book and just for ease,
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I say, you're, you know, you're menopausal at that point.
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But those are the phases we look at.
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I think perimenopause can be the most frustrating
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because we're at the height of careers.
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We're dealing with children.
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We have aging parents.
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We're looking possibly at career changes or pivots.
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And oh, there's a bunch dozens of possible symptoms
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you could be going through.
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Well, let's talk about some of those symptoms.
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What are the most common symptoms that you come across?
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And then maybe some of the more surprising ones?
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Yeah, there's a little bit of everything with this.
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When I sat out doing the research,
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I was like, okay, there's hot flashes, irritability.
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And I guess this thing called brain fog,
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which we finally have words for,
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but I didn't really know much else, maybe weight gain.
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And as I dove deeper into it,
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and even through the course of the book,
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34 symptoms was kind of this golden number
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that we were looking at.
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And that came out around 2020, 2021.
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And then more research has been done to say
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there could be 100 plus symptoms
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because we have estrogen receptors all over our body.
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So it makes total sense.
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But some of the symptoms that you see at that younger age
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are irregular periods.
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So you can have a heavy period or skip a period.
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Those are kind of those hallmark areas of it.
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Irritability, mood swings,
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some people refer to it as having rage,
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difficulty or disruptive sleeping.
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You could be dealing with weight gain,
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which is not uncommon, especially when it comes
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to a dead in the belly area,
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when you've got these hormone fluctuations,
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all these things start to happen.
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Brain fog where you're in the middle of a sentence,
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talking and all of a sudden the words go away
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or you walk into a room and you can't remember
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why you're there.
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And then we have things like dryness all over the body.
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You know, that's a really a big one.
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So you're dealing with hair and you're dealing with skin
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and you're dealing with vaginal dryness.
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You could be dealing with low libido or painful sex.
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So these are some of the things that we as women
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have happened and then we're saying,
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like, why am I depressed over here
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or why am I getting weight over here?
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And I see a lot of women that I speak to
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saying I'm playing whack-a-mo with all these different symptoms.
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Hey, it's Jeff.
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And as an athlete, I've been told my entire life
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to make sure that I get enough electrolytes.
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But it's only recently that I have truly understood
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what electrolytes are and the many essential
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physiological functions that they fulfill.
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Okay, so you ready for electrolytes 101?
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Here we go.
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When essential minerals like sodium, potassium, chloride
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and magnesium dissolve in a fluid, they form electrolytes.
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Positive or negative ions needed to maintain
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vital bodily functions, for example.
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Sodium ions are used by the brain
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to send electrical signals.
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Hello, electrolytes.
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Through your neurons in order to communicate
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with other neurons and the cells throughout your body.
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So electrolytes are key for brain health.
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Sodium also retains water and maintains proper hydration levels
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and fluid balance in your cells
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through a process called osmosis.
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Now, calcium and potassium are needed for muscle contraction.
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They facilitate muscle fibers to slide together
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and move over each other as the muscle shortens
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and contracts.
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A magnesium is also required in this process
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so that the muscle fibers can relax after contraction.
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A magnesium is a total other beast.
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It plays a role in protein synthesis, sleep
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It's really astonishing.
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Over 100 possible symptoms
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all driven by fluctuating hormone levels.
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And yet, most women still have very, very little support.
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But that's starting to change.
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There's been a lot of talk about hormone therapy recently,
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especially after the FDA held public hearings
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on removing the black box warnings on vaginal estrogen.
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But here's one specific treatment
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that's a game changer for many women.
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When we talk about vaginal estrovial,
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usually we're talking about this low dose vaginal estrogen.
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And the dose is important because if you put something
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in the vagina, if it's a high enough dose,
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it will get into the rest of the body.
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Just like if you put a patch on your skin,
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if it's a high enough dose,
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it will get in through the bloodstream
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and the rest of your body.
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What are some of the symptoms
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that vaginal estardial addresses?
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So anything related to low estrogen in the pelvic floor,
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so for instance, vaginal dryness, pain,
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as you get older, and your vagina starts to thin,
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so sex is painful, get yeast infections,
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you get UTIs, and this estrogen can help with that.
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It can also even help with stress hearing or incontinence
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or incontinence, like bladder leakage.
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They can happen as you get older
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when those muscles start to become less strong.
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So it's really helping across the board with pelvic health
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for women, and it's super easy, super safe, and very cheap.
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Easy safe, cheap, and incredibly effective.
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Yet most women have never heard of it
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due to lingering fears from that 2002 study.
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Amy makes a fascinating comparison here.
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You put out an interesting, sub-stack article
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talking about vaginal estardial,
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and you made a comparison that I'd never heard before
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between vaginal estardial for women and Viagra for men.
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How does that comparison hold up?
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Yeah, they're actually very similar
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in the way that they work.
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You may know those, but Viagra actually helped
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to keep the cells in the penis healthy over time.
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So it doesn't just increase blood flow.
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It's actually really beneficial for the sexual organs,
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same thing with estrogen for women.
