Your Menopause Masterclass Pt 2: How to Lose Belly Fat, Sleep Better & Stop Suffering Now! Dr. Mary Claire Haver

Back by popular demand, one of the top menopause doctors in the world, Dr. Mary Claire Haver is here, in this Part 2 Menopause Masterclass Episode where we’re tackling your changing hormones, and Hormone Replacement Therapy! We’re going there with everything you want and need to know! Plus everything your doctor forgot to mention to you about menopause! Right now 1.2 billion women are in perimenopause or menopause and whether or not you’re experiencing this personally in your life right now, I guarantee you someone in your life is…whether you’re a man or woman, menopause is going to affect you because it’s going to affect 50% of our society. Right now whether you or someone you love is experiencing perimenopause which can start at 30 or even younger, or menopause which can typically start in your 40s, 50s or 60s, there is so much conflicting information about this subject, experts say so few doctors are well-trained, and there’s so many things our mothers didn’t tell us or even know about it, and it’s time that you feel informed about what's going on with your body, your brain and your hormones. Today is your menopause masterclass and you’re going to leave this episode with your own menopause tool kit, equipped with the info and tools you need that I know are going to impact your life today! Our guest today, many call her the top menopause doctor on the planet. Dr. Mary Claire Haver is a board certified obstetrics and gynecology specialist and certified menopause practitioner from the Menopause Society. She's also a certified culinary medicine specialist from Tulane University, a bestselling author of multiple books including her incredible new book, The New Menopause. She's also the founder of the Mary Claire Wellness Clinic. She’s a mom of two, a wife, and a woman on a mission who says that while menopause is inevitable, suffering doesn’t have to be. ____ Are You Ready to believe in YOU?🙌⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠jamiekernlima.com ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠👈 Sign up for my FREE Inspirational Newsletter and get ready for your self-worth to soar!🩷 Explore Dr. Haver’s trusted tools and programs, including her new perimenopause book, a menopause-informed providers list (including telehealth), menopause and a menopause quiz: ⁠⁠The New Menopause⁠⁠ ⁠⁠Dr. Haver's Recommended Physicians⁠⁠ ⁠⁠Menopause Quiz Chapters: 0:00 Welcome to The Jamie Kern Lima Show 11:20 When Does Perimenopause Start? 18:50 Why Women Need These 3 KEY Hormones 31:55 4 Myths About Hormone Replacement Therapy 50:25 Hormone Replacement Therapy Options - There Are A Lot! 59:20 Top Dr's Menopause Hormone Replacement Routine 1:03:30 Are You A Candidate For Hormone Replacement Therapy? 1:06:10 How Progesterone Helps In Menopause & What It Costs 1:16:55 The Cancer/Hormone Therapy Myth 1:00:10 "Whiny Women" - How Drs Discount Women In Menopause And whether you're joining me today for yourself or because someone that you love shared this episode with you, I want to welcome you to the Jamie Kern Lima Show podcast family. And remember this episode is not just for you and me. Please share it with every single person that you know because it can change their life too. It’s such an honor to share this podcast together with you. And please note: I am not a licensed therapist, and this podcast is NOT intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional. Click ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Here⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠to Subscribe to the YouTube Channel Follow me here: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Instagram⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠TikTok⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Facebook⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ — Sign up for my inspirational newsletter for YOU at:⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ jamiekernlima.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ — Looking for my books on Amazon? Here they are! ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠WORTHY⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Believe IT⁠⁠⁠⁠⁠⁠⁠

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Jamie Kern Lima?

  You've asked for it. Actually, you pretty much demanded it. So back by popular demand, one of the top menopause doctors in the world, Dr. Mary Claire Haver is here in this Part Two Menopause Masterclass episode, where we're tackling your changing hormones and hormone replacement therapy. We are going there with everything you want and need to know. And whether today you're listening for yourself or because someone that you love shared this episode with you, I want to welcome you to the Jamie Kern Lima Show Podcast Family. Can you explain our key hormones? And which ones change and what that means for us?

• 0:41Speaker 01

  In perimenopause, that whole system goes chaos. And then in post-menopause, estrogen progesterone flatline to almost undetectable levels.

• 0:49Jamie Kern Lima?

  With the average age of menopause defined by, you know, the day you stop menstruating, 46 to 55, and seven to 10 years before that, we enter perimenopause and our hormones start going haywire. One of the biggest, biggest, brand-new pieces of information for so many people that you say nine out of 10 doctors don't even get this right. So many women have symptoms when their hormones are off that might look like mental health things, anxiety. It could be, you know,

• 1:19Speaker 01

  Bloating.

• 1:20Jamie Kern Lima?

  Bloating, sleep disturbance, weight gain, heart issue. And then we go and we get that thing treated, but we never get our tests done to go, well, wait a minute. Is it that my hormones are off that are causing these other things? And so we have, I'm going to guess, millions and millions of people being treated for symptoms.

• 1:39Speaker 01

  Right, on multiple medications.

• 1:41Jamie Kern Lima?

  On multiple medications.

• 1:42Speaker 01

  When, you know, no one knew enough to say, let's do some blood work to rule out. So let me walk you through the patient experience. We put out the fire of her menopause first with hormone therapy.

• 1:52Jamie Kern Lima?

  Estrogen, progesterone.

• 1:54Speaker 01

  And testosterone.

• 1:55Jamie Kern Lima?

  Testosterone. For someone who's like, I've never had mine checked. Right now, 1.2 billion women are in perimenopause or menopause. And whether or not you're experiencing this personally in your life right now, I guarantee you, someone in your life is. I want to break this down. For exactly what we should do because there's a number of people that can only afford to go through insurance.

• 2:21Speaker 01

  Right.

• 2:21Jamie Kern Lima?

  So many even women in my life wouldn't have the courage to aggressively ask a question. You say nine out of 10 doctors probably don't understand

• 2:31Speaker 01

  Right.

• 2:31Jamie Kern Lima?

  hormones or hormone replacement therapy. So they might be getting advice on a symptom, but not actually on the cause. Those three hormones, estrogen, I know you call estradiol. That's estrogen, right?

• 2:43Speaker 01

  Right.

• 2:43Jamie Kern Lima?

  Same thing. Okay, estrogen, progesterone, testosterone. Look, why should she care? And what do we do?

• 2:49Speaker 01

  I mean, if you feel great and your quality of life is not affected, you're good. But that's not most women. You know, most women, there is something not right. If you're like, I'm not my best self and I deserve to be.

• 3:03Jamie Kern Lima?

  Like something's off.

• 3:04Speaker 01

  Something is off.

• 3:05Jamie Kern Lima?

  Mm-hmm.

• 3:06Speaker 01

  Your wonderful OB GYN, your wonderful family medicine doctor, who has done incredible care, might not know enough to be able to help you or not know how. You deserve better than that. How to find a doctor who takes insurance? How to find online providers? 30% of women will have palpitations in, as a symptom of their menopause. Then we have visceral fat, the intra-abdominal fat that wraps around our organs. All of this could be preventable. Healthy libido that that is suddenly gone.

• 3:36Jamie Kern Lima?

  Hormone replacement therapy. I remember people saying hormone replacement therapy can cause cancer. I mean, what's, yeah, a myth? What's the truth? What is it?

• 3:45Speaker 01

  Okay.

• 3:46Jamie Kern Lima?

  Who needs it?

• 3:47Speaker 01

  Myth number one.

• 3:49Jamie Kern Lima?

  Can you explain the difference between bio-identical hormone replacement

• 3:53Speaker 01

  Yeah.

• 3:53Jamie Kern Lima?

  therapy?

• 3:54Speaker 01

  Not every woman will choose hormone therapy or is a candidate, to be clear.

• 3:58Jamie Kern Lima?

  Mm-hmm.

• 4:00Speaker 01

  But she's not getting the choice. No one's having the conversation with her by and large. She has to literally go through incredible mazes and hoops to find someone who will even talk to her about it. And that is the problem. That's where we're failing, women.

• 4:13Jamie Kern Lima?

  When a woman walks into her doctor.

• 4:16Speaker 01

  Mm-hmm.

• 4:18Speaker 01

  What does she need to ask? Those three questions you listed are huge. I want everyone to pause the episode, rewind it, write those questions down. Share this episode with every girl and woman right now. I'm thinking about the woman right now who maybe her insurance covers very few doctors and she's trying to figure out, what do I do? Would it be wise to first?

• 4:42Jamie Kern Lima?

  Another trick which has worked. Two things. So everyone pause the episode, rewind, write that down, write that down, bring it into your doctor. I love preventative stuff.

• 4:55Speaker 01

  I love it.

• 4:56Jamie Kern Lima?

  So like what options are there exactly?

• 4:59Speaker 01

  Thank you.

• 5:00Jamie Kern Lima?

  For hormone replacement therapy?

• 5:01Speaker 01

  We have so many.

• 5:02Jamie Kern Lima?

  What ones you use right now? How you apply them? Who's a candidate? Who's not? Like you put a cream in your vagina?

• 5:08Speaker 01

  Yep. Yes. We have pelvic floor physical therapy. Most women have no idea it even exists and it is literally the best thing. Women deserve that conversation. We have great studies showing safety and efficacy of topical estrogen for the skin.

• 5:20Jamie Kern Lima?

  Is it covered by insurance?

• 5:22Speaker 01

  Things have to be FDA approved to be covered by insurance. Now you can get it for the vagina and some women are choosing to put a little on their face.

• 5:30Jamie Kern Lima?

  On their face.

• 5:31Speaker 01

  And it's actually wonderful for women who have urgency and frequency. So they have to pee a lot, you know, and this is a new thing.

• 5:36Jamie Kern Lima?

  And do you personally use vaginal estrogen?

• 5:39Speaker 01

  I do. I started having delayed orgasms. Then I started having to get up to pee again in the middle of the night. I tell that story not to embarrass myself, but to be like, I didn't even realize it was still too taboo.

• 5:51Jamie Kern Lima?

  Is there something you can use that speeds up orgasm?

• 5:53Speaker 01

  Huh. I'm telling you right now, we are not getting this info from our doctor.

• 5:57Jamie Kern Lima?

  You use the patch. What do all of those typically cost?

• 6:02Speaker 01

  I'm going to go into how we find coupons. Let me be clear. You can be healthy without hormone therapy, but it is harder.

• 6:10Jamie Kern Lima?

  You clearly say for you, and you've been very definitive about who's a candidate, who's not, that the rewards can far outweigh the risk.

• 6:18Speaker 01

  I'm, I'm living my best life. I get up every morning excited. I feel better than I did in my 30s and 40s. I have better relationships, I have better boundaries, I'm a better businesswoman, I'm a better doctor, I'm a better mother, I'm a better wife, I'm having better sex, I'm, you know, I want everyone to have this.

• 6:38Jamie Kern Lima?

