267. Esther Blum Demystifies Hormone Replacement Therapy (HRT) for Perimenopause and Menopause Relief

In this 7th (and final!) episode of season 14, I interview integrated dietitian and menopause expert Esther Blum on all things hormone replacement therapy for women. In the past 27 years, Esther has helped thousands of women master menopause through nutrition, hormones, and self-advocacy. In addition to her incredible expertise, I always love having on  guests who have walked their talk. Known for being Gwyneth Paltrow's menopause mentor, Esther is the bestselling author of See ya later, Ovulator, among several other books.

Disclaimer: While this conversation leaned heavily torwards the benefits of HRT, it's critical for you to do your own research and, of course, to always check with your doctor. This episode—along with every other Insatiable episode—is not intended to replace professional medical advice. 

Among the Topics Covered:

• Why are so many women afraid of using horomone replacement therapy (HRT)?
• What symptoms would someone be experiencing that would make them want to even consider HRT? 
• What does HRT do exactly? 
• What are some of the first signs that HRT is working? 
• What are the different types of HRT?
• What are some of the risks associated with HRT?
• What are some considerations when researching HRT and discussing with your doctor?
• How is HRT part of a larger midlife puzzle, but not a silver bullet?

Guest: Esther Blum is  an integrative dietician, menopause expert and bestselling author of See ya later, Ovulator. Esther has been featured on the Today Show, ABC-TV, and Good Day NY and is frequently quoted in goop, Well + Good, Forbes, Fitness, and Time Magazine.

Mentioned in this episode:

• My once-a-year group program Truce with Food is open for registration through January 31st. 
• Inferior: How Science Got Women Wrong with Journalist Angela Saini (Insatiable Season 2, Episode 5)
• Dr. Pamela W. Smith's research

Transcript & Show Notes: alishapiro.com/esther-blum-interview-hrt/

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Transcript

Ali Shapiro [00:00:07]:
Hello, everyone. Today, we have integrated dietitian and menopause expert, Esther Bloom, joining us To delve deep into the world of hormone replacement therapy for women, you may have heard of hormone replacement therapy abbreviated as HRT. In the past 27 years, she has helped thousands of women master menopause through nutrition hormones and self advocacy. And I love to have people on who have also walked their own path of having to really figure their health out, and she has done that through working through Lyme Mold toxicity, and now she's also in the late stages of perimenopause. Esther is also the best selling author of See You Later, Ovulative, Cave Women Don't Get Fat, Eat, Drink, and Be Gorgeous, Secrets of Gorgeous, and the Eat, Drink, and Be Gorgeous project. She's also known as Gwyneth Paltrow's menopause mentor and by Forbes for helping women thrive through menopause. She's been voted the best nutritionist by Manhattan magazine, and she's appeared on the Today Show, ABC TV, and Good Day New York and is frequently quoted in Goop, Well and Good, And Forbes and Time Magazine. Esther received a bachelor of science in clinical nutrition from Simmons College in Boston.

Ali Shapiro [00:01:26]:
She's also graduate of the New York University where she got her master's of science in clinical nutrition, and she's also a certified nutrition specialist or CNS. And for those of you who don't know that, that's really nutritionists who take a functional approach to nutrition. I brought Esther on because she's nuanced. She has a depth of knowledge and has the chutzpah we all need when navigating our health in menopause, especially when it comes to considering HRT. And we're gonna get in today why into today why a lot of us when we hear HRT, especially for of a certain age, gen x and older, I would say, Who had this visceral isn't HRT bad reaction, which I did, and I wish I had known sooner that All the problems with that initial bias towards it. So I really want you all to be educated, and and Esther is gonna give you the education I wish I had had several years ago. You're and you'll learn more about why I value her combination of expertise in this interview. So before we get to this, Two quick mentions.

Ali Shapiro [00:02:34]:
1st, this episode isn't medical advice. No insatiable episodes are, but especially this one. You should always consult with your doctor. And in today's episode, Esther will tell you exactly what to say to your doctor if you want to experiment with HRT and what to do based on their reactions. And if you have to find a new doctor, she'll tell you how to find one that is qualified to support you during perimenopause or if you're in menopause, Also thought of his postmenopausal. 2nd, in the interview, I asked Esther about the term bioidentical hormone replacement therapy Because it's really confusing out here. So I wanted to make it clear here that bioidentical is indeed an accurate term, And Esther says this too. We just our conversation kinda went off on a tangent, and so I wanna make sure you realize that, yes, it is a term even though some doctors Dismiss it as a marketing term.

Ali Shapiro [00:03:31]:
What bioidentical means is that the hormones you are using have the same molecular structure With endogenous hormones in hormone replacement therapy. And endogenous just means the hormones your body naturally produces. Right? So if after this episode or if you're already on it, if you go on bioidentical estradiol, progesterone, or testosterone, What you're doing is is it's molecular the same as what your body produces. This compared to some doctors will recommend the birth control pill for hormone replacement therapy in menopause, but the birth control pill does not molecularly represent the estrogen we normally make. Or as we go into the Women's Health Initiative study that initially made everyone think hormone replacement therapy was bad, those Hormones they studied were not bioidentical either, and and Esther will tell you what they were made of. So you can get bioidentical from either an FDA approved prescription, like you'll hear, I'm currently on this through my insurance, through Big Pharma, Or you can go to a compounding pharmacy. So there are 2 different categories of bioidentical, but bioidentical is indeed a term. We talk more about this, but I wanted to make sure you walk away understanding what bioidentical means and why it matters.

Ali Shapiro [00:04:57]:
Okay. On to today's episode that I think is gonna really open your mind and hopefully empower you to advocate for yourself. Enjoy. Thank you so much for joining us today, Esther. You are just a wealth of knowledge, so I can't wait to get to let everyone learn from you. They're in for such a treat. Thank you. Where are you in your perimenopause or menopause journey?

Esther Blum [00:05:22]:
I am late perimenopause. I have been on an HRT cocktail for at least 2 years. I take progesterone nightly and by day I use ByEst cream blended with testosterone. That's transdermal Estrogen and testosterone. I use vaginal estrogen and testosterone twice a week as well and DHEA and Pregnenolone. So I am, like, locked and loaded, but my dosing does change. You know? It has we're slowly titrating it up as my ovaries wind the party down.

Ali Shapiro [00:06:02]:
Got it. Got it. I love that. So have you had a relatively What changed once you got on that, I guess? Did you know

Esther Blum [00:06:10]:
Sleep, for sure. You know, I had been really sick with Lyme and mold for a long Time and really insomnia and the inability to lift weights without crashing or do anything really other than walking without crashing was a real struggle for me. And once and then I also had brain fog, Irritability, so and just bad PMS. And so once I went on hormones, you know, moods Far more stable. Cognition, dramatically different, like, really firing on all cylinders. Vocabulary came back, and a chunk of that certainly was eradicating mold out of my brain too and my gut, but also the ability to strength Train again. I mean, I have a son who's almost 17, and we go to the gym together. And I just feel like The luckiest human in the world to lift weights and feel good while I'm doing it and then go home and sleep well.

Esther Blum [00:07:10]:
And I just I can't even tell you. I never took it for granted before, but now I'm, like, really just so like, I Just pinch myself every time. I'm like, I can't believe this is my life. I'm so grateful and happy.

Ali Shapiro [00:07:25]:
I love hearing that. Yeah. My main Menopause symptoms, it was insomnia, and I got a lot better by learning all the things that you need to change. But when I got on HRT, the sleep, I'm dreaming again. The the cognition came back, and I feel like you do. I'm like, I just I pinch myself knowing I'm gonna get a good night's sleep every night. And I've always been a great sleeper about those things. And, yeah, my performance at the gym is improving, and it's just like, oh my god.

