When to Start Hormone Replacement Therapy: Protecting Your Heart, Bones, and Brain in Perimenopause with Dana Culp, DNP

Are you feeling overwhelmed by the changes your body is going through during menopause? You're not alone! Join host Heather Carey as she sits down with Dana Culp, a certified menopause expert and founder of Thrive Midlife Medicine, to unravel the complexities of menopause and explore the transformative power of hormone replacement therapy. This episode of Real Food Stories dives deep into the common confusions women face regarding symptoms, hormonal treatments, and lifestyle adjustments during this critical phase of life.

Dana shares her personal journey through perimenopause, shedding light on the challenges she encountered while seeking medical help and the glaring gaps in support for women navigating hormonal changes. Together, Heather and Dana emphasize the importance of individualized care, realistic expectations for symptom management, and how nutrition plays a pivotal role in menopause health.

Discover valuable nutrition advice and healthy eating tips tailored specifically for women experiencing perimenopause and menopause. Learn about the seven pillars of abundance and how to nourish your body with mindful eating practices, sustainable eating, and even cooking techniques that align with your health goals. This episode is not just about managing symptoms; it’s about empowering women to take charge of their health and well-being.

Dana also discusses the potential benefits of hormone replacement therapy when managed properly, alongside exciting advancements in menopause care, including the anticipated availability of FDA-approved testosterone products for women. This episode aims to demystify menopause, offering listeners the knowledge and tools needed to thrive during this transitional phase of life.

Whether you're seeking insights into midlife nutrition, exploring the Mediterranean diet, or simply looking for inspiration through personal food journeys, this conversation is packed with empowering content. Tune in for a heartfelt discussion that celebrates midlife body positivity, embraces the power of nutrition, and encourages open conversations about women's health and wellness.

Join us on this enlightening journey as we break down menopause myths, challenge diet culture, promote healthy lifestyle choices and explore hormone replacement therapy. Don't miss out on the chance to transform your understanding of menopause and learn how to advocate for your health with confidence. Empower your menopause experience and embark on a nourishing path toward wellness with Real Food Stories!

Transcript

Meet The Midlife Medicine Expert

SPEAKER_00 0:40

Hey everybody, and welcome back to the Real Food Stories podcast. Now, with all of the newfound buzz around menopause and hormones, my question is why is menopause still so incredibly confusing? So I wanted to bring in an expert to answer all of your burning questions on symptoms, medications, food, all of it. Dana Kulp is the founder of Thrive Midlife Medicine, a virtual medical practice focused on providing evidence-based care for women in perimenopause and menopause. She is a doctor of nursing practice, a nurse practitioner, and a certified menopause expert with over 25 years of clinical experience. When Dana went into perimenopause herself, she saw firsthand how broken the system can be. She went to multiple different providers, including two well-respected OBGYNs, and left feeling unheard and frustrated. One doctor prescribed a medication that she later learned had safety concerns. Another pushed a one-size-fits-all plan instead of providing individualized care. Dana created Thrive Midlife Medicine to give women the care she wishes she had and to make advanced expertise accessible to all women. Her goal for her patients is at least an 80% improvement in their symptoms so they can thrive, not just survive in midlife. And I love that you say that, Dana, because when we are out on the internet and with all the wellness influencers now, there's a there seems to be this big promise of 100% resolution of your menopause symptoms, like as if you can get back to feeling like you were 25 again. And I just like that you're very realistic in saying that there's 80% at least improvement, because there's it's not a perfect science, right? But anyway, before we get into that, thank you so much for coming on the show. And I am just very excited to talk to you about hormones and menopause. As a woman who is on hormone replacement therapy herself, who I and I have been for the last 10 years very happily. I know how confusing, though, it can be. And I know that my journey was as probably as confusing as yours when I first started. Let's just jump in and start with you. And I want to hear a little bit about your story and then how you specifically started to focus on midlife and menopause care.

