PERI and POST Menopause Testing and Therapy Choices with Dr. Jill Carnahan

Betty Rocker (00:18):

What’s up, rock stars Coach Betty Rocker right here. Hey, thanks a lot for becoming a member of me. My visitor as we speak is Dr. Jill Carnahan, a frequent visitor on this present. You might have heard her earlier than. She is dually board licensed in household medication, a practitioner of built-in holistic medication, and can also be a practical medication skilled. She’s the creator of Surprising, a really inspiring learn, and she or he’s additionally the topic of a documentary referred to as Physician Affected person. She’s acquired a wonderful podcast and a very, actually useful weblog, simply filled with nice free content material you’ll be able to entry anytime and is a survivor of breast most cancers, Crohn’s illness and poisonous mildew sickness. She brings a novel perspective to treating sufferers within the midst of complicated and persistent sickness. She’s the medical director on the Flatiron Useful Drugs Middle simply exterior of Boulder, Colorado. And my very own private physician and I all the time really feel actually fortunate to get to work along with her and in addition to have the ability to share her with you guys as a result of she actually helps make sense out of so many complicated well being associated topics which can be related to us all. Please be a part of me in welcoming her to the present. Nice to see you, Dr. Jill. Thanks a lot for becoming a member of me as we speak.

Dr. Jill Carnahan (01:31):

You’re welcome. So good to be with you once more.

Betty Rocker (01:34):

Sure, it’s all the time nice to get to verify in and, and have a dialog. And one factor I really feel like has been on my thoughts and on the minds of lots of the girls I serve, um, is that this dialog about menopause, perimenopause and submit menopause. Proper? The all-encompassing menopause umbrella, . And it’s nice to see menopause having its day. I really feel like lastly we’re listening to extra about it. There’s much more analysis than there was. And after I assume again to our conversations possibly early on in my very own perimenopause journey, I take into consideration how a lot nervousness I had about listening to about issues like bioidentical hormones or hormone substitute remedy and the way that dialog sort of advanced and the way rather more we all know lately. Why, why are folks nonetheless, I really feel like there’s nonetheless loads of concern round hormone substitute remedy, although. I imply, simply to get us into it, like the place’s that come from?

Dr. Jill Carnahan (02:33):

Properly, it truly comes from our career and I’ll inform you the story and it’ll make a lot sense. So I graduated 2001 and acquired out of medical faculty and that yr was the yr the Girls’s well being Initiative first got here out within the information. Because the researchers are compiling the info, the information took this data earlier than they even completed compiling and stated, oh my goodness, is there an elevated threat of breast most cancers with hormone substitute? And actually a whole bunch of hundreds of ladies stopped their hormone substitute as a result of this media took this story, put it on the market. And whilst a health care provider, that was the story that we had been instructed. So all of us began, that is 20 plus years in the past, being afraid of this. What occurred in that 20 yr sense is that they analyzed the info in that largest randomized management trial of ladies on hormone substitute. And the info got here out very clearly.

(03:18)
Primary, there was two arms, one was an estrogen solely arm, they usually used Premarin, which is definitely a horse estrogen, not even the most effective cleanest bioidentical, however it’s an estrogen. And the opposite arm was a Premarin, which is an estrogen plus, um, a purvey, which is an artificial progestin. I’ll clarify that actual briefly in a minute. So these two arms, the primary arm got here out and this has been the final, uh, analyzed analysis, effectively documented by anybody who’s checked out this. There was truly a 34% discount in breast most cancers in that arm. So not solely was it not impartial like simply, or or dangerous, it was truly a discount. And we’ve identified for all of this time that hormones, particularly estradiol, helps the mind, the bone, and the um, menopause signs dramatically and the center. So these issues had been by no means questioned. It was solely this query about breast most cancers.

(04:09)
Now, in that different arm, right here’s the place the controversy got here in. That they had this slight enhance above baseline with the Premarin Provera arm for breast most cancers incidents. However what occurred is what they had been, um, going in opposition to because the baseline truly had a better incidence of regular. So it skewed the info. And the second factor about that was, as I discussed earlier than, this was an artificial progesterone. It wasn’t progesterone in any respect, which may truly mimic progesterone deficiency in the long run as a result of it hits these receptors, but it surely’s not a pure progesterone. So neither of those trials, regardless that they confirmed a decreased threat of breast most cancers, had been even utilizing the sort of hormones that you just and I are speaking about, which is the very same as our our bodies, our ovaries produce. So I confidently, and also you talked about earlier than, I’m a breast most cancers survivor, so I’m 20 plus years out.

(04:53)
And for me, this can be a very private challenge. ’trigger right here I’m in menopause and I’m like, what’s secure for me? As a result of I’ve had breast most cancers and I can confidently say and not using a shadow of the doubt, I used to assume we had to decide on. We don’t. I feel so long as you’ve practitioner who is aware of what they’re doing, you’re checking ranges. And we’ll discuss all that as we speak. Um, this can be a large challenge for girls and it’s gonna have an effect on bone, mind and coronary heart in constructive means. And now we predict it could even be protecting in opposition to breast most cancers.

Betty Rocker (05:25):

I’ve been studying that information as effectively and it’s nice to listen to it from you. And a part of why I needed to ask you that query to start out us off is in order that you understand that you’d share that you’re a breast most cancers survivor. It’s one thing that’s so deeply private to you. I do know that there’s no means that you’d’ve prescribed that to me. You wouldn’t have prescribed hormone substitute remedy to me or to quite a few different sufferers you’ve served if you happen to thought there was a threat for us. Now, in fact, there are gonna be some individuals who it’s contraindicated for. There’s sure issues as a clinician, I’m positive that you just take a look at, I’m positive there’s the blood clotting issue. There’s all of those various things that we wanna be careful for, and that’s one thing that when somebody’s individually working with a health care provider, they should care about.

(06:06)
However I feel it’s actually essential to simply, regardless that that was, to me that was a bit technical, what you shared, and if you happen to’re listening and also you’re considering, I didn’t fairly observe the whole lot she was saying, but it surely, you perceive the info as mm-hmm . A physician who reads the science, you perceive that it’s secure. Sure. That’s principally what you’re saying. And like that these research in some methods had some actual flaws. Sure. They had been finding out, um, types of hormones that we don’t truly use in girls’s medication. And likewise that the, the, and, and so it, and so there’s all this concern, there’s all this concern round it. And, and it’s not for everybody both, proper? Like, you’re proper. I do know we’re not gonna say, oh, everybody must be on hormone substitute remedy, however

Dr. Jill Carnahan (06:46):

Should you’re present process breast most cancers remedy, for instance, I might not give somebody hormones throughout remedy. In order that’s a really clear contra.

