How Hormone Shifts Affect Women’s Health with Sarah Norris, ARNP, MSCP

What if the symptoms you’ve been blaming on stress, aging, or “just life” are actually connected to hormone shifts?

This week, I’m joined by Sarah Norris, a nurse practitioner in urology and a Menopause Society Certified Practitioner. Sarah also happens to be my urology provider, and I have been so excited to share this conversation because it touches on so many things women experience but often don’t talk about openly enough.

We talk about peri-menopause, post-menopause, hormone therapy, vaginal estrogen, urinary symptoms, recurrent UTIs, painful sex, libido, testosterone, sleep, bone health, heart health, and that hard-to-explain feeling of, “I just don’t feel like myself.”

Sarah explains these topics in such a clear and compassionate way, and my hope is that this episode helps you feel less alone, more informed, and more confident starting a conversation with your own healthcare provider.

This conversation is educational and encouraging, but it is not personal medical advice. Please talk with your own healthcare provider about your body, your symptoms, and what may be right for you.

Resources:

Sarah Norris, ARNP, MSCP: https://www.mercycare.org/doctors/doctor-public-profile/sarah-norris/ 

The Menopause Society: menopause.org

Books:

Avrum Bluming, MD and Carol Tavris, PhD, Estrogen Matters
Mary Claire Haver, MD, The New Menopause…
Mary Claire Haver MD, The New Perimenopause…
Kelly Casperson, MD, The Menopause Moment…
Heather Hirsch, MD, The Perimenopausal Survival Guide…
Dr. Louise Newson, Preparing for Perimenopause and Menopause
Dr. Jessica Shephard, Generation M…
Stephanie Faubion, MD, The New Rules of Menopause…

Podcasts:

You Are Not Broken
The Dr. Louise Newson Podcast
The International Menopause Society Podcast
Menopause and Cancer
Hello Menopause
Menopause: Unmuted

Guest speakers to search for: Kelly Casperson, Corrine Menn, Heather Hirsch, Mary Claire Haver, Stacy London

Documentaries:

Balance: A Perimenopause Journey, Amazon Prime (Jan. 2026)
The M Factor: Shredding the Silence on Menopause (2024)
Your Fantastic Mood: Menopause, PBS (2023)
Sex, Myths and the Menopause (2021)

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Transcript

How Hormone Shifts Affect Women’s Health with Sarah Norris 

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​[00:00:00] 

[00:00:02] Penny Fitzgerald: Hello, my friends, and welcome back to Penny For Your Shots: Conversations and Cocktails with Brilliant Women. Today's conversation is one I've been so excited to share with you because we're talking about something that affects so many of us, and for far too long, we just haven't talked about it enough: perimenopause, post-menopause, hormones, urinary health, sexual health, and what it means when we hit that phase of life where we just don't feel quite like ourselves 

My guest today is Sarah Norris, a nurse practitioner in urology and a Menopause Society certified practitioner. she also happens to be my urology provider, so I can tell you from personal experience that she has helped me understand my own body in ways I wish I had known years ago.

And before we jump in, just a quick note.

This conversation is meant to be educational and encouraging, but it's not personal medical advice. Sarah and I are sharing information to help you ask better [00:01:00] questions and to have better conversations with your own healthcare provider about your body, your symptoms, and what might be right for you. What I love about this conversation is that Sarah takes topics that can feel awkward or intimidating and makes them feel normal, understandable, and kind of empowering.

If you've ever thought, "What's going on? Is this just part of aging? Am I stressed out? Is something wrong with me?" I hope this conversation reminds you that you are not alone, you're not broken, and it's absolutely okay to ask questions and to advocate for yourself.

So pour yourself whatever feels good today and join me for this important conversation. Here is Sarah Norris.

[00:01:45] Sarah Norris: I think it's gonna help a lot of people because this is just a topic that, um, we don't talk about, or we haven't been talking about enough. 

Yeah. We, we really haven't, and the more and more that I'm hearing is girlfriends getting together and actually starting to talk about, like, what's going on in- Yeah

[00:02:00] their life, right? Whether it's, like- 

[00:02:01] Penny Fitzgerald: Yeah ... 

[00:02:01] Sarah Norris: symptoms they're having or, like, issues with relationships and just kind of realizing, like, hey, we are kind of all experiencing a lot of the same stuff. 

[00:02:09] Penny Fitzgerald: Yeah. 

[00:02:09] Sarah Norris: You know? 

[00:02:10] Penny Fitzgerald: So- It's helpful to know you're not alone. 

[00:02:12] Sarah Norris: Yes, absolutely. It, it- Yeah ... it takes a village, right?

[00:02:16] Penny Fitzgerald: Absolutely. 

[00:02:17] Sarah Norris: To get through menopause and get through menopause- Oh ... and raise a family. 

[00:02:21] Penny Fitzgerald: For sure. For sure. Well, let's back up a second and, um, for my audience, tell us a little bit about you. Give us your name and a little bit about what you do. 

[00:02:31] Sarah Norris: Yeah. So I'm Sarah Norris. I'm a, a nurse practitioner. I work in urology.

I specialize in a few different things within the urologic realm. So, um, one of my most recent kind of passion projects has been menopause hormone therapy. But what kind of led me there was when I started in urology, um, I would, you know, see a lot of women coming in with complaints of urinary symptoms, right?

So, um, urgency, frequency, um, recurrent urinary [00:03:00] tract infections, and realizing very quickly that, well, we prescribe vaginal estrogen to help with a lot of these symptoms. Um, and then seeing how well it worked, and I'm like, well, why does it work so well, right? Why does- Mm-hmm ... vaginal estrogen, a cream that we put in the vagina, why does it work so well to actually improve not only, like, skin integrity, um, but urinary symptoms, right?

Like leakage, having to go to the bathroom several times a night, um, recurrent urinary tract infections. I mean, that's a, a bother that a lot of women have and can end up in the hospital. So it led me down kind of a rabbit hole of discovering, um, what hormones can do for the body in general. In urology, it was very common for us to see men to replace their testosterone, right?

Uh-huh. Um, and also to manage sexual function in men. And it just kinda got me thinking too, like, who's doing this for the women? [00:04:00] You know, because- Right ... I know as a woman myself going to the gynecologist, they don't ask... I've never been asked about sex before or, you know, if I'm having- Mm-hmm ... other, like, female sexual, uh, symptoms or other symptoms just related to hormones in general.

So, um, it kinda just led me down a rabbit hole. Mm-hmm. Started doing some research, and I'm like more- More women need to know this, that this is, you know, help is here. It's been around for decades. These are natural hormones that we can provide to women and can really improve quality of life. 

[00:04:33] Penny Fitzgerald: I, you know, I did a little bit of, um, digging before, before our chat today. 

[00:04:37] Sarah Norris: Yeah. 

[00:04:38] Penny Fitzgerald: And I was curious about women's health in general. 

[00:04:43] Sarah Norris: Mm-hmm. 

[00:04:43] Penny Fitzgerald: And I knew it was recent, but it, it infuriates me to find out that it's, it was 1993 when it w- it became mandated to study women's bodies, and the effects of some of the drugs that, that are out [00:05:00] there, and just in general.

Yeah. That 1993. 

[00:05:04] Sarah Norris: Yeah. I mean, that's insane. It's... To think about how long, you know, there have been studies, um, on new medications and treatments that are coming out, and to not include women until- Yeah ... just recently. I mean, really- Yeah ... that is, like, just recently. It, it is- For sure ... it seems bizarre. Um, you know- Well-

we look at- What I think is interesting too is so on that point, think of how many women are prescribed statin drugs when their- Mm-hmm ... cholesterol levels start to rise- Mm-hmm ... post-menopause, right? And we see that all the time. Right. Statin drugs were never studied in women either. 