Dismissed By Doctors, Driven To Change

The System’s Gaps And Self‑Education

SPEAKER_01 3:20

Well, okay. Well, I'm very excited to be here. I love the work that you do and how you show up for women and excited to talk with you about this, my favorite topic in the world. So by the way. What inspired me to change from a family medicine provider, primary care, to strictly a menopause provider was my own journey in perimenopause. There were some very significant changes that were happening to me. I only identified a couple of them, a couple of symptoms that maybe could be hormonally related. It wasn't until I got over to the other side that I realized how much of what was happening to me was hormonal. But um, so I was having a lot of changes, weight changes, gaining a lot of weight, low-level anxiety all the time out of nowhere, agitation, being very frustrated, easily frustrated, which was impacting, you know, interpersonal relationships, brain fog was impacting my um my beloved work, and then some partner problems because of some of the functional changes that happen when your hormones are depleted. But what drove me into my doctor's office was my blood pressure because I couldn't sleep every single night, waking up, waking up, and my blood pressure was going up and up and up. And I made that, that's how I made the direct correlation with, oh, maybe hormones. But all of those other symptoms I mentioned, I thought, well, maybe I'm not eating right or I'm not eating, um, you know, not limiting myself or not moving enough as as we do as a woman, we we blame ourselves. If I just tried harder, if I just did better. So, so when I when I got to my my doctor's appointment that I had waited weeks and weeks for, feeling worse and worse every day, and I showed up and I was completely dismissed. She, a female, completely dismissed me that not only did she not feel comfortable in this area, she was not sure what she thought about hormone replacement and was not prepared to even have those conversations. So I left there in tears. I am in the industry. I presented as a colleague and I used the correct language, and I still was dismissed. So that was a very big wake-up call. And uh then I ended up going to two very uh high-level OBG wins from stamp from Stanford and got kind of the similar situation. One, here's some medicine, goodbye. Um, I later was horrified with what was prescribed to me. Nobody prescribes that anymore. And then the next one, um, she had a plan, but that was it. She was not able to discuss options or additional things I could do. So I did leave at least that appointment with something and I started to feel better and getting clear headed. Now I can sleep. Now I can think. Now my moods are level again. So I was grateful for that. And then that launched me into really educating myself because this is not part of a provider's education, actually. OBGYNs one in five even report that they get any formal training in their medical school, which is kind of shocking because we think of OBGYNs as the women's health uh, you know, pinnacle. So I got educated myself. And as I did, I learned more and more and more how broken the system was. It became so impactful for me that I just felt compelled to focus on helping women and just try to be that voice and that partner. So finally I ended up with a new primary who didn't know anything about uh perimenopause or menopause, but she was very open to learning. So I educated her and she's been with me ever since. And slowly the word got out in my local community that I was an expert in this care. Very quickly, within a couple of months, my entire practice was taken over by uh my family medicine practice was taken over with my midlife women. And but I'm just one person in one geographic area. I got the idea that I needed to do more. And so Thrive Midlife Medicine was born. And that is a virtual, completely telehealth practice for all of um California and all of Nevada, and we're very quickly expanding east, adding more and more states. So that was very long-winded, but that is my experience. And I think quite often we are driven by things that happen to us, injustices and things that we see. And so I'm no I'm no exception to that.

SPEAKER_00 7:50

Thank you for sharing that. And my story feels similar to yours in that when I first went to see my doctor, first my primary care, then my OBGYN, and and I was having a lot of vaginal dryness, not so much, it doesn't sound like you were having very typical like hot flash symptoms either, but the word anxiety was never a word in my vocabulary until I felt like I was going into perimenopause. And then, but the vaginal dryness was was the biggie for me. And I knew enough about hormones to ask about them, and I was just dismissed all over. I if you've listened to any of my other, some of my other episodes, I mean, I talk about like my story about my primary care doctor who told me she'd rather go to jail than to be on estrogen, which I at that point I was already taking estrogen and I thought she's being ridiculous. And but same, my gynecologist was trying to get me to use coconut oil and just I mean, just sill silly things that just did not make any sense to me. So it took me also a long time to find a doctor who could understand and be open to being on hormones because some things you can absolutely, of course, work out through your nutrition and your lifestyle. And sometimes it takes hormones.

Shared Stories Of Dismissal And Stigma

SPEAKER_01 9:13

Agreed. Agreed. And your story and my story is so common that it's um heartbreaking. Um, can you imagine uh a woman who does walk into her doctor's office and maybe isn't as comfortable advocating for herself or or having that kind of power dynamic? The provider says, no, this is what's happening, or no, you can't have that. And I I think most women cannot push back, um, uh, even if they're powerful in every other part of their life, that that I think is really common. So um, yeah, so I I love that you I I have listened to your podcast and I love it, by the way. And um, I do love that you share your story because women can really relate to that. And I just want to touch on what you just mentioned. And I know your background, you know, as a as a culinary nutritionist, uh, food is is one of the pillars of our life. But uh, if we don't have our um our foundational hormones um uh in line, that is fighting, you know, life with one arm tied behind your back. You can eat perfectly, you can reduce calories and and move and still not push the needle. When I think of all of the things we should be doing in midlife, and I do not like to complicate this, I think getting the hormonal foundation um uh nice and solid, and then the next is proper nutrition and movement and and the rest. But as opposed to the other way around, and not to say that you know you shouldn't always be working on your nutrition, but it leads women to think, if I just try harder, if I do just do harder, you know, just do more, like we we were saying earlier. And it can be really demoralizing when the needle doesn't move enough. And I do see colleagues occasionally still say to patients, get all of these things dialed in and come back and we'll talk about what symptoms you have left. And I and I do think that that's that's the reverse way to do things.