  Whether you're a man or a woman, menopause is going to affect you because it's going to affect 50% of our society. Right now, whether you or someone you love is experiencing perimenopause, which can start at 30 or even younger, or menopause, which can typically start in your 40s, 50s, or 60s. There is so much conflicting information about the subject. So few doctors are well-trained, and there are so many things our mothers didn't tell us or even know about it. And it's time that you feel informed about what's going on with your body, your brain, and your hormones. Today is your menopause masterclass, and you're going to lead this episode with your own menopause toolkit,

• 7:23Jamie Kern Lima?

  equipped with the info and tools you need that I know are going to impact your life today. Whether it's how to sleep better, understand what's a menopause myth and what's the truth, lose belly fat, or stop suffering finally. My guest today, many call her the top menopause doctor on the planet, Dr. Mary Claire Haver, is going to take us from feeling powerless to powerful on everything your doctor forgot to mention, on topics including the exact tests you need to ask your doctor for during your next visit, the three stages of menopause, on what's actually happening in your body, on your changing hormones,

• 8:08Jamie Kern Lima?

  on hormone replacement therapy, including the risks versus the benefits. Should you do it? How and when? On belly fat and weight gain linked to menopause, and what you can do about it right now. And on the surprising symptoms happening to so many women that go untreated and overlooked by the majority of doctors who just aren't as well-informed as they could be. Today is a masterclass from the master of menopause herself. Dr. Mary Claire Haver is a board-certified obstetrics and gynecology specialist and certified menopause practitioner from the Menopause Society. She's also a certified culinary medicine specialist from Tulane University,

• 8:53Jamie Kern Lima?

  a bestselling author of multiple books, including her brand new book, The New Menopause. She's also the founder of the Marie Claire Wellness Clinic. She's a mom of two, a wife, and a woman on a mission who says that while menopause is inevitable, suffering doesn't have to be, and she is here to help you and me today. I love a truly life-changing episode, and I am so excited for this one today. Whether you're listening for yourself or because someone that you love shared this episode with you, I want to welcome you to the Jamie Kern Lima Show Podcast Family. And today, we are shedding light on everything your doctor forgot to mention to you about menopause.

• 9:39Jamie Kern Lima?

  And for everybody new to this episode, can you do me a favor? If you like the show and the guests that I bring you, please hit the subscribe or follow button on the app you're listening or watching on. It truly means the world to me, and thank you. And I want to remind you, this episode is not just for you and me. Please share this with every single woman that you know, because what you are about to hear will change your life and hers.

• 10:06Speaker 02

  Welcome to the Jamie Kern Lima Show.

• 10:09Jamie Kern Lima?

  Oprah, how have you defied the odds?

• 10:13Speaker 03

  Her show is unlike any I've ever done. A revelation. When you listen, it feels like a hug, but your brain and your spirit and your heart is like, wow. Melinda French Gates.

• 10:26Speaker 04

  When I look into Jamie's eyes, I feel like I am on some other cosmic level with her.

• 10:33Jamie Kern Lima?

  I could see the light around her. She's infused with light. Imagine overcoming self-doubt, learning to believe in yourself and trust yourself and know you are enough. Welcome to the Jamie Kern Lima Show.

• 10:48Speaker 03

  Jamie Kern Lima is her name. Everybody needs Jamie Kern Lima in their life.

• 10:52Jamie Kern Lima?

  Jamie Kern Lima.

• 10:57Jamie Kern Lima?

  Jamie, you're so inspiring. Jamie Kern Lima. When we talk about hormones, okay, this is going to be a brand new topic for a lot of people. It's not part of the thing they maybe tend to focus on in their day to day life. For every girl and woman listening in particular, can you explain our key hormones? And which ones change and what that means for us?

• 11:24Speaker 01

  Sure. So in the female human body, actually, men and women have the same sex hormones. We just have different levels. So men have estrogen, women have estrogen, men have testosterone, women have testosterone. We actually, females have four times the amount of testosterone than we do estradiol when we're in our reproductive years. Testosterone is the precursor for estrogen. And that testosterone gets, you know, an enzyme attached to it that flips over, you know, a carboxyl chain and turns it into estradiol. So without testosterone, we would not have estradiol in our body. So like, women think of testosterone typically as a male hormone, but it's actually one of the most important hormones in our body as well. And then we have progesterone, which,

• 12:07Speaker 01

  so in a normal menstrual cycle, when we're ovulating regularly and we're having this ebb and flow of hormones, we have hormones start out low. So you start your period, that's day one, okay? Hormones, estrogen and progesterone start out low. And then we see a rise in our estradiol level towards ovulation. Then it drops down again. And then we have a second little bump towards the end of the 28 day cycle. And then in the second half, after we ovulate, we see that spike in progesterone. And that goes, repeats itself month after month after month. And for some women, even that fluctuation that we normally have can be kind of devastating with premenstrual dysphoric disorder, with cramps, with headaches, you know, lots of things can kind of affect women. But most women can manage it, no problem. Thank God we have treatment and therapies

• 12:51Speaker 01

  for when your ebb and flow is causing problems in your life. We can help you with it. We've gotten pretty good at that. In perimenopause, that whole system goes chaos, right? Estradiol level is bouncing around like a, you have this roller coaster effect on the way down till you completely lose your eggs for both estrogen and progesterone. And then in postmenopause, estrogen progesterone flatline to almost undetectable levels. And that FSH and LH from the brain stay high for the rest of our lives, which is how we diagnose menopause or postmenopause.

• 13:23Speaker 01

  So that's kind of it in a nutshell.

• 13:25Jamie Kern Lima?

  In a nutshell. And I know, you know, big pictures zooming out. And this can vary, woman by woman, it can vary based on a number of factors. But with the average age of menopause defined by, you know, the day you stop menstruating for a year, right, that day, can range 46 to 55, normal curve for when we enter menopause. And then seven to 10 years before that, we enter perimenopause. And when our estrogen can, you know, start decreasing or surge or plateau, and our hormones start going haywire. One of the biggest, biggest, brand-new pieces of information for so many people that, you say nine out of 10 doctors don't even get this right.

• 14:10Jamie Kern Lima?

  It's so newly being talked about. You talk about this in detail in your book, The New Menopause. This is such a big thing that so many women have symptoms when their hormones are off that might look like mental health things, anxiety. It could be, you know,

• 14:26Speaker 01

  Bloating.

• 14:27Jamie Kern Lima?

  Bloating, sleep disturbance, weight gain, heart issue. I mean, the number, the number of symptoms. And then we go and we get that thing treated, but we never get our test done to go, well, wait a minute. Is it that my hormones are off that are causing these other things? And so we have, I'm going to guess, millions and millions of people being treated for symptoms.

• 14:50Speaker 01

  Right, on multiple medications.

• 14:52Jamie Kern Lima?

  On multiple medications.

• 14:53Speaker 01

  When, you know, no one knew enough to say, let's try, let's do some blood work to rule out. So when a patient comes to my clinic, let me walk you through the patient experience. Now, again, I have a, I've stepped away from the insurance model so that I'm not going to be told by an insurance company what I can and can't do. Because they don't recognize menopause, really. Medicare doesn't even have a menopause code. Okay, if you realize this. So. I get to practice medicine the way I want to and I need to. I spend an hour with my first patient, you know, with each new patient, getting to the bottom of it. You know, we've done a ton of paperwork beforehand and I do a lot of blood work. But if she's in peri-menopause, knowing that that's a huge chaotic hormonal zone, I'm not, you know, depends on what day,

• 15:36Speaker 01

  what time of the day, where she is, it's not going to really be diagnostic for me. It's wonderful for post-menopause because we know high FSH, low estrogen, she's there, okay? But in peri, I'm ruling out autoimmune disease, nutritional deficiencies, you know, a lot of these symptoms can be caused by other diseases. I want to make sure I'm not missing anything. In my clinic, I've diagnosed lupus, I've diagnosed iron deficiency, vitamin D deficiency in 80% of my patients. And so I'm, you know, making sure she's optimized. So we put out the fire of her menopause first with hormone therapy, okay? Now, in peri-menopause, we have two options. We can either override the system with something like a birth control pill, or the doses high

• 16:19Speaker 01

  enough in a birth control pill is to press the occasional ovulation and tell the brain, shut down, we're good, which is how birth control pills work, and there's problems there, and we can talk about that. Or we support, give her menopause hormone therapy doses, which in our clinic are bio-identical. So we're giving her just estradiol and progesterone, the exact same thing her ovaries used to make, feeding back to the brain, telling it to calm down. Calm down, it's okay. We've got some estrogen on board. Don't send these crazy signals to the ovaries. Not enough to completely, so you're still kind of doing what you're doing in the background, but we seem to be taking away the drama out of it. We're seeing the mental health challenges getting better, the brain fog clearing up, the sleep is improving, especially with progesterone. And then in post-menopause, it's actually easier to treat

• 17:02Speaker 01

  because you're starting from scratch. Where in peri-menopause, we're trying to pin the tail on a moving donkey. Remember, because there's all kind of chaos going on.

• 17:10Jamie Kern Lima?

  So your hormones, estrogen, progesterone, testosterone.

• 17:16Jamie Kern Lima?

  For someone listening right now, who's like, huh, I've never had mine checked. And I've gone into my doctor, I'm forty-five, or fifty-five, or thirty-five. I've gone in with these other kind of symptoms happening. I've gotten treatment or medication for them. But actually, I wonder, what if the underlying

• 17:37Speaker 01

  Right.

• 17:38Jamie Kern Lima?

  issue is actually

• 17:39Speaker 01

  What is she do?

• 17:40Jamie Kern Lima?

  my hormones? So, I want to break this down for exactly what we should do. Because there's a number of people that can only afford to go through insurance.

• 17:50Speaker 01

  Right.

• 17:51Jamie Kern Lima?

  Um, there's also people who, you know, are trying to figure out, how do I get free resources and learn more about this? There's also so many of us. I've had, I had this experience very recently, actually. Um, but anyway, very, it was, it was a, an unrelated type of a doctor appointment. But I watched as the doctor was in and out so fast. He must have been in the room under sixty seconds. And, you know, I'm not shy anymore. So I will keep asking questions, and he had no time. And I just remember thinking to myself, so many even women in my life wouldn't have the courage to aggressively ask a question. Because we're just like, oh, okay, okay. And, and then we don't.

• 18:35Jamie Kern Lima?

  So, I think of every woman listening who's in all types of situations right now with her doctor.

• 18:39Speaker 01

  What are her best options?

• 18:40Jamie Kern Lima?

  She can't afford to go to someone where it's out of pocket, things like that. So, just, just starting zoomed way out.

• 18:46Speaker 01

  Yeah.

• 18:47Jamie Kern Lima?

  Um, can you share, just top level?

• 18:52Speaker 01

  Yeah.

• 18:53Jamie Kern Lima?

  Why should she care about where those three hormones are at?

• 18:58Speaker 01

  Yeah.

• 18:58Jamie Kern Lima?

  And especially estrogen? How it can impact every part of her health? Mental health, physical health? Even though, you say nine out of ten doctors probably don't understand

• 19:11Speaker 01

  Right.

• 19:11Jamie Kern Lima?

  hormones or hormone replacement therapy? So they might be getting advice on a symptom, but not actually on the cause. Why exactly should she care, and everyone listening, care about those three hormones? Estrogen, I know you call it estradiol? That's estrogen, right? Same thing? Okay, estrogen, progesterone, testosterone. Look, why should she care? And what do we do?