[00:05:40] Penny Fitzgerald: Mm. Right. 

[00:05:41] Sarah Norris: But we do know that estrogen, when replaced in women or maintained at good adequate levels in women, can actually decrease cholesterol levels, right?

Mm-hmm. And, and just as effectively as statin drugs. So it's, it's just, it's interesting that we've known that. Statins were never studied in women, but [00:06:00] yet here we are prescribing them to most women- Yeah ... with cholesterol problems. 

[00:06:05] Penny Fitzgerald: Yeah. We're not just little men, you know? 

[00:06:07] Sarah Norris: Right. Yeah. 

[00:06:09] Penny Fitzgerald: It's just annoying. Yeah.

The other thing I saw too that was, oh my God, so stupid is menopause is still, um, an elective. It's not stu- Mm ... it's not taught in medical school unless you ... It's an elective. You can grab it if you want it. Yeah. If you wanna learn about it. But that, how is that possible? I mean, o- so I think you said to me half of the popul- population roughly is women, and 100% of us will go through it.

[00:06:39] Sarah Norris: Yeah. 

[00:06:39] Penny Fitzgerald: And it's an elective? Yeah. How's that possible? 

[00:06:42] Sarah Norris: And, you know, just from what I've heard too, I mean, I know from my education i- in nursing school and then in NP school, I didn't have any, uh, set courses on menopause in general or really what happens to the body, um, or to women's health in menopause. [00:07:00] We learned you quit having periods, you can't have babies any longer, and you might have some hot flashes, right?

Like essentially- ... that's what we learned. You 

[00:07:07] Penny Fitzgerald: might. 

[00:07:08] Sarah Norris: Yeah, you might. Yeah. And it, and so which again, when you actually start to study what hormones do in women, um, it's- Mm-hmm ... it's astounding. And I think what is most frustrating about it is that we know, so for decades, estrogen alone, which is, you know, one of our dominant hormones, um, can

is actually FDA approved to prevent osteoporosis, right? Like that is- Mm ... one single FDA approved reason to start a woman on estrogen therapy. And how many women develop osteoporosis? Like most of us. A lot. Right? Mm-hmm. And so that's frustrating to me in its, in its own is that primary care docs aren't educated on that.

I mean, we could start women on estrogen and decrease their risk, um, of fracture, right? Mm-hmm. Ending up in the [00:08:00] hospital with a hip fracture when they're 70, and then we fracture a hip, most of us don't return home independently either. So- 

[00:08:08] Penny Fitzgerald: Mm-hmm ... 

[00:08:08] Sarah Norris: um, a lot of scary statistics behind that as well. 

[00:08:12] Penny Fitzgerald: Wow. 

tell me a little bit about the study that came out that scared everyone away from taking hormones, the hormone replacement therapy. What's, what's the deal with that? 

[00:08:24] Sarah Norris: Yeah. So I mean, the, the Women's Health Initiative Study is what most people think of when they think, well, uh, estrogen causes stroke or breast cancer, right?

Mm-hmm. And so w- even though that study did, um... It was mis- some of the data was misrepresented. We actually got a lot of very good data from it as well, so it shouldn't be, you know, put down completely. Um, but the data that they got on the breast cancer, for instance, basically we had two groups of women. So one group of women was prescribed hormone therapy- Mm-hmm

and these were different [00:09:00] hormones than what we prescribe now, right? These were synthetic hormones, um, that again, have some great safety da- uh, data behind it. But synthetic hormones, both the estrogen and the progesterone. Mm-hmm. And then we had a group of women that were not on hormones. In the group of women on hormone therapy, 5 out of 1,000 developed breast cancer.

In the group not on hormone therapy, 4 out of 1,000 developed breast cancer. 

[00:09:26] Penny Fitzgerald: Oh my. 

[00:09:27] Sarah Norris: When they compared the numbers and they said, "Well, you know, four versus five," um, they looked at that as like some 20% increase in breast cancer risk. 

[00:09:38] Penny Fitzgerald: Oh 

[00:09:38] Sarah Norris: my God. When really if you were to tell any woman it was the difference of like one person out of- Uh-huh

thousands of women, most of us could decide for ourselves like that is not statistically significant, which it really isn't. Um- Right ... and it, what they really found out that it was more so the women that were taking the synthetic progesterone, um, in- Mm ... [00:10:00] in that group that developed the breast cancer. So really doesn't pertain to the estrogen, um, at all.

In other studies, they've found that women that start hormone therapy, uh, specifically estrogen, within that 10-year window of your last menstrual cycle or natural age of menopause, that there's actually a decreased risk of breast cancer. So- Mm ... um, it can be very breast, uh, protective, right? Mm-hmm. So something, you know, that they also did not tell us about.

In that same study, they were really trying to research the effects of hormones on cardiovascular health. They were looking at, you know, can estrogen decrease, um, cardiovascular disease risk or even improve cardiovascular function? The problem is, is a lot of these women were well past the age of menopause, and they did that on purpose.

Mm-hmm. Because they wanted... They knew that if they gave a woman in her early 50s, late 40s [00:11:00] estrogen, she would know she was in, you know, the, the control group because, "Oh, I'm not having hot flashes. I'm not having night sweats anymore." Okay. "So I know I must be getting the estrogen," right? So they picked women that were like a median age of, like, 65, right?

Okay. So anywhere from, like, 63 to even, like, um, early 70s, uh- Mm-hmm ... were the ages of these women. Um, and so a lot of them already had a l- other comorbidities. So that in itself, you know, when we're looking at- Mm-hmm ... starting hormone therapy in women, we, we look at all of the cormobities, comorbidities that they have.

And, um, women that already have some degree of heart disease, right, it's a little riskier- Mm-hmm ... to start hormones. So just the, the whole study and how they, how they looked at the data that they got, um, was really just misrepresented. 

[00:11:50] Penny Fitzgerald: Mm-hmm. 

[00:11:51] Sarah Norris: We did still find, though, um, that it can, in the younger women, i- in these...

This has been in studies following the WHI, um, [00:12:00] that hormone therapy, particularly estrogen, if started within that 10-year window from, um, last menstrual cycle or natural age of menopause, that estrogen is cardioprotective, and it can decrease- Mm ... one's risk of heart disease by 30 to 40%, right? So- 

[00:12:17] Penny Fitzgerald: Wow ... 

[00:12:18] Sarah Norris: that is huge.

Um- Mm-hmm ... that is also something that I wish every woman knew so that they could make their own decision on whether or not to start hormone therapy. 

[00:12:27] Penny Fitzgerald: Exactly. Yeah, just having the information so that you can make an informed choice, rather than just trusting You know, one piece of information 

[00:12:37] Sarah Norris: One piece of information, or a lot of times it's like w- the women aren't reading this study, right?

Right. They're talking to their friends, and, you know- Yeah, or they're 

[00:12:46] Penny Fitzgerald: going to the internet ... 

[00:12:47] Sarah Norris: other... Yes. And, like, is hormone therapy safe? And then, like, the first thing that will pop up is, "Oh, hormone therapy has been found to increase, like, stroke risk and breast cancer," and it's like, you know, you've just gotta be careful where you get [00:13:00] your information.

[00:13:01] Penny Fitzgerald: Right. Right. Well, and so much of that information was from that one study- 

[00:13:05] Sarah Norris: Mm-hmm ... 

[00:13:05] Penny Fitzgerald: many years ago- Mm-hmm ... that has been debunked. 

[00:13:08] Sarah Norris: Yes. 

[00:13:09] Penny Fitzgerald: And it- but it's still out there It's like anything on the internet. It is just there. It's forever. 