SPEAKER_00 11:10

I totally agree with you on that. I think that there's no food that I know of that can help reverse any menopause symptom. We can talk about phytoestrogens and soy products and everything, but those are not gonna help your hot flashes, really. I I I have yet to see any evidence towards that. But food can help so much. And we'll and we'll we can talk about that later. I want to just still just touch on this um you're starting out the journey of perimenopause and menopause and thinking about hormones, because even though now it's 2026, there are so many women that I know who are so confused about whether the hormones are safe, whether to go on them, how long to go on them for, when you're supposed to get. I mean, I I'm telling you, if I could, if I had 10 of my friends or clients here right now, I would have 10 different opinions from their doctors as to when they should start getting off of hormones, which I don't know, personally, I'm never gonna get off my hormones unless I you like drag me off my hormones. But I I mean, but there's so much confusion and so many different opinions from doctors, which just says to me that there's still not a consensus as to how you're supposed to be prescribing hormones. Um but let's just go back for a second. As a clinician, what do you think that most women are just unprepared for when they just even enter perimenopause? For me, I had heard about menopause, but I didn't really know that much about perimenopause. And then I heard that it was gonna last for 10 years about, and I was horrified. And I think that's when I knew I need to help myself here. So, what do you think that most women are unprepared for when they just start the whole process?

Hormones First, Then Food And Movement

Perimenopause Surprises Beyond Hot Flashes

SPEAKER_01 13:10

Uh, I think that there are so many things that can start changing that we all know about hot flashes, we all know about the dreaded midsection weight gain and not understanding why that's happening. But those are things that that are so common and talked about that the that might be on their radar. But I find in my practice it's the um the lack of clear thinking, the things you used to be able to manage and handle very busy lives. Maybe you have a family, maybe you have a a busy job, maybe you have a wonderful social life, and just struggling to manage that like you did before. And then the mood swings, being easily irritated or easily angered, snapping maybe at your children or everything your partner does bothers you now, and not being able to stop yourself from from going there, you know, from the snapping and which feels terrible. I find that those because they're they're so vague, you know. Maybe he deserved for me to snap at him, or you know what I mean, or or maybe today I can't handle my stress. And so I think that that um, yeah, those are the areas that I think are the least uh understood. And then after that, I would think energy, women losing their energy, which is it is a direct correlation with with your hormonal changes. So, and then just the lack of anyone talking about it until you know the last few years. Maybe someone might talk about menopause. And I don't know about you, but I thought it was kind of like a okay, now at first I'm here and now I'm here. Like, okay, here I go, and now my hormones are gonna change. Nobody told me they were gonna change for years and have some uh chaos for, you know, it could be 10 years or more. And if um a woman could be in her 30s and start experiencing these things, like, you know, that just sounds so young. Um, so those are the things I think women are not prepared for. And then what do you do about it? Um, and what can I do about it? There is a lot of um confusion out there. Um, I love that people are talking about it. The providers, the vast, vast majority of providers are not educated and are still working from a fear-based model that was set in motion almost 25 years ago from a you know misinterpreted study. And that's the last anyone thought about it. It's dangerous. We shouldn't be using it. Everybody get off hormones and don't talk to me about them. Um, so that's yeah, I think that that sets the stage for that end of the conversation. And then there's the other side that you alluded to. When do you need to stop them? Also, very arbitrary and very misunderstood. I too shall die with my estrogen patch on. And it is, it has changed my life so incredibly that there's no way I would consider it. And in my practice, sadly, I see so many women, I have lost count, that come to me who were cut off at the age of 60, just cut off. I will not renew your prescription. And to see the devastation that happens very rapidly, because now, now there is that one-to-one correlation, as opposed to kind of that slow slide into the hormonal deficiency, you know, to go from I feel like myself again into now my hormones are cut off. And their worlds, honestly, I'm not being hyperbolic, they fall apart very quickly. I've seen women have to leave their jobs, their marriages end. So that is an arbitrary cutoff that again is based in very, very old understanding that that has been proven to be incorrect.

SPEAKER_00 16:48

Am I correct in this that the Menopause Society just redid their guidelines? So, and then there is no real cutoff. Correct. I just want to make sure that that was correct. So there but but there's plenty of doctors who are not part of the Menopause Society who don't read those guidelines and don't know.

SPEAKER_01 17:10

Exactly. And and I just want to have a tiny moment of defending the providers that I like to mention this that we don't know everything about everything. And and that goes for any disease process or any uh diagnosis process. Folks have to stay up on the literature and they have to stay up on the guidance. And the resources we use are usually behind current literature that gets released. They also might not be up to date on you know diabetes care or hypertension care. So it's a lot to know, especially as a primary care provider, family medicine. So I just wanted to mention that. They they might be amazing, but they just don't know about this area and are operating on old, old misinformation that is completely inaccurate.

Old Fears, New Guidance On HRT

SPEAKER_00 17:54

Well, that's a very good point, right? I don't want to throw every outdated gynecologist under the bus. It seems like all of a sudden it's been just in like hyper mode to get the education around menopause is just accelerating at a very, very fast rate. Because, like I said, 10 years ago, I couldn't get a friend to talk to me about hormones. I was probably the only one of my friends on hormone therapy. I mean, it was just because everyone was scared of them.