• 19:33Speaker 01

  I mean, if you feel great, and your quality of life is not affected, and you are not having crazy hemorrhagic periods, or, you know? You're good, but that's not most women. You know, most women, there is something not right. At least in my clinic and in my experience and the people who follow me on social media. So if you're one of those women out there and you are like, "I'm not my best self and I deserve to be."

• 19:57Jamie Kern Lima?

  Like something's off.

• 19:58Speaker 01

  Something is off. Unfortunately, this is probably a big problem. Why we're not diagnosing perimenopause is, one, we weren't taught anything about it. And two, we don't have a great blood test. It takes someone who can rule out other overlapping causes. And then realize, based on her symptoms, this constellation of symptoms, this most likely is perimenopause. Let's do a treat, you know, let's do a trial of treatment and see how you feel. See what gets better and then go from there. Okay? How do you find that unicorn? Because your wonderful OB GYN, your wonderful family medicine doctor, who has done incredible care, might not know enough to be able to help you or not know how. And just be under the assumption, this is just what women go through. You'll be fine in a couple of years.

• 20:43Speaker 01

  You deserve better than that. So, the Menopause Society has a list of certified providers on their website. It's not perfect, but it is a definite place to start. We have a resource for our patients online called the Menopause Empowerment Guide. It's a 14-page PDF completely free with how to find a doctor, who takes insurance, how to find online providers. So this is a really kind of niche thing I think is pretty cool. There are some very affordable online telemedicine clinics that have been built. And I've gotten to be friends, they don't pay me to say all this stuff, but I am friendly with them because I've vetted what they do to make sure if this comes out of my mouth, that it's legit and I'm not going to harm a woman who's seeking help. But if you can't find anyone in your community,

• 21:25Speaker 01

  there are wonderful telemedicine options that are very affordable and Midi takes insurance. That are built simply to serve the woman in perimenopause and menopause. And, you know, to help you determine if you're a candidate for a trial of hormone therapy and see how you feel from there.

• 21:41Jamie Kern Lima?

  If we have, if we're deficient estrogen, can you talk about, because I think this is, this is a huge revelation for so many people.

• 21:52Jamie Kern Lima?

  Estrogen can impact what almost every organ

• 21:56Speaker 01

  Every, just about every organ system in your body.

• 22:00Jamie Kern Lima?

  Can you share with us if we are out of balance in estrogen? What are some of the common things that can impact?

• 22:10Speaker 01

  So, um, quality of life issues, brain fog, risk of dementia increasing. But you know, the immediate things, brain fog to where you don't feel like you feel like you're getting, you're developing dementia, you are worried about your job at work, you are not functioning normally. Okay. And you are waking up scared that something's wrong with you. That's the most extreme form. Mental health challenges that are extremely affecting your life, your relationships, your ability to function. You deserve to not have that happen to you. Okay. Palpitations, let's go to the heart. Palpitations.

• 22:49Speaker 01

  Oprah Winfrey tells a fabulous, well, bad for her, but you know, extremely liberating for women who realize that happened to me. We now know that vasomotor symptoms include palpitations that 30% of women will have palpitations. And as a symptom of their menopause. You go to the cardiologist, you get your full workup, everything looks normal, you deserve a workup. But then they're like, well, that's just what you're going through. When I tell you the percentage of women whose palpitations are completely gone by replacing her hormones is incredible. Liver. Most women's cholesterol with no changes in diet and exercise will go, their LDLs will shoot up.

• 23:32Speaker 01

  Their HDLs will drop a little and their total cholesterol numbers, numbers will increase. And they have done nothing different and it is absolutely shocking to them. That this is happening outside of familial hypercholesterolemia, that's a different thing. But this is a woman who always had normal cholesterol. And then all of a sudden, somewhere in her late 30s and 40s, you see this sudden uptick. And every time she goes back, it's higher, higher, higher. And she's following all the dietary guides and she's doing everything she should, but it was her menopause that caused this. New onset of prediabetes. Never had an issue with your blood sugars before, all of a sudden in perimenopause. And all of these are leading to the increase, increasing risk. Like before menopause, women enjoy.

• 24:13Jamie Kern Lima?

  Much lower risk of cardiovascular disease than men. And through the menopause transition, we pass them up and our risks go up. And then we have visceral fat, which is cosmetically distressing and no woman likes it. But visceral fat, the intra-abdominal fat that wraps around our organs. My patients used to come in to me for their well-women exams and grab their tummies in their little paper gowns and say, "What is this? I never had this." And I would say, "We need to pause for a super brief break. And while we do, take a moment to share this episode with every single woman that you know, because this information can truly change your life and hers." In life, you don't soar to the level of your hopes and dreams.

• 24:55Jamie Kern Lima?

  You stay stuck at the level of your self-worth. When you build your self-worth, you change your entire life. And that's exactly why I wrote my new book, Worthy: How to Believe You Are Enough and Transform Your Life for You. If you have some self-doubt to destroy and a destiny to fulfill, Worthy is for you. In Worthy, you'll learn proven tools and simple steps that bring life-changing results, like how to get unstuck from the things holding you back, build unshakable self-love, unlearn the lies that lead to self-doubt, and embrace the truths that wake up worthiness, overcome

• 25:40Jamie Kern Lima?

  limiting beliefs and imposter syndrome, achieve your hopes and dreams by believing you are worthy of them, and so much more. Are you ready to unleash your greatness and step into the person you were born to be? Imagine a life with zero self-doubt and unshakable self-worth. Get your copy of Worthy, plus some amazing thank you bonus gifts for you at worthybook.com or the link in the show notes below. Imagine what you'd do if you fully believed in you. It's time to find out with Worthy.

• 26:22Jamie Kern Lima?

  Who you spend time around is so important as energy is contagious. And so is self-belief. And I'd love to hang out with you even more, especially if you could use an extra dose of inspiration, which is exactly why I've created my free weekly newsletter that's also a love letter to you, delivered straight to your inbox each and every Tuesday morning from me. If you haven't signed up to make sure that you get it each week, just go to jamiekernlima.com to make sure you're on the list and you'll get your One-on-One with Jamie weekly newsletter and get ready to believe in you. If you're tired of hearing the bad news every single day and need some inspiration,

• 27:07Jamie Kern Lima?

  some tips, tools, joy, and love hitting your inbox, I'm your girl. Subscribe at jamiekernlima.com or in the link in the show notes. Do you struggle with negative self-talk? Living with a constant mental narrative that you're not good enough is exhausting. I know because I've spent most of my life in that habit. The words you say to yourself about yourself are so powerful. And when you learn to take control over your self-talk, it's life-changing. And I wanted to give you a free resource that I created for you if this is something that could benefit your life.

• 27:51Jamie Kern Lima?

  It's called Five Ways to Overcome Negative Self-Talk and Build Self-Love. And it's a free how-to guide to overcome that negative self-talk, to build confidence and develop unshakable self-love so that you can dream big and keep going in the pursuit of your goals. Don't let self-sabotaging thoughts hinder your progress any longer. It's time to rewrite the script of your life, one filled with self-love, resilience, and unwavering belief.

• 28:23Jamie Kern Lima?

  If you're ready to take charge of your narrative, build unwavering confidence and empower yourself to persevere on the path to your dreams, you can grab your free guide to Stop Overthinking and Learn to Trust Yourself at jamiekernlima.com/resources or click the link in the show notes below. And now, more of this incredible conversation together.

• 28:48Speaker 01

  My patients used to come in to me for their Well Woman exams and grab their tummies in their little paper gowns and say, "What is this? I never had this." And I would say, "Oh, park further, take the stairs, eat less, work out more." Because that was what I was taught to do. I had no idea that the loss of estrogen was driving, was increasing inflammation and driving fat to the abdomen. You know, women with debilitating musculoskeletal pain, 80% of us will have a change, you know, musculoskeletal pain. And for like 30% of them, it's their worst menopause symptom. It's debilitating. They're not able to work out and exercise and do the things that they used to do because of this. All of this could be preventable. And when I think of cortisol levels,

• 29:33Speaker 01

  of what we've put a whole generation of women through, gaslighting them, not recognizing the constellation of symptoms that could be related to menopause, and what that has done to their shame and their guilt and their worry and all the things that drive up our cortisol levels. Because we weren't advocates in their care. We weren't holding their hands through the process. Even if she chooses not to have hormone therapy, wouldn't it be nice to know?

• 29:56Jamie Kern Lima?

  To know.

• 29:57Speaker 01

  That this would happen?

• 29:58Jamie Kern Lima?

  I just don't have willpower. Oh, I've let myself go.

• 30:02Speaker 01

  Yeah. And the shame and like, you know, the change in libido.

• 30:06Jamie Kern Lima?

  Yeah.

• 30:07Speaker 01

  And how the guilt she feels around that, especially for a woman who enjoyed what she felt was a healthy relationship and a healthy libido, that that is suddenly gone. And she doesn't care that it's gone. And it's dramatically affecting some relationships. Like, all of this is treatable. All of this is part of this, what's happening in our bodies and in our brains from this transition. And yes, it's natural, but it doesn't mean it's not pathologic and that you have to live with it.

• 30:32Jamie Kern Lima?

  And I want to call out that of all those... Symptoms you just listed, you didn't even say hot flashes, right?

• 30:38Speaker 01

  No.

• 30:38Jamie Kern Lima?

  And so many of us, that's the only thing we ever hear.

• 30:40Speaker 01

  So, one of the greatest things about these telemedicine companies is women go to their sites to get information and they'll take a little quiz, could I be a menopausal? They are collecting data by the hundreds of thousands. So Evernow, one of the companies, and my daughter actually interned for them last year, which is why I know this. They, over a hundred thousand women, they said, what are your worst symptoms? And they went through the, you know, they included all the ones in the book, right? And hot flashes was like number six or seven on severity and frequency and how much it affected their lives. I mean, my hot flashes were debilitating, which is what, you know, drug me reluctantly to take hormone therapy. But, you know, oh my gosh, it was fatigue, sleep disturbance, depression, loss of libido,

• 31:24Speaker 01

  relationship issues, like all of this stuff that no one was teaching, no one, you know, very few are still being taught that this could be a symptom of her menopause, especially a woman who had it. She was great. She was living her life. She had stress, but she had it managed. It was all good. She was, you know, she was in, living her best life. And then all of a sudden, it gets pulled out from under her and no one is helping her through this.

• 31:46Jamie Kern Lima?

  Hmm. Mm-hmm. Can you share, Dr. Mary Claire Haver, what is hormone replacement therapy? What is bio-identical hormone replacement therapy? We're gonna go deep on all the forms of it. The perceived risks, right?

• 32:05Speaker 01

  Sure. Yeah, there are risks.

• 32:06Jamie Kern Lima?

  And there has been sort of this thing that's been out there in the universe since, I mean, I remember this as like

• 32:12Speaker 01

  2002.

• 32:12Jamie Kern Lima?