Ali Shapiro [00:07:53]:
I'm just so grateful. You know? We were joking before we got on that I'm integrating my big pharma shadow because I'm like, thank you, big pharma. I thought I you know? I mean, with discernment.

Esther Blum [00:08:05]:
So now are you on FDA versus bioidenticals? Like, what's your cocktail when you say big pharma?

Ali Shapiro [00:08:12]:
Yeah. So I just started, and we'll get into this. But I think of, like I've only been on it almost 3 months. So and I was doing I mean, I do everything. You know? I eat well. I exercise. I get my morning sunlight. I do the incidental movement, all that stuff, But I'm on the lowest dose just to get started because I am sensitive to medication, but I'm gonna see my doctor in the next couple weeks and talk to her because that's of the questions I wanna ask you later on about dosing because you know? And we'll get into this, but I think a lot of people Think of HRT as dangerous, and you want the lowest dose possible.

Ali Shapiro [00:08:48]:
So but before we get there, what symptoms would someone be experiencing That would make them wanna even consider hormone replacement therapy.

Esther Blum [00:08:58]:
So first of all and you should know, ladies listening, the window Of perimenopause, which is the years before menopause when your ovaries start to wind down their production of Hormones, that can start 10 to 15 years before full onset of menopause, which is 12 consecutive months without a period. So a good indicator that you're starting to go down that path is just look at your monthly cycle. Look at your personality and your mood, Weeks 1 and 2 versus works weeks 3 4. If it is a Jekyll Hyde situation where you're just, like, Happy and energized and you're having great gym sessions and you're feeling really just Happy and even keel versus the second half when you're, like, sluggish, starting to gain weight and puff up, but, like, really depressed or just Really, really irritable, menorrhage as I call it. That's an indicator like, wow. I'm in the early stages of perimenopause. Also, like, Starting to get those crime scene periods where, you know, just a lot of clots is a sign your progesterone is really taking a nice dip. And that really bad insomnia, even if it's, like, the week before your period, you're up peeing more, like bad cravings.

Esther Blum [00:10:18]:
Also, you can get hot flashes and vaginal dryness. So and it's interesting, Ali, because I'm seeing women younger and younger who are going on hormones younger and younger, and I I think I think it's stress. Some of it, we've been through a lot. We are going through a lot collectively, but, also, I do believe our hormone receptors are pretty clogged up. We've got a lot of environmental toxins and Just the, you know, hundreds of chemicals you can get just from washing your hair, putting on makeup, and skincare is a lot. But, like, your cook and then, like, your, you know, your drinking bottles glass versus plastic and just so much environmentally, all of that affects us. So You wanna be mindful of all those things. If you but if you're having those symptoms, yes, you can start to say, okay.

Esther Blum [00:11:07]:
I'm starting the perimenopause journey for sure.

Ali Shapiro [00:11:10]:
Yeah. And, also, if someone's like so I it's interesting you say about younger women because when I was talking to my cousin who's I think she's, like, 48, and then a friend texted me The other day, because she's, like, 51, I asked her, like, how old are you? But she was like, I'm a little nervous. You know? I worry about my health. She's like, but my vagina hurts. You know? And I was like but I was and then I was like, how old are you? And then she was talking about just certain other symptoms and migraines, and I'm like, I think that might be menopause. Like like, you're nothing's happening to you. So I also think this like, I'm 45. My gender like, my age and older, a lot of people are are still, like, HRT is bad, or I don't I don't know.

Ali Shapiro [00:11:50]:
I need that. But then the younger generation is like, I'm not taking this, you know, sitting down. So if if someone is in maybe in menopause, Would there be other symptoms if they're later on in their in their menopause journey that may be different than what you've described for the perimenopause?

Esther Blum [00:12:09]:
Yeah. Well, certainly, your libido can absolutely take a nosedive. A lot of midsection weight gain, high cortisol, more intense Hot flashes that can be at night or it could be all day long. Again, really bad brain fog, low energy, Itchy skin, itchy tip of the nose, and itchy ears as well, like in like the ear canal. Interesting. Yeah. The flu I mean, you're Drying up a little bit more wrinkles. Like, you may notice, like, holy shit.

Esther Blum [00:12:40]:
I just look really old all of a sudden or older all of a sudden, like, real, real skin changes. So all of those can be a huge part of it, and, yes, the migraines and headaches too. I definitely notice an uptick in headaches, And I'm like, damn. I don't the only time I ever get a headache is if I'm getting sick. Yeah. But now it's like, nope. I get hormonal headaches for sure.

Ali Shapiro [00:13:01]:
Yeah. Okay. Great. So that'll help people be like, oh, that's me. That's me. Yes. And so you talked about as you're going more into menopause, you're upticking your hormones. So What does hormone replacement therapy do exactly?

Esther Blum [00:13:15]:
So there's 4 major benefits. I mean, there's so many benefits, but let's just Kind of tick off the big boxes first. So first of all, cognition. We know that estrogen maintains Gray matter in the brain, but progesterone and testosterone also support cognition, learning, memory, mood, Focus. So we think about what happens when when our mothers, our grandmothers, our aunts are getting Alzheimer's. Right? They're usually the symptoms show up usually in their seventies. It takes 20 years for The symptoms of changing gray or disintegrating gray matter to manifest. Well, what is that event 20 years prior? It's menopause.

Esther Blum [00:14:01]:
So if we got women on hormones preventatively and you don't have to wait a year After hitting menopause to start hormones, women start and I have them start perimenopause. If we did that, That 1st 10 years from the menopausal women is the most critical time to be on hormones to prevent the loss of gray matter. Now Can you benefit if you start hormones later? Yes. But not the same. And to that end, bone density benefit number 2. Estrogen Prevents the loss of bones far better than weight lifting, magnesium, vitamin d, calcium, now you and vitamin k. You should still be lifting weights and eating a high protein diet, but without estrogen, the clinical research shows the outcomes are not the same And hip fractures are the leading cause of death in people above the age of 65. Again, All we have to do is start our hormones early and we can offset that risk.

Esther Blum [00:15:07]:
Number 3, Cardiovascular health. Hormones prevent plaquing on the arteries. They prevent high insulin and high cortisol and really help control blood sugar as well and all of those inflammatory pieces can contribute to arterial plaque. So and the other thing, doctor Pam Smith talks a lot about this for those of you who are like, where can I see this research? Doctor Pam Smith's books are excellent resources, But she also and she was a former ER doctor and she said there's clinical research to show that Even if you do have a cardiac event, if you're on hormones, the effects are less than if you are not. So they're really, really dramatic, So that can be life or death?

Ali Shapiro [00:15:53]:
And I just I just wanna say one thing. It's important for women to realize that heart disease is the leading cause of death for women. Yeah. I so I think I just wanted to point that out. That's a really important, huge benefit.

Esther Blum [00:16:05]:
And it's missed because women present differently. Like, I think about that Show with Rosie O'Donnell when she was talking about how she had her stroke, and she didn't know it or or she had it was either a heart attack or stroke, and she was vomiting. And her wife was like, you better go take some aspirin. She took, like, 4 aspirin, but she didn't go to the doctor for, like, 3 or 4 days. And the doctor was like, if you hadn't taken that aspirin, you would have been dead. Like so you really do have to know the signs of stroke. Like, even just vomiting and and feeling a little dizzy, you go right to the hospital people. I mean, it's no joke.