[00:13:15] Sarah Norris: Yeah. It's, it's true. I mean, and one, um, you know, kind of great landmark that we've made recently was the FDA has actually now removed, um, of the black box warning labels- Yeah

on estrogen products, right? So estrogen- Yeah ... products across the board. Um, sure, we know that, like, oral estradiol, even in bioidentical, um, form, the oral estradiol can still increase one's risk of a blood clot very, very, very slightly, right? But, um, in, in speaking of- That is saying that estrogen causes stroke or dementia or breast cancer is truthfully just wrong, incorrect.

Mm-hmm. And so, um, I know doctors have been trying to get that black box warning removed for a long, long time. It's [00:14:00] finally- Mm-hmm ... happened, which is great, and I think will really help decrease that fear, um, i- you know, amongst women- Yeah ... interested in taking hormones. 

[00:14:07] Penny Fitzgerald: Yeah. That's great. Yeah. Well, can you t- tell us a little bit about, um, taking progesterone with es- estradiol and how that works?

[00:14:16] Sarah Norris: Yeah. So in women with a uterus, we do need to prescribe a progesterone in conjunction with estradiol just to decrease the risk of uterine hyperplasia. So estrogen causes the uterine lining to build up all these extra cells, which without a progesterone, could increase your risk of uterine cancer. So a progesterone comes in, causes the uterus to shed those extra cells, um, pretty much negating your risk of uterine cancer.

So, um, that's, you know, essentially why we would prescribe a progesterone. Mm-hmm. However, I have lots of women, um, or I see lots of women that benefit from progesterone even if they don't have a uterus, [00:15:00] right? Progesterone is a- Mm ... lovely hormone that can really help with mood stability, um, especially- Mm ... if one is experiencing really heightened moods, um, anxiety, feeling panicky, maybe irritable, um, or difficulty sleeping, right?

If, if you feel like- Mm ... you can't shut your brain off at night to fall asleep, it, it can really- Mm-hmm ... benefit, um, sleep as well. 

[00:15:21] Penny Fitzgerald: Wow. 

[00:15:22] Sarah Norris: Yeah. 

[00:15:22] Penny Fitzgerald: So many things. And a lot of these things, I, I feel like when I'm talking with my girlfriends or in the last- Mm ... you know, 15, 20 years since- Yeah ... perimenopause for me.

[00:15:31] Sarah Norris: Yeah. Yes. 

[00:15:33] Penny Fitzgerald: Um, talking with women, you know, you don't correlate, you don't put it together that, okay, oh, this was a perimenopause thing, or this was a hormonal th- you know, like- Mm ... a frozen shoulder, a frozen hip, hair loss- Yeah ... not sleeping through the night. Yeah. All of those things I didn't equate with... I just thought, "Oh, I'm just getting older.

That's just a part- Yeah ... of getting older." 

[00:15:54] Sarah Norris: Or I'm in a stressful phase of life, and I'm sure I'm just stressed- Yes ... because I've got kids, and I'm working full [00:16:00] time, and I'm going to all these, um, activities, you know, running my kids around, um, managing a household, right? And I think that- Yeah ... as women in general, um, w- we tend to put a lot on our shoulders anyways, right?

[00:16:13] Penny Fitzgerald: For sure. Um, 

[00:16:14] Sarah Norris: but yeah, so I think a lot of us are in that same boat where we just feel like I'm sure it's just, it's just stress. I just need to maybe do a face mask and have a glass of wine or something, you know? 

[00:16:25] Penny Fitzgerald: But it's like, no. Well, that won't hurt, but- 

[00:16:26] Sarah Norris: Right? It, it never hurts. But, um, like those hormonal changes can begin as early as our mid to late 30s.

And so it's very- Yeah ... common for women to start noticing, um, some symptoms based on hormonal, um, fluctuations that early. 

[00:16:41] Penny Fitzgerald: Mm-hmm. Yeah. Uh, I just am so grateful to learn all of these- Mm-hmm ... things. And now that ... I'm grateful that we're all talking about it now finally. Yes. You know? That it's really getting more, um

Oh, it's the taboo is gone. 

[00:16:55] Sarah Norris: Yes. Taboo- That's happened ... is gone. I think we're really starting to see the pendulum kind of shift back the other [00:17:00] way, um, towards- Mm-hmm ... look, hormones are good. They're beneficial, right? So- Yeah. 

[00:17:04] Penny Fitzgerald: Yeah ... 

[00:17:04] Sarah Norris: um, yeah, it's been a really fulfilling part of my career. Um, I've, sometimes I just feel like the middle man of like-

let's just give you back some of your hormones, right? I mean, these are things your body once produced. Um, it's always kind of been my goal in doing so, like, I want women to be able to, um, self-schedule, right? They should be able to just- Mm-hmm ... reach out and come see me if they want to or come see a provider if they want to, because a lot of women have talked to their primary care docs and they're like, "Eh, it's, it's just part of life.

You don't, you don't really need the hormones," right? Um- 

[00:17:39] Penny Fitzgerald: Yeah, they haven't been trained. 

[00:17:41] Sarah Norris: They, and they haven't been trained. And so there's no- Yeah W- I get, I get it, right? I didn't get the training- Yeah ... either. And so I, I, I think at the same time, though, women felt like, "Well, if my doc... Like, I don't want my doc to be mad if I'm going to see someone to talk about hormones."

Oh my gosh. You know? I don't want them to feel like I'm- It's your body ... [00:18:00] creeping around behind their backs or anything. But, um, and then it was also really important to be able to see women in a setting where they can bill insurance, and then also- Mm-hmm ... go get their hormones and have it be covered by insurance, right?

Because the- Right ... hormones, bio-identical hormones, you don't have to go to some fancy compounding pharmacy for them. They're available at your local pharmacy, right? Mm-hmm. And go to Walgreens and pick it up and use your insurance. So they should be affordable. They should be accessible and, and to me that was really important, um, for, to provide to women.

[00:18:34] Penny Fitzgerald: Yeah. That's amazing. And you have had, I don't know if that, if we mentioned this yet, um, you are now certified as a menopause- 

[00:18:41] Sarah Norris: Mm-hmm ... 

[00:18:42] Penny Fitzgerald: provider. 

[00:18:43] Sarah Norris: Yep. Yep. Yeah, and the- The, um, Menopause Society, so they have a certification, and they provide a lot of great information too for, for, um, women in general, right? Not just those in the healthcare field.

So- Mm-hmm ... the Menopause Society has a lot of great resources for women if you're interested [00:19:00] in, you know, looking up, um, any more information on hormones or just menopause in itself. 

[00:19:06] Penny Fitzgerald: Mm-hmm. Yeah, I, I, um, I just feel like e- It's harder to find people who, providers who are- Mm-hmm ... very knowledgeable as you are, you know?

Yeah. I mean, it's really, there aren't enough of you. 

[00:19:21] Sarah Norris: Yeah. Love 

[00:19:22] Penny Fitzgerald: to clone you. Well, 

[00:19:22] Sarah Norris: thank you. And I did just recently finish, um, educating some primary care, um, providers in our area- Awesome ... just kind of providing the basics, right? Yeah. Because again, it was like we didn't get that, and I know that women now are talking about it.

They're asking their doctors, right? Which is great. And I really, um, I've always kind of felt like education is key, whether that is for my patients, um, for myself, or for my colleagues, right? And it's like you give someone the education and the information they need, I mean, they can be successful. And then, you know, now we've got providers that are really wanting to provide [00:20:00] great care to their patients.

Mm-hmm. And so that was a lot of fun to be a part of. Um, and I think a lot of providers were very grateful to have just good information, and hopefully we see, um, that being offered more in just the primary care setting now. 