  A teenager, right? Like a long time ago, I remember people saying, oh, you know, hormone replacement therapy can cause cancer. I mean, all of that. So can you talk about what's

• 32:24Speaker 01

  Yeah.

• 32:24Jamie Kern Lima?

  A myth? What's the truth? What is it?

• 32:27Speaker 01

  Okay.

• 32:27Jamie Kern Lima?

  Who needs it?

• 32:28Speaker 01

  Myth number one, it's dangerous for most women. Absolutely untrue. Myth number two, it's only for hot flashes and severe hot flashes at that. By the way, who gets to determine if they're severe? Not me. That's you, the patient, right? Um. Number three, oh, there's so many that you have to do compounded to get bio-identical. We have wonderful, safe, efficacious, affordable bio-identical hormone therapy for 25, 30 bucks a month. And number four, it's expensive, very, very, very affordable for most women. You know, if you, if you go to a clinician who's willing to help you find the right pharmacy. I spend a lot of time shopping pharmacies with my patients to get the best deal with that.

• 33:09Speaker 01

  You know, pharmacy benefit managers is a whole nother, you know, but we do a lot of work in our clinic to help patients find affordable hormone therapy. That it's just estrogen, or just progesterone, or just testosterone, and not some kind of mixture of the three, that, you know, you can't talk about one without the other. I think that's another big myth.

• 33:28Jamie Kern Lima?

  And hormone replacement therapy is basically supplementing your body's hormones that are deficient.

• 33:35Speaker 01

  Supplementing or replacing.

• 33:36Jamie Kern Lima?

  Or replacing. Can you explain the difference between bio-identical hormone replacement therapy?

• 33:42Speaker 01

  Yeah, so when, let's go back in history. When estrogen compounds were first being developed, they were mostly synthetic. They were made in labs, you know, chemists in white coats cooking up things and cleaving different compounds to create these products. And so the number one ingredient in birth control pills on the estrogen side of things. So let's go high level. We have estrogens, we have progestogens, which includes progesterone, and then we have androgens, which include testosterone, right? And for each of those, we have body identical, meaning pretty much looks like exactly what we have in the body, or then we have other options that are non-identical, but still bind to the receptor.

• 34:28Speaker 01

  The body identical ones tend to be plant-based, and the chemical ones tend to be synthetically made. That's kind of high level. For what we have commercially available in the U.S. for birth control, and this is a big pharma problem, and I hate to demonize, you know, the pharmaceutical industry, but this is one place I'm not that happy, is that the only thing really commercially available, and I took them for years, is synthetic options. Why don't we have a bio-identical option? Why don't we have an estradiol and progesterone-containing dose for suppressing ovulation so that you don't get pregnant? Because when we suppress ovulation, we also suppress heavy bleeding, acne, a lot of other things, you know? Why do we have to go with a synthetic option for that? Okay? But then when we move over to menopause hormone therapy, dosing.

• 35:13Speaker 01

  It's much lower than what's in a birth control pill. So when we think about birth control pills, we're developed to stop, not get pregnant. And you need a high dose to do that. And the only reason why hormone therapy was developed was to stop a hot flash.

• 35:27Speaker 01

  That was, we need to stop hot flashes. That is menopause. How much do we need to stop a hot flash? And then those formulations now, modern formulations tend to be estradiol and progesterone. Now, that doesn't work for everyone. And what I want to make clear to your audience is not every woman will choose hormone therapy or is a candidate, to be clear. But she's not getting the choice. No one's having the conversation with her by and large. She has to literally go through incredible mazes and hoops to find someone who will even talk to her about it. And that is the problem. She needs to be able to make that decision for herself after consultation with a clinician who's educated. And that's where we're failing, women.

• 36:07Jamie Kern Lima?

  Right now, when a woman walks into her doctor,

• 36:13Jamie Kern Lima?

  what does she need to ask?

• 36:16Speaker 01

  Before you even hit the door, don't make the appointment until you have asked these questions.

• 36:23Speaker 01

  Is this clinician willing to discuss hormone therapy with me? What percentage of patients receive hormone therapy? If it's 100%, that's a red flag. Okay? If it's less than 25%, that's probably another big red flag. Okay?

• 36:38Jamie Kern Lima?

  Wow.

• 36:39Speaker 01

  And are you going to offer me all of my options? Or are you going to steer me towards one product? That's a red flag. So one of the commercially available products that is compounded is something called pellets. And in my world, and clinicians I trust, you know, we have our little menopausey. It's a cute name for just a group of docs who we're constantly chatting all day on WhatsApp across the world. What are you doing with this? What do you know? You know, we're a think tank. And by and large, we are not fans of pellets because, one, they're not, you know, I think we can do better for our patients. But a lot of clinicians, that is all they're offering. And I think that's an ethical red flag. I think that you, if you decide that pellets are best for you, that's your choice. But if you're not given all of your

• 37:23Speaker 01

  options, remember that your clinician is profiting off of the sale of those pellets. And they have a financial drive to push that towards you.

• 37:32Jamie Kern Lima?

  Is the clinician profiting off all the different options?

• 37:35Speaker 01

  No.

• 37:35Jamie Kern Lima?

  Or just some?

• 37:36Speaker 01

  Just some. The ones that they-

• 37:37Jamie Kern Lima?

  Is that why they only recommend some in some cases?

• 37:39Speaker 01

  I mean, think about the economics of it. They're going to make a lot more money by giving them something that they're going to insert in the office.

• 37:46Jamie Kern Lima?

  Those three questions you listed are huge. I want everyone to pause the episode, rewind it, write those questions down. Share this episode with every girl and woman right now. Ask her to write those three questions down.

• 37:58Speaker 01

  So, call ahead. Ask those questions.

• 38:00Jamie Kern Lima?

  Yes, yes. Now, I want to ask you this because I want to get just really specific here. Do you call your regular doctor, meaning-

• 38:08Speaker 01

  Maybe.

• 38:08Jamie Kern Lima?

  Your doctor that does your physical every year? Who, or which doctor do you ask for a referral to?

• 38:15Speaker 01

  I wish I could tell you that you could walk into every OB-GYN's office.

• 38:18Jamie Kern Lima?

  Yeah.

• 38:19Speaker 01

  It's not happening. Okay? Go to the Menopause Society, look on their website for someone who's certified. It's not perfect, but it is a place to start. Then ask those questions. Okay? On our website, I have a crowdsourced database of women who've had fabulous experiences with their clinicians. And we organize their testimonials by city and state. That's another place to start. There are, and it's getting bigger and it's getting faster, telemedicine options, you know, we're getting there.

• 38:47Jamie Kern Lima?

  Yeah, and we're going to link to all of those. I want to make sure everyone knows that in the show notes. We're going to link to all of those and as well as Dr. Mary Claire Haver's sites and books and all the stuff. I'm thinking about the woman right now who maybe her insurance covers very few doctors and-

• 39:03Jamie Kern Lima?

  And she's trying to figure out, what do I do?

• 39:06Speaker 01

  Mm-hmm.

• 39:07Jamie Kern Lima?

  Would it be wise to first call, let's say you only see one doctor a year, uh, and maybe you also go and get, you know, your pap smear done from a gynecologist. Would it be wise to call those two?

• 39:18Speaker 01

  Call ahead first. Another trick which has worked. Two things. One is on our website, we have the Menopause Society Guidelines for Hormone Therapy in a PDF that you can just print out.

• 39:30Jamie Kern Lima?

  Print it out, bring it to your doctor.

• 39:31Speaker 01

  Bring it to your doctor. You may be able to teach them. It's not guaranteed, but it has worked. And the second is say, hey, let me try this for three months. I'll come back and tell you how I'm doing. And these poor physicians, clinicians, nurse practitioners are so overwhelmed, so overworked. Their situations are not great. They have no time. And they'll be like, I tell you, they'll be like, okay. Try it. And now you're going to educate them. You're going to come back in three months. And I promise you, the vast majority of you are going to feel amazing. And you're going to tell them, this worked so beautifully for me. Thank you so much. And they're going to remember that. And maybe read that guideline or, you know, take five minutes to educate themselves

• 40:13Speaker 01

  or get inspired to go and take the, uh, you know, go get educated by the Menopause Society.

• 40:19Jamie Kern Lima?

  Should you ask for a referral to an endocrinologist?

• 40:23Speaker 01

  Maybe. Those are getting better as well. But a lot of endocrinologists tend to work in niches of like thyroid or, you know, whatever their area of specialty is. You would think, you know, Dr. Rosio Salaswailen, one of my dear friends, who is a triple boarded in obesity medicine and endocrinology and internal medicine. She did three, two fellowships on top of her residency. Said she learned very, you know, she's the expert in how little clinically relevant information that she got and how we've all had to bring ourselves up to speed to be able to really give the best advice for a woman in menopause.

• 40:57Jamie Kern Lima?

  When you say nine out of 10 doctors aren't trained and don't have the knowledge or get hormone replacement therapy wrong. I just want to call that out because for everyone listening, there's a very good chance you're going to call your doctor, you're going to proactively

• 41:12Speaker 01

  And they'll say, no, it's dangerous or no, it's sort of, or, um, another friend was on a plane, she's an OB GYN and she's not practicing anymore, but she run in, she was flying home, she ran into her former program director. So I was a program director for residents for 10 years. And they were just chatting on the plane. He talked about his wife and she said, oh, is she on hormone therapy? He goes, I don't believe in that. Like it's Santa Claus. Like, like this is that generation of mindset of somehow you're weak or I don't believe in it. And you're just giving a woman permission to be whiny, you know?

• 41:47Jamie Kern Lima?

  Do you, do you recommend the bio-identical?

• 41:51Speaker 01

  I do, I do. But you have to be careful. Bio-identical originally, that term was really a marketing term, not a medical term. We don't go into medical textbooks and read the word bio-identical. But it is an easy way to explain to a patient, the difference between synthetic and something that is chemically identical to what your body made. And it makes sense to people. So I have adopted using it, always with a caveat, like remember, you're not going to pull up the American College of OB-GYN or any medical textbook and read the word bio-identical, right? But that, you know, I do tend to stick to those formulations because they have the greatest safety and efficacy, you know, well, everything's efficacious, actually. Synthetic is efficacious. But when we start really teasing out risk, you know, blood clots and, you know, the biggest risks are the blood clots and the

• 42:35Speaker 01

  potential for, you know, potential for tumors, cancers, et cetera, nothing is risk-free, that the bio-identical formulations seem to have the best safety profile.

• 42:46Jamie Kern Lima?

  Is there a blood test that we can do in general, or any type of test, that can give us the best sense of if our hormones are imbalanced? We need to pause for a super brief break. And while we do, take a moment to share this episode with every single woman that you know, because this information can truly change your life and hers. Who you spend time around is so important as energy is contagious, and so is self-belief. And I'd love to hang out with you even more, especially if you could use an extra dose of inspiration, which is exactly why I've created my free weekly newsletter that's

• 43:28Jamie Kern Lima?

  also a love letter to you, delivered straight to your inbox each and every Tuesday morning from me. If you haven't signed up to make sure that you get it each week, just go to jamiekernlima.com to make sure you're on the list and you'll get your one-on-one with Jamie weekly newsletter and get ready to believe in you.