Esther Blum [00:16:39]:
So you wanna rule out a cardiac event as a woman. And then the last big benefit is Supporting the genitourinary system and preventing vaginal dryness, vaginal atrophy, and urethral and clitoral atrophy, so offsetting UTIs. Again, like how many of us have had a grandmother in a nursing home in diapers With UTIs, dehydrated, disoriented, those can kill you when you're older. So all you have to do is use some vaginal estrogen Twice a week until you're dead. Right? Internally and externally. And that can really, really help. And especially because with, you know, lower libido in women, like, so many of my clients are like, it's really hard for me to achieve orgasm or it's Just the pleasure sensations are not as intense, that's atrophy. So you really wanna make sure, you know, you're supporting that, you're not peeing your pants, You're obviously doing pelvic floor exercises and strengthening.

Esther Blum [00:17:43]:
So all I mean, the the hormone benefits are was tremendous. But to me, oh, if you want the big answer, it's quality of life.

Ali Shapiro [00:17:51]:
Yeah. Yeah. Totally. Which then helps you make healthier choices, so it's like a snowball running down the hill instead of feeling like you're pushing all your health habits. Like you said, it was like I couldn't lift without getting Like, it breaking me. So it is huge quality of life. I'm so glad you you mentioned that. So what are if someone starts taking it, How would they know? What are some of the first signs that HRT is working?

Esther Blum [00:18:15]:
Sleep. That is first. I mean, I'm like, when peep women come to me just Destroyed from not sleeping. They're up at from 3 AM on, and I'm like, dude, the first thing we're gonna do is fix your sleep. That can improve in a couple days on some Progesterone at night and you can get Prometrium at your regular pharmacy. Mine is under $4 a bottle And it hits up those GABA receptors in the brain and it knocks you out and helps you sleep. And by the way, if your doctor wants To put you on the pill or the IUD, those only have synthetic progestins, which don't touch the GABA receptors in the brain. So you've got to get bioidentical oral progesterone.

Esther Blum [00:19:00]:
That's step 1. Step 2 is my friend I was checking in on one of my girlfriends who started HRT, and she's like, I don't feel like murdering my family as much as I used to. I'm like, well, that is progress. So better mood, better memory. Right? More energy throughout the day, less craving and periods that are more under control. So this is a great story. So one of my clients was a corporate attorney out in LA. She would bleed so heavily that it would, like, pool in her shoes at work.

Esther Blum [00:19:35]:
Can you imagine? Can you imagine the scenario? And I was like, dude, We're gonna get you on progesterone. We got her on progesterone, and that week before her period, we had her double up on it. And, again, I worked with her doctor. I can't Scribe legally. I'm a dietitian, but I was like, pro tip. Here's, you know, what you can do, and it totally offset. She never had another crime scene period after that. Because if you're getting clots, right, it means that your project it doesn't necessarily mean you're estrogen dominant.

Esther Blum [00:20:06]:
It means you have Your estrogen levels can be normal, but you have a relative dominance because your progesterone levels are so low. And so Going on bioidentical progesterone just is it serves to keep estrogen in balance and in check. And, again, A lot of doctors will say, oh, your periods are heavy. Go on the IUD or go on the pill. Well, guess what? Those synthetic progestogens In those products, suppress progesterone so you cannot ovulate. Well, when your progesterone is suppressed, then you can also get anxiety and you get depression because your GABA receptors in the brain are not getting their fix. They're not getting their fill. So a lot of times when women come to me in perimenopause and they've been on the IUD and the pill and they want to continue it To use it for birth control or they're just afraid to go off, we still can add in and stack Bioidentical progesterone on top of that until they're fully menopausal and ready to come off.

Esther Blum [00:21:13]:
Transition over. Isn't that crazy?

Ali Shapiro [00:21:16]:
But it's great that you can combine. I know the I so I take progesterone progesterone at night, and I remember the first Time I woke up after it, I felt like I had, like I I don't know. I was like, I felt like I smoked pot. Like, I thought I'd smoke pot in forever, but I was So relaxed, and I was like I mean, I eventually normalized, but I felt, like, spaced out, but it was amazing. Yeah.

Esther Blum [00:21:39]:
Yeah. Yes. And, Yeah. I mean, my son, you know, he's a high schooler, as I mentioned, and he's like, so many of the moms are just so Crazy. He's like, you're so chill. And I'm like, I take hormones, dude. Like, these women are not crazy. They just need Hormones.

Esther Blum [00:21:57]:
Like, I would kick his ass out of the house 7 ways till Sunday if I was not on hormones. You know? I mean, he He's a really great kid, but, like, there's times where I'm able to just talk it through and not, like, freaking explode and lose my shit like I used to. So it really does it really does make a very big difference.

Ali Shapiro [00:22:18]:
I love that. So you describe so let hormone replacement therapy or menopause hormone therapy isn't a monolith. So can you you said bioidentical. You said the pill or IUD. So can you tell people the different types of hormone replacement therapy because they aren't all the same.

Esther Blum [00:22:37]:
That's correct. And just to be clear, a the pill and IUDs are not approved for menopause treatment. That's not what they're designed for. They're designed for birth control. So if you want them for birth control, go ahead, but don't it's not gonna have the same protective effects. And so with bioidentical hormones, Estrogen and by the way, the risks the very scary risks were based on studies that were not even statistically significant using The urine of pregnant horses, like, estrogen derived from the urine of pregnant horses. So that was an oral form of estrogen, which is also in the pill. Right? That has a far greater risk of blood clot and stroke.

Esther Blum [00:23:24]:
That's why there are black box warning labels, birth control pills. They can contribute to clots and strokes. Now if you're using transdermal estrogen, either in the form of an estrogen patch or a cream like Biast, which you can get compounded at a compounding pharmacy, you're getting very low doses. Same with vaginal estrogen. These are microdoses. These are dosages that are about a 5th of a birth control pill. We're not Trying to get you ovulating again in menopause. We're trying to just give you enough to where you prevent The chronic diseases of aging, and that's a very low gentle gentle dose.

Esther Blum [00:24:07]:
You can start at at, you know, 0.25 milligrams and work your way up when it comes to estrogen. Give your body time to adjust your whoever your practitioner is And whoever can prescribe this, I mean, a nurse practitioner can prescribe it. In some states, a naturopathic physician can prescribe, A medical doctor, a GYN, your GP can prescribe any of these hormones, but you've gotta really work someone who's form illiterate and who's gonna monitor you every few months, who's gonna titrate your doses as needed. So that's just a little Sidebar. So estrogen is topical. Testosterone is also topical. I do not like palates or injections. You cannot Regulate the dosages, and there are very, very few studies done on pellets.

Esther Blum [00:24:59]:
And there are terrific side effects. And if you have side effects, You've gotta just sit and wait it out for months up to 6 months till they get out of your system. They're they're literally inserted subcutaneously in your tush. So, yeah, you just it's an incision of little tunnels dug. They're dropped in, and then you just have to sit and wait for them to flush out. So that's why transdermal, Again, topical testosterone is great because you can titrate or adjust the dose the next day. It's that easy. Now Or you can ask your doctor to write you a prescription for male testosterone at, like, a 10th of the dose, which would be a topical gel.

Esther Blum [00:25:51]:
That's kind of the workaround. I don't know if it's covered by insurance or not. I have to I'm learning the system here with you as well. And then there's, again, vaginal estrogen. You can get progesterone vaginally. You can get testosterone vaginally. If you are really struggling with libido and orgasming, you can also get compounded oxytocin, which you can put on topically To the clitoral region and the labia, I mean, it's really freaking cool what we can do with hormones these days. And if you don't want to use now The Framingham nurses study looked at women using vaginal estrogen for 18 years and deemed it safe even at b because it stays And it a, it's a microdose, and, b, it stays localized.