Betty Rocker (06:52):

Proper. So there you go. There’s a, there’s a motive not that, and there are most likely another causes too. And, and but it must be an accessible, viable possibility that girls have entry to is all I’m seeing with out all of the concern. And, and that’s why I needed to simply begin us off speaking about that. ’trigger you understand, if we’re gonna get into a few of the viable remedy choices for girls within the menopause years, it’s essential to know that we’ve thought of this firstly, as a result of I feel security, girls’s security and, and and their entry to healthcare choices is de facto essential. It’s important. Yeah. At all ages, and that is an age that I really feel like has been ignored, has been ignored, has been too lengthy, simply kind of like, you’re simply getting outdated. I can’t inform you what number of girls have written me, and also you’ve most likely seen this in your follow as effectively, saying, I’ve been dismissed, I’ve been instructed I used to be depressed. I’ve been placed on anti-anxiety medication. I’ve been instructed I would like to simply train extra and eat much less. I’ve been instructed I’m simply lazy. Um, it’s all in my head. I’ve been placed on contraception, like all of those various things which can be like getting at signs however not likely addressing the foundation trigger, which is that this shift in our hormones that occurs. I don’t know, it’s simply, it’s it’s

Dr. Jill Carnahan (08:05):

So true. And I like that you just stated it’s even as we speak, day-after-day in my follow, I’ve these discussions with girls and there’s some who select to not, and that’s okay too. However everybody deserves a dialogue with an informed supplier. Um, and in case your supplier is completely no, and there’s no dialogue, you then wanna discover a totally different supplier as a result of it isn’t for everybody. And there’s a vital alternative. And if in case you have loads of nervousness or concern, I by no means push anybody. So there’s nonetheless, I could also be possibly 20% of my girls that we discuss they usually don’t go on hormone substitute, and that’s okay too. However to have the choice and to know the

Betty Rocker (08:34):

Selection, you stated alternative. That’s the phrase. That’s, that’s it. And the training about it, to know you can make an knowledgeable alternative for your self to know there are threat elements for sure folks, after which a few of us there aren’t. Properly, let’s discuss a bit bit concerning the, the levels of a lady’s life that we undergo. There’s the perimenopause years, these years main as much as menopause, the occasion the place our interval stops for 12 months after which we’re within the postmenopausal years. So there’s actually perimenopause and submit menopause and menopause kind of like defines that cusp the place we go to the subsequent stage, as we name it. Proper? And, and so there are girls who come to you at, at these totally different levels of their menopause journey. And so they wanna know every kind of issues. Like, effectively, how do I do know I’m in perimenopause? How do I do know I’m, how do I, what, what ought to my hormones seem like at these totally different levels? And I might think about that these are the sort of issues that you just assist handle in your follow. So if, if somebody involves you and says, I feel I’m in perimenopause, or I’m having these bizarre signs, what do you check for? And what sort of signs do they present up with? In order that possibly you could possibly, we may assist somebody on the market who’s attempting, who’s possibly struggling proper now or attempting to determine what to ask their

Dr. Jill Carnahan (09:44):

Physician. So generally girls as younger as 35 can begin to expertise these perimenopausal signs. And often from 35 to 45 is that realm. It could possibly go so long as 55. I feel the common age of that menopause date is round 52, 55. After which after is submit. However this could once more be nearly a 20 yr span from 35 to 55 that some girls wrestle. So one factor I’m a fan of, and never all docs do that is testing. I exploit blood, urine, various kinds of issues to evaluate various things. And this can be a complete nother lecture value of fabric as a result of relying on if you happen to’re utilizing a cream or an oral or the way you’re doing it, sure assessments choose up issues otherwise. And that’s an entire different dialogue. However it’s essential that you’ve a health care provider that may assess the place you’re at as a result of you’ve the signs usually.

(10:26)
And the signs can, um, for instance, in that early half, so say 35 to 45 or 50, usually you begin to first have an absence of luteal section progesterone. That’s often the very first thing that drops. So that you usually expertise estrogen dominance and hormones are all about steadiness inside each other. So if we’ve our cycle follicular section, estrogen goes up, second a part of our cycle, luteal section, progesterone goes up and that simply yin and yang occurs all by way of our twenties and thirties. Properly, in our late thirties or early forties, what begins to occur is that progesterone will usually diminish manufacturing. So you’ve this dominance of the estrogen all through the cycle that may trigger breast tenderness, moodiness, heavy, painful intervals, uh, endometrial ache, endometriosis, fibroids, all these sorts of issues. And that may be a symptom in and of itself that may be handled with pure progesterone or typically herbs that may enhance the lead section progesterone.

(11:16)
And that’s often the very first thing. Then someplace in there your ovaries begin to sputter. And I all the time say it’s nearly like if you happen to had a bottle of Heinz ketchup and also you’re squeezing out the final bit and the, then the hormones are beginning to go, you understand, simply kinda like this little simply really fizzling out. There’s a large number of a spurting out and anyone may have a day that’s excessive and high and low and you’ll’t determine what’s occurring. And even testing, it’s a must to watch out as a result of if you happen to’re testing that interval, you check one month, you may need excessive estrogen, low progesterone the subsequent month it is likely to be low and it simply does this dance. And that’s the time when girls are so pissed off ’trigger like, I don’t really feel effectively what’s occurring? They may begin to have scorching flashes, however they’re nonetheless having heavy cycles.

(11:50)
And so in that window, girls can nonetheless do bioidentical hormones. However it’s essential to have a clinician that is aware of assess the signs associated to what they’re seemingly experiencing hormonally. After which additionally check realizing that the check could be up and down. And in that section it’s gonna be just like the Heinz ketchup spurting out randomly. And you then get to a degree the place these ovaries identical to, I’m performed. And that’s when the estrogen begins to actually drop. And that is when girls would begin to have scorching flashes, night time sweats, hastily they can not keep in mind names. Locations the place they put their keys, the place they’re going, they get within the automobile like the place am I driving to? Like issues the place they actually, girls have come to me and stated, I feel I’m shedding my thoughts. They will begin to have this such as you and I’ve been pushed girls in our discipline.

(12:33)
And I do know after I first hit menopausal, just like the overwhelm, the sensation like I couldn’t deal with issues usually is de facto widespread with girls. ’trigger they’re pushed they usually’re doing effectively and the estrogen actually helps our mind keep on observe. And when that drops we’re like, oh wait, my govt operate, the planning, the executing is impaired. And I’m like, I really feel like I’m shedding my thoughts. Or that the issues that I used to have the ability to deal with are tougher. Mm-hmm . Emotionally, you’re up and down. It’s possible you’ll be extra tearful sooner or later extra offended, sooner or later extra unhappy, you gained, don’t wanna get outta mattress sooner or later and when none of these issues had been there earlier than. So I like speaking to girls as a result of so many ladies actually really feel like they’re going loopy if nobody validates this and it’s a standard expertise, however it will possibly really feel so disorienting. And you understand, even the dad so far as damaged relationships and divorces on this time, it’s not stunning that that goes up as a result of girls really feel like they’re going loopy. And most males and lots of docs gaslight them into considering they’re going loopy and it’s simply their hormonal transition.

Betty Rocker (13:29):

So I hear you saying that there are these actual distinct phases of perimenopause that we undergo and that is why it’s tougher to pinpoint typically as a result of it’s a shifting goal. Sure. As we undergo these, these years of our lives. And it’s stunning to listen to you say that it will possibly begin as early as 35, but it surely additionally is smart, proper? And, and it, I suppose it’s possible you’ll not know precisely the place you’re. It might not go precisely together with your age. Proper? So if we keep on the perimenopause dialog for a minute, say

(13:57)
Say I’m a youthful lady, or say I’m like 40 years outdated mm-hmm . And I come to you and I say, I feel I’m in perimenopause. What would you particularly check for? I can keep in mind a few of the stuff you examined me for particularly after I got here to see you. And naturally I had complicated signs and many various issues occurring. It wasn’t simply menopause once we first began working collectively. However I do keep in mind that over time you’ve examined me for some particular basic items. Sure. To assist see what if, if it was perimenopause. So would you share a few these? Sure.