[00:20:15] Penny Fitzgerald: Mm-hmm. Yeah, I think that's a great step forward. 

[00:20:18] Sarah Norris: Mm-hmm. Absolutely. 

[00:20:19] Penny Fitzgerald: Um, can you talk a little bit more about the vaginal, um, estrogen?

Mm-hmm. 'Cause I feel like that's, you know, it's something that's out there. 

[00:20:28] Sarah Norris: Mm-hmm. 

[00:20:28] Penny Fitzgerald: Um, I've heard about it long ago- Yeah ... but never used it because it kinda seemed gross to me. 

[00:20:34] Sarah Norris: Yeah, yeah, absolutely. It does, it seems a little weird. And, you know, I think, um, when we talk about vaginal estrogen, so we've gotta talk about the genitourinary syndrome of menopause, okay?

Yep. So this is also a real syndrome, right? This, that encompasses- Mm-hmm ... symptoms associated with, um, you know, the, the vagina, with vaginal dryness, um, which can lead to, um, uh, [00:21:00] pain with intercourse, bleeding with intercourse. The tissue of the vulva, um, and the vagina becomes very tight and thin, um, can be very, very painful, right?

Mm-hmm. I think this is something that's very slow to progress to where all of a sudden one day you're like, "Man, sex is really painful." That'll do a whole lot to a woman's libido too, right? Oh, for sure. Like if all of a sudden sex is painful, you're not desiring sex, right? Um, and so that's not something that's just a natural part of aging, if, you know, you ask anyone.

Um, but not only does it impact, like, vaginal and vulvar health, um, but the urinary system. Mm-hmm. So the urethra, the bladder, um, in addition to the vaginal vault, very highly, um- There's lots of estrogen receptors in, in the whole pelvis, and so when we are not producing enough estrogen anymore, we start to see changes not only with the, the tissue, but, um, in [00:22:00] urinary symptoms like urgency, frequency, burning with urination.

I see a lot of women that feel like they have an infection, like a UTI quite often- Mm ... and they don't. It's just the tissue changes in the bladder, maybe some inflammation, right, that can be causing- Mm-hmm ... um, these symptoms. So by replacing estrogen to the pelvis, so with vaginal estrogen, either with a cream, a ring, or a suppository inserted regularly, like one to three times a week, kinda depending on the severity of symptoms- Mm-hmm

um, it can really improve the urinary symptoms, um, the, uh, tissue integrity in general, uh- Mm-hmm ... helps the vaginal vault produce its own natural lubrication again, so it can really help with that pain with intercourse Estradiol itself, um, can decrease inflammation in the tissue in the bladder. It, um, restores blood flow to the tissue.

So I typically have women use the [00:23:00] intravaginal cream suppository or ring, but then also applied externally some cream to, like, the, the clitoris, the labia minora, and just the whole vaginal opening to really restore blood flow to that area. Um, you know, when we think about sexual function, something else that can decrease with age is, um, the ability to orgasm, right?

Mm-hmm. Or maybe it takes longer, or it's ... they're just not as intense. So if we can increase blood flow to the clitoris and the vulvar tissue, that can really improve, um, orgasm quality and, um, achieving orgasm. Mm-hmm. So lots of benefits to vaginal estrogen. Um, and again, I think, you know, when, when you realize what it can do, then you're like, "Okay," instead of it being like, "Oh, you've got recurrent UTIs.

Here, use this cream in your vagina three times a week and it'll fix you right up," right? And women are like, "Ew, I'm not doing that." Like, "No. Why?" Yeah. "Why the hell is a cream in my vagina gonna fix [00:24:00] my UTIs?" Mm-hmm. But if we really kind of, again, educate the women on why it's working, what it's doing in the body, then they're like- 

[00:24:07] Penny Fitzgerald: Mm-hmm

[00:24:08] Sarah Norris: "Makes sense," right? I mean, it's- Maybe it's 

[00:24:09] Penny Fitzgerald: worth it. Yeah. 

[00:24:10] Sarah Norris: Yeah. Yeah. 

[00:24:11] Penny Fitzgerald: The thing that shocked me the most, I think, is I was a pretty regular, okay, 3:17 to 3:23. I don't know why, but- 

[00:24:18] Sarah Norris: Yeah. ... 

[00:24:18] Penny Fitzgerald: every time I'd look at the clock- Yeah ... I would have to get up to go to the bathroom. 

[00:24:22] Sarah Norris: Yeah. 

[00:24:22] Penny Fitzgerald: I don't have to do that. 

I sleep through the night now. 

[00:24:24] Sarah Norris: I love hearing stories like that. Um, I think that when I'm first talking to women about vaginal estrogen cream, and they, they probably leave my office and think, "This lady's crazy," like, "She's obsessed- ... with this cr- vaginal cream," right? And but then it's like they come back in a few months and they're like, "Oh, my God.

I haven't had an infection in four months. Um, I can have penetrative intercourse with my husband," you know? Like- Mm-hmm ... "I'm not dry anymore." Mm-hmm. And a lot of women are like, "I didn't even realize I was dry," until you're not, you know? Yeah. Um, so it's... Yeah, I mean, it... And then those, the urinary symptoms, that's the other thing.[00:25:00] 

Sure, we can give women medications for urgency and having to get up at night a couple times. 

[00:25:07] Penny Fitzgerald: Mm-hmm. 

[00:25:07] Sarah Norris: But then you're on a medication for, you know, probably the rest of your life. 

[00:25:11] Penny Fitzgerald: Mm. Yeah. 

[00:25:11] Sarah Norris: Those bladder medications come with side effects. Mm-hmm. Vaginal estradiol really doesn't, right? Yeah. So, I mean, very, very safe for women of all ages to use.

[00:25:22] Penny Fitzgerald: Plus, you know, if you're taking something orally, that goes- Mm-hmm ... through your kidney and liver, right? I mean, you have- Yeah. I n- I need my liver for other things. 

[00:25:31] Sarah Norris: Yes, yes, we do. Yes, we do. 

[00:25:35] Penny Fitzgerald: Yeah. Yeah. Yeah. My husband and me were talking about all of this and, um, he said, "Tell your urologist I'm a big fan."

[00:25:46] Sarah Norris: Happy to help. 

[00:25:47] Penny Fitzgerald: Yeah. 

[00:25:48] Sarah Norris: Always happy- Yeah ... to be of service. 

[00:25:50] Penny Fitzgerald: Yes. I'm a big fan, too, by the way. 

[00:25:52] Sarah Norris: Yes. Well, thank you. 

[00:25:54] Penny Fitzgerald: Yes, absolutely. Um, tell- talk a little bit about testosterone, if you would. 

[00:25:59] Sarah Norris: [00:26:00] Yeah. So, um, one thing that most women don't know is that our ovaries produce more testosterone than estrogen, right? Hm. Wow.

So testosterone is a very important hormone for women. It's just, again, one of those things that we were failed, um, to be taught in health class, you know? Yeah. So, um, we produce about a 10th of the testosterone that men do, but testosterone is still very important when it comes to sexual function, cognition, mood, muscle mass maintenance.

So lots of benefits can be had from testosterone replacement therapy. A lot of women may think, "Well, how do I know if I need that? Um, or, you know, will I benefit that, from testosterone?" So I always look at symptoms when we talk about, um, prescribing testosterone in women, but I think it's important to note that our testosterone levels peak when we're in our 20s and 30s, and then that is one that doesn't fluctuate a whole lot, [00:27:00] you know, through perimenopause like our estrogen and progesterone, progesterone do, but it kind of just slowly peters out, right?