Esther Blum [00:26:38]:
So even, you know, a lot of breast cancer patients who aren't using systemic Estrogen or ovarian cancer patients can safely use vaginal estrogen for quality of life. However, For some women who just really still don't want it, you can use vaginal DHEA and have the same results. You'd it's just more expensive. You have to have it compounded and you have to use it for 12 weeks straight before you go down to a twice weekly dose, whereas Vaginal estrogen used for 2 weeks straight and then go down to twice weekly. So so many, so many, so many options.

Ali Shapiro [00:27:13]:
Yeah. And so just for for people listening, I want them to understand that bioidentical means that it's the most molecularly similar to what your body would produce. So when Esther was saying and we'll and I want us to talk about that study because I think a lot of people hear HRT, and they think of bad it's bad because of that study. And, I mean, I'm a cancer survivor as a teenager, and I that's why I was like it like, I'm not even gonna look at it at first, but then So I wanna talk about that. But Yeah. What what Esther was saying in that study, they used the estrogen that comes from Coarse urine, which is what is in birth control. So I just want people to realize that's not bioidentical. And it gets even more confusing Because there's some people who are doctors who are trained in menopause who will say bioidentical doesn't mean anything, and then people get it confused with natural.

Ali Shapiro [00:28:03]:
So can you I just Yeah. What would you say when see people say bioidentical doesn't mean anything, you know, but it does. So I Or I think it does. I mean, what would be your response to that?

Esther Blum [00:28:15]:
So bioidentical is it can be manufactured in a lab Or it can be plant based. A lot of doctors are very down on compounding pharmacies because not all compounding pharmacies are perfect. They are, You know, each batch is handmade, and so they're only as good as the pharmacist making it. But I've had really, really positive for, I mean, 98% of the time with compounding pharmacies. The nice thing is this. Right? You can get Bioidentical Prometrium, which is oral progesterone in your pharmacy. You can get bioidentical vaginal estrogen. The problem is both of those have fillers that are not natural.

Esther Blum [00:28:57]:
I mean, Prometrium has peanut oil in it. So if you have a sensitivity to peanut oil, you need get compounded with olive oil or vaginal estrase, which is estrogen cream, has propylene glycol in it. That is not natural. That is not a healthy additive. So, again, it is a microdose, but understand you are still putting some synthetic ingredients into your body. I'm actually working on, an ebook on this, like an essential guide to hormones really break this down for women and just say, here are the ingredients in what you're getting. And if you that should not stop you from going on. Believe me.

Esther Blum [00:29:38]:
If you tell me you don't have a lot of money to work with, you got a tight budget, and you want something you can just get at the pharmacy, no muss, no fuss, Don't let perfect be the enemy of done. I would much rather see you preserve your heart, your bones, your mind than worry about a touch of additives. Okay? But if you have the means, if you want a more couture experience versus off the rack, if you want something super duper customized, if your system is more Sensitive, if you wanna be able to titrate up the dose by microgram, then bioidentical compounded Products are for you.

Ali Shapiro [00:30:13]:
Yeah. And for people listening because I had heard of compounding pharmacies before listening to you, but I didn't really It like you said, it's just an independent pharmacy. And I was reading again, I would love your thoughts on this because you can't believe everything you read on the Internet. But I was reading that even though so I I'm right now just on the FDA, like, a Mylan transdermal patch and the progesterone that's, You know, probably filled with peanut oil right now because I'm like, I'm just just trying to get it done right now. But then I was reading that even though Those are FDA approved because they're generic. They might be made overseas, and the FDA isn't overseeing generic Fulfillment and compounding pharmacies have to go through different types of regulation. So is that is that true, or is that is that just A bad Instagram post

Esther Blum [00:31:06]:
that

Ali Shapiro [00:31:06]:
I shouldn't have believed.

Esther Blum [00:31:08]:
I will be transparent and say I would have to delve deeper into that. I haven't looked at the overseas manufacturing. I will tell you this. At the last a four m conference I was at, there was a lot of talk from the lecturing physicians about how The FDA does not like compounding pharmacies. Right? Even though, please, these compounding pharmacies are, like, biting to stay float. They're not rolling in 1,000,000, but the the there are pharmaceutical companies that wanna Shut down compounding pharmacies and say you will get option 1, 2, 3, or 4 for your HRT, and that is it. So that is something to be very mindful of. I would say if you've got good compound in pharmacy, keep supporting it, and, You know, time will tell what will happen with all of that.

Ali Shapiro [00:31:58]:
Yeah. And the price at least, again, everyone's plan is different, but So I got also recommended a prescription for the vaginal estrogen cream. And when I got it from the pharmacy, it was it had all of those, like, Sodium, lauryl, sulfate. I'm like, I pay extra in my skincare and all this stuff not to have this. And so the nurse was like, we'll call in a prescription to a compounding pharmacy, but Your insurance won't cover it, but the difference was, like, $30 for a 90 day supply. So it's not that much more exorbitant. At least, Again, this is Pittsburgh. This is, you know, what my insurance so it's all gonna be different.

Ali Shapiro [00:32:32]:
But I was thinking, oh my god. This is gonna be a small fortune. And I was like, A $30 difference over 90 days is not, like, you know, gonna break the bank, I guess.

Esther Blum [00:32:43]:
That's it. Because people come to me a lot, and they're like, oh, you know, I got Charged all this money from a compounding pharmacy, but I'm like, it's a 90 day supply versus a a 1 month supply. But somebody recently messaged me on Instagram and said, I got charged $500 for my estrogen. I said, dude, go to a compounding pharmacy. It'll be way cheaper than your like, yeah, because their insurance didn't cover it at all. So I was like, you're gonna have way better luck at a compounding pharmacy. So you just don't know.

Ali Shapiro [00:33:10]:
Yeah. Yeah. Yeah. You bet and yeah. That's why I'm like, okay. I'm on this now. And, 2, I think if people are starting on HRT, don't you think like you said, you may need to have a trial period to see in terms of dosage which actually works, and so it can potentially be helpful Even if, like again, I'm on the, like, you know, the the I'm on the Costco version, I guess Yeah. Of hormones.

Ali Shapiro [00:33:36]:
But As I figure out what I need and maybe if I need to dose, a compounding pharmacy can help with much more what you're saying, titrated doses and stuff like that. But you They can.

Esther Blum [00:33:46]:
But a regular doctor can also change your doses as you need to titrate too.

Ali Shapiro [00:33:51]:
Oh, okay. Good. Good. Here

Esther Blum [00:33:52]:
I am

Ali Shapiro [00:33:53]:
trying to do it myself. I'm always trying to do it myself.

Esther Blum [00:33:56]:
I know. I know. No. You gotta work with you gotta listen. As knowledgeable as I am, I still have, like, you know, Functional GYN. I've got nurse practitioner. Like, I've got a team helping me. I don't I do not write my own prescriptions or, you know, or say, this is what I want.

Esther Blum [00:34:12]:
I let them Say, this is what you need, and I'm like, okay.

Ali Shapiro [00:34:15]:
Yeah. Yeah. I think I'm just so used to having to, like because I got I, you know, I had chemo when I was 13. And so by age 23, I had, like, point I had this was before functional medicine was, like, Very popular. So I was coming to my doctors being like this, and they were like, we don't know what you're talking about. So I'm just so used to having to be the one to be like, You know? But my doctor, you know, she was like, okay. No estrogen for your bones because of chemo. You know? Like, she was very on top of that stuff, so I should just follow-up with her because I trusted them in good hands.

Ali Shapiro [00:34:50]:
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Ali Shapiro [00:37:06]:
Once you sign up, you'll receive access to a limited replay of what you missed. I hope to connect with as many of you who listen to this show as possible at this series. Once again, visit alleyshapero.com backslash flow for more details. Now back to the show. So we talked about the women's Framingham study. And can you tell people a little bit why especially, I told My truce with food community that I was gonna interview you and this woman who is 60 was like, I told my friend I'm considering HRT, and she was like, no. That's bad. And My cousin, I was talking to her over the holidays, and she was like, wait.