SPEAKER_01 18:23

Yes. Or didn't make that connection. Um, you know, I love to always tell women hormones are not the cause of everything and they are not the cure for everything. Looking at your stress management and how you're eating, and you know, and maybe there's a thyroid problem, maybe there's another cardiometabolic thing happening at the same time. That's important to think about as well. But I love that there, this conversation is getting louder and louder. Um, as much as I am challenged by some of the things out there on social media, a lot of folks speaking as experts. There are some actual amazing experts. I tend to lean toward the medical folks who are speaking from speaking about the data, speaking about what the literature shows, uh, just because I'm a data nerd and that's what how I like that. But they have very, very big voices right now. Um, you know, they are consulting with the FDA, um, you know, a direct correlation with how the black box warning got removed. Um, and so I think that's why the conversation is is seeming like all of a sudden it's everywhere. I'm I'm very grateful for it. And I hope it just gets louder and louder. As loud as it sounds, um, you know, because we you find what you're looking for, and you know, um the algorithm feeds us what we're looking for. But I do think that um more women are are are being introduced to these ideas of how they can feel like themselves again, but it's still in, I believe, still in the single digit decimals of how many of the women that actually do get care. So um we still have a lot of work to do.

SPEAKER_00 19:56

I agree. I think it's gonna just keep evolving, which is which is great. Um, I'm just taking some notes here, and I was just as we're like talking. I know you said that some of the beginning symptoms you think of perimetopause are just weight gain and foggy thinking and mood swings. Now hormones are really FDA approved for hot flashes and vaginal dryness, correct? Right? I mean that's like it's like the first line. What is your opinion on hormones helping things like weight and mood and brain fog?

When To Stop? The Myth Of Age Cutoffs

SPEAKER_01 20:32

Uh I think they are miraculous when they are managed properly, life-changing to be more specific. And I'd like to point out, too, that even though there can be more than one thing happening at a time, like we like we spoke about, why not go a little bit further upstream and see if there is a hormonal component? Labs, you know, oh, your labs are normal, so you must be fine and it must be something else, or there's something wrong with you. That is the message. So labs, directing care with labs has very little value, in my opinion, in perimenopause. But being open to prescribing off label, you know, you mentioned what is FDA approved. We do that every day with all kinds of medications. So if a woman thinks and I think after we have our, you know, assessment and and we decide what the plan's gonna be, why not try it and see what it can if it if it helps? If it doesn't, then you see what else can be, you know, can be managed. But I and you can always, it's not the one-way street. You can always change, discontinue maybe till later. There's just so many different ways to to look at it. And the risk is so low for most women that I say do a trial and see if this can help you. In perimenopause, it isn't as isn't as easy to navigate the medica medication piece. So my particular way of looking at this, and I would I would urge your your uh listeners to think of it this way that we have our three main hormones, you know, estrogen, progesterone, testosterone. And it while there's tons of overlap, they have some major things that they that they can do for someone. So if they do uh find themselves working with a specialist, it's not just estrogen, it's not just progesterone, it's deciding which one will have the most impact and starting there and then stacking the hormones on as needed uh until a woman feels like herself again. And I know I I say 80%, and I do think you have to be realistic, but I see all the time, and I see it, and it happened for me, I was myself again. Um, and uh I I like to leave that hopeful, hopeful piece.

SPEAKER_00 22:42

You mentioned just the word risk. Is there ever a time when you don't recommend a woman be on hormones?

Balanced View: Provider Limits And Updates

SPEAKER_01 22:50

There is some nuanced conversation if someone has certain health histories that are significant that could be impacted. But with that said, so for instance, you know, estr an estrogen-driven cancer, but that doesn't mean that there's no options for her. It just might mean it's a little different conversation about that risk-benefit analysis, or that maybe the entire menu is not open to her at this time. Um, as far as the hormone piece, it doesn't mean she just doesn't get doesn't get any help. And that I think is a black and white thinking that is really, really prevalent. Um, you are you're over 60. Oh, your mom had breast cancer. Oh, you might have had some kind of maybe um uh gynacological cancer, and and it's just things shut off. But that is absolutely not uh not the case for for, I'm not gonna say 100% of women, but I'll say 99.9. For instance, sexual function, challenges with uh lubrication, dryness, difficulty arousal, and things like that. Vaginal estrogen is perfectly safe at any age for almost every woman. And progesterone and testosterone, that's a different very different conversation than estrogen. So maybe estrogen is the risk-benefit, you know, analysis change, but again, there's a whole menu. And um, and so I personally have never told a woman that there's nothing we can do. And keep in mind, too, there are non-hormonal options as well. So if certain hormones are maybe riskier for that particular woman at that particular time based on her health history, there are non-hormonal things that can help with symptom management. Those particular non-hormonal medications will not potentially help her long-term health span like hormonal uh replacement therapy would, but at least she is it gets some relief from her symptoms. So it's uh it's nuanced conversation for each woman.