Mm-hmm. Until it's at a very low amount. Um, so and, and testosterone levels in women are going to vary, right? We don't know, um, really what our testosterone level peaked at because we don't regularly check hormones in women- Right ... when we're, unless there's, like, some fertility issues going on or other hormonal, um, issues going on.

But so testosterone can be very beneficial. We do have really good guidelines, um, on how to prescribe testosterone in women, uh, specifically for female sexual dysfunction or, um, low libido. So we prescribe testosterone at a very low dose compared to men. It's usually about 5 milligrams a day. You can get that compounded.

Um, there is not a female FDA-approved testosterone product in the US yet. Mm-hmm. So a, you know, compounding pharmacy is a great way to go. Um, [00:28:00] we have some ways of, uh, prescribing male products, you know, off-label clearly. 

[00:28:05] Penny Fitzgerald: Mm-hmm. 

[00:28:06] Sarah Norris: Um, but to get that testosterone replacement, um, and to have it still be cost-effective, right?

[00:28:12] Penny Fitzgerald: Right. 

[00:28:12] Sarah Norris: But yeah, I mean, I see a lot of women benefit significantly, um, when it comes to libido, mood, energy levels- Mm-hmm ... um, focus, uh, motivation. So it can be really helpful, whether you're a woman in your 30s, 40s or even, you know, a woman in your 70s. 

[00:28:31] Penny Fitzgerald: Yeah. It's, it's kind of shocking. I think, um, a lo- well, a lot of it is, but 

[00:28:37] Sarah Norris: Yeah 

[00:28:37] Penny Fitzgerald: And, and I don't know if we talked about this yet, but it, being y- your hormones, every, like a h- a man and a woman, that we both have- Mm-hmm

estrogen and- 

[00:28:46] Sarah Norris: Yes ... 

[00:28:47] Penny Fitzgerald: um, testosterone. That I think is, you know, growing up you think estrogen is for girls and testosterone- Yeah ... is for boys. Yeah. But it's not. That's not true, right? But- Yeah ... during, um, our [00:29:00] childbearing years, our... Can you talk a little bit about the levels? Like, we, we have a higher level of estrogen and then it just crashes in menopause.

Yes. Correct? 

[00:29:08] Sarah Norris: Yes. And so typically, I mean, again, we don't do a whole lot with, like, checking, you know, our hormones, um- Mm-hmm ... throughout the month. But on average, during the reproductive years, a woman's estrogen level's gonna be at, like, a, anywhere from maybe 30 to 50, and then before your period it's gonna spike up anywhere to maybe 300, 500, 700.

Wow. Right? Um, and then come back down. Um- Mm-hmm ... where progesterone kind of also has those, um, peaks and valleys as well throughout the month, uh, according to- Okay ... you know, other hormone responses in your body. Um- Mm-hmm. And so again, when we're pregnant, then our estrogen levels can creep up to the thousands, right?

Even ten thousands. Wow. So very dominant hormone, while men, they have usually a pretty steady state of estrogen in their bloodstream, you know, maybe [00:30:00] around 30 to 40, um, you know, throughout the, their lives essentially. 

[00:30:05] Penny Fitzgerald: Mm-hmm. 

[00:30:07] Sarah Norris: In perimenopause, we don't have that predictable, uh, flow or influx of hormones. It just is kind of all over the place- Mm-hmm

as our body's trying to ovulate and kinda get every last egg out that it can, right? And then once we reach menopause, we're just essentially at zero, like zero progesterone- Wow ... zero estrogen, and then our testosterone is slowly creeping out the door too. Okay. So then men, when... You know, I, I talk to a lot of wives, and it's like your husband probably has more estrogen than you do right now, so if we can at least match your level to his, I mean, that would be great, right?

You'd probably be- Yeah ... feeling a whole lot better as well. 

[00:30:47] Penny Fitzgerald: Mm-hmm. Yeah, that's, that swing is just mind-boggling really. 

[00:30:53] Sarah Norris: Yeah. And 

[00:30:53] Penny Fitzgerald: I- And it explains a lot. 

[00:30:55] Sarah Norris: It does, and I think those fluctuations of the hormones in general, um, are, [00:31:00] you know, really are what c- are causing the symptoms in women, whether it's physical or, like, the cognitive or mood changes.

Um- Mm-hmm ... you know, a lot of women are very sensitive to those hormone fluctuations, and they can always tell, like, "You know, I'm gonna be starting my period here in the next day or two." Mm-hmm. "I can tell based on how I feel." Yep. Right? 

[00:31:17] Penny Fitzgerald: Why am I so pissed off? And so- Yeah. Yeah. Four days 

[00:31:21] Sarah Norris: later. Yeah. And so I feel like when you're really sensitive in your reproductive years to those hormonal fluctuations, um, perimenopause can be quite rough.

[00:31:29] Penny Fitzgerald: Mm. Preach. 

[00:31:32] Sarah Norris: Yeah.

[00:31:35] Penny Fitzgerald: Oh my gosh. I, I just feel like, um, we've covered so much, but I know I'm not thinking to ask you everything. What other things do you encounter in your practice or, um, have you noticed? 

[00:31:47] Sarah Norris: Yeah. Um, I mean, I guess if we're speaking particularly around women's health, right? Um- For sure ... I have just found it very fulfilling, um, to be one to [00:32:00] ask kind of the hard, awkward, uncomfortable questions, right?

Um, and again, I think it's just because I wanna know the answers to those questions. Mm-hmm. So when it comes to, like, sexual health, right, I think that I, I really like to provide a safe place when it comes to sexual function, sexual health. Um, and so, you know, libido is something that we discuss quite often.

Mm-hmm. And I think as a urology provider, it fits really well, um, with, with, um, what I do, right? With kind of the field- Mm-hmm ... that I'm in. Um, and there's been so much focus on men's sexual health in history. Oh. So- 

[00:32:36] Penny Fitzgerald: Yeah ... 

[00:32:37] Sarah Norris: to be able to provide good sexual health to women has been very fulfilling, and I think very validating to women, too, because a lot of women will come in and say, "I just have no desire for sex anymore."

And it's like, well, let's, let's break this down a little further, right? Because desire is a very complex topic. Oh, 

[00:32:56] Penny Fitzgerald: yeah. 

[00:32:57] Sarah Norris: And so a lot of times when we break it down, we can say, [00:33:00] "Well, is sex painful," right? And they're like, "Yeah, I am so dry. It's very painful to have sex." Okay, well then, clearly you're not going to desire that, right?

Mm-hmm. So if we can fix the physical aspects of that, um, and improve the comfort and quality of, of intercourse for them, then, um, they might desire it a little more, right? 

[00:33:20] Penny Fitzgerald: Mm-hmm. 

[00:33:20] Sarah Norris: We, um... Or if it is truly just I just don't think about it, and I would love to initiate sex with my husband. Like, I love him. I want to have sex with my partner, right?

Mm-hmm. But just not thinking about it can be very, um, devastating for women, right? It's like I used to be- Mm-hmm ... a very sexual being, like, what's wrong with me? Um- Right ... and truly, there's nothing wrong with you, right? And it is okay- Mm-hmm ... to want to desire sex, right? Like, that is okay. And I think for women 

[00:33:51] Penny Fitzgerald: to- 

[00:33:51] Sarah Norris: You know, 

[00:33:51] Penny Fitzgerald: that's-

realize that- ... big ... yeah, it is. That's just a shift, you know, 'cause, um- Depending on how you grew up, but you know- Yeah ... to, to want to [00:34:00] desire sex, that's a big- Yes ... shift for a lot of us. 

[00:34:03] Sarah Norris: It is. And it's, it's one of those things too that I think as women we've always kind of... It's, it's never that like we can't have it, 'cause we can always receive penetration, right?

But it's like we are more than just like this receptacle for penetrating partners. More than a vessel. 