Ali Shapiro [00:37:47]:
I thought HRT was bad. And, again, I thought this too. So can you tell why people Potentially might think that. Yes. Talk about that study.

Esther Blum [00:37:57]:
Yeah. This women's health initiative study is what Allie's referring to, and it was done about 2 decades ago where women who were 10 years postmenopause, they were average age 62, They already had an increased risk for heart disease and unfavorable lipid profiles, and they were put on Conjugated equine estrogen, and they were and orally, and they were not given any opposing progesterone or testosterone. Now hormones are a symphony. Right? You were not born with your ovaries only making estrogen. You were born with Pregnenolone and DHEA and estrogen, progesterone, testosterone. So, you know, and and so the study was designed so poorly. Then the data was analyzed and Misinterpreted, which shame on them, and the risk of developing cancer and clots went from 4 in 10,000 to 5 in 10,000. I mean, so statistically insignificant.

Esther Blum [00:39:03]:
And I remember on the Today Show, They yanked they I forget who was it wasn't Katie Couric, but it was one of those old, you know, Today Show reporters. Maybe it's Meredith. What was her last name?

Ali Shapiro [00:39:15]:
Viera.

Esther Blum [00:39:15]:
Yeah. Meredith Vieira, and she was like, hormones are dangerous. They cause cancer. And decades 2 decades of women were immediately yanked off hormones. My mother at the time was on estrogen. I was like, get the hell off it. And sure enough, she had, like, major bone density issue, major bladder issues, Cognitive changes. Right? Wow.

Esther Blum [00:39:34]:
And died, like, cardiac issues, so which and blood pressure issues. I'm like, oh my god. I like, Did I wreck my mother? I don't know. But you know? So, anyway, the North American Menopause Society revamped Their position papers in 2018 and 2022 stating, you know, the data has been reanalyzed. Hormones are safe to take for at least 10 years. And by the way, like, position papers are gonna be revamped again. Hormones are safe to take for life. If you have Hypothyroidism.

Esther Blum [00:40:08]:
You're gonna take Synthroid or Levothyroxine for life. You don't just stop. The women I treat in my practice who are in their seventies Often come to me, and they're like, my doctors or my friends say, and by the way, ladies, your friends are not qualified to make medical for you. Just saying. PSA for the day. Oh my god. So, You know, they say, oh, I think I should go off my hormones. I'm like, I think that's a terrible idea.

Esther Blum [00:40:38]:
I wanna try it. And immediately, their hot flashes come back. They wrinkle up like Crazy. They, you know, get vaginal dryness and depression and brain fog and they go right back on. So it's something you can stay on for life. It is something you can start at any point in time, even if you're 10 years out. You may not see the strongest Correlation of benefits that you will see when you start within 10 years of menopause. However, you will see benefits at every age, number 1.

Esther Blum [00:41:08]:
Number 2. PSA number 2. For those of you without a uterus, you can and should still take progesterone. Progesterone doesn't only protect the uterus, It helps with mood, cognitive function, sleep, fat loss. Right? So we have hormone receptors on every cell in the body, not just in the uterus, so you should absolutely be on progesterone too.

Ali Shapiro [00:41:34]:
I love that that's the patriarchy being like, oh, if it's not for reproductive health, why does it matter? Right?

Esther Blum [00:41:40]:
Don't even get me started. That'll be Barbie 2 point o. Right? Yeah. Yeah. In fact, since she ended at the gynecologist, we can pick right back.

Ali Shapiro [00:41:51]:
I still have to see that. I have not had a chance to see it yet, so I can't I I want to see it. I just haven't had a chance. I think that reminds me too when you said, Just for everyone listening, like, the media loves drama. We had I had Angela Sini on who's a journalist, And she wrote the book inferior, how science got women wrong, and she talked about the study where they were trying to say there are these Drastic differences in men and women's brains, but it was this, like, small significant, you know, difference, and then the media just ran with it and blew it up. You know? And it's like when you said like, I remember the media said there was, like, this 25% increase risk of cancer with HRT, but they weren't looking at relative risk. Right?

Esther Blum [00:42:34]:
That's right.

Ali Shapiro [00:42:35]:
So to your point, it was, like, 4 went to 5. It didn't go and they're like like, it was just so irresponsible. And so I think sometimes it's like it it can feel emotionally like I'm going against the truth, right, by looking at HRT, and it's like, No. The media made up a truth, and even the study founders have have told people, like, We did this wrong. We you know? And and they didn't have any healthy people, right, like, in the study. So it just There's, like, so many problems with it, but it still persists to this day, and so many women are suffering as a result.

Esther Blum [00:43:11]:
It does. It does. And if you are a late bloomer starting hormones. You should absolutely get a calcium channel score done. Get your cardiac risk markers checked, which would be lipoprotein a little a, homocysteine, triglycerides, cholesterol, insulin, fasting, glucose, and c reactive protein. And, also, you do want to get pelvic ultrasound just to make sure you're not having any thickening of the walls of your uterus. Aside from that, you're good to go. I mean, your doctor will will tell you, but that's it.

Esther Blum [00:43:46]:
You just have to make sure so that you're treating those issues too. And by the way, all women should have cardiac risk factors checked anyway. All women should get a bone density test done Prior to menopause, by the way, late forties is a great time to get bone density, not like when you're 56 or 62 or whenever. Get it done early. Get your baseline.

Ali Shapiro [00:44:06]:
I love that. Everyone, write down those tests that Esther said because and do you think people

Esther Blum [00:44:11]:
should my book too. They're in the book see it later, I'll view it later also. Yes. Great.

Ali Shapiro [00:44:16]:
Yeah. I recommended that to some clients. They were like, this was so helpful. I was like, yes. Thank you. But, yeah, I think that's really Important. And so do you think people should be monitored with that, like, every year if they're gonna go on HRT? Okay. To make and well, let me back up too.

Ali Shapiro [00:44:32]:
Why do they think people should go within 10 years? What happens to the cardiac risk if you're not on HRT or, You know, if you'd if if you are in your sixties, what what are they afraid of?

Esther Blum [00:44:45]:
Yeah. I think they're afraid of clots and stroke. And so you know? And and By the way, to your earlier conversation, there are still black box warnings on hormones. To this day, even though the Studies have been, you know, refuted. They're still there, which is why people are scared. Doctors are not updating their knowledge at all. This is ignorance. It's lazy medicine, and medical Schools are not teaching menopause care and I'm like, but the FDA has approved HRT.

Esther Blum [00:45:20]:
So that's really ass backwards. And I love it when, you know, doctors are like, I'm too busy. I'm too busy seeing other clients. People, when do you think I do my research? Search, that's called nights and weekends. I gave up family times. I was a complete a hole to my family when I was, like, grinding, writing a book While seeing patients 5 days a week and then working all weekend, like, you have to fight if you're gonna better the care of women. If you're gonna change the landscape of menopause, guess what? Sometimes you gotta give up some personal time because what made me write the book was how angry I was. I had my own man of rage.

Esther Blum [00:45:55]:
I was like, I am so sick and tired. If 1 more woman comes into my practice gaslit, I'm gonna freaking burn the the house down. Like, I'm just So sick and tired, and women have to start speaking out. And I wrote the outline for the book. I was sitting on the couch next to my husband and dog, And I got out, and one of my colleagues was like, your book is here. I was like, I don't think I have another book. He's like, your book is here. And I sat down that night, and in 5 minutes like, my bookshelves behind me, I still have the outline.