SPEAKER_00 24:50

The age that you start hormones, does that matter? Is there a bigger benefit to starting them earlier rather than someone starting them when they're 60? Even though they're I mean, we talked that there are certain doctors who say get off hormones around 60. We know that that's that's probably not the case. So you can stay on hormones, right? For correct. But is there a benefit to I'm sorry, is there a a benefit to starting them sooner rather than later? Just for overall health. And we can talk about the what the health absolutely.

SPEAKER_01 25:26

Absolutely. Um there is search a lot of research being done on that right now, and there was a big study that was just uh spoken about that there now we have irrefutable proof that the earlier a woman starts when she starts having the hormonal chaos, the better for long-term health span. One thing to keep in mind about hormone replacement therapy is it is better at prevention than it is at cure. So when you think of it that way, if a woman starts hormone replacement earlier, before disease processes start setting in, then obviously the outcome and her health span is are going to be better. And I'm thinking of, you know, bone health, cardiovascular health, uh brain health. So as a woman gets older, the benefit can be reduced if she already has these disease processes set in. The hormone replacement therapy is not going to cure those things. So that's that's why earlier intervention is so important. Hormone replacement is I think of it as two big umbrellas. One is symptom management. I feel help me with this these horrible symptoms and I feel better. And in the second umbrella is how will it help my long-term health? So even if long-term health that conversation is a little bit different or the symptom is a little bit different, they they need to be thought of two separate categories depending on when it starts. I hope that made sense.

What HRT Helps: Beyond FDA Labels

SPEAKER_00 26:58

Yeah, no, that definitely. So yeah, so sooner rather than later is to your benefit. Just for the overall other health things that we don't, I think, really consider when we think about menopause, right? Which are bone health, heart health, brain health, right? I mean, estrogen really from head to toe is involved. So the sooner you get on it, really the better. Then this just goes back to, I think, this like old thinking that when you go into when you're like menopausal and you don't get your period, which is, you know, you don't have your period for one whole year, that that's the end of menopause. I think that that's like a lot of like really old thinking that like, okay, well, I'm through that now, which means I'm done with hot flashes. I'm done with and that's not the case at all. Correct. Great. Okay. Yeah. Yeah. Just wanted to hear that from you. I mean, I I know that I just wanted to hear from you because I talk to a lot of women who say that now that I'm I'm out of menopause, I'm like, you're never out of menopause, right?

Personalizing Estrogen, Progesterone, Testosterone

SPEAKER_01 28:01

Yes, correct. I hear that as well. I didn't have such a bad time and now I'm on the other side. I am always happy to hear a woman, her life did not fall apart because of the symptoms. But as far as now what's happening, aging quite and deteriorating basically quite rapidly. Um, because after menopause, you know, perimenopause is the hallmark is hormonal chaos. And that is where so many of the problems um come in. And then once you start heading toward the 12 months without a period, and then you get past that, that decline is more linear and much sped up. So now blood pressure goes up, cholesterol goes up, bone health deteriorates very rapidly, especially in the in those first couple of years. And then brain health, um uh, you know, dementia is setting in potentially, because like you said, we have estrogen receptors everywhere. It's no wonder that women, say, in their 50s, end up with frozen shoulder and diagnosis of fibromyalgia, um, you know, bone pain, joint pain, that there's no lab that says anything's wrong, but we have estrogen receptors all over our bones. Vonda Wright speaks about this uh quite eloquently. She's an orthopedic surgeon. She has uh coined a term, uh, the musculoskeletal syndrome of menopause. And I have uh seen countless women have their, you know, they're seeing rheumatologists and all these folks to figure out why they hurt so much. And there's the labs just don't indicate it. So there's all these new diagnoses because something is obviously wrong. We just can't find the etiology. And maybe they try hormones and have significant improvement or reversal. I see it every day. So yes, looking at long-term health, we know that estrogen um, you know, is FDA approved for the prevention of osteoporosis. And we have a um an epidemic now of women with osteoporosis, which one in two of us will have an osteoporotic fracture in our lifetime. And that is um horrifying to think of spine fractures and hip fractures, that can be uh devastating.

SPEAKER_00 30:06

Do you think that um if a woman doesn't really present with classic symptoms, because I hear this too, oh, I don't need to go on hormones. I I've never had a hot flash in my life. I don't, you know, they don't have those classic symptoms. Should they still go on hormones just for the the health benefits that we just talked about?

SPEAKER_01 30:26

So I have a pretty strong opinion about this. Um, I my goal is not for women to take hormones. I take them and I prescribe them every day, and I understand how life-changing they are and health protected they are. So I come at it from the science piece. My goal is that every woman has this conversation and has the education of risks, benefits, what are her options, and and then she can make an informed decision, informed, educated decision about what she wants to do because I think it's very personal. And even if I think she might benefit from it, she needs to decide. And so having having that conversation and being allowed to have shared decision making about her own health is my is my highest goal. We know that it can help, but a woman should be able to decide what she's gonna do with her body herself.