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Estrogen is helpful for keeping the organs unhealthy as well.
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And both of them, if given systemically,
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potentially have both brain benefits
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and heart-cardi-protective benefits.
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And we've seen that in some of the literature
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on the PDE5 inhibitors for men and dementia risk
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and heart disease risk going down.
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And then certainly we know with estrogen,
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the systemic estrogen is extremely good
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for women's cardiovascular health.
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Beyond estrogen, another key and often overlooked hormone
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for women is testosterone.
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Oral estrogen like the estardial in birth control pills
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can increase globulant levels,
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which then bind to free testosterone
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and reduce its availability in the body.
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For some women, that drop in testosterone
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doesn't cause noticeable changes,
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but for others, it can lead to low libido
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and vaginal dryness, even at a young age.
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Here's Amy again explaining how testosterone levels
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change over time and what to look out for.
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Yeah, in the US, there is no FDA approved testosterone.
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And so we have to kind of use it off label.
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We could write it certainly,
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but we have to use it off label.
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And testosterone is different than estrogen
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or progesterone in women.
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It starts high at about age 20, 25, just like in men.
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And it just starts to kind of slowly go down over time.
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It doesn't like fall, like a cliff, it menopause.
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It just kind of slowly goes down.
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But oftentimes women, maybe in their 40s,
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it could be earlier, it could be later,
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will have some symptoms of low testosterone,
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like classic symptoms or things like difficulty,
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low arousal, difficulty with libido,
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difficulty forming muscle, burning fat,
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lack of motivation to do things.
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And so those are some classic symptoms.
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And if you have those symptoms,
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you can get your testosterone checked.
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And as long as it's not high,
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it turns out that oftentimes testosterone
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is helpful, especially for the sexual side effects.
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So you could be 30 years old, you could be 50 or 60 years old,
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but if you need it, then it could be really helpful.
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And should women worry about presentation
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of secondary sexual characteristics,
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like facial hair and stuff like that with testosterone?
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I mean, you definitely should know it's possible
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if you get too much testosterone.
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So we have to be careful and not take a large amount.
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We don't want to be dosing you.
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Men have about 10 times more testosterone than women do.
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So our doses are much smaller.
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We want to generally stay within that normal
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physiologic reference range for women.
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And I will say that I've had,
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I've had it not myself personally,
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but I've had some female singers reach out to me
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on social media that they take a testosterone
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and no one warned them that you could have
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a little bit of the deepening of the voice.
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And that's one side effect in testosterone
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that doesn't go away all the time.
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If you choose to explore testosterone supplementation,
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it's essential to do so under medical supervision.
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Your levels should be carefully monitored
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to ensure that they stay within a safe and healthy range.
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Now, as both of our guests emphasize hormones
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are just one piece of the puzzle.
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Lifestyle, how you move, what you eat,
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and how you rest, shapes everything else.
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So here's Tamson Fidahl,
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sharing what she discovered on her own health journey.
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Belly Fat has been something.
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You know, that was one of the big things.
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I was getting up every day,
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working out the same way if not harder,
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eating better than ever.
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And then I was like, what is happening?
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And when I was on television during that time,
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which as we know is a very youth-based industry,
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and it was hard.
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It wasn't easy to say,
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like, how's my body changing like this?
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And a lot of times you'll go to a doctor
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and a doctor will be like,
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this is all part of aging.
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This is what happened.
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You should metabolism slows down.
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But the truth of the matter is,
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is that this all happens during these paramedicosal
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and menopausal years.
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And yes, they happen with age.
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But they're also happening as we're watching
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those hormone levels go down.
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And so cortisol has been a real source of conversation
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for me, insulin resistance has been a real conversation
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for me.
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I went back to school to get a degree as a health coach,
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because I said, I wanna understand what's happening
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in my body, because I can't believe
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that I've worked so hard to take care of myself fear,
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coming from my passive, from my mother,
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of health has to be so, so important.
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And lifestyle changes the only way I can do it.
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I now understand that there are other ways to do it
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in hormone therapy has been incredibly life-changing for me,
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but I will never dismiss lifestyle changes
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as being critical.
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And those are things we can start in our 20s and 30s,
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and get leading up to this,
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so this does not become a fearful time.
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And that's really what I want for the younger generation.
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I don't want women in their 20s to think,
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oh my gosh, this is what I have to look forward to.
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I want them to think, okay, this is another part,
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and we transition through this,
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and then we get into some really beautiful years.
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As women enter this phase of life,
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many start to notice changes in their energy mood,
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and even how they feel in their own skin,
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concerns about longevity, vitality,
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and appearance often become top of mind.
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And as Dr. Kellen reminds us,
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longevity isn't about chasing youth,
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it's about building strength inside and out.
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You know, I think the main things for women
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are probably the main things for men as well,
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especially as we get older,
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building muscle is one of the most important things.
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Another big one for me is just getting outside
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and like getting out in nature.