Dr. Jill Carnahan (14:31):

So one factor is this may be performed at any standard lab. And regardless that blood work isn’t all the time good, if you happen to’re utilizing like a cream or no matter, it’s a fantastic place to start out. It usually will probably be lined by insurance coverage. And what you’d wanna do is a primary panel. Estradiol is the principle E two estrogen and you may get estriol and estro. However simply estradiol is an efficient place to start out.

Betty Rocker (14:48):

Simply to say simply she stated E two after which she stated all these issues. In order that’s E one, E two, and E three. There’s three forms of estrogen. So estradiol is E two and that’s the one you wanna learn about, proper?

Dr. Jill Carnahan (14:58):

Yeah, that’s the principle one. So once more, it’s nice if you may get ’em all, however if you happen to simply get one, get estradiol. And currently the lab now has a extremely delicate estradiol. So HS are extremely delicate is best as a result of that is very, very, very tiny components within the blood. In order that they’re measuring little tiny issues and it will get a bit extra, um, particular and delicate with that extremely delicate estradiol. You wanna get proactive.

Betty Rocker (15:17):

Do it’s a must to get a particular check to check for that. Does your physician,

Dr. Jill Carnahan (15:20):

No, this might be only a common LabCorp quest common hospital lab. Simply writing estradiol on the lab order would do it.

Betty Rocker (15:27):

Okay, good. Good to know. Okay. Sorry to interrupt. I simply needed to ensure there wasn’t one thing particular we needed to ask for .

Dr. Jill Carnahan (15:32):

Yeah, no, estradiol. After which progesterone additionally crucial. ’trigger we all the time take a look at the ratio. Identical to we stated, these two are the dance companions. So we’re checking these two in conjunction. Um, if I’ve a alternative, I’m testing all these and I’ll proceed with the remainder of them on day 19 by way of 21 of the cycle. In order that’s assuming you’ve a typical 26, 28 day cycle ’trigger that’s gonna hit your LAL section. And what you’re gonna see there’s if the estrogen and progesterone are in steadiness. Proper? In order that’s the timing of what you would possibly do for this. So estradiol, progesterone, DHEA sprint S is how we check DHEA, which is one other steroid hormone within the blood. Testosterone, I prefer to get each free and whole. Mm-hmm . After which cortisol within the morning. ’trigger that’s sort of a typical, though you could possibly get it randomly by way of the day. And if you happen to simply get these 5 estradiol progesterone, uh, DHEA free and whole testosterone and cortisol, you’re gonna have a reasonably good thought. Now you may get fancy and get one thing like DHT. It is a, a really potent steroid hormone like testosterone that may trigger hair loss or could cause zits or PCOS. However you don’t must get that fancy. Should you simply get these imply 5, that’ll offer you map.

Betty Rocker (16:38):

And I keep in mind these. That’s that primary panel I’ve had repeatedly and I needed to the touch on that as a result of A, these, so that you’ve had these assessments performed for me a number of methods over time. So at first we’d do a mix of the Dutch check, which is a urine check that we do on these very particular days of the luteal section of the cycle. And you have to be monitoring your cycle with a purpose to know the place you’re and when your luteal section is. And I discover that it’s truly actually useful to be monitoring your cycle whenever you’re in perimenopause as a result of it’s gonna offer you some indication of realizing as your cycle begins to get erratic. It, it’s simple to simply neglect about your cycle. Truthfully, I usually would neglect I used to be even gonna get my interval in my common biking years as a result of it was simply so like I I might be like, oh, this once more.

(17:27)
Proper, proper. Yeah. I wouldn’t have a lot sense. Me too. Proper. So, however now, like in perimenopause it’s been actually useful to trace it, to have a way of it. And I, in fact I’m carrying my Oura ring and that basically helps me. ’trigger I can see my basal physique temperature go up when round ovulation and it stays elevated by way of that second half of the cycle. However anyway, again to, um, these assessments, I might usually do this Dutch check. You’ll order that Dutch check for me, the urine check. After which I might additionally go fasted very first thing within the morning, early morning and get a blood check as effectively. And that was the place you had been checking that T three, the free T three, the, the free thyroid hormones. Proper. The free T three and T 4. One among ’em is free, I don’t keep in mind. Mm-hmm.

(18:05)
However T three and T 4. And you then, you’d even be checking the fasting cortisol within the morning ’trigger we’d wanna see like the place that was. After which we’d additionally additionally, I feel you could possibly see issues like testosterone and you could possibly see the opposite hormones mm-hmm . Um, but it surely was the, the mix of that with the Dutch check that collectively gave you a a lot clearer image of what you needed to see that might make it easier to see if my hormones had been in steadiness, how out of steadiness they had been. We began to see over the course of the few years that we examined these two issues again to again the, the blood and the urine, how my hormone ranges actually went down and down and down. Yeah. And I keep in mind at first I used to be capable of get by with merely utilizing some adaptogenic herbs that basically helped help my stress response and helped nourish my hormones.

(18:52)
And, and I used to be capable of really feel higher regardless that it didn’t actually make my hormone ranges go up a lot, I felt loads higher and it decreased loads of the signs I skilled. However then as I acquired a bit farther into the perimenopause journey, it turned actually important for me to start out utilizing issues like hormone substitute remedy. After which I really feel like I’m possibly within the, the top of that center stage of perimenopause now I’m like utilizing a mix of various kinds of hormone substitute remedy. I’ve some props right here to indicate you guys, in case you’re watching this on YouTube. I’ve acquired my patch mm-hmm . So I exploit this little patch and I’ll simply open up the little foil packet so you’ll be able to see it. It’s just a bit sticker that I placed on and, um, you modify it each few days. Or Dr.

(19:40)
Jill had even given me some suggestions as I’m very delicate to loads of these things the place we tried it for an extended interval at the beginning to see how I responded. After which we examined once more just a few months later and I’ve additionally acquired some totally different lotions, topical lotions. She up to now had had me strive, an oral progesterone. And we discovered that for me personally, the standard advice was I feel to take it at night time. My physique didn’t like that, so I took it within the morning. So there’s simply all of those effective tuning kind of nuanced points of this. After which there’s additionally a pellet, which I do know you really helpful for very particular conditions, however if you happen to’ve acquired a pellet injected beneath your pores and skin, which we talked about in different podcasts, you’ll be able to’t change that. Yeah. It’s there. You may’t take it out simply your self. Proper. So it simply gotta do its factor so it’s much less customizable. Whereas with the lotions you want, you are able to do two clicks, you are able to do one click on, you’ll be able to actually management your dosing, I feel actually, very well. These are all issues that I’ve skilled primarily based on the testing. And I will even say that you just and I examined quantity, like it will be a, just a few occasions a yr we’d check to see like

Dr. Jill Carnahan (20:51):

Each three to 4 months. That’s

Betty Rocker (20:53):

Nice. Each Yeah. Completely. To see like, how did my physique reply to the remedy? We needed to provide it sufficient time for it to, to have some impact. And we needed to then see how was the physique doing with this stuff. After which if there was, if one thing responded, we may see that. And if it didn’t, we may regulate my dosage. However we didn’t simply go actually quick into issues we needed to like take. And that may be, that may be a bit little bit of a course of, proper? Like, ’trigger you need outcomes instantly, however if you happen to overdo it, you’ll be able to really feel worse. And that’s,

Dr. Jill Carnahan (21:26):