• 43:50Jamie Kern Lima?

  If you're tired of hearing the bad news every single day and need some inspiration, some tips, tools, joy, and love hitting your inbox, I'm your girl. Subscribe at jamiekernlima.com or in the link in the show notes.

• 44:07Speaker 02

  I am so excited for this book. You know why? Because it's going to save so many people. It's going to save people. Worthy, your new beautiful book, Worthy. Get this book. This book? I'm telling you, it's a book that can change anybody's life who picks it up. Anybody who's ever felt that they were not good enough, didn't measure up, something's missing in your life, I have to tell you. It's powerful. It's happening. It's worthy.

• 44:39Jamie Kern Lima?

  Imagine what would you do if you fully believed in you? I went from struggling waitress facing nonstop rejection to founder of It Cosmetics, a billion dollar company, by learning how to overcome self doubt and believe I'm worthy of my hopes and dreams. And I'm sharing how you can too in my new book, Worthy: How to Believe You Are Enough and Transform Your Life. If you're ready to truly trust yourself and break through that barrier of self doubt and know that where you come from, or even where you are right now, doesn't determine where you're going, then worthy is for you.

• 45:22Jamie Kern Lima?

  It's time to go from doubting you're enough to knowing you're enough. It's time to step into all of who you are and into the person you were born to be. And it's time to believe that you are worthy of it. Because in life, we don't become what we want. We become what we believe we're worthy of.

• 45:44Jamie Kern Lima?

  Join the Worthy Movement today by grabbing your copy of Worthy anywhere books are sold. Then head to worthybook.com now for free gifts, including my five-part course on Becoming Unstoppable and my 95-page Worthy Workbook Action Plan that teaches you how to implement the tools from the book into your real life right now.

• 46:08Speaker 05

  Worthy is groundbreaking.

• 46:10Speaker 06

  Yo. Oh my God. Worthy, you are worthy.

• 46:13Speaker 05

  This book is going to change lives.

• 46:15Speaker 06

  This book literally will teach you how to actually feel worthy so that you can have the strength, you can have the confidence.

• 46:21Speaker 05

  The lessons in this book and the strategies will change your life. You will never be the same again after you read this book.

• 46:27Speaker 03

  Jamie's book, Worthy, is a must-read. It is going to inspire you, empower you, give you the hope that you need and the kick in the rear end that you deserve. Jamie's book, Worthy, is incredible.

• 46:40Jamie Kern Lima?

  The gifts are going away, but they're all free right now on worthybook.com.

• 46:47Jamie Kern Lima?

  And now more of this incredible conversation together. Is there a blood test that we can do in general, or any type of test, that can give us the best sense of if our hormones are imbalanced?

• 47:01Speaker 01

  Not in perimenopause, not a single one-time blood test. Remember, it is a constant level of fluctuation. So what we tend to do in our clinic, if a patient is still cycling regularly, we will have her come in on day three of her cycle for blood work. And fertility docs do this all the time, and we're going to check an estradiol to FSH ratio to give us some kind of an idea. We know from the straw staging, which is, you know, very medical, that if a woman's FSH level is consistently above 25 on at least three occasions, she probably has about two years left until her period's in. Like, there are some things we can do, but they're very nuanced and very complicated. There's new studies been doing on AMH, again, used in the fertility world, but give you an idea of ovarian reserve.

• 47:45Speaker 01

  It's not great, but it is something that can kind of help tease out the information, especially if she's had a hysterectomy, or she's had a IUD place that has stopped her periods, or had an ablation, you know, to help, give us a better clue, because we can't use her cycles to, to, you know, help us line up what's most likely happening with her.

• 48:02Jamie Kern Lima?

  So everyone, pause the episode, rewind, write that down, write that down, bring it into your doctor. Now, is there, is there a blood test or other test to tell if we are in menopause?

• 48:13Speaker 01

  Yes, it's so easy. It's FSH and usually estradiol together. FSH is above 50 are pretty much pathognomonic for you are fully menopausal. You might see occasional ovarian activity, but for most women, you know, and that's basically, FSH consistently above 50, she's not going to be able to get pregnant again, is what that means. And then estradiol level that's below 20 is pretty much, that's it, you're done.

• 48:36Jamie Kern Lima?

  You're in menopause. For perimenopause, what about the Dutch urine test that's like a 30 day in a row one?

• 48:44Speaker 01

  Yeah.

• 48:45Jamie Kern Lima?

  Pee on the paper for 30 days.

• 48:47Speaker 01

  To be honest, you know, that is so far outside of, of traditional medical training. That is very much in the functional world. Like, I've kind of scooted toward functional in my clinical practice.

• 48:57Jamie Kern Lima?

  Yeah.

• 48:57Speaker 01

  But I promise you, I don't need a Dutch test to be able to tell if a woman's in perimenopause.

• 49:02Jamie Kern Lima?

  Will it help other doctors who are less educated and like tuned in?

• 49:05Speaker 01

  No, it's too confusing. Like, they, there's nothing in our medical training, if you went the traditional route, that says anything about the Dutch test. They fascinate me. I looked at one yesterday for-

• 49:14Jamie Kern Lima?

  I love preventative stuff. I love it. I love it.

• 49:17Speaker 01

  So like, remember, we have reactive medical knowledge, right? So we're there to fix what's broken.

• 49:23Jamie Kern Lima?

  Yeah.

• 49:23Speaker 01

  We don't learn much about prevention in medical school. So this whole new functional preventative world is very exciting to me. But it's not being policed and managed by the same groups that are kind of controlling medical education right now. So I think that's, there's got to be some kind of a bridge, you know, there's got to be a consensus. And so Dutch, what I don't love about Dutch is it's not recognized by CLIA, which is like the national standard of laboratory testing. And it's only offered by one lab, and it's very, very expensive, you know, and I feel like I can give good, high-quality perimenopause care, and I can pretty much tell if she's in it, without needing to resort to the expense of a Dutch test.

• 50:01Jamie Kern Lima?

  Can you share, because this is going to be a big aha for, I bet you right now, I'm just waiting for the DMs on Instagram and the emails that are going to come in about this, that there's going to be women saying, wait, I did go to my doctor and they offered pellets. I didn't know there was something else.

• 50:16Speaker 01

  Right.

• 50:16Jamie Kern Lima?

  Can you share, Dr. Mary Claire Haver, can you share what options are there exactly?

• 50:24Speaker 01

  Yeah, thank you.

• 50:25Jamie Kern Lima?

  For hormone replacement therapy?

• 50:27Speaker 01

  We have so many.

• 50:27Jamie Kern Lima?

  What ones, I'm going to ask you what ones you use right now? And I want to ask how you apply the certain ones?

• 50:35Speaker 01

  Yeah.

• 50:35Jamie Kern Lima?

  Kind of break it down.

• 50:36Speaker 01

  Yeah.

• 50:37Jamie Kern Lima?

  You mentioned risk and I'm going to go there. Because how you describe, and I want to encourage everyone to grab your book, The New Menopause, your future book, The New Perimenopause, but you go granular on this. But I want to ask you now also, just, you know, the risks associated with each one? How you apply them? All of it. Who's a candidate, who's not? We're going to go there.

• 50:57Speaker 01

  Okay. So, we break it down into the big three, right? The estrogens, the progestogens, and then the androgens. Okay, so let's start with estrogen because most conversations around hormone replacement kind of start with estrogen. So estrogen is available in systemic, meaning we're treating the brains, the bones, the whole body, the uterus, everything. It's going into the blood, it's going everywhere. And then we have local. So local is topical. So it's either skincare for here or skincare for down there.

• 51:27Jamie Kern Lima?

  Like you put a cream in your vagina?

• 51:29Speaker 01

  Yep. Yeah, so as far as formulations, we have creams, we have gels, we have suppositories. So we have multiple ways to get it there. And thank God, because not everybody reacts the same way. Alcohols can be drying, some people have reactions to them. So, you know, but pretty standard where we start is a vaginal estrogen cream for the genital urinary syndrome of menopause. Now, right now, it's only FDA approved for when you have symptoms. But why would you wait? Why would you wait to be miserable? Like, isn't there a place for prevention? When almost 100% of us will develop GSM eventually if we live long enough? The loss of estrogen is not benign in the vagina, in the bladder. And so it's the best treatment for recurrent UTIs, for vaginal dryness, for painful intercourse.

• 52:14Speaker 01

  Now, again, it doesn't fix everything. There's a lot of things that can cause problems in the area. So it's important that if you've gotten your prescription for vaginal estrogen and things aren't getting better quickly, that you see something like Jill Kraft or, you know, someone who specializes in the pelvic floor to be able to help you. We have pelvic floor physical therapy. Most women have no idea it even exists. And it is literally the best thing that we should be talking about after childbirth. Because we just pushed a bowling ball out of our vaginas or carried one around for nine months. And to expect that it's just going to bounce all back and you're not going to have any problems after that? Women deserve that conversation. So that's kind of systemic. The good news about systemic topical therapy, because I put it on my face as well, is that...

• 52:55Jamie Kern Lima?

  Is estrogen cream on your face for collagen appearance?

• 53:00Speaker 01

  Yes, for the health of your skin. Thinning skin, thickening the collagen in your skin. And we actually have several great studies. We had some really good studies before WHOI. Then the whole world freaked out and nobody would ever, you know... And then 20 years later, people got brave enough and started doing... So we have a gap in our studies. But we have great studies showing safety and efficacy of topical estrogen for the skin.

• 53:19Jamie Kern Lima?

  And just really high level while we go through all of these options, vaginal estrogen cream or topical estrogen cream?

• 53:26Speaker 01

  Doesn't absorb systemically, right?

• 53:28Jamie Kern Lima?

  Not clinically, not... It's considered local.

• 53:30Speaker 01

  It's considered local. And even with breast cancer, you can use vaginal estrogen.

• 53:35Jamie Kern Lima?

  Is it covered by insurance?

• 53:36Speaker 01

  Yes, typically with regular, normal insurance, vaginal estrogen is covered. And even out of pocket, the generic estradiol cream can run $10 to $15 a month.

• 53:46Jamie Kern Lima?

  And what about for your face?

• 53:47Speaker 01

  So for your face, those are compounded only. So you can take the vaginal estrogen cream. And if patients want to try it, it's alcohol-based. So it can be, you know more about this than anyone. It can be a little bit drying, so... You can mix it with something topically, like a pea-sized amount, you know, couple of times a week, no more than that. Or you can buy a compounded version, which is what I do, that has a moisturizing base in it. And so, just to use on my face. For your face, is it ever covered by insurance? Or is that more of a... No. Things have to be FDA-approved to be covered by insurance. Now, you can get it for the vagina, and some women are choosing to put a little on their face. On their face, you know. And Dr. Gendler recommends the backs of your hands as well, you know, because we have a lot of thinning skin here as well. Yeah.