Esther Blum [00:46:24]:
I wrote it in 5 minutes with a marker on a legal pad and cranked that baby out in, like, six 8 months. I self published it because I was like, I'm not going through a traditional publisher. I'm waiting 2 more years for this to get out. If I had done that, the book wouldn't even be out yet even I wrote it, you know, in COVID, basically. So so, yeah, it's just lazy medicine is not acceptable medicine.

Ali Shapiro [00:46:50]:
Yeah. Well and that I have that question. And if a woman goes to a doctor, like, what Why what is their typical response going to be? Because I had a bunch she's Canadian, but her doc and she knows we're friends. We're good friends, and she's interested in it. And she's like, my doctor said this causes cancer. She's like, I know she's in the stone ages. She said she'll do whatever I want, But so I think a lot of women get that reaction. So, like, if their doctors give them that, what do you recommend or their next steps in terms of?

Esther Blum [00:47:23]:
Great. So first and foremost, you know, in the back of my book is there's a 100 studies. If you get the digital version, you can even just click on the study links. There's a 100 studies there and if you even Google or look at 1 or 2, you're gonna be like, oh my god. Or if you go to pubmed.com and look up Benefits HRT, safety, efficacy, or read the book Estrogen Matters by doctor Avraham Bluming. That's another great one. So you can say to your doctor, you don't have to look at all the studies, but you can say, look. I've done the research.

Esther Blum [00:47:58]:
I'm having tremendous side effects. I am willing to take the risk. I want to be on hormones. Why don't you give me a 3 months trial and let's see how this goes? Right? That's option 1. Some doctors are gonna say, don't they've I'm acting out what my clients and friends have told me. Gonna hold up the hand and say, if you even talk to me about hormones, this conversation is over, and they will be a holes, those people you want to leave immediately. Or option 3 is you can choose the path of least resistance. Call your local compounding pharmacy.

Esther Blum [00:48:35]:
If you don't know where your local one is, just Google compounding pharmacy with your ZIP code. You're gonna get at least 1 per 1 or 2 per state, at least. So call them up and say, what doctors What are your favorite doctors who run hormone prescriptions through this pharmacy? You will get doctor recommendations that way. You can also go to the, Institute For Functional Medicine, this is ifm.org, and do a search in your ZIP code and look for a hormone literate doctor there. But, again, you've gotta do your due diligence. Any doctor recommendation you get, go on their website, see, are they doing pellets and injections Or are they open to you know, you could say, I don't want pellets or injections. Will you please do transdermal? Will you please do oral? And I've never had a doctor say no to that, and, you know, see if they feel like a fit for you. See if the office is responsive to you.

Esther Blum [00:49:31]:
See if you're gonna get Good care, good people. If the doctor's office doesn't respond to you and he can't bother to call you back, don't go there. You won't get good help. So Just go with your gut. Do due diligence. You can ask your girlfriends. Facebook groups are often a good place to ask. But there there really are good doctors out there and some of them are out of pocket.

Esther Blum [00:49:52]:
That is the downside, and I feel terrible about that. But, you know, they will spend far more time with you. That's my practice. I mean, my clients get at 90 minutes with me on the 1st visit and then, you know, half hour visits thereafter. A lot of people a lot of doctors will also spend a good hour with you when you pay out of pocket. And you will save mental real estate and emotional bandwidth. You will have a permanent solution to your problems And your investment well, I mean, how much is it costing you to not sleep every night? What is the toll on your marriage when you're not having any sex at all because you can't physically fit anything up there anymore without feeling like, you know, burning pain or broken glass. Right? So, You know, you do think long term, like, when often when women are like, well, I don't know.

Esther Blum [00:50:44]:
It's expensive. I've talked to my husband. I'm like, Ask them how much they're willing to pay for regular sex again. Believe me. That credit card payment goes right True. So let me tell you, that's not a problem. Not a problem.

Ali Shapiro [00:51:01]:
This is why in my marriage, we each have our own separate accounts too. So

Esther Blum [00:51:05]:
Well, exact honestly, I'm a huge believer in that and really asking for not permission. No woman should ever ask a husband permission because nobody's ever gonna say, yes. Here's 1,000 of dollars to go spend on your health. Nobody's ever gonna say that. And a lot of times too, Ali, it's interesting because women are like, oh, well, I've got you know, my kids are in College, and we've got all these house expenses. I'm like, when was the last time you ever put yourself first? You are the glue of this family. No matter How modern our times are, no matter that we're earners now and we can out earn our husbands, women are still putting themselves last. And I'm like, I'm sorry, but if you're down, the whole ship is down.

Esther Blum [00:51:47]:
So take care of yourself first. Even if a husband is very supportive Of his wife, a lot of the times, women don't give themselves permission to invest in themselves. They're always putting their families first. Even if they're the earners, they're, like, still putting themselves last. And I'm like, people, if you are down, Your whole team is gonna be down. You've got to put your oxygen mask on first. Like, when was the last time you put yourself first? And then they realize I'm like, you you can't run at full capacity. You can't be present in your own life without putting yourself first and and taking care of during this time when your health is down.

Esther Blum [00:52:25]:
So it's really important people understand the mentality of investing and getting a return, what the return on that investment looks like. And Here's what the return looks like, by the way, people who are like, I don't know. This still sounds dodgy. What's on the other side? You have to go through your list Current symptoms that you're having. Right? Vaginal dryness, insomnia, hot flashes, irritability, brain fog, exhaustion, body fat, low self esteem, Depression, anxiety, you know, all of these symptoms. Now imagine you get tested, you go to a hormone literate practitioner and then you get a hormone prescription. And within 3 to 6 months, this is all in the rearview mirror. You start sleeping through the night.

Esther Blum [00:53:08]:
You have better energy. You're nicer to your Family gets a vaginal estrogen, so sex is actually pleasurable again. And, you know, you just are more balanced And you have the energy to work out better and prep food better so you can work out and lose weight better. Like, imagine the profound impact that it has on you. And to me, that is priceless. It's like I went for years when I had lime and molds. You know, I really cobbled together my health care, and I had colleagues who were like, I'll treat you for free, which is never a good idea because you just never wanna ask them For better care when you're not getting it and you know you know, and it just I was not getting better after years years. And finally, I was like, I don't have the money.

Esther Blum [00:53:56]:
I'm gonna pony up and hustle and figure out how to do it. I was, like, too sick to work. And, you know, we had to do 2 home remediations And I paid, you know, good money for tests. I paid for doctors, and I was so committed. And let me tell you, that money showed up like clients start appearing in my practice and I was able to fund all of that and I was better. Within a year, I was an entirely new person. And and I was like, why didn't I do this sooner? So, you know, we hold off on investing, and we're like, next year, after Christmas, after my bonus, after. Do it now.

Esther Blum [00:54:32]:
There's never a good time. Your kids are always gonna have expenses, private school, college, uniforms, blah blah blah blah, groceries, Vacations and have a good time. Just

Ali Shapiro [00:54:44]:
And I feel like with HRT, like, the sooner you do it, especially if you're in that window, the better. And, though, as as you're saying this, though, I do because HRT felt like a magic bullet for me because I was doing all the things. And I know that you're big on, like, Yes. HRT is great, and you still have to do those big, you know, rocks of eating well Yeah. You know, moving and, again, it doesn't have to the HRT can help that, but can you explain why that is so important to that HRT is like a compliment to that and not viewed as a silver bullet.

Esther Blum [00:55:20]:
Yes. It's a piece of the pie. You can never Out hormone or out supplement your lifestyle at all. So let's start with diet. Okay? A lot of women love, Especially after COVID, wine o'clock. Right? A lot of women, really, it's very there's a lot of cultural pressure to drink. It's like socially acceptable mommy juice, sippy cups. You know? I I used to joke that I was Gonna invent a straw that was the length of a wine bottle that women could just plunk and just drink the whole thing.