That’s like, you don’t need breast tenderness with the estrogen, which is the use typical. And one factor, lots of people are frightened about clot threat. And what if I’ve this, uh, there’s totally different gene issues that you just would possibly’ve been instructed

Betty Rocker (21:35):

Issue V(5) Leiden, proper? Like that’s my household. Yep,

Dr. Jill Carnahan (21:38):

Yep. Or, um, sure different ones on the market. And so if you happen to’ve been instructed that’s a threat, the deal is oral hormones, particularly estrogens do enhance the danger of clot. It’s why you’ll nearly by no means see me prescribe oral estrogen as a result of I don’t wanna even go in that class, proper? Mm-hmm . Transdermals would not have the identical threat. Transdermal simply means a patch or a cream or one thing you apply to your pores and skin. Our pores and skin absorbs hormones very well mm-hmm . So I nearly completely do the compound of lotions that you just confirmed or the patch that you just confirmed. And, um, there’s alternative ways to do these, however these are actually nice and secure methods to use. Now you talked about usually doing blood and urine on the similar time. The dutch hormones is what you talked about. I usually to observe the hormones, love to do the Dutch, as a result of within the blood you gained’t all the time see the true ranges of a cream or a patch.

Betty Rocker (22:25):

Mm-hmm .

Dr. Jill Carnahan (22:25):

So I typically do each, like we did with you. If I’ve a affected person who’s keen to do each, that’s the most effective. However you’ll be able to see the variations as a result of if you happen to’re actually following a cream or a patch or a protocol, um, your Dutch urine check is gonna present extra the correct ranges of your physique versus the blood.

Betty Rocker (22:41):

Mm. That’s tremendous attention-grabbing. So if somebody had been simply attempting to observe their hormones, in the event that they had been simply, if they may simply check sort of consecutively, possibly not each month clearly, however like on an honest foundation, possibly each three or 4 months they’d use the Dutch check as their major to, to see in the event that they had been doing hormone substitute remedy. Sure. Now you talked about compounded.

Dr. Jill Carnahan (23:04):

Sure.

Betty Rocker (23:04):

That that’s, so, so there’s a few various kinds of these transdermal or cream-based mm-hmm

Dr. Jill Carnahan (23:10):

.

Betty Rocker (23:10):

Hormone substitute remedy varieties. May you wanna converse on that a bit bit? I really feel like there’s loads of

Dr. Jill Carnahan (23:15):

Positive.

Betty Rocker (23:15):

There’s, you hear about HRT, you hear about BHRT. Yeah. You hear about all these things. So inform us concerning the variations

Dr. Jill Carnahan (23:21):

There. Positive. And simply to reiterate what you stated about testing my customary affected person, we’d begin them on a protocol and often about each six months is sort of when, typically sooner in the event that they’re having signs, however on a routine, and on the very least, I’m gonna verify them yearly.

Betty Rocker (23:35):

Positive.

Dr. Jill Carnahan (23:35):

So all people who will get hormones is required by me to do a yearly check. So I do know, and typically extra steadily if we’re altering doses, in the event that they’re actually secure, yearly does fairly good. Positive. Like I’m at a spot now, I do yearly and I’m secure on doses. So what is offered? So there are common pharmaceutical professional prescriptions you may get at CVS, Walgreens or your common pharmacy which can be bioidentical hormones. Estradiol, as we already talked about, is the principle hormone that you just’re gonna see. And this may be prescribed as a cream, um, as a, um, foam like a, roll-on, as a patch, which is my favourite most typical ’trigger girls don’t have to consider it.

Betty Rocker (24:09):

Yeah.

Dr. Jill Carnahan (24:09):

Um, so there’s a number of alternative ways. And that is just one, it’s the E two, the estradiol that’s essentially the most robust. It really works, it’s an effective way to do it. However loads of occasions girls need to have a mix and we are able to prescribe compounded estriol, which is that weaker type of estrogen. And for instance, if we’ve somebody who has current breast most cancers or very, very involved, estriol is sort of a caboose, estrogen that means finish of the road. And the physique doesn’t take and make different issues with it. So it tends to be the most secure, even amongst oncologist with somebody being handled for breast most cancers with vaginal dryness, they’d say, oh, such a estrogen is de facto secure. So if in case you have any concern, you’ll be able to all the time compound these. And infrequently I’ll do both 80 20, imply 80%, one 20% one other or 50 50, and also you mix these two estriol and estradiol right into a cream. And since you’ll be able to compound it, I can begin with a lot tinier doses for somebody who’s actually delicate. And you can even put progesterone in that cream. So lots of my girls have like a biased that means like two forms of estrogen with a bit progesterone multi function, they usually use a pair clicks on their pores and skin at bedtime or morning. So it may be fairly simple to do, however that means I can truly choose the precise dosages for that particular person affected person and regulate it primarily based on their outcomes with effective tuning.

Betty Rocker (25:24):

That’s so cool. Uh, I like that. I, I really feel like I’ve been having my very own little apothecary over right here. Yeah. And I can see that my estriol estradiol is a combo and I can, I’ve a separate progesterone mm-hmm . And I even have my little testosterone.

Dr. Jill Carnahan (25:42):

Sure.

Betty Rocker (25:42):

And that’s been I really feel like actually useful. Um, sure. You wanna discuss a bit bit about that as a result of we don’t usually discuss testosterone and, and

Dr. Jill Carnahan (25:50):

I do as a result of I get so enthusiastic about, simply, so that is, we consider it as a male hormone. We have now testosterone – decrease than males, however we’ve testosterone. We want testosterone. It helps our bones, it helps our brains, it helps our motivation, it helps our physique composition. Girls who’re poor in testosterone. It’s one of many explanation why there’s 4 occasions the incidence of autoimmunity in girls as there’s in males, as a result of that decrease testosterone truly will increase threat of autoimmunity. So there’s, I’ve even used off-label testosterone as a part of a protocol to deal with autoimmunity as a result of it’s so highly effective in girls. So I’m an enormous fan now. You don’t need extreme, however getting the precise dose will actually change your life, your thoughts and all these issues. Along with the estradiol libido for girls, it completely has an impact. Vaginal dryness.

(26:39)
And like I stated, bone and mind are large with testosterone. So testosterone could be given as a, we nearly by no means need to give a capsule the place you swallow as a result of your liver has to course of estrogen, testosterone, no matter. And we don’t wanna load up the liver. So I’m all the time attempting to bypass the intestine with hormones that’s both a cream or a patch. With testosterone, there’s a pair methods you are able to do it. You are able to do a cream, however for girls, wherever you apply that cream, inside thigh or wrist, you’re gonna get a bit hair progress. So loads of girls don’t like that. And so as an alternative of doing the cream, I’ll usually do a trochexf or a sublingual tab that dissolves beneath your tongue so that you just get that dose with out stepping into your intestine and thru the liver. Um, loads of girls, uh, do injectable now.

(27:19)
It was that the business varieties had been just for males. So to get the tiny doses that we wanted, had been actually onerous to attract it in a syringe. However I do discover, effectively now we are able to compound it like girls concentrations. And I do like, so long as girls’s are afraid of doing a injection as soon as per week or as soon as each 10 days, that’s an effective way. It usually does give a stage that sort of goes up and down each time you inject. So you’ve a bit bit extra variation than you’d with a each day dose. So testosterone could be cream, it may be in troche or an oral sublingual, and it may be injectable. And people are the principle methods. And since proper now our pharmaceutical business is geared in the direction of males and testosterone, a lot of the business, if not the entire business, um, ones, patches, lotions, even injectable, are usually made for male dosing. So that is usually compounded for girls, um, to get that dose.