• 54:32Speaker 01

  And so you're saying like a pea-sized amount, a couple times a week on your face? Right. Now be careful. There was one sweet woman who was using the equivalent of a tube a day or something, and covering all over her skin. Of course, if you're using that much, she ended up having some, you know, systemic absorption because she was using it well more. So I always make very clear, you know, this is a prescription, you need to talk to your doctor, and, you know, make clear it with them, and be very clear on how little we need to see efficacy. To get a prescription for it? And let's say someone wants to do it because they know it's going to happen to them 100% of the time, they don't want to ever end up suffering, but you want to get it covered? Yeah.

• 55:17Speaker 01

  Is that... So it'll be covered for genital urinary, yeah, so vaginal dryness, for recurrent urinary tract infections, and it's actually wonderful for women who have urgency and frequency. So they have to pee a lot, you know, and this is a new thing, or they all of a sudden have to pee and the urge is coming really quick. Or they laugh and cough and they pee. Well, that's stress incontinence. So estrogen can be a little bit helpful for that, but that's more of an anatomic problem. So don't go in with that. And so pelvic floor physical therapy, yeah. So, yeah, if you're going in with like, I just feel like I have to pee all the time, I'm getting up in the middle of the night with this urge to pee, cough, laugh, sneeze is more stress incontinence, and that's a different treatment protocol. Okay. But, yeah. And do you personally use vaginal estrogen? I do.

• 55:59Speaker 01

  It took me about seven years into my menopause, this is such a funny story, like, physician treat thyself, and I started having delayed orgasms.

• 56:08Speaker 01

  Like I'm like, what's going on? Like, everything's working. I'm on testosterone. My brain's in it. And it was like taking forever. And that was new for me. And then I started having to get up to pee again in the middle of the night. Now, I never had any GSM.

• 56:20Jamie Kern Lima?

  Delayed orgasm, meaning it just wasn't a long time.

• 56:23Speaker 01

  It was taking forever compared to normal. You know, beautiful, healthy relationship with my husband. You finally get in the mood, you know, like all the planets line up. Yay. And then you're like, hm. And this was new for me. So I called Corinne Men, one of my menopause girlfriends. I'm like, I'm so frustrated. She goes, well, how much vaginal estrogen are you using? And I go, what? And she goes, Mary Claire, you're not treating? And I said, well, I just wasn't having any symptoms. She said, yes, you are. And so I tell that story, not to embarrass myself, but to be like, I didn't even realize it was still too taboo. And I happened to tell my girlfriend. And she said, clearly, this is, this is, you're GSM. You're losing blood flow to the area.

• 57:04Speaker 01

  Let's get you a little vaginal estrogen, because I was on systemic, but I wasn't getting enough penetration.

• 57:09Jamie Kern Lima?

  Interesting.

• 57:09Speaker 01

  So a lot of my patients have to use both. And it's happened to me, too. And now everything's kind of working back again.

• 57:14Jamie Kern Lima?

  Is there something you can use that speeds up orgasm?

• 57:18Speaker 01

  So there are some topical, mostly compounded out there that have things like sildenafil, like Viagra in them. And also have other compounds that will increase blood flow to the area. So, and a lot of women find that it kind of helps. You know, it's not a problem here. They're having an arousal issue. And so it can help with that as well. But those are compounded and can be a little bit tough to find.

• 57:40Jamie Kern Lima?

  So you use that personally daily? And I've heard you share this before. You're talking about the topical estrogen, vaginal or on your face?

• 57:48Speaker 01

  So vaginal, for me, it's twice a week.

• 57:50Jamie Kern Lima?

  Twice a week.

• 57:50Speaker 01

  Because it's a stronger dose. And then my topical skin, which is formulated for skin, is daily.

• 57:57Jamie Kern Lima?

  Is daily. And I've heard you share that you can also do topical while also doing systemic.

• 58:02Speaker 01

  Absolutely.

• 58:02Jamie Kern Lima?

  At the same time.

• 58:03Speaker 01

  So, yeah.

• 58:03Jamie Kern Lima?

  What are the systemic options?

• 58:05Speaker 01

  So let's go through systemic. So systemic means you're putting it into your bloodstream. So there's two classes there. We have oral and we have non-oral. Okay? Oral is pills, for the most part. Non-oral, meaning you swallow it, it goes through the stomach, gets picked up by the hepatic system, like anything we ingest orally, gets processed in the liver first. That is the natural way of doing things. When we ingest estrogen orally, it goes to the liver and we can see two things happen that don't happen with a non-oral formulation. Our steroid hormone binding globulin increases. And our clotting factors can very slightly increase. And for a woman with a predisposition to having blood clots, either through clotting disorder, she's had a history of a blood clot,

• 58:49Speaker 01

  then you want to avoid the oral estrogen formulation. By switching to a non-oral, like a patch, a cream, a gel, a spray, a strokey, a pellet. I don't want to demonize pellets. It's just a method of delivery. It's just the how they're ethically sourced. It's just a problem. So, you know, we have lots of ways to get things into our bloodstream that are FDA commercially available and covered by insurance.

• 59:14Jamie Kern Lima?

  So.

• 59:15Speaker 01

  So I use a patch.

• 59:16Jamie Kern Lima?

  You use the patch. So when you talk about systemic forms of estrogen, if you put it in your mouth and swallow it and it goes through your liver, that is when the increase you're saying of blood clots.

• 59:28Speaker 01

  We can, and it's not for everyone. It is very, very low. But we can remove that risk by using a non-oral formulation.

• 59:36Jamie Kern Lima?

  Now, that's the patch, the cream.

• 59:38Speaker 01

  Patch, cream, gel.

• 59:39Jamie Kern Lima?

  Pellet, gel.

• 59:40Speaker 01

  Gel. And where we need more research is all the data on cardiovascular protection that came out of the WHOI was with oral estrogen, was with Primorin. And we saw cardiovascular protection. And so some of the people who like really using oral formulations are like, we don't have data on the transdermal saying that it's cardioprotective. You know, we need so much more research. But I know that my cholesterol went down, way down. Now, I did change my diet and how I move my body and stuff when I went through menopause. But my cholesterol was tracking way up, you know, with no, just from being menopausal. And by using hormone therapy, changing my diet, increasing my fiber, you know, doing all the things in the toolkit, then I was able to bring that.

• 1:00:25Speaker 01

  My LDL is down to 108 and I was doing a victory dance. I was, I just got it, I literally just got it this morning. I had it drawn on Friday before, or whenever we flew out. And I was so happy. So knowing that all the way.

• 1:00:38Jamie Kern Lima?

  You attribute that to the estrogen. So you use the patch?

• 1:00:42Speaker 01

  I do.

• 1:00:43Jamie Kern Lima?

  As your systemic form?

• 1:00:44Speaker 01

  For my estrogen, for my systemic form.

• 1:00:46Jamie Kern Lima?

  In addition to the local, which is the vaginal cream? And then on your face?

• 1:00:50Speaker 01

  Right.

• 1:00:50Jamie Kern Lima?

  Just real quick, before we move on to other forms, I just want to ask for everyone listening, because I'm telling you right now, we are not getting this info from our doctor. We are getting it from you who are our doctor today, which I'm so grateful for. And thank you so much. But for women that say, oh, okay, I, you know, I don't want to swallow a pill. I don't want the, even though small, the increased clotting risk or the other things that when it goes through your liver. So I want to do a systemic form that is, you know, coming from the outside, like a patch or a cream or a pellet. You use the patch. What do all of those typically cost? And are they covered by insurance?

• 1:01:30Speaker 01

  So anything that's FDA approved. So there's a estragel. There's a couple of gels out there. There's a spray called Eva Miss. There's the patch, which has multiple generic options. There's a vaginal ring, actually, that has a big dose that gets absorbed systemically. So the cheapest option is oral estrogen. That's like $2 a month. $2. So for...

• 1:01:53Jamie Kern Lima?

  That's what you swallow?

• 1:01:54Speaker 01

  That's what you swallow. So for patients who are low risk for clots and really, really, this is a budgetary thing, then the pill sometimes, you know, the pill option is great for them. Then we have the patch, which, you know, with a good RX coupon or a little bit of hustle, we can get for about $20 to $25 a month for a box of patches. Then the sprays and gels don't have a generic option. And I've seen anywhere from $75 to over $200 a month. And the ring, over $200. But the ring lasts for three months. So that's wonderful in that for, you know, if the ring is the best option for you as far as your lifestyle and how you want to do things, because you get systemic and vaginal all in one, with the ring being in the vagina, then, and they could afford it.

• 1:02:38Speaker 01

  A lot of women really like the ring option.

• 1:02:40Jamie Kern Lima?

  Do you insert the ring yourself?

• 1:02:42Speaker 01

  Yeah. It's a little flexible ring. There's a birth control option of it, as far as what it looks like. And there, you know, I don't know if you're... If you put your finger and thumb together, it's about that big around. It's super flexible, so you just have to have the dexterity to fold it like a taco and insert it into the vagina. It's kind of like a tampon. You know when it's in the right place because you don't feel it anymore. And for some patients who struggle, we kind of tell them to get an empty tampon holder and shove the ring in there and then just insert it that way.

• 1:03:10Jamie Kern Lima?

  Insert it.

• 1:03:10Speaker 01

  It's a little trick.

• 1:03:11Jamie Kern Lima?

  You know, I'm going to go into how we find coupons, all the things. Because that's a big thing when it comes to some of these drugs. But I want to ask you, who listening right now is a candidate for HRT and who's not?

• 1:03:26Speaker 01

  Yeah. So most of the candidacy is around estrogen. You know, we don't talk about candidacy for testosterone or progesterone, but it's estrogen. And so progesterone can be a little tricky because of breast cancer. But who is not a candidate is easier to talk about. If you have a tumor right now that is being fed by estrogen or progesterone, you are not a candidate, okay? If you have severe liver disease, I'm not talking mild fatty liver. I mean severe like liver disease where you have constantly elevated liver function tests. This is where estrogen is processed in our bodies, okay? And this is going to be tricky to keep you therapeutic because your body's not able to break it down, okay?

• 1:04:09Speaker 01

  So we have to, that's a very nuanced conversation with liver disease. If you are being treated for a blood clot right now, most people would steer away from estrogen. Once your blood clot treatment is over and we get all your levels back and we've done all the evaluation, you need to avoid oral estrogen at all costs, okay? But you will be a candidate for transdermal estrogen. If you've had a recent stroke and we're not sure why. So there's two kinds of stroke. One is hemorrhagic, meaning you popped a blood vessel. And then another is a blood clot in the brain, okay? If you've had a blood clot in the brain, that's going to be another very nuanced, tricky conversation around if you're going to be a candidate for hormone therapy moving forward. And if you simply don't want it, you know, some people are very concerned about putting

• 1:04:50Speaker 01

  anything in their body that their body didn't make naturally, that's okay too. Let me be clear, you can be healthy without hormone therapy, but it is harder. And it's going to take a lot of hustle and you may end up on multiple other medications to control certain conditions that are impacting your life.

• 1:05:08Jamie Kern Lima?

  Hmm, that's a really, um, a really fascinating point.

• 1:05:12Speaker 01

  Mm hmm.