Esther Blum [00:55:53]:
But, seriously, There's a real cultural fixation on women getting loaded all the time even, like, play dates. I remember there was a mom in my community. The 1st day of school, She would start serving alcohol at 9 in the morning, and I was like, like, the kids are out of the house. Let's start drinking. And I was like I got disinvited after a couple years because I never went. I was like, who has time for this shit? I'm working, but I I don't want even if I wasn't working, I would not wanna drink at 9 in the morning. So alcohol really is, you're writing checks that your hormones in your body cannot cash. It's a class 1 carcinogen.

Esther Blum [00:56:32]:
It takes 4 to 6 hours for your liver to detox 1 cocktail. And while your liver is detoxing that, Your hormone detoxification, estrogen in particular in your liver, gets put on hold. So then you be become estrogen dominant for 25% of your day. So that's just from 1 cocktail. So I'm not saying never drink if you don't wanna give it up. That's totally cool. Just be really judicious and cut way back because it's also gonna wreck your sleep. It's gonna slow down your thyroid function.

Esther Blum [00:57:02]:
It's gonna leave you bloated and make body composition changes Very, very difficult. Okay? So I'd much rather drink a mocktail and be in my bikini confident than, like, boozing it up, and it It shocks me. I mean, I was such a heavy drinker in my twenties, and I'm like, now I'm like, no. Thank you. So Alcohol and also developing a healthy respect for caffeine, your liver may not metabolize or clear it the same way anymore.

Ali Shapiro [00:57:32]:
I noticed that I I've had to switch to tea, and that is how how how frequently I have to pee. Yes.

Esther Blum [00:57:40]:
Exactly. Exactly. And then really prioritizing protein. Women are so afraid of protein. The average woman I see who comes to me in practice is Eating 60 to 70 grams of protein a day, and I'm like, ladies, this is what my dialysis patients used to eat in a hospital. Okay? Like, Women need protein. We need more as we age, not less. I wrote a whole another book on that called Cave Women Don't Get Fat, But we need a minimum of a 100 grams of protein.

Esther Blum [00:58:12]:
I try and get my women up to 120, 130, 150 grams of protein, especially if they're lifting Weights. We need protein to, build and sustain lean muscle mass and you need to pair that with some strength training. Now Strength training, you know, not everyone is going to the gym and deadlifting 80 to a 100 pounds. Some women are Starting with 3 to 5 pound weights or doing Pilates or resistance training, as long as the weight is heavy for you and your muscles are fatigued and burning or you get to failure, that that's gonna be individual for everyone and as long as you add to that weight and slowly increase your strength and increase the amount of weight you left. That's great. You also want to make sure that your ratios of carbs to flip. So premenopause, a lot of women have, you know, about a 150 grams of carbs per day and about 60 grams of protein. And I'm like, if you flip those ratios.

Esther Blum [00:59:08]:
If you get your protein higher than your carbs and if you track your food for 3 days in a log you in an app, you can quickly see what your numbers look like. So if you make sure that your protein numbers are higher than your carbs, your insulin levels are gonna be better controlled, You're not gonna get cravings. Your energy is gonna be way better. You will raise and sustain your serotonin and dopamine. So aim for 30 to 40 grams of protein at a meal. Okay? That's also rule my meno law for fat loss, number 2. And number 3 is having carbs at night. And most women are like, oh, oh my god.

Esther Blum [00:59:45]:
I can eat carbs at night. I'm gonna get so fat. What's gonna make you fat is not sleeping at night. Right? So if you okay. The insulin all connection is a very real thing and gives you that nice minnow pot right in the midsection. If you add a sweet potato, a baked potato, some lentil, some quinoa to your dinner at night with your protein and fibrous veggies. You're gonna get a slight bump in your insulin That is going to tamp down your cortisol. Nighty night.

Esther Blum [01:00:17]:
You're gonna sleep through the night, which will make you far more insulin sensitive. And, also, ladies, if you are lifting weights, you need to fuel your workouts with carbs. Do you know what I eat before I lift weights, ladies? I eat rice cakes with honey and salts. My son and I chug a lug, and I go and lift my ass off. And then I come home, and I eat more carbs, and I sleep no problem. So I have rice, potatoes, sweet potatoes. Don't be afraid of carbs. They are your friend, and menopause not your foe.

Esther Blum [01:00:49]:
Oh.

Ali Shapiro [01:00:49]:
I love that you said that. We just had doctor Stacy Sims on last week, and she was saying, like, the same thing. Yeah. Yeah.

Esther Blum [01:00:56]:
The best.

Ali Shapiro [01:00:57]:
Yeah. Her carb recommendation, I have to go back and listen, but it was, like, kind of even higher than that. And I was like, woah. So I I gotta go back and listen. Yes. Because I was, like, Trying to interview. No. No.

Ali Shapiro [01:01:08]:
No. Go ahead.

Esther Blum [01:01:08]:
Go ahead. The more insulin sensitive you are, I mean, Stacy is teaching women to to lift heavy and really fuel their workouts. So For those women, they can have a 1 to 1 ratio of carbs to protein. So you can have a 150 grams of carbs and a 150 grams of protein. If you're looking to build muscle, you will need that, and you do need those insulin spikes to build muscle. You do. So it's not a bad thing. But, yes, if you're sedentary, and a lot of my women are, like, gentle activity, they're just so tired.

Esther Blum [01:01:40]:
Right? Or they're just Tired to work out, so I'm like, okay. Then cut your carbs down or cycle them half more on the days you workout and less on the days you don't.

Ali Shapiro [01:01:50]:
Yeah. Yeah. I love that. Alright. I have 2 more questions for you. Well, actually, 3. So back to HRT, What I'm seeing now so when I first got into this space, it was like realizing, oh, HRT is safe, and especially Having gone through menopause early because of the chemo, it's like a no brainer for my health protection. But now that I'm, like, in this space of people who have, like, Known like, kinda get it.

Ali Shapiro [01:02:14]:
You know? I see, like, some people are recommending, like, physiologic doses into their fifties and sixties. So what are your thoughts on like, should should women try to get back to, you know, what they're do what they were, That level of when they were menstruating, that seems to be, like, a little too unnatural. Or what are you what's your thoughts on actually replacing with physiologic doses?

Esther Blum [01:02:39]:
You know, a good clinician is going to really monitor your levels. I I don't think you need to be at physiologic doses, but it's This is where art meets science. Right? So the science will say, you know, to maintain your bone density and prevent cardiovascular issue and optimize brain biochemistry, your doses should be this in the blood. Right? And they'll they'll look at blood tests or they'll do a Saliva test or a 24 hour urine collection. Right? But like thyroid like treating thyroid conditions, sometimes blood work can be optimal, But symptoms can still be present, and that's a case when you do want to bump up until symptoms disappear and you can kind of override the blood work. So, but, again, I don't prescribe legally. I'm a dietitian, not a doctor. So but there hasn't been evidence to show Physiologic doses are better and I can tell you with the women I've seen with the side effects from the pellets, I mean their doses are extremely, their levels are Extremely high.

Esther Blum [01:03:46]:
They have lost hair on their head. They have grown hair on their chin. They have, like, such a raging libido that it scares the Crap out of their partners, and it's, like, uncomfortable for them. They feel irritable, often a 10 pound weight gain. So, you know, it's Don't fool mother nature. You know? Be conservative with hormones. They're still hormones. They're not, you know, innocuous, And you wanna make sure too, you know, the testing I do, I do the Dutch and the GI MAP because I make sure that women are passing the checkpoints for detoxification for phases 1 and 2 in the liver and phase 3 in the gut.