Betty Rocker (28:06):

And also you and I’ve discovered that my physique simply loves that. It simply, it simply has actually helped me a ton. Mm-hmm. And I’ve taken such a tiny dose over the, the time that I’ve been utilizing it. It’s been actually useful, I really feel like, for steadiness. After which I additionally take, um, the oral DHEA complement to assist, as a result of that’s in fact a precursor to is estrogen and testosterone. Proper. It’s a precursor. It helps our adrenal manufacturing. Um, as, and that’s one thing that I all the time so discovered actually attention-grabbing is that due to course we’re making our estrogen and progesterone primarily in our ovaries, however we additionally make some hormones in our adrenals. Appropriate?

Dr. Jill Carnahan (28:46):

Yeah. Sure.

Betty Rocker (28:46):

And if our adrenals get overwhelmed by stress, the stress response, it’s gonna be tougher for them to make a few of these backup hormones. And I keep in mind a very attention-grabbing dialog. You and I had some time again the place you had been like, you understand, you see girls who’ve a very sturdy, um, adrenal operate have a neater time in, in going by way of perimenopause as a result of they aren’t strapped of the backup hormone system. Virtually. Did I say that proper? That’s

Dr. Jill Carnahan (29:13):

That’s precisely proper. As a result of when our ovaries conk out they usually’re like, I’m performed, I’m for drained. Proper. Which is what occurs once we hit menopause. They ovaries cease producing the hormones, our adrenals take over. So we nonetheless do produce a bit little bit of hormones from the adrenal glands after menopause, not practically as a lot as ovarian. But when these adrenals are so taxed, ’trigger you’ve been working 80 hour weeks and never getting sleep and taking good care of your mother and father and your kids and all these generations, then it’s actually widespread to have a way more tough in menopause. And I like DHEA, to start with, it’s the one one among these that isn’t requiring a prescription. The remainder of these, you do want a prescription. Proper. Um, and only for the document, testosterone remains to be thought-about managed, whether or not it’s athletes or there’s some issues that they, so that’s a type of you can nonetheless get a prescription no downside.

(29:57)
However it’s within the class of managed prescription. So that you may need to get a decrease quantity, like six months versus a yr or sure issues. Um, however DHEA is offered over-the-counter and girls usually do effectively on 5 or 10 milligrams upwards of 25. However that’s a reasonably excessive dose for lots of ladies. And what can occur there’s that may help your manufacturing of cortisol. If the adrenals are low and also you’re low cortisol, it’ll help testosterone and DHEA. So it’s sort of a pleasant adrenal help in case your adrenals are in a weakened spot. Should you’re actually excessive cortisol and also you’re susceptible to breakouts, these are the sort of folks I most likely wouldn’t placed on DHEA. ’trigger you then elevate the cortisol and you’ll have some extra breakouts, however often girls will know as a result of they’ll take 5 milligrams, which is a tiny dose they usually escape. So cease the DHEA.

Betty Rocker (30:41):

Proper. Uh, I feel this can be a good alternative for us to shift a bit bit to the postmenopausal dialog. I wanna discuss the whole lot suddenly, in every single place, in fact. However, however I actually need, I’m actually and curious as a result of I’ll be in submit menopause quickly and I wanna know what to anticipate. And I’ve acquired loads of girls who pay attention who’re in submit menopause, they usually wanna know, effectively, what ought to, is there one thing, how, what assessments ought to I get? After which what choices are there for me? What ought to we do and the way can we assist them?

Dr. Jill Carnahan (31:14):

Yeah. So there’s principally two or 3 ways this might occur. We talked about like, say you’re 35, 40, 45, and also you’re beginning up signs and your physician’s open and also you get some prescriptions. You may truly undergo this very easily after which hit menopause and sort of have been on hormones. Positive. However what you’re speaking about, I feel is say that lady out there’s 65 they usually have by no means been on hormones. By no means.

Betty Rocker (31:33):

Sure.

Dr. Jill Carnahan (31:33):

Proper.

Betty Rocker (31:34):

Proper.

Dr. Jill Carnahan (31:34):

And so they’re like, effectively, what about me? Properly, very first thing is Dr. Dale Bredezen does a ton of analysis on Alzheimer’s. And he’s one Who’s that? Dr. Dale Bredezen. Okay.

Betty Rocker (31:42):

He

Dr. Jill Carnahan (31:42):

Wrote the e-book Finish of Alzheimer’s. And he’s one among our researchers and main specialists in dementia. And I discussed this as a result of in his protocols, there’s a sort of Alzheimer’s that’s associated to lack of estrogen within the feminine mind.

Betty Rocker (31:55):

Wow.

Dr. Jill Carnahan (31:56):

So he’s placing 85-year-old girls on hormone as a result of it’s so essential to our mind operate. And, and so this outdated fantasy was that, oh, after 65, we don’t want hormones. So if we’re on hormones, we cease at 65. Or if we’re above 65, you’re too outdated for hormones. That’s not true. Our brains, until the top of our life can use the hormones. Now, possibly sooner or later you want lesser doses, however I might say to any lady who’s postmenopausal and possibly having signs, possibly not, I might nonetheless begin with testing after which discuss clinically about signs after which discuss security. Security’s the identical factor right here. However what occurs is, say you went, uh, into menopause at, otherwise you hit menopause 55 and also you’ve been with out hormones for 10 years, your receptors begin to and shrink up. So what occurs is whenever you first begin hormones, if in case you have by no means been on them, there’s a bit little bit of adjustment as a result of it’s possible you’ll not both be capable to sense that hormone effectively, or it’s possible you’ll in a short time get flooded with an excessive amount of. So it simply takes a practitioner who’s cautious with that, however they’re actually with coronary heart, mind, and bone. There isn’t any age too outdated that doesn’t profit from hormones so long as there’s a dialog and all of that

Betty Rocker (33:06):

Occurring, and it’s approached rigorously. That makes whole sense. And I’m so glad you stated that. Um, a few of the telehealth websites that assist girls with balancing their, their hormones submit menopause, they are saying that they’re, they’re not gonna prescribe if you happen to’ve, or they, they, there’s some wording about if you happen to’ve been 10 years with out having a interval and also you haven’t by no means been on HRT, like they, they wanna verify in about that due to precisely what you’re speaking about. Like these receptor websites kind of, are they atrophy, such as you stated? Yeah. However that there nonetheless might be, that you just nonetheless may have that chance. So, so say, say somebody got here to you and she or he’s identical to possibly just a few years in to submit menopause. What would you check her for? What would you be ? Would you take a look at, I imply, you most likely nonetheless wanna see like what her ranges of estrogen or like, you most likely wanna verify her cortisol, I don’t know. What, what do you kind of take a look at to, to assist her? And, and clearly it’s individually primarily based as effectively, but when she’s desirous about some kind of hormone substitute remedy, I suppose what, what dialog and the way do you check?