SPEAKER_00 31:18

It's a very personal decision. And I'm not, yeah, and I'm also not leashing like hormones on everybody, but it is a very personal decision. And I know how much it's changed my life for me. So it's really helped me so much. You know, hormones are like come in like all shapes and sizes now. I think back 10 years ago, there was like maybe, I don't know, very few options of like what you're gonna get, but now compounding pharmacies, pills, patches, gels, rings, like it's all all sorts of different shapes and sizes. Is there something, some kind of formulation? I mean, some that you recommend over others, does it does it matter when what's your opinion about compounding pharmacies? Definitely there's a place for them.

Contraindications, Nuance, And Options

SPEAKER_01 32:02

I tend to lean toward FDA-approved, insurance-covered medications. And then if we're talking about strictly hormone replacement therapy, there are synthetic versions of the hormone replacement, and then there's what we call bioidentical versions, um, which didn't exist 10 years ago. Uh, I love always seeing if a woman is a candidate for bioidentical. Just because the risk profile is so different than the older synthetics that we that we use doesn't mean there's not a place for it. There are some women that, you know, you do the risk benefit and they for some reason can't use bioidentical, which is kind of rare, but it happens. Synthetic, there is a place for it. So I definitely don't push a one size fits all. But if you had a hierarchy, I would love for bioidentical to be looked at first. And I'm not sure if I mentioned what that means. That just means the hormones that our body recognizes as their own, the molecule for molecule. There is plenty of data that does tell us that the many different ways of using the bioidentical does have more benefit than some of the synthetics as far as health span. They both can help with symptoms. If we're talking health span and improving, you know, long-term health, bioidentical would be the one I would lean toward first, whenever possible. And then I personally, I know we don't have any testosterone products for women in the United States. And I prescribe testosterone every day. I think it's exceedingly important. So there is two ways to go with that. One is a compounding pharmacy, and I'm so glad that they're there. But I tend to just prescribe um the male FDA-approved topical product and dose it teeny tiny for a female, mostly just for the cost of it's a lot uh less expensive, and I never want price to be a barrier for any woman. And then the compounding pharmacy can also be fabulous if if a woman is very, very sensitive and the doses that are available from FDA pro approved products don't quite fit with what she needs. For myself and my own practice, I do lean toward the FDA-approved uh products. And I think GLP1 is another compounding versus FDA approved. And I typically I prescribe both of those because of the difference in the price point, and I don't want any woman left out. So compounding pharmacies are probably my go-to for those, because I do believe those are so impactful for uh midlife women. But I, you know, I prescribe the FDA approved a lot as well.

Timing Matters: Prevention Over Cure

SPEAKER_00 34:33

I want to go back to the word bioidentical for a second because I think this word alone in the world of hormones has caused a ton of confusion. Bioidentical used to be identified with alternative, like an alternative to FDA, those bad FDA-approved hormones, and and the FDA has bioidentical hormones, correct? Uh yes. So bioidentical doesn't mean like more natural or safer. Can you just explain what bioidentical is? There's a lot of women that I've talked to to who've said, like, I am I will only take bioidentical hormones. And I think they think that that comes from an herbalist or a naturopath or or just a compoundine pharmacy.

SPEAKER_01 35:17

I I'm so happy you point this out. There is a lot of confusion and there is a lot of controversy, actually. So, yes, bioidentical, there's absolutely FDA-approved bioidentical. And I think a better word is body identical. If we removed bioidentical, which I believe I agree with you, I think that it's thought of as like different from, you know, big pharma. And I get that. But so body identical might be more accurate, just the molecule our body recognizes as its own. For instance, progesterone is a perfect example. We only have one body identical progesterone, and that is oral micronized uh progesterone or prometia. All of the other uh progesterones are actually progesterens. And our body doesn't, doesn't recognize it, it can help us with our symptoms, but our body doesn't identify it the same way. Um, and then estrogen, of course. We have estradiol, which is body identical, and then we have a bunch of estrogens, others that can really change your life, but they are, but they're different and they have a different risk profile. So I do like to point that out. They are, they're just they're all FDA approved, especially the ones I I prescribe. And so I, yeah, so there is confusion. And one other thing I think to point out is when you, when women are hearing the controversy, I want them to always be looking at who is speaking with with that understanding of where that person might be coming from. So if somebody cannot prescribe, they might be offering something that is a non-pharmaceutical, but might have something in there that could potentially impact hormones. Um, also, depending on where the prescriber works, compounding, I love my compounding pharmacies and pharmacists, but um often the providers can basically say there's a financial impact to them to use sometimes those particular um ones over the insurance paid for pharmaceuticals. And so just having that looking at things with that cynical view of who is telling me this and who who is who you know, where are they coming from?

SPEAKER_00 37:30

No, because I just I know that word bioidentical has just been it's almost like the word natural in uh food world, which is it's it's almost like a meaningless term in when it comes to food. So bioidentical.

SPEAKER_01 37:43

I definitely think it's a I definitely think it's a more of a marketing term, but when you do look under the hood and look at the science, our bodies do recognize them different. So body identical is probably better, but um is not typically used.