• 1:05:13Jamie Kern Lima?

  Is that there's a lot of people that maybe are scared and they've heard things over the years, but now they're on all these other medications.

• 1:05:18Speaker 01

  The people who are demonizing hormone therapy by and large on social media are women who haven't gone through it yet, men, and people who aren't allowed to prescribe it in the health space. So they're trying to sell you their supplement or their program or their, because you don't need this, there's somehow you're weak or your body's not detoxing or processing, you know, and I'm like, wait a minute, we're simply, it's a she's had her thyroid removed. No, no one would tell a woman, you know, and let me tell you, if men's testicles shriveled up and died at 51, we would not even be having this conversation. Like, you know, there would be no question we would replace this testosterone and probably a little bit of a zestrogen because it's protective, you know?

• 1:06:02Jamie Kern Lima?

  Progesterone?

• 1:06:03Speaker 01

  Yeah.

• 1:06:03Jamie Kern Lima?

  Testosterone. I know we're talking so much about estrogen.

• 1:06:06Speaker 01

  The last two. If you have a uterus, progesterone is mandatory if you get estrogen to protect the lining of the uterus. You don't want to just feed the uterine cavity estrogen by itself. That lining will grow and could become cancerous. So we give you a progestogen, you're fine. If you don't have a uterus, or if you have the progesterone in your uterus with an IUD, um, or you, uh, but if you have an ablation, you still need it. But, but say you don't have a uterus. Progesterone is an option. It is fantastic for sleep. Fantastic. Few things work better. Estrogen will stop the hot flashes so that you can sleep, you know, without hot flash waking you up. But when I tell you I have to protect my sleep with my life now as a menopausal person

• 1:06:50Speaker 01

  more than I ever did in my twenties, I just put my head on the pillow, the end, right? If I don't, it's like I have a sage and a shaman, you know, in the bedroom. I'm like, I have my progesterone, my magnesium, my L-theanine, you know, my L-theanine. You have all this potions and magic because, and I can't have alcohol if I expect to sleep well, at least six hours before I go to bed. It is like life-changing, the progesterone for my patients to help with their sleep. So even if they've had a hysterectomy and they don't absolutely need it for protection, I am talking to them about their sleep and recommending it for that.

• 1:07:26Jamie Kern Lima?

  So if you're on estrogen right now and you're not on progesterone, that's a big red flag.

• 1:07:31Speaker 01

  That's a big red flag. That is someone who doesn't understand endocrinology and what happens to the uterus. So I could save someone's life right now. And that, the topical progesterones, if you're doing bioidentical, oral is the only way. The molecule is humongous and has a horrible time going through the skin. And so we really struggle to get endometrial protection. So most of us who know what we're doing, we're using oral micronized progesterone and that is $10 a month. Now, if you have an allergy, if you're allergic to peanut oil, you know, we have options. Thank God we have compounded options for a non-peanut oil containing. Some people, the formulation, they feel groggy or kind of hungover when they get up in the morning. So, you know, it's wonderful that we have different options.

• 1:08:11Jamie Kern Lima?

  This is huge because I just want to call that out again in case someone is, you know, running an errand, doing something else right now and they're listening to this. You're saying if you are on estrogen right now.

• 1:08:21Speaker 01

  Right.

• 1:08:22Jamie Kern Lima?

  But you're not also on progesterone.

• 1:08:23Speaker 01

  Huge red flag.

• 1:08:24Jamie Kern Lima?

  Big red flag.

• 1:08:25Speaker 01

  Stop immediately and call your doctor. If you have a uterus.

• 1:08:27Jamie Kern Lima?

  Yep.

• 1:08:28Speaker 01

  Okay. You need progesterone. Now, if you have a progesterone-containing IUD, you're covered. But if you don't, this is a red flag.

• 1:08:36Jamie Kern Lima?

  And then testosterone.

• 1:08:37Speaker 01

  Testosterone. So we know beyond the shadow of a doubt that it can be extraordinarily helpful for hypoactive sexual desire disorder, or what in layman's terms, you would call low libido. We know it works. We also have two FDA approved medications that work pretty well too. So I always discuss all three with my patients. Where the controversy around testosterone lies, most people in the menopause world agree, if she's suffering from HSD, let's give her a trial of testosterone, see how she does. Where we're seeing the backlash is that we know mood is a, you know, libido is a mood. It's in the brain. We know anecdotally and some from older studies that testosterone looks like it's helpful for maybe depression.

• 1:09:20Speaker 01

  I'm recommending it off label for my patients with low muscle mass. In my clinic, I have a body scanner, so I'm able to check their muscle mass and visceral fat and all that. I can measure those things for them. If they're working out, we know that women with higher testosterone levels have higher muscle mass. And so if I supplement her a little bit, then I can help with her muscle mass, decrease her risk of osteoporosis and frailty as she gets older. And so, but any conversation of testosterone right now around, outside of libido, some people in the medical world go a little bit crazy. But I'm telling you, my patients who I'm using it for desire are telling me it's helping with mental clarity, stamina, mood. They are really, really loving it. And how do we put it in your body? You

• 1:10:02Speaker 01

  want to avoid an oral formulation, again, because of what it does to the liver. So we have, most of my patients are using AndroGel, which is an FDA approved for men version, but we're using it off label through the skin, on the shoulder, here, daily, to give them a nice steady state. I'm just trying to get them back to their 30-year-old levels, right? Because female testosterone just gently declines throughout life. It does not fall off a cliff in menopause. Okay? It kind of gently declines. And then what we're trying to do is get them back up the hill a little bit to where they felt better and their bodies seem to be healthier at that level.

• 1:10:39Jamie Kern Lima?

  For testosterone for a woman, is that ever covered by insurance?

• 1:10:44Speaker 01

  No.

• 1:10:44Jamie Kern Lima?

  Never?

• 1:10:45Speaker 01

  It's not FDA approved for women, for anything, even though we have great data for, for, it is in Australia, approved by their version of the FDA. They have commercially available preparations, but it has been removed from approval for women. And it's also a controlled substance. Like a narcotic. So there's a lot of hoops we have to jump through to get it for our patients because it's been abused. Not by women typically, but because of that, it's controlled and it's really hard to get for a lot of women.

• 1:11:10Jamie Kern Lima?

  How much is it out of pocket?

• 1:11:12Speaker 01

  So, once you get it with the GoodRx coupon or through something like HRT Club, you know, we have workarounds for everything. I can get a six-month supply for about $60.

• 1:11:23Jamie Kern Lima?

  So about $10 a month.

• 1:11:24Speaker 01

  Hmm.

• 1:11:26Jamie Kern Lima?

  When you say, and we're going to dive into, I'm so excited about this, how do we find coupons? How do we build our menopause toolkit?

• 1:11:33Speaker 01

  Toolkit, yeah.

• 1:11:33Jamie Kern Lima?

  Everyone listening right now, you're going to build your own menopause toolkit, right, with us? For, I just want to clarify one question on compounded versus non-compounded. So there's going to be a lot of people listening right now that are like, that maybe even missed that we just said that word, but there's compounded, non-compounded forms of medication, and then there's pharmacies that do compounding.

• 1:11:58Speaker 01

  Right.

• 1:11:58Jamie Kern Lima?

  Can you explain what both of those things are?

• 1:12:00Speaker 01

  Yeah.

• 1:12:00Jamie Kern Lima?

  And do either of them freak you out ever?

• 1:12:04Speaker 01

  Uh-uh.

• 1:12:04Jamie Kern Lima?

  And, because you know, as a, as a, as a consumer-

• 1:12:08Speaker 01

  I like having options.

• 1:12:09Jamie Kern Lima?

  I think like, wait, is there human error involved if someone is compounding?

• 1:12:13Speaker 01

  There tends to be more human error, so-

• 1:12:15Jamie Kern Lima?

  So, share with us what this, what this is.

• 1:12:17Speaker 01

  We have large scale, so a pharmacy is just a room that makes medication, right? Regardless of how they do it. So we have FDA-approved, and they tend to be these really large pharmacies that are cranking out the patches and the pills. Most pharmaceuticals we use in the US, most people use non-compounded options. Compounding was originally how we got medicine. There was a guy in a lab coat with a bucket somewhere who was mixing up some potion, all right, for you to take. And that kind of evolved. So not everything works for everybody in the FDA-approved world. So a few guys still stayed back compounding special things or things that people needed because they, they didn't fit the mold, okay? Compounding is done on a case-by-case basis typically, but it became, there's a, there's a loophole there.

• 1:13:01Speaker 01

  And so now these giant compounding pharmacies have been made that are making things like pellets, and they don't, they're not subject to FDA oversight. So there's no one going in on a regular basis from the government that are testing to make sure what they say is in the box is in the box. And it gets even tougher when you have the smaller, local guy, I love these guys, who are mixing up things. No one's going to check him, and we just have to trust that what he's doing is doing. And some of these places are excellent, you know? But it's really hard to tell, is this a good, you know, compounding pharmacy or not? So in the hormone therapy world, there wasn't a lot of commercially available stuff after the WHO available that people felt comfortable using. So in the functional world, they started leaning heavily on the compounding pharmacists to make things for them.

• 1:13:46Speaker 01

  And then those pharmacies were getting bigger and bigger and bigger. So about five years ago, the FDA went into the top 12 compounding pharmacies and pulled their hormone therapy options. And what they found, so we know that when the FDA goes in to check the FDA-approved ones, 98% of what they say is in there. We had about a 30% discrepancy of

• 1:14:07Jamie Kern Lima?

  Wow.

• 1:14:08Speaker 01

  Yeah, formulation and amount in the top 12 compounding pharmacy. I don't know their names.

• 1:14:13Jamie Kern Lima?

  What year was that?

• 1:14:14Speaker 01

  So it kind of gives you an idea. I'm sorry?

• 1:14:16Jamie Kern Lima?

  What year was that?

• 1:14:17Speaker 01

  I think it was about five years ago.

• 1:14:18Jamie Kern Lima?

  So, so basically, when the FDA went into FDA-approved labs that are

• 1:14:23Speaker 01

  Yeah, they said, let's do a side-by-side comparison. Yeah, they checked them. We know this is 98%.

• 1:14:27Jamie Kern Lima?

  They're 98% accurate. What they said's in that medication's in that medication.

• 1:14:30Speaker 01

  Yeah.

• 1:14:31Jamie Kern Lima?

  When they went into the compounding, which is when

• 1:14:32Speaker 01

  They just ordered it like they were Jane Doe.

• 1:14:35Jamie Kern Lima?

  Right.

• 1:14:36Speaker 01

  And ordered it and had it shipped to wherever they were. And then they went to the lab and tested them. They saw up to a 30% discrepancy.

• 1:14:41Jamie Kern Lima?

  So the compounding's when someone's actually compounding the medication or making it for you, putting it together, they tested and found about

• 1:14:49Speaker 01

  There tends to be more human error and we're not getting consistency with each compounding dose.

• 1:14:53Jamie Kern Lima?

  So about 30% wasn't what they said it was. So that's the risk right there.