Dr. Jill Carnahan (34:04):

Yeah. So we’d nonetheless do most likely blood work or Dutch hormones, one or the opposite, or each. After which what we’d wanna do is there’s a threat of if in case you have uterine fibroids which can be unchecked and really massive, otherwise you had extreme endometriosis, so any of the endometrial illnesses, this implies like the liner of your, your uterus was irregular or thick. Or you’ve these growths which can be benign progress, however they’re stimulated by estrogen. These situations, um, might be stimulated even by wholesome bioidentical hormones and fibroids are benign, however they’re a ache if in case you have them. They’re massive or uncomfortable. They’re usually not malignant, which suggests like they’re not most cancers. However these are caveats or issues that as, as a doctor, I’d be very involved or have a dialogue about. And likewise, if you’re perimenopause or in these earlier years, forties or fifties, and you’ve got had an enormous challenge with fibroids or endometriosis, these are discussions we wanna have about dose this and be watching that rigorously.

(35:00)
So usually a lady who’s by no means had any hormones, I might display screen them with a pelvic ultrasound to simply take a look at that pelvis and ensure the whole lot’s secure. As a result of if they’ve fibroids, these may develop with hormones. And it’s a must to know that after which be capable to watch it. If any lady has breast tenderness with these, uh, hormones, that’s an indication. I’m all the time like, oh, that’s, you’re hitting your threshold. We’ll, most likely ought to decrease it. In order that’s like a warning factor. I’ll say, you don’t wanna have breast tenderness, or if you happen to do and it’s simply transient for per week and it goes away, that’s most likely okay. After which the third factor is if you happen to ever cease bleeding for over a yr, that’s technically the definition of menopause. You’ve gone into submit menopause, um, and also you begin to have bleeding that yr and not using a cycle that requires you to get an endometrial biopsy and a workup to ensure your lining just isn’t getting too thick. And these are simply these cautious issues {that a} good physician would do if you happen to’re on hormones, as a result of hormones could cause that lining to get thicker. And so if in case you have a excessive threat of that, or some motive, you’d should have that dialogue about security and efficacy together with your physician. However I might all the time do a pelvic ultrasound and verify their scientific historical past after which discuss with them rigorously. I might additionally most likely begin a 70-year-old lady on a a lot, a lot, a lot decrease dose than I might a 45-year-old lady.

Betty Rocker (36:10):

Positive. Thanks for sharing that. And that’s so useful to know as we go into this stuff, we wanna have our eyes open about threat elements. And also you talked about that you just, you do a Dutch check as one of many choices for a post-menopausal lady. However since she isn’t having a cycle anymore, when does, when do you, when do you do do this? Yeah, anytime You are able to do it that

Dr. Jill Carnahan (36:29):

Anytime. Proper,

Betty Rocker (36:30):

Proper. Since you’re simply seeking to see the place her ranges are at in order that you could possibly decide now. After which for somebody who’s post-menopausal, are you gonna be placing her or a person as an anyone, I suppose, would they be getting on the same protocol to what somebody in perimenopause is getting on? Are you gonna be giving all of them the identical forms of hormones? Would they want all of them? Or are you, are they extra more likely to be simply getting on an estrogen or possibly some testosterone? Or is there a motive to nonetheless add progesterone? I’m simply so .

Dr. Jill Carnahan (36:57):

Sure. So, um, the, the standard medical coaching is if in case you have a uterus and you utilize unopposed, estrogen, that means all you get is estrogen, that’s a threat for that lining being thicker and truly creating endometrial most cancers. So we as physicians who’re doing good work, would by no means give a lady who nonetheless has her uterus unopposed estrogen by itself. You’ll all the time give it with progesterone. Progesterone protects you from having that. So no matter age it’s, and if I consider order of operations so far as security, and even from 35 on what you do, progesterone nearly all the time comes first for a lot of girls, as a result of many ladies from 35 to 45 do very well with simply progesterone. They don’t want any estrogen. There’s estrogen dominant, that’s what the ketchup, the Heinz ketchup factor is.

Speaker (37:39):

Yeah.

Dr. Jill Carnahan (37:40):

After which finally as they hit the ovaries begins to tank, then they, we add the estrogen. And so somebody older, I might begin with progesterone estrogen alone, earlier than I might add loads of testosterone DHEA, as a result of then you could possibly, there’s, as you’ll be able to inform, the variables are nearly infinite in how with, yeah. So it’s a lot simpler to, to evaluate with some small quantities of estrogen, progesterone first, see how they do in two or three months, after which if wanted, add a bit testosterone. Um, and see, and I might say extra girls above the age of 65 are on a really small dose of estrogen, progesterone with out testosterone. However even they will profit from small doses if acceptable.

Betty Rocker (38:17):

Fascinating. Wow. Properly, you’ve given us loads of actually nice data to consider, however I feel that one factor that we’ve not talked about but, that’s all the time been part of our work collectively that I wanna be certain girls hear about is what hormones are doing in our physique and the way they’re truly excreted. As a result of there’s a actually essential side of our hormone steadiness that has to do with our intestine well being. Proper. And would you converse on that a bit bit, as a result of I, I feel that is one thing that you just care loads about and also you’ve guided me very well on as effectively.

Dr. Jill Carnahan (38:51):

Thanks, um, Bree, as a result of it’s, so what occurs is estrogen, progesterone, all these hormones in our physique, they’re handled by our liver, identical to a drug or a chemical. So we’ve to detoxify these. And infrequently when girls get into hassle, even with threat of breast most cancers, endometrial most cancers, any kind of hormone associated challenge, it’s not that their hormones are the unhealthy guys, it’s that they’re not capable of do away with the surplus. They accumulate sure metabolites that may injury DNA, and that results in unhealthy issues. And apparently, in our world that we reside in, there are hundreds and a great deal of issues that mimic estrogen. They’re referred to as endocrine disruptors on our physique. So loads of occasions the, our bathtub and physique merchandise are make-up, um, issues that since we use in our home, um, even atrazine that’s used on corn within the Midwest, and these chemical substances act like hormetic or hormone results on our physique, and it’s very poisonous.

(39:43)
So it’s nearly worse the atmosphere than the hormones we take, however we’ve to consider that. So if I’m actually going deep or somebody has loads of concern, I’ll even go so far as to do genetic testing on their liver’s capability to deal with hormones, as a result of there’s just a few totally different genetic, we name them snips, which simply means issues that you just don’t course of usually. Um, like say a standard particular person is 100% processing, it’s possible you’ll course of it 60% or 30%. So typically I take a look at sure ways in which you course of hormones. And people folks, I would do decrease doses, I would monitor them extra steadily. Um, and once more, that is likely to be the ten% of the inhabitants. So if in case you have a household historical past of most cancers, particularly hormone associated, or you’ve a, you would possibly wanna get right into a deeper dialogue together with your physician, however on the core, what you are able to do is that this, you’ll be able to just remember to are utilizing clear merchandise in your hair, in your face, in your physique.

(40:31)
Transdermal medicines work for a motive as a result of we take up the whole lot by way of our pores and skin. And if we’re placing stuff on our pores and skin, standard perfumes or stuffed with phthalates, um, or any non-organic produce usually has, um, glyphosate residues or, or, uh, pesticide residues and all this stuff have a poisonous impact. So I prefer to preserve it easy. And if we simply begin with clear air, clear water, clear meals to the most effective of our capability, that provides us a basis for secure hormone substitute as a result of we’re not getting a bunch of additional alerts to our physique from the meals that we eat or the water that we drink.