[00:34:18] Penny Fitzgerald: Yeah. 

[00:34:18] Sarah Norris: Yeah. And so I think it, you know, it's, it's important to discuss that with women and having a, a healthy libido if you want, we can do that. There are a couple- Hmm ... new medications on the market that have been out, um, just recently within the last few years, um, targeted specifically at hypoactive sexual desire disorder, so for low libido in women, right?

[00:34:43] Penny Fitzgerald: Um- I didn't even know that's a thing. 

[00:34:44] Sarah Norris: Yeah, yeah. And so new medications that are out there, you know, I still love testosterone as a first line treatment for libido just because of the other benefits that it can offer. Mm-hmm. But, um, these other medications that exist, there's one, it's an [00:35:00] oral pill. You would take it daily.

Um, it's called Addyi or the little pink pill, so there's a lot of talk about that lately. Hmm. Um, but that can... It works in the serotonin receptors. It's a serotonin agonist/antagonist, um, so actually works within the brain, right? Okay. To help with libido, with the mood. So that is a great option for women.

And then there's also like an as needed injectable formulation of like a cyclic, uh, peptide medication, um, that w- we don't really know why it works to increase libido. They discovered that it... They were looking at this medication, it's a mel- melanocortin receptor agonist, which when you, when you think like melanin you think of skin pigment, right?

Yeah. So they were studying this agent when they were looking at like how the skin tans essentially. Okay. And found out that in the people that were using it had increased libido. So- Oh, really? ... [00:36:00] now we have this other great treatment option for low libido for women. 

[00:36:03] Penny Fitzgerald: Wow. 

[00:36:03] Sarah Norris: So I just... Yeah, I think it's important for women to know that you're not alone in that either.

Mm-hmm. There's help, you know. If you want to want sex- ... if you want to think about it- Uh huh ... that is fine, right? And so there are- Yeah ... things to try. 

when we think of, like, serotonin, um, receptor inhibitors, right?

Or medications- Yeah ... for, like, um, depression. 

[00:36:27] Penny Fitzgerald: Sleep, right? 

[00:36:28] Sarah Norris: Anxiety and sleep. Yeah. So, like- Mm-hmm ... antidepressants, um, they can cause low libido, right? And so there's a lot of- Okay ... um, SSRIs, SNRI medications like the Prozac, um, Well- Mm ... or not Wellbutrin, but like Effexor, like all these medications that work- Uh-huh

with the serotonin receptors in the brain. 

[00:36:49] Penny Fitzgerald: Uh-huh. 

[00:36:50] Sarah Norris: And they can cause low libido. So then this medication kind of comes in and causes the- Wow ... opposite effect. Yeah. 

[00:36:56] Penny Fitzgerald: Okay. 

[00:36:57] Sarah Norris: Yeah. 

[00:36:58] Penny Fitzgerald: Wow. [00:37:00] Fascinating. And so, a- a- all these, this, the chemical imbalance that we could go through- Mm-hmm ... just because of the hormones is just- Yeah

fascinating and, um, yeah, I'm so grateful that there are people out there studying it like you and talking about it and- 

[00:37:16] Sarah Norris: Yeah. It's important- 

[00:37:18] Penny Fitzgerald: Making it okay ... for 

[00:37:18] Sarah Norris: sure. 

[00:37:19] Penny Fitzgerald: Yeah. Yeah. Um- You know, the other thing I, that, um, I thought of when through this whole process was how important it is for elderly women- 

[00:37:32] Sarah Norris: Mm-hmm

[00:37:32] Penny Fitzgerald: to know about the vaginal cream especially. Mm. But the hormone replacements, you know, as we're aging. 

[00:37:38] Sarah Norris: Mm-hmm. 

[00:37:39] Penny Fitzgerald: I remember when Mom and Dad were in the care center. 

[00:37:42] Sarah Norris: Yeah. 

[00:37:42] Penny Fitzgerald: And a lot of the women in there had UTIs and were- Mm-hmm ... just miserable. 

[00:37:48] Sarah Norris: Yeah. 

[00:37:49] Penny Fitzgerald: And it was just part of aging. I mean, that was just something that- Yeah

they had to deal with. And but that, the vaginal cream is now helping that, right? 

[00:37:58] Sarah Norris: Yes. And it can. So I mean, [00:38:00] the vaginal estrogen alone can decrease a woman's risk of UTI by 60 to 80%. And it's so common in our elderly, um, female population just because- Mm-hmm ... they've been without estrogen for decades, right?

Right, right. And so we see that quite often. Um, and I think that it's important to know, so like, if, if, you know, if your listeners have moms or aunts or, you know, family members- Yeah ... that are in a care facility, there are other options than the vaginal cream, right? I have a lot of- Okay ... elderly patients that maybe live at a facility, and they don't want the nursing staff putting vaginal cream.

[00:38:36] Penny Fitzgerald: Right. You 

[00:38:37] Sarah Norris: know?

So they do make, um... They have a, a vaginal estrogen ring. It's called the Estring, and that can be placed by a healthcare provider. Mm-hmm. It stays in for three months. Oh, nice. Provides that local estrogen therapy. Uh-huh. And then when they can go back to their doctor and have it removed and put back in.

Okay. And so very easy. Um, it's similar to, like, I don't [00:39:00] know if you remember, like, the NuvaRing birth control. There was, like, a little- Yeah ... silicone kind of ring. So it's very- Mm-hmm ... very flexible, um, very easy to insert and remove, um, and can be a really good option so that then those elderly women aren't having to, you know, have their nursing staff- Yeah, that 

[00:39:16] Penny Fitzgerald: invasion.

[00:39:17] Sarah Norris: Yeah. Yeah. Ugh, yeah. And you know, I think there's, like, a generational divide there, too, of, uh, comfortability with even- 

[00:39:24] Penny Fitzgerald: Oh, yeah ... 

[00:39:24] Sarah Norris: touching the vagina, right? So we just- Right ... we want them to be comfortable as well. 

[00:39:29] Penny Fitzgerald: Even talking about it, I'm sure. You know? Yeah. And, and yeah, all of it is... That's, that's a difficult conversation for a daughter to have with a mom.

[00:39:38] Sarah Norris: Mm-hmm. 

[00:39:38] Penny Fitzgerald: Probably. 

[00:39:38] Sarah Norris: It is. Yeah, it really is. Yeah. 

[00:39:41] Penny Fitzgerald: Mm-hmm. Wow.

[00:39:43] Sarah Norris: um, I, it, it can be overwhelming I think too for women- Oh, for sure

to take it all in. 

[00:39:48] Penny Fitzgerald: Uh-huh. Yeah, what are, um... And I know you gave me a whole list of resources to- Yeah ... go to. Um, I'll include that, that list in my show- Yeah ... notes for people. That's 

[00:39:59] Sarah Norris: great, [00:40:00] yeah. 

[00:40:00] Penny Fitzgerald: Yeah. Is there any- anything that, um, anyone listening, what should they ask i- when they go to their primary care provider?

What, what would be a good way to start the conversation? 

[00:40:13] Sarah Norris: Yeah. Well, I think, um, you know, b- being educated for one, and knowing, you know, like, that, that there are safe routes of estradiol for essentially anybody, and that you, it's not too early to start them. So if you're still having menstrual cycles, sometimes that's a big, like, "Oh, no, you don't need it yet," right?