Menopause Isn’t “Over” At 12 Months

SPEAKER_00 37:56

Yeah, and I think there's a bit just a lot of fear over like big pharma that women would prefer to use something more natural. And so it's there is just a lot of confusion. So thank you for that. Let's talk about diet. You you mentioned weight gain at the beginning of our conversation, and and we've touched a little bit on food. I think GLP1s have completely dominated the weight loss arena, but menopause diets, like specific menopause diets. Do you believe that there's specific foods that women like need during menopause? Do you feel like like where where are you at with how much diet plays a role?

Musculoskeletal Syndrome And Bone Health

SPEAKER_01 38:38

I think diet is is the most important thing, you know, that that we can do and and especially that we have control of. Um so diet is very important. I cancel it, it's very important in my life, and I cancel all of my patients. And we have you know tons of data, um, you know, that and you know, let food be thy medicine. So squarely in the corner of get the diet right. And but things change as we get older. It can be everything from how we how our body metabolizes food and how you know things I we used to be able to eat, we can't eat anymore, that type of thing, but also some adjustments that can be made to protect this changing body that we have. So I do think that there are some changes that that likely would be beneficial for most women as they they get into this um this age range because of the weak gain that does happen, our metabolism changes and the hormones that protected us and kept us kind of in this homeostasis are changing or going away. And the things we did before just don't work anymore. If you want me to be specific, there's, I know, um, so let's just talk about like just some minor changes. So when you say a menopause diet, when I hear that, and I I can't think of anything specific, but when I hear that, I think of so our muscle is going away pretty quickly, percentages every single year. And our muscle is our metabolism. So it has to be what we have has to be protected, and maybe we can grow a little bit more. That would be amazing. And so to do that, we need to uh consume protein, whether it's from animal sources or plant sources, and shift the priority of what we're eating. So I came up thinking you high, high volumes of food, of low calorie density food, because of course, what was the goal? Um, the goal is just to be smaller. That's that was all that mattered is I need to be as small as possible. So I either need to eat as little as possible or somehow consume as few calories as possible. And that thinking really has to go out the window at this stage of life. Um, you know, I'm in my 50s, and but I think that any woman, even probably getting to be around 40 or younger, should start thinking of her plate a little bit differently, prioritizing the protein first, and then what you have left is is all of the beautiful, in my opinion, plant foods should be the next uh priority and the wonderful micronutrients that that we get from that. And then the rust, believe, should be looked at as almost like condiments, you know, breads and pastas and rices and treats and stuff like that. But having um having the pyramid be turned upside down, prioritizing protein, then plant foods, and then enjoying special treats with everything else. And that would be that will keep our energy balance. We won't have as much uh blood sugar uh swings, the baseline for our basic caloric needs, and also preserving muscle. So that's why I would recommend that to all of my midlife women. And now there's gonna be a woman who's maybe an endurance athlete or something like that that can potentially still tolerate um having having not having that view of her food, her plate anymore. For most of us, that is gonna be the best approach to try to maintain our weight and to preserve our muscle.

SPEAKER_00 41:54

So I want to add in just strength training, weightlifting. I think we have to get our muscles not just from protein, but from being active and doing and and lifting as heavy as possible. I want to just emphasize just eating for health, all those things that we mentioned earlier, our heart, cholesterol, diabetes, bone. I mean, that all also comes from food. We can't just fully rely on hormone replacement to fill in those gaps. I mean, that's incredibly helpful, but our food still also counts. And I and I bring that up because you mentioned GLP ones before, and I want to talk about that. What I'm seeing lately out in the universe is a huge emphasis on just losing weight, right? GLP ones, we're just gonna lose weight. And the and the way that you lose weight on a GLP one is that you start eating less calories, right? So there's I see very little emphasis on what we're eating and just making sure that we don't eat enough. Because that, I mean, that is how you lose weight. You reduce your calories. And we still need to focus on our food. Uh we have to like make our food our priority. So what's your take on using GLP ones? I know you prescribe them, and I know that they've been helpful, incredibly helpful for so many women. But where do you think that this is going? And how and how do you feel like this is contributing to how women are eating?

Choice, Consent, And Shared Decisions

SPEAKER_01 43:28

Such a great question, and I'm of two minds of this. I I I am a huge fan of this category of medication, and I prescribe it every day. I think it's super impactful for midlife women because the weight is not, it is, it's it's very challenging for the vast majority of women. And I like to point out that it's not just the aesthetic of being heavier. X uh having excess weight on your body is detrimental in so many ways. So it's not just I want to fit in my pants and look better. This is, you know, being as close to normal weight as possible will really protect long-term, you know, current health and long-term health. So so that's the first thing. I think the but where I get hung up on is how they're prescribed without the education that you're speaking to. So, yes, if you take a GLP one, you will create a calorie deficit because it reduces hunger. And if what's left, what you're what you can eat, is not highly tuned in to protect your health, I believe women can end up in a worse situation than when they started because they will lose way too much muscle because we'll lose fat, we'll lose muscle. And then if they regain weight or when They regain weight, it will be very rapid and they won't be growing that muscle back. They will be adding fat. So now the equation is even worse and they are more metabolically dysfunctional. And in a worse situation, the last thing a woman needs is to be losing muscle. So I have a, I'm pretty pretty strict about how I prescribe them. And kind of a deal breaker situation for me is I give a lot of education about exactly what you just spoke about. The the diet has to be optimized. It's not just about eating less. And so, you know, again, protein plants and body composition. We want the body composition to change. I want you to lose fat and hold on to as much muscle as possible. It's not about what it shows on the scale, you know, and hydration, uh lifting weights to maintain muscle and maybe grow a little bit more. So I think that it has to be a whole um care plan around how to have this calorie deficit using this medication. And uh while I'm glad more women have access to it, I personally see that that education is not there. And so they unknowingly are taking these drugs that could be great for them, enhancing their health. But without the education, I just worry that they're actually hurting their health.