Betty Rocker (41:05):

Sure. And even, even with out hormone substitute remedy, if our intestine just isn’t working optimally, we’re not gonna be capable to course of extra. So like we talked a bit bit about estrogen dominance a bit bit in the past, and I do know that one of many issues that may make estrogen dominance worse, whilst we’re shedding that progesterone, possibly we’re within the early levels of perimenopause, is, uh, not with the ability to course of the surplus estrogen that we do have out of our physique. Proper. And we’ve, there’s this part of the intestine microbiome referred to as the estrobolome that helps to course of the estrogen. And if it’s not working, if it’s not capable of operate effectively, it, it’s gonna ship that again into our system as soiled estrogen. What does that imply precisely? And the way does that, how does that affect us?

Dr. Jill Carnahan (41:51):

So that is actually huge and I’m so glad you introduced it up, as a result of what occurs is, um, our liver’s all the time doing the detox work and it simply squirts out stuff into the bile that’s purported to be eliminating, and that’s in our stool. So if you happen to’re a lady who has persistent constipation, that alone places you at larger threat of reabsorbing toxins out of your atmosphere or meals. And even if you happen to’re on hormones and you’ve got persistent constipation, you’re gonna have extra hassle eliminating the identical dose as a lady with out constipation. So the bowels and eliminating are so essential to this complete pathway and to changing hormones appropriately. So if we’re not, principally that, that enterohepatic circulation, which is a very fancy phrase for the…,

Betty Rocker (42:28):

Did you say entero? And say it once more.

Dr. Jill Carnahan (42:30):

Enterohepatic. So it’s like intestine hepatic.

Betty Rocker (42:34):

Acquired it. Intestine liver.

Dr. Jill Carnahan (42:34):

Kinda like one other means for intestine liver circulation, that pathway on a regular basis is being reabsorbed. And so if we’ve a bunch of poisons in our intestine and we’re not pooping out each day, um, we’re gonna reabsorb toxins and we’re gonna reabsorb hormones and we are able to get extreme ranges. Um, so it’s a actually huge deal to, it’s like fiber alone, getting good fiber out of your meals, which you’re professional at that together with your meal plans and all of the issues that you just do as a result of that’s,

Betty Rocker (42:58):

However I’m an advocate for it as effectively. Yeah. In addition to strolling, strolling after a meal Sure. Or strolling extra on the whole, like mm-hmm. That helps peristalsis all this stuff that assist the intestine and assist you’ve your common motion. Sure. Yeah.

Dr. Jill Carnahan (43:08):

And that’s a part of hormone substitute, as a result of if you happen to’re not shifting your bowels, you will get extra poisonous. And this stuff which can be useful and exquisite may turn out to be a poison to your system.

Betty Rocker (43:17):

Yep. Yep. Precisely. So I, I’m so glad that you just talked about that as a result of it’s, other than any kind of hormone substitute remedy, our physique has this elimination course of naturally for the hormones that we have already got in our system, our pure hormones. And so if we’re not eliminating effectively already, and we go pile hormones on high of that, like bioidentical hormones or no matter sort of hormone substitute remedy you’re utilizing, and also you’re not eliminating effectively, you simply set it so effectively, we’re poisoning ourselves moderately than serving to ourselves. You’re, you’re turning one thing that’s this potion right into a poison. Proper, precisely. Which precisely we don’t need. Proper. We would like wanna take. Yeah. So, um, we talked about fiber, we talked about strolling extra. I feel staying hydrated additionally. So important for supporting intestine operate, chewing extra mindfully, chewing extra, slowing down whenever you eat to assist your salivary glands and the amylase and the entire issues that assist digestive digestion start in your mouth. What different like little scorching suggestions do you’ve for folks to assist them with higher intestine well being? I simply stated just a few.

Dr. Jill Carnahan (44:19):

Find it irresistible. So I feel probiotic, I love to do spores. Um, however there’s so many good ones on the market. I simply spores have tended to work with even my powerful, uh, you understand, tough to deal with shoppers with intestine points. These are typically very well tolerated. Um, one factor actually attention-grabbing is there’s loads of pure substances that may assist us on these pathways, and you’ll discuss to your physician about these, however some which can be actual widespread are sulforaphanes, which come from broccoli sprouts mm-hmm . And sprouted, um, seeds and issues. In order that’s a fantastic place. You should buy it as a cap, however you can even sprout your broccoli and have that in your salads. Um, Calcium D Glucarate is a sort of, it helps this section two of the liver, so processing that hormones and we are able to truly see markers within the stool if we’re doing particular testing for somebody who isn’t processing effectively.

(45:02)
And we are able to add that calcium deg glucarate as a complement to assist them eradicate on this liver intestine entry. After which a 3rd one is DIM, and that is additionally a very highly effective one. Um, the one caveat with DIM is it’s so good at reducing estrogen, and if somebody was like 65 and already having osteoporosis and already actually low estrogens, that’s robust sufficient that I most likely wouldn’t use it in that inhabitants, however I might, if it’s a 45-year-old lady on hormone substitute, having a tiny little bit of breast tenderness, these are sort of the ways in which you could possibly use that sulforaphane, Calcium D Glucarate, and DIM. After which in fact methylated B nutritional vitamins, simply B nutritional vitamins are essential for this course of. Um, and issues like NAC, which is de facto supportive for the liver as effectively.

Betty Rocker (45:46):

So, attention-grabbing as you’re saying all of these, I’m remembering all of the protocols we did whenever you had been serving to me heal from, uh, mildew publicity, which was horrible. And it, that occurred proper in the beginning of my perimenopause journey and loads of these issues that I wanted, the liver help, all of that. It was simply in, it’s simply attention-grabbing considering again on it now, you understand, there’s that nice Steve Jobs quote that was that “you’ll be able to’t join the dots wanting ahead, solely wanting backwards.” And now as I’m considering again on the entire various things, oh yeah. The way you handled me, I’m understanding the connections that we made there and the ways in which you actually had been attempting to assist help all of these holistic processes and all of these issues I used up to now that I don’t want particularly anymore mm-hmm .

(46:28)
And that, that basically will get me again to this factor that girls want entry to particular, individualized healthcare that’s this, that has this breadth, that has this depth that, that cares about these totally different points of our well being and is educated in that sense. , and and I, I’ve been so fortunate to have you ever in my life, and for individuals who, who don’t get to have you ever as a result of you’ve a follow. You, you’ve, you’ve an incredible e-book. There’s a film about you . You might have, uh, an unimaginable web site with this depth of knowledge so that individuals can be taught extra and turn out to be advocates for themselves with their very own docs. You might have a complement retailer the place folks should purchase loads of all these dietary supplements for themselves. And I simply, I really feel like you’ve loads of wonderful sources. And is there something I disregarded of that as a result of, effectively, your social media, what else did I neglect to say? Your

Dr. Jill Carnahan (47:28):

YouTube podcast visitor, however yeah, that’s it.

Betty Rocker (47:30):

Your podcast, proper? Your unimaginable podcast, which I’ve been honored to be a visitor on myself.

(47:34)
Um, however the place I used to be going partly with that, other than saying, okay, women, all of us want these sources and right here’s a few of what you may get from Dr. Jill. Um, and Dr. Jill and I had been speaking earlier than this podcast began about, effectively, the place else can girls go? Sure. And I used to be saying, I’ve been researching these totally different firms that do this follow telehealth, and I’m gonna learn just a few and I’ll in fact have all these linked within the present notes. And, um, I keep in mind I ran them by you earlier, Dr. Jill. ’trigger I simply wanna ensure that this was , that I wasn’t going. , I, I assumed they had been nice. However it’s good to listen to your vote of confidence in these as effectively, as a result of that is I feel the way forward for that kind of medication. And, and for girls particularly? Sure.