• 1:14:57Speaker 01

  Yeah. So that's really the big risk. Do I use compounding? Yes. I'm so grateful to have options for my patients who need something out of the box. Okay? And I have a couple of compounders in the Houston area who I've actually driven up, checked their, you know, loved everything that they're doing, trust them. One of my nurse practitioners is married to a PhD pharmacist. Their daughter is a PhD pharmacist. They lean in heavily on what they think are the most reliable compo- You know, so for my little, small clinic, you know, in Texas, it's great to have these options, but on a large scale, shipping out all over the US, I worry. And I think we, we don't need to do that for everyone, that I can get them safe, high-quality, efficacious, FDA-approved, bio-identical hormone therapy that's very, very affordable.

• 1:15:40Jamie Kern Lima?

  You know, we're going to talk about GLP-1s in a minute, which is such a big thing right now when it comes to, we're going to talk about belly fat and what do we do about it?

• 1:15:48Speaker 01

  Yes.

• 1:15:48Jamie Kern Lima?

  Uh, we're going to talk about GLP-1s. Are they safe? Are they not safe? And there's such a huge area of GLP-1s from compounded pharmacies right now. So I'm going to ask you about about that in a minute. But this is really, really good to know because I think a lot of people, you know, when we're in our doctor's office and if we get two minutes of their time and they just say the word compounded really fast, it it's hard to even process what that is for a lot of us because we're just worried, am I going to get my question out? Am I going to, am I going to leave the doctor's office with more questions than answers still? And this is happening over and over for so many people. So I think, you know, you breaking down, I'm going to call it a masterclass here today of what, why are our hormones changing? What are they? What are all the symptoms that maybe we thought was something else?

• 1:16:33Jamie Kern Lima?

  And then, you know, this idea of hormone replacement therapy. I want to ask you, uh, because, you know, uh, you talk about the women's,

• 1:16:44Jamie Kern Lima?

  health initiative, women's initiative of health.

• 1:16:48Jamie Kern Lima?

  For a long time, you know, there was this moment where a study came out linking cancer to hormone replacement therapy. And then just, I feel like decades went by where everyone was just scared of it. Two decades. So from your, you know, as someone who is called the top menopause doctor in the world, now by millions of people, does it, tell me about the risk in a nutshell. Does it scare you at all? And what should women be thinking about right now when it comes to HRT?

• 1:17:21Speaker 01

  So we know that there are certain windows of opportunity where the benefits are going to outweigh the risk. So if we look at, you know, it's always going to stop a hot flash, no matter your age, if you have hot flashes, it will probably get rid of it if it's due to menopause. Not all hot flashes are menopause, by the way. Most are though. It will always protect your bones. It is FDA approved for the protection, you know, for you to protect your bones against osteoporosis. We can cut osteoporotic fracture probably by 50% with the use of hormone therapy.

• 1:17:53Speaker 01

  Cardiovascular benefit, we have a window of opportunity. And thank God for Howard Hodis and Wendy Mack and Roger Lobo and all these incredible clinicians who've been studying this. So the WHI data, they went back and looked and said, let's break it down by age. Because the average age in the WHI was 63 years old. We don't start women on hormone therapy generally at 63. We start them when they're most symptomatic, late perimenopause, early menopause, right? So it wasn't a representative sample of the typical patient, okay? They started women who probably had early pre-existing breast cancer or were, you know, getting very close, put them on hormone therapy. And the estrogen-only arm, they saw 30% decrease at all ages for breast cancer.

• 1:18:37Speaker 01

  It was the estrogen and progestin, it was a very specific progestin called Provera or midroxyprogesterone acetate, that saw the slight but not statistically significant increased risk. It never reached statistical significance, yet they shouted it from the rooftops of this incredible, you know, they vastly over-exaggerated the risks and barely talked about the benefits of all-cause mortality decrease. If, starting in the first 10 years of menopause, 50% per year decrease in cardiovascular disease. That's how protective estrogen is of our endothelium, of the vessels around the heart. Okay, we can decrease your risk of having a heart attack, not 100% and not forever, but we can delay it. So that's the kind of data we're talking about.

• 1:19:20Speaker 01

  So when a patient comes in, and she's early, she's young, you know, young 50s, you know? And she's like, what's the benefit to me? I'll just lay out what the studies say. Now, the US Preventative Task Force has not gotten around to saying these things, but we can decrease your risk of all-cause mortality, of a heart attack, of, you know, if you have no pre-existing heart disease, it's probably going to delay the formulation of clots and plaques and calcified plaques in your endothelium, and we know this clearly. But we have a window. Once those things start, it's not, it's better at prevention than cure. But it will always protect your bones, it will always protect your vagina and your bladder, you know, and keep you from getting urosepsis and incontinence and all these things that are plaguing women. Because...

• 1:20:06Speaker 01

  Here's the biggest thing I want everyone to realize. We have a huge gender health gap in this company. When I hear the wellness bros, who I adore, I'm going to one today, who talk about living forever and living longer and living to 120, I'm like, yay. Women live longer than men, doing nothing, just existing. We live four to five years longer than men. We don't live healthier than men. We spend 25% of that life in poorer health than our male counterparts. And we spend much longer time with loss of independence, usually due to dementia and frailty and osteoporotic fracture. This is avoidable. This is what we do in our clinic when we talk about the toolkit. This is why we talk about hormone therapy is what is its place in the prevention of these diseases?

• 1:20:51Speaker 01

  So that you can age better and longer and stay healthier longer. And, you know, right now, my mother, terrible Alzheimer's, and just fell and broke her hip. How can I, and like, all the, you know, it's a privilege to be able to do it, but the communication and the drama and the stress and what these diseases are doing to American families? And what the prevention of these or the delay or shortening that time of mom losing her independence? And all the things that have to go into place to take care of her? You know, if my mother truly knew what was happening, I think she'd jump off a roof. And so my husband and I's conversation are around, what are we gonna do to not do this to the girls? You know, how do we live healthier longer? So that we're not as much of a burden for so long? And not that I feel like my mother's a burden,

• 1:21:35Speaker 01

  but she wouldn't want this if she knew it was coming. And no one talked to her in her life about preventing what has happened to her. What could she have done to prevent her dementia? And to prevent her osteoporosis? And leaving menopause out of that conversation is a mistake.

• 1:21:50Jamie Kern Lima?

  You say that the study from a few decades ago was statistically insignificant. And a few decades ago, there were still just a few news channels that everyone had to watch. And so when something like that got broadcast, it just became so dominant.

• 1:22:07Speaker 01

  It was viral, back in how you defined viral back then. It was the number one medical news story of 2002. Every newspaper, ABC, CBS, NBC, cover of, you know, cover of Time Magazine.

• 1:22:19Jamie Kern Lima?

  So right now, you have...

• 1:22:24Jamie Kern Lima?

  You utilize hormone therapy in your life.

• 1:22:26Speaker 01

  I do.

• 1:22:27Jamie Kern Lima?

  And you clearly say for you, and you've been very definitive about who's a candidate, who's not, but that the rewards can far outweigh the risks.

• 1:22:37Speaker 01

  I'm, I'm living my best life. I get up every morning excited. I feel better than I did in my 30s and 40s. I have better relationships, I have better boundaries, I'm a better businesswoman, I'm a better doctor, I'm a better mother, I'm a better wife, I'm having better sex. I'm, you know, I want everyone to have this. And I'm really looking forward to the next 30 years. I'm not scared.

• 1:23:00Jamie Kern Lima?

  Can we be on hormone therapy forever?

• 1:23:03Speaker 01

  Potentially. As long as for you, the benefits outweigh the risks. There's no reason to stop as long as you want to keep going.

• 1:23:10Jamie Kern Lima?

  Remember, this episode is not just for you and me. Please share this with every single woman that you know, because it can change her life too. Coming up, this conversation is so incredible and y'all can't seem to get enough of Dr. Mary Claire Haver and this menopause masterclass. So, we're continuing this conversation and diving even deeper. I'm so excited that you are not going to want to miss part three of our conversation with Dr. Mary Claire Haver, where we're giving you your menopause toolkit, including the tests you need to ask your doctor for, how to prep for your next appointment, what resources are available for free, and so much more.

• 1:23:52Jamie Kern Lima?

  That's coming up in the next episode of the Jamie Kern Lima Show. And if you loved today's episode, please click the follow or subscribe button for the show on your app and give it a five star rating or review. And again, please share this episode with everyone you believe in. Share it with another person in your life who could benefit from it. Post it and share it with others online or in your community who just might need the words and tools and lessons in this episode today. You never know whose life you're meant to change today by sharing this episode. And thank you so much for joining me today. Before you go, I want to share some words with you. Couldn't it be more true?

• 1:24:34Jamie Kern Lima?

  You, right now, exactly as you are, are enough and fully worthy. You're worthy of your greatest hopes, your wildest dreams, and all the unconditional love in the world, and it is an honor to welcome you to each and every episode of the Jamie Kern Lima Show. Here, I hope you'll come as you are, and heal where you need, blossom what you choose, journey toward your calling, and stay as long as you like, because you belong here. You are worthy, you are loved, you are love, and I love you. And I can't wait to join you on the next episode of the Jamie Kern Lima Show.

• 1:25:18Jamie Kern Lima?

  In life, you don't soar to the level of your hopes and dreams, you stay stuck at the level of your self-worth. When you build your self-worth, you change your entire life. And that's exactly why I wrote my new book, Worthy: How to Believe You Are Enough and Transform Your Life for You. If you have some self-doubt to destroy and a destiny to fulfill, Worthy is for you. In Worthy, you'll learn proven tools and simple steps that bring life-changing results, like how to get unstuck from the things holding you back, build unshakable self-love, unlearn

• 1:25:59Jamie Kern Lima?

  the lies that lead to self-doubt, and embrace the truths that wake up worthiness, overcome limiting beliefs and imposter syndrome, achieve your hopes and dreams by believing you are worthy of them, and so much more. Are you ready to unleash your greatness and step into the person you were born to be? Imagine a life with zero self-doubt and unshakable self-worth. Get your copy of Worthy, plus some amazing thank you bonus gifts for you at worthybook.com, or the link in the show notes below.

• 1:26:39Jamie Kern Lima?

  Imagine what you'd do if you fully believed in you. It's time to find out with Worthy. Who you spend time around is so important as energy is contagious. And so is self-belief. And I'd love to hang out with you even more, especially if you could use an extra dose of inspiration, which is exactly why I've created my free weekly newsletter that's also a love letter to you, delivered straight to your inbox from me. If you haven't signed up to make sure that you get it each week, just go to jamiekernlima.com to make sure you're on the list and you'll get your One-on-One With Jamie weekly newsletter.

• 1:27:23Jamie Kern Lima?

  And get ready to believe in you. If you're tired of hearing the bad news every single day and need some inspiration, some tips, tools, joy, and love hitting your inbox, I'm your girl. Subscribe at jamiekernlima.com or in the link in the show notes. And please note, I'm not a licensed therapist and this podcast is not intended as a substitute for the advice of a physician, professional coach, psychotherapist, or other qualified professional.