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I live in Utah, so I'm right the side of a mountain,
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so I can go out and go out and hike,
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but that I find that for the mental benefits,
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as well as physical benefits,
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that the time in nature, a little bit of sun,
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you know, talking to the bears and mountain lions
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is never worth anything.
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That's what I'm talking about.
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And then sleep is the other thing
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that I really focus on with myself.
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I was an ER doctor for 10 years before all of this back at,
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and I quit in 2013,
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but I went 15 years or more,
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really without sleeping much.
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And then I had twins and you know,
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just a whole series of things where my sleep was messed up
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and when I started sleeping,
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after I left the ER, like it was amazing,
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you know, all of a sudden I last wait like in a good way.
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I, you know, I, the inflammation went down,
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like I just looked like a different person,
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and so I really credit sleep with a lot of that as well.
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So I cry, I prioritize that for sure.
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There's certainly a muscle-centric medicine movement
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happening now, particularly for women.
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There's a lot of prominent doctors
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that have, I think, really come forth
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and there's a number of books out about muscle-centric medicine.
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For you, does that mean, you know,
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a regular resistance training protocol?
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And you know, also there's a lot of talk
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about protein consumption that's going on right now too.
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I mean, are you in that sort of one gram per pound
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of ideal body weight camp or, you know,
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what's the Amy Killing recipe here?
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Well, I mean, I, personally, I won't say
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that I'm perfect at any of this,
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but I do, I do, resistance training.
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I have a total machine of home and I love it.
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So I'll do that.
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I tried to do that like four days a week.
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So I do weight training and then I try to make sure
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I'm doing some kind of high intensity something,
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whether that's, you know, steep hiking or, you know,
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jogging or whatever.
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And then most, and then just a lot of walking.
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So I do that.
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And then I don't do, I don't do as much protein personally
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as I probably should.
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And I suspect that's maybe part of why I have a hard time
spk_0
building muscle, but I have a very hard time
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getting that much protein.
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I just don't, I don't tend to be that hungry in general.
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So I have to kind of force myself to eat,
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but I also probably think we, we overshot a little bit
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on the protein.
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Like I don't necessarily think that most people
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need that much protein.
spk_0
It would or to be healthy into build muscle,
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unless you have like very specific, you know,
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bodybuilding goals.
spk_0
I think we could probably swing that pendulum back
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a little bit to be more reasonable.
spk_0
For too long, women have been told to tough it out
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to accept exhaustion, the brain fog, the loss of libido.
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As if it's just the price of getting older,
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but the truth is these symptoms are not a moral failing.
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They're a biological transition, one that deserves
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understanding, research and care.
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A woman deserve to be seen, not as a special interest group,
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but as half of humanity, they deserve to be heard,
spk_0
not dismissed or patronized.
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And they deserve to have their biology represented in science.
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Their experience is reflected in medicine and their
spk_0
well-being treated as essential and not optional.
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So where do we go from here?
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The good news is that things are changing.
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The FDA is finally reconsidering those black box warnings.
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More doctors are being trained in bioidentical hormone therapy.
spk_0
And women are speaking up, demanding better care
spk_0
that honors their experience and their biology.
spk_0
To sum things up, here's what you need to know.
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First, perimenopause can start in your mid to late 30s.
spk_0
If you're noticing changes in mood, sleep, cycles, cognition or energy,
spk_0
don't ignore them.
spk_0
Talk to your doctor.
spk_0
And if your doctor dismisses you, find a new one.
spk_0
Second, hormone therapy, when done correctly with bioidentical
spk_0
hormones and started at the right time is safe and effective for most
spk_0
women.
spk_0
Don't let outdated fears from a flawed 2002 study keep you from getting
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help.
spk_0
Third, vaginal estradiol is a game changer for pelvic floor health.
spk_0
And it's incredibly safe if you're experiencing
spk_0
dryness, pain during sex or recurring UTIs, ask your doctor about it.
spk_0
And finally, lifestyle is medicine.
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Move your body, manage your stress, lift something heavy, get outside and
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sleep deeply.
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Hormones can help, but they work best when your lifestyle supports
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them.
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If you found this podcast compelling, well, please share it.
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Talk about it with your friends, your partners, your daughters, your
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doctors, because the more we talk, the more we normalize and the more we heal.
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Be well and remember, your body is not the enemy.
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It's your teacher.
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Oh, thanks so much for listening to today's episode.
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You can find links to both Dr. Amy Killin and Tamsa Fidel's work in the
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show notes for more of my weekly musings like today's episode along with
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ad free episodes and livestream conversations head over to my
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substack at Jeff Krasno.substack.com.
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I also want to let you know about our commune course platform, which contains
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Okay, that's all from the commune for today.
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Topics Covered
women's hormonal health
perimenopause
menopause
hormone therapy
Women's Health Initiative
menopause symptoms
hot flashes
mood swings
women's health empowerment
Dr. Amy Killing
Tamson Fadal
menopause stages
breast cancer risk
hormonal fluctuations
women's longevity medicine
healthcare system for women