Hmm. But if you are having symptoms and things ju- something just feels off, I think that's what I hear the most is that, "I can't put my finger on it." Hmm. "I just don't feel like myself," right? "Something is wrong." Um, that should be a, a trigger to talk to your doctor, um, about possibly starting some hormones.

if you do share that list, there's a lot of great resources on there from urologists, OBGYNs, internal [00:41:00] medicine doctors, that they review all the data. And so you are going to get very good knowledge from those providers. But, um, I, I think to say, you know, to even to take in a, a, a, a paper, you can take in the Menopause Society's mission statement from 2022- Mm-hmm

and it says exactly what the hormones can be used for, and it talks about the safety and efficacy. So if you feel like you need fuel for your fire- Mm-hmm ... you know, to start this conversation- ... take that in and say, "I, you know, I have read that estradiol- Mm-hmm ... is safe and can help with this, and I would like to try some."

I mean- Mm-hmm ... there's really very few side effects or risks to using a hormone that your body actually produces, um, compared to some other medications that you may be offered, right? 

[00:41:51] Penny Fitzgerald: Mm-hmm. Yeah, absolutely ... 

[00:41:53] Sarah Norris: and, and don't give up, right? Like, you, you can always seek out someone else. I think that [00:42:00] healthcare, it really does require a team of people on your side.

Yeah. Right? Yeah. And so if you have your primary care doc, and you love them, and they're taking care of your immunizations and your annual physicals and getting you referred to places that you need to be, that is amazing. You need a good primary care provider in your corner. But, like, to, to seek out other specialties, um, to really help build your healthcare team to make you feel very well-supported and healthy, that's very important.

Mm-hmm. So never be afraid to seek out other specialties or providers. 

[00:42:31] Penny Fitzgerald: Yeah, absolutely. You know, when I look back to when I first started having symptoms- Mm ... I couldn't put my finger on anything really. Mm-hmm. You know? I mean, 'cause those, some of those things sneak up on you. You know, you might have- Yeah ... a little, you feel a little off.

Yeah. But I'm just going through a phase, or I'm stressed out, or, you know, something might be going on. For me too, a lot of them, I, I would have some of these symptoms for a few months at a time, a few weeks at a time. Mm-hmm. And they'd go away for a while, and [00:43:00] then- Yeah ... something else would pop up, like the frozen shoulder.

I mean, it was- Yeah ... it was so weird. I would have it for seven or eight months- Mm-hmm ... and poof, it's gone. You know, I went to- Yeah ... physical therapy. Didn't help it really, and then- Yeah ... it's just gone. You know, some of those things just, I didn't, equate those things with maybe it's hormones.

You know? Yeah. 

[00:43:24] Sarah Norris: I think that's very common. And, you know, I, what I hear a lot of women say is, you know, "I do- I don't know if I have adult onset ADD. Am I- Right ... developing dementia? Um, do I need a divorce and move out of the country?" You know? Like, what is, do I have, like, insomnia all of a sudden? Like- 

[00:43:44] Penny Fitzgerald: Uh-huh

[00:43:44] Sarah Norris: and, and I think that's why when you go to the doctor it's like, "Oh, well, here, we can, you know, yeah, try physical therapy." Here's 

[00:43:49] Penny Fitzgerald: Ambien, and here's this- Try, yeah, here- ... and- 

[00:43:51] Sarah Norris: Yes, here's an antidepressant. And it's like, but I'm- Yeah ... not depressed. 

[00:43:55] Penny Fitzgerald: Right. 

[00:43:55] Sarah Norris: But I don't know, I just can't put my finger on it. And to me, that screams [00:44:00] perimenopause, you know?

And I just, it's like- 

[00:44:02] Penny Fitzgerald: Exactly ... 

[00:44:02] Sarah Norris: ugh, you know? I mean, they, there was a study done recently where they looked at women aged 35 to 55- Mm-hmm ... um, and just asked about the, the statement of I don't feel like myself, right? The not feeling- Mm-hmm ... like yourself is just- Yeah ... it's, like, almost its own symptom. And, like-

60% of women reported that in that age category. Just, like- Wow ... their symptoms aligned with this I do not feel like myself. Um- Yeah ... and that, I think that just speaks volumes, and I think, a- again- Mm-hmm ... to show that a lot of women are living through that exact same, same thing. Yeah. 

[00:44:37] Penny Fitzgerald: Well, and for years, because it wasn't studied, uh, I think a lot of women were told it's all in your head.

[00:44:44] Sarah Norris: Mm. Yes. 

[00:44:44] Penny Fitzgerald: I distinctly remember my mom going through some perimenopausal, um, issues, episodes, problems, um, back years ago, and she was told, "Oh, it's all in your head." 

[00:44:57] Sarah Norris: Yeah. And that's awful. I mean, [00:45:00] because then women don't wanna talk about their symptoms, right? Right. Because they feel like, "Oh, they're just gonna think I'm crazy," you know?

[00:45:06] Penny Fitzgerald: Something's wrong with me. Yeah. Yeah. Um, I think- Something's wrong with me 

[00:45:11] Sarah Norris: or nobody cares. Yeah, or n- or they're not gonna do anything anyways, so why should I bring it up? Right. Right? 

[00:45:15] Penny Fitzgerald: Yeah. 

[00:45:15] Sarah Norris: Um, I think it's important to note too that, like, there are some women who coast through menopause without a lot of physical symptoms.

They feel fine, right? Like- Mm-hmm ... great. Lucky them. That's amazing. But those women should still have the conversation about hormones, because when we do look at estrogen, um, being, you know, uh, approved to prevent osteoporosis, so not only does it prevent the loss of bone, but can promote bone rebuilding, right?

So- Mm-hmm ... I think that's really important, too. Um, you don't have to be struggling with these symptoms to still benefit- Mm-hmm ... from estradiol. Um, even at a very low dose of estradiol, you can have that, uh, those good benefits to bone health. Um, and then again, if started within that [00:46:00] 10-year window, um, can be very protective of, uh- Mm

your cardiovascular health as well. So- Hmm ... for women that don't have symptoms, you can still benefit. 

[00:46:10] Penny Fitzgerald: Wow. How common is it to not have symptoms during menopause or during perimenopause? 

[00:46:15] Sarah Norris: You know, I, I really don't know that exact statistic. I don't know that number. I know 

[00:46:19] Penny Fitzgerald: one woman in my circle. Yeah. One.

[00:46:21] Sarah Norris: Yeah. 

[00:46:22] Penny Fitzgerald: 

[00:46:22] Sarah Norris: Yeah. I know, and it's like, this is not fair. And I've, I've only come across a couple in my practice as well, and they have come in- Mm-hmm ... just to discuss, like, well, what are the benefits? Like, I'm not having any of these symptoms. What are the benefits? And I think that's great, because, um, you know, some women may feel like, "Well, shoot, if estrogen can do this and this and this, they're not gonna prescribe it to me because I'm not symptomatic."

And it's like, that's not true. You can still reap the- Yeah ... benefits for bone health and heart health, so. 

[00:46:50] Penny Fitzgerald: Yeah, yeah. And that kinda shows, if you have not encountered much of it, that I, I mean, that's just a anecdotal reference. Mm. But- 

[00:46:59] Sarah Norris: Yeah ... 

[00:46:59] Penny Fitzgerald: you know, [00:47:00] there's not many, there are not many of us who have not had- There-

something. 

[00:47:03] Sarah Norris: Correct. Correct. Yeah. 

[00:47:05] Penny Fitzgerald: Yeah. Okay. Okay, can I switch gears on you? 

[00:47:08] Sarah Norris: Yes, please. 

[00:47:11] Penny Fitzgerald: What's your favorite cocktail or glass of wine? 

[00:47:14] Sarah Norris: Ooh, okay, so I am a sucker for a good glass of prosecco. Ah. Honestly. I love that. 

[00:47:20] Penny Fitzgerald: Just... Yes. Yeah, I love prosecco, too. 