SPEAKER_00 45:54

Yeah, I agree with that. I think that you can see sometimes in women's faces when they've lost too much weight too fast that they're on one of these drugs. Yeah, you have to be strategic with how you lose weight.

SPEAKER_01 46:06

And have to have a proper prescriber and have a relationship with them so they can help guide. Um, you know, it can't just it can't, you can't just check some boxes online, get it in the mail, and figure it out yourself. It shouldn't work like that. Um so I hope changes are coming in that way. Um, and it's more of a personal situation with a um educated prescriber.

SPEAKER_00 46:27

Dana, you have given us so much information. I'm looking at the time. I can't even believe how fast this time went. So I want to just ask you one last question, just to wrap things up. Is there anything in the menopause world that you're feeling excited about? I think I tend to sometimes focus on all that, those like wellness influencers who are just putting out like, you know, all this stuff that is like just so dangerous, I think, for women and supplements and things that just don't matter. But is there anything in the world of the menopause field that you feel excited is like coming our way?

Bioidentical Vs Body Identical Explained

SPEAKER_01 47:04

Gosh, there's so much uh that I feel excited about. I'm very the thing that I love is that people like you uh and people like me are talking about this so women can go into this next stage of life with so much excitement, so much hope. You know, this is this is like your second act. And it doesn't have to be uh, you know, slow slide into irrelevance and deterioration. It it can be an amazing time. So I think for me, that's the biggest thing in the menopause space is women just feeling really empowered and excited about the next chapter. Um, and then as far as as far as the clinical side, uh, I love that maybe women might get a testosterone product here pretty soon, an FDA-approved science-backed testosterone product because I see it every day how impactful um testosterone can be for women. And we don't have any products right now in the United States. Other countries are starting to have them, but we don't have one yet. So I think maybe in the next couple of years that will come. Those are the two things I'm most excited about. I love women and I just want them to feel like themselves again.

SPEAKER_00 48:11

And that's a really great point. I'll just end with this too, right? That considering that women also produce testosterone. It's not just a male hormone, right? Women produce testosterone too. So why don't we have a female version of testosterone? But yeah, great. If you say it's coming, then good, we're gonna get excited for that because that should definitely be happening.

SPEAKER_01 48:32

Well, well, the excited the excited part is because it will then be an FDA-approved insurance covered. So then back to the, you know, I don't want things to be out of reach for women. Now, if they do access a um an educated specialist, they can have access to it, but they just have to um to either FDA-approved male products or compounded products, um, but they have to pay out of pocket for that. And um, I don't want money to ever be a barrier.

SPEAKER_00 48:58

So um now your clinic, okay, your Thrive Midlife Medicine is you are just on the West Coast, but you are slowly coming over to the East Coast, which is where I'm actually actually rapidly, but yes. Okay, and I will put those all the links for you in my show notes. Okay. So women can get in touch with you. And when do you think that what what tell me just are you gonna be national?

SPEAKER_01 49:25

Uh that is the goal. So it's taking it piece by piece. Um, because my practice is one of the few that takes insurance. They're usually, you know, a cash-based type of um online platform. It is challenging getting all those contracts in c in place and hiring all the right people. But uh, yes, so slowly rolling it out across the country, hoping to be really expanded by the end of the year, which is uh maybe a lofty goal, but we're doing our best. Uh so online platforms are great. And one thing to think of is if a woman doesn't quite know what's going on, you know, I wonder if this is what's happening to me. You know, it's hormones an issue right now. I do have a really simple uh a few minutes, it only takes a few minutes, a perimenopause quiz. So if a woman is confused, like, I wonder if that's what's happening. On my website, uh thrivemidlifemed.com, there is a perimenopause quiz. And the results come back quite quickly to let you know if this is something you should look into, hormonal uh or what your options are. So that's that's kind of exciting. A lot of women find a lot of benefit from that.

SPEAKER_00 50:25

Okay, great. I will, yes, I will definitely link that as well. And thank you so much. I really appreciate it. You've answered every one of my questions. I think my audience will be very satisfied with this conversation.

SPEAKER_01 50:39

Yeah, thank you so much. I love what you're doing for women, and I'm excited to be here with you.