(48:15)
So listed below are a pair that I discovered. One is known as Midi and I like midi. It’s like M-I-D-I and it’s, it’s a feminine based firm. It’s all these cool girls docs and it’s telehealth firm. There’s telehealth choices, proper? After which additionally they will prescribe hormone substitute remedy or no matter you’re snug with and no matter you want. And I simply watched a pair movies from one of many co-founders and was simply so impressed. She jogged my memory of you. She was so cool and right down to earth and like she, it was all very private for her ’trigger she’s gone by way of the journey herself. So I like Midi. One other one which I discovered, clearly you’ve most likely heard of Winona. I feel Winona’s been round for a short while they usually’re nice. In addition they have the telehealth choices. Um, one other one I discovered that’s down in Tampa, however they do, uh, telehealth and, and do various cool prescribing is defy, like they’re referred to as Defy, which I like.

Dr. Jill Carnahan (49:04):

Love

Speaker (49:04):

It. Def. I find it irresistible.

Betty Rocker (49:06):

Yeah. Defy. After which there’s one referred to as Stella And Stella I assumed was actually cool. They’re additionally, additionally they have telehealth choices. They’ve the hormone substitute remedy choices. They’re, um, they’ve an internet site for US primarily based sufferers in addition to UK primarily based sufferers. Oh, good. So you’ll be able to, you should use one or the opposite relying. I do know loads of you guys are within the UK that, that take heed to my podcast. Thanks a lot. Um, after which I additionally, I used to be excited about my, my folks in Australia. Um, there’s one thing referred to as Clinic 66, and if, if you happen to’re, if you happen to’re in search of choices for your self in your nation, I feel simply utilizing a few of these key phrases that Dr. Jill and I had been speaking about as we speak on this podcast, like, search for issues like telehealth, choices for hormone help in menopause. I really feel like I did that myself at totally different occasions and I’ve, and and I put it into totally different international locations to see like, the place are they doing these things? And you then simply learn what’s on the web site and you then simply sort of should observe the threads and see the place, the place, the place it’s gonna be just right for you. And I’ve observed the US primarily based ones, a few of them have limitations by state Yeah. That they’re gonna deal with. And are you aware a lot about that or like, you understand, I do know you’re not gonna know what every particular person gonna do, however what are a few of the limitations that you just do know of in

Dr. Jill Carnahan (50:15):

State? Sure. Um, medical docs are nonetheless licensed by state. So you actually, um, usually are, until somebody involves see me in Colorado, I’m, I’ve to be extra cautious about who I deal with exterior of the state. In order that’s an entire deal. One of many issues that is likely to be tremendous useful is if in case you have a compounding pharmacy in your space, that’s a fantastic place to name as a result of they know what physicians in your space are prescribing hormones. And often the compounding pharmacies additionally know who actually know, as a result of they’re gonna be, like, for me, they know I prescribe loads of hormones. I discuss to the pharmacies on a regular basis. And so an effective way is that if you understand there’s a compounding pharmacy in your space, you name ’em and say, Hey, what docs are you aware in my space which can be doing this? And that’s one other good strategy to get in your space. Somebody who’s legit and your compounding pharmacy will usually know who that is likely to be.

Betty Rocker (50:56):

And with a purpose to discover a compounding pharmacy, would you simply Google compounding pharmacy in my space?

Dr. Jill Carnahan (51:00):

Yeah. Yeah. There may be P-C-C-A was the largest, um, group that, uh, licensed Ok, so PCCA, I don’t know precisely what it’s one thing “Coumpounding Pharmacies of America”. However, um, if it’s simply pcca.org, I suppose, I don’t know the precise web site it is best to be capable to discover, uh, firm pharmacies. However yeah, you can even simply Google compounding pharmacy in my space.

Betty Rocker (51:21):

That’s nice. And I, I feel, I imply, and there are numerous greater than those that I simply, that brief listing I gave you guys. I, I’ve, I’ve, I like all, I like all these choices which can be on the market for us. And I really feel prefer it’s, it’s, it’s gonna get higher. It’s, there’s gonna be an increasing number of of them hopefully over time, however actually simply having this dialog, asking for what you want, advocating for your self. I, you and I had a dialog, um, a month or two in the past and we had been speaking about the way you stated as we speak, like some docs you are feeling like they gaslight their sufferers and it it’s as a result of they don’t know. Proper? They don’t have a clue. Proper. And I stated on a podcast the place we had been speaking about this, I used to be like, I really feel just like the docs don’t imply to be jerks about these things. They simply don’t know. And in the event that they knew, they’d possibly attempt to get extra data, proper? As a result of all of them

Dr. Jill Carnahan (52:07):

Have, you concentrate on like, even me, if I graduated from med faculty and I’m instructed that that is harmful and that I by no means look and by no means be taught, which loads of docs cease studying after, proper? Then why wouldn’t I say, oh, nope, don’t do it. That’s what I heard 2001, which is outdated information now. Proper? In order that’s loads of them simply don’t know the newest information and the security.

Betty Rocker (52:22):

If we had been to anticipate science to be this static factor, and we are able to solely take no matter’s been stated earlier than, I imply, we’d by no means have any girls particular,

(52:29)
Proper? Like we’d don’t have anything we, that we’ve to permit science to be this evolving like, studying course of. That’s what science is. , they’re, they’re observing information they usually’re reporting on it, and over time they get higher and higher at their strategies, hopefully. And yeah, I imply, simply seeing them, simply seeing, not them, however seeing the extra particular research performed on girls particularly. I imply, it’s like a revelation. You’re like, effectively why didn’t we do this earlier than? I do know , it’s about time , proper? Don’t y’all have a mother? Like, don’t you’ve a sister? Don’t. Yeah. So it’s simply, it’s nice to see that and I’m glad we’re having these conversations. However Dr. Jill, I simply wanna thanks once more a lot for taking the time to speak about all of this as we speak. We lined a lot in a short while. And is there something that I didn’t say or didn’t ask you that you just’d wanna be certain to get throughout simply in case?

Dr. Jill Carnahan (53:17):

No, simply thanks for the fantastic work you do on the planet and uh, thanks for having me on. It’s all the time a lot enjoyable. It’s like having espresso with a good friend and if you happen to’re on the market and also you’re struggling for hormones, you don’t should. And there are simply, I like the sources you gave. There are such a lot of individuals who do perceive this. Um, and uh, I might simply proceed to look till you discover these solutions.

Betty Rocker (53:36):

I might agree. I might agree with that. Sure. And thanks a lot in your work. And I’ll have hyperlinks within the present notes in fact. And with this video so that you guys can observe up with Dr. Jill and get all of her unimaginable sources. She has so many, you’ve performed a lot work for girls and a lot work in your sufferers on the whole, women and men. Um, thanks once more a lot for being right here and we stay up for speaking to you once more. Thanks you, thanks a lot. And hey Rockstar, thanks a lot for listening as we speak. It’s been nice to spend time with you. I hope you realized one thing that’s useful and I’ll have all these hyperlinks to the issues that we talked about, in addition to a few books and sources Dr. Jill shared with me that we didn’t get an opportunity to speak about on the present. Be sure you take a look at the present notes web page for this episode over on my weblog at thebettyrocker.com within the podcast part for all of these hyperlinks. And I hope that wherever this finds you, you’re taking nice care of your self. Until subsequent time, I’m Betty Rocker and you’re so superior, flawsome and wonderful. Bye for now.