[00:47:22] Sarah Norris: Dry prosecco. And, and- I, and I've loved that for years, right?

Um, and then my wine is more of like a seasonal thing. So I love like- Yeah ... in the fall, winter, I love a good like Cabernet Sauvignon. Uh-huh. I love a Pinot Noir. Mm-hmm. Um, and then in the summer, Sauvignon Blanc. Yes. Probably my fave. 

[00:47:41] Penny Fitzgerald: Mm-hmm. So, 

[00:47:42] Sarah Norris: but Prosecco year-round, love it. 

[00:47:45] Penny Fitzgerald: Love it, too. There's something about bubbles.

It's- Yeah ... you can make a Tuesday a celebration, so. 

[00:47:51] Sarah Norris: Absolutely. Absolutely. 

[00:47:53] Penny Fitzgerald: Yeah. Do you like spicy things? 

[00:47:56] Sarah Norris: I do. 

[00:47:57] Penny Fitzgerald: Um, try, if you're up for it, [00:48:00] try a sliced fresh jalapeno. Put a couple of rings in your Sauvignon Blanc next time you have a Sauvignon Blanc. 

[00:48:05] Sarah Norris: Um, I tried that once last year actually. 

[00:48:08] Penny Fitzgerald: You did? 

[00:48:08] Sarah Norris: We have, we grow a small garden in our house.

Yes. And we had some jalapenos sitting on the counter, and I just happened- Uh-huh ... to have a nice cold bottle of Savvy B in the fridge. And so I, I tried that, and it was fantastic. So. Isn't 

[00:48:20] Penny Fitzgerald: it good? 

[00:48:21] Sarah Norris: Yes. 

[00:48:21] Penny Fitzgerald: Yeah. 

[00:48:21] Sarah Norris: Very good. Yeah. 

[00:48:22] Penny Fitzgerald: It's almost lethal in Prosecco, though. I tried that one time- ... and it did not work. 

[00:48:27] Sarah Norris: The bubbles must do something to it, I would imagine.

[00:48:30] Penny Fitzgerald: They must- Yeah ... 'cause it was like, "Oh my God, I can't even get my nose up to it," 

[00:48:33] Sarah Norris: so. Yeah. Oh, that's funny. I won't, I won't try that then. 

[00:48:36] Penny Fitzgerald: Okay. Yeah, just word to the wise. 

[00:48:38] Sarah Norris: Yeah. Yeah, absolutely. 

[00:48:40] Penny Fitzgerald: So what's a, uh, w- a fun memory of sharing Prosecco or anything- Yeah ... uh, with some girlfriends? 

[00:48:46] Sarah Norris: I just think that there is nothing better than opening a bottle of wine with a- Yeah

girlfriend, whether it's out at a fancy restaurant, at a, a, a vineyard, or like at one of our houses in our comfy jammies and [00:49:00] just talking and being- Yes ... present and laughing. And I mean, you know, I think most women would agree that like time with your girlfriends is just, it's healing, right? It is- Mm. It is so amazing.

So much. And yeah, I, I mean, honestly I could be anywhere, you know, sharing a bottle of wine- Yeah ... with a girlfriend, and it's just, it's my favorite. So. 

[00:49:22] Penny Fitzgerald: Yeah. Me too. I think, um, the older I get too, the more important it becomes to- Yes ... spend time with girlfriends. 

[00:49:30] Sarah Norris: Absolutely. I've, I've really tried to focus on kind of scheduling that in at least- Yeah

once a month, you know? Um- I think once your kids are a little bit older and they don't need you as much anymore, that was a really hard time for me in my life, and it was like, nope, I'm reconnecting with my girlfriends, and it really just- Mm-hmm ... kind of brought me back to life. And it's like- Mm-hmm ... they get it, you know?

Yep. We understand each other, and you can laugh and you can cry and just never feel judged, and it's- Yeah ... girlfriends are the [00:50:00] best. 

[00:50:00] Penny Fitzgerald: It's awesome. And y- y- it's really important, I feel, to schedule that time because it, life gets in the way. It's just we get busy. Yeah. Other people take our prior- you know, other things are priority.

Yeah. And we put ourselves last so often. Yes. So it's just important, you know, make that a scheduled time and, and- 

[00:50:17] Sarah Norris: Mm-hmm ... 

[00:50:18] Penny Fitzgerald: do it. 

[00:50:19] Sarah Norris: Yeah. It's, yeah, very important. It's, not only do they fill your cup, you know, emotionally, but they refill your wine glass, right? 

[00:50:30] Penny Fitzgerald: Yes, they do. 

[00:50:32] Sarah Norris: They're always good at that. You can always count on your girlfriends for that.

[00:50:34] Penny Fitzgerald: For sure. For sure. I'm here for you. 

[00:50:37] Sarah Norris: Yeah. 

[00:50:40] Penny Fitzgerald: Oh, gosh. Um, is there anything else that you would love to share with my audience that I haven't, haven't asked you about? You know, 

[00:50:46] Sarah Norris: I, I don't know. I think we've covered quite a bit. Um- 

[00:50:49] Penny Fitzgerald: Yeah ... 

[00:50:49] Sarah Norris: so if there's any questions, you know, from anybody, you can always send them my way.

I'm happy to- Okay ... help, um, answer any questions or help when it comes to if you've got people wanting to [00:51:00] go to the doctor and, you know, what information can I, um, can I ask the doc, right? But again, those res- that resource list that I gave you- Mm-hmm ... a lot of the docs have lists, like on their website, that you can print out- Mm-hmm

and take to your primary care. So, um, they are all women's health advocates as well, which is why I love learning from them. So- 

[00:51:22] Penny Fitzgerald: Yeah ... 

[00:51:23] Sarah Norris: some good resources to share 

[00:51:25] Penny Fitzgerald: Awesome. I- if someone has questions and would like to reach out, how would you like them to get in contact with you? 

[00:51:31] Sarah Norris: Yeah. So they could, um, email me for, with questions.

Okay. Right? Mm-hmm. So, um, you have my email address if you can share that- Mm-hmm ... just on your- Yeah ... um, on your show notes. 

[00:51:40] Penny Fitzgerald: Sure. 

[00:51:41] Sarah Norris: Um- Yeah ... but if you'd, you know, if you are interested in actually coming for, like, a consultation, right? Mm-hmm. Um, my website, the, which you could probably share that, too, um, at mercycare.org- Uh-huh

you can actually self-schedule with myself and one of my colleagues. Um, I've got a nurse practitioner that I work with that is [00:52:00] also, um, practicing menopause hormone therapy as well. So, um, yeah, if you, if they wanna actually have a sit-down and have some r- you know, some designated time to discuss individual health needs and hormone needs, then they could get in touch with me that way.

[00:52:14] Penny Fitzgerald: Okay. Awesome. And you're in the Cedar Rapids area for- Correct ... those listeners that might not be nearby. Yeah. And- 

[00:52:19] Sarah Norris: Yep ... 

[00:52:20] Penny Fitzgerald: um, if, uh, do you know of a... Well, I think in your resources there's a, a link, but do you, how would you recommend someone listening from Houston or, you know, somewhere else- Mm-hmm ... how would they find a provider like you?

Yeah. 

[00:52:35] Sarah Norris: So the Menopause Society website, you can actually search for a Menopause Society certified provider, um, on their website. Okay. So, you know, I would start there, um, and because they're all over the country. Um, I would start there to find a, a provider. 

[00:52:50] Penny Fitzgerald: Okay. Awesome. This has been so fun. Thank you so much.

[00:52:54] Sarah Norris: It's- 

[00:52:55] Penny Fitzgerald: Very helpful ... it has been fun. 

[00:52:55] Sarah Norris: Thank you for thinking of me and having me on today.