Esther Blum [01:04:24]:
So your hormones should never be Stagnant, like a pod that should be like a gently moving stream. And I see a lot of women who go on hormones and they're not testing their levels and they're having a lot of breast tenderness, they're having weight gain, irritability, you know, just a lot of imbalances and it's because they're really too dominant in estrogen or their testosterone levels are too high. So, you know, there could be side effects in the other end too.

Ali Shapiro [01:04:55]:
Yeah. No. That's good to that's good to know because I you know, again, this question is, like, for me personally, because I'm like, should I be because I'm only 45 And should I be at physically even though I feel great, I'm still gonna, like, experiment with bumping up a little to see what could I feel even better? I don't know. You know? But I guess it's really to go with the symptom, and that's what my doctor said. She's like, we manage the symptoms, not the not necessarily, like, always what the blood work says.

Esther Blum [01:05:22]:
So this in mind. Okay? You're still cycling regularly. Yeah?

Ali Shapiro [01:05:26]:
No. No. I'm postmenopausal.

Esther Blum [01:05:28]:
You're postmenopausal. Okay. So that makes sense. For women who are in perimenopausal the perimenopausal window, your hormones can fluctuate Up to 30% on any given day, which is why a lot of doctors are like, I don't even wanna bother testing your blood. It can only tell me what's happening that day. So you wanna make sure that you this is why, again, I'll do a DUTS test. It will give me a better window or you look at a saliva test which shows tissue saturation. You know, there are many ways to test and not guess where you really find the sweet spot for you.

Esther Blum [01:06:02]:
And, yes, if you're postmenopausal, it's a much easier, much more controlled experiment. Yeah. So but I'm so glad you're on hormones now. I mean, you're preserving your bones, like you said, and all your tissues and your brain. That's awesome.

Ali Shapiro [01:06:16]:
Yeah. Well, that's that's why I'm like, should I have more so I preserve more? Because I still sometimes feel like my recall, but the more that I sleep, Because I'm only, like I said, two and a half months into this. The more that I sleep, the more that I can recall easier and, you know, my brain is back, which is, You know, so important to me because I I'm intellectual, so it's really important.

Esther Blum [01:06:35]:
Well, yeah, you kind of need your brain. And, you know, Kind of. Yeah. But we can't overlook the gut in this either. You know? People skip over the gut, And they have a lot menopausal women have a lot of changes in the gut lining and in the estrobolum, which is that Subset of the microbone microbolum, it's a subset bacteria that metabolize a detox estrogen in the gut so you can poop it out. So And you also have to pay attention to those big rocks, those lifestyle pieces. It's not just, let me just my hormones and everything's gonna be fine. It's are you detoxing your hormones? Are you processing them? Is your gut healthy? Are you absorbing your nutrients? You know? And all those pieces make sense.

Ali Shapiro [01:07:22]:
Yeah. And you can read about the estra bloom in Esther's book, See You Later, Ovi Later. I learned about that. Had no idea. That was a whole thing, so get the book, and we'll put links to it in the show notes. So 2 other questions. I have also heard about cycling hormone replacement therapy or menopause hormone therapy, and different people do it different ways. And then I asked my doctor.

Ali Shapiro [01:07:45]:
I said, should I be taking a day off so I don't blow up my receptors? Or I've seen some people who are on those physiologic doses. They will actually stop progesterone for 2 weeks so that it's almost like they're, you know, getting a period again. I mean, they're shedding the lining and and stuff. And she was like, the research doesn't back that up, and I was like, okay. But but, like, if I had waited 20 years for the research to compound about how to heal my gut, I'd still be in a really bad place from from the chemo. So it's like, I know that there's this balance of, like To your point, art and science of, like, here's where the science is, but we're also really behind on the science. So how do you think of cycling?

Esther Blum [01:08:26]:
Not for postmenopausal women. I agree with your doctor. There's no research to back it up. And what happens is women then start to kind of get PMS y all over again. So I've seen that with clients where the doctors, you know, cycle them, and I'm like, why? Why? Because you take a woman who's not sleeping and you take away her progesterone, and then she's gonna go back to not sleeping those 2 weeks a month. Yeah. I do believe in taking a day off A week to give your receptor sites a break, but I will tell you personally, I'll take a week off my bias with testosterone, but I do not take off my progesterone because I just don't sleep. And I'm like, I'd be dead.

Esther Blum [01:09:04]:
You know, I'm so grateful. Every morning, when I every time I should say I get that hormone delivery, I'm like, thank you, god. Thank you. Because it I'm just they have saved my life. Right? And so many women like you too. It's just the quality of life is incredible.

Ali Shapiro [01:09:21]:
Yeah. Yeah. And just too, I also heard that if because you mentioned testosterone. I haven't gotten there yet. But for people who are listening to this, Should they figure out their progesterone and estrogen first before doing testosterone, or can you just do it all at once, or what's your recommendation there?

Esther Blum [01:09:37]:
Yeah. You can do it all at once. You don't have to wait, especially if your hormones are rock bottom and everything's in the toilet and you're just You have no cortisol curve, which happens a lot because hormones help give you a cortisol curve, then, yes, testosterone can be extraordinarily beneficial and especially with cognition and mood and energy and libido, oh my god. Just All a really good game changer. Now that being said, you if your hormones are rock bottom and you have no cortisol curve, you should also do some good adrenal support With that too, to help get your cortisol curve back, again, don't hormones alone do not do all the heavy lifting.

Ali Shapiro [01:10:18]:
Yes.

Esther Blum [01:10:18]:
And then getting in a lot of protein and some carbs to also restore your cortisol curve. You do need carbs because carbs help the conversion of t 4 to t 3, which is the active form of thyroid hormone. If your thyroid is underactive, you if you have a subclinical hypothyroidism, Your adrenals are gonna crash around 3 PM, and you're gonna feel exhausted. So start adding carbs in throughout the day.

Ali Shapiro [01:10:46]:
I love that. I love that. So one last question, and this is from my friend who's in early perimenopause. She said that she and I think this is A lot of people question this because I get the ads myself, but what's the difference between HRT and all the supplements on the market that claim to balance hormones and solve menopause symptoms. And she said, for example, happy mammoth or o positive.

Esther Blum [01:11:11]:
Oh, yeah. I've seen happy mammoth. You know, again, a, the dosages on those products are usually so freaking low. It's like someone Stood in front of the bottle and waved some herbs in front of it.

Ali Shapiro [01:11:24]:
Under a full moon with crystals. Yeah.

Esther Blum [01:11:27]:
I mean, there are brands I will not I will not call out the names, but there's a lack of integrity with a lot of those products. Now some products are really good. I love doctor Anna Quebec. I love her. Maca is incredible. I think it's so good and made so carefully. You really should be getting supplements through a practitioner who is vetting your products for you that Our I use only practitioner grade that are third party tested and that are a little more expensive because there are therapeutic Doses of ingredients. I I too am launching a line of just 2 simple products to help support women on hormones, to help them detox their hormones, and you better believe the dosages are going to be clinical.

Esther Blum [01:12:14]:
I mean, that there's gonna be 500 milligrams of glutathione Ione in there. You will not find that in any product out there. So you have to be really careful. And then, you know, listen. If it brings you relief, You know, I don't think there's any harm in taking happy mammoth. You may just empty your back bank account. But some women again, I do have supplement protocols in my book with therapeutic dosages so you know what to look for on the labels. And I have a full script account too with, like, Some really nice protocols I give to women for hormone support too.

Esther Blum [01:12:48]:
It's you don't have to all you have to do is, like, create an account And you get access to this stuff. So

Ali Shapiro [01:12:55]:
That's amazing.

Esther Blum [01:12:56]:
You know, just make sure that you're really vetting the products and having Guide you is really the best way to do it. So you once you do testing, then you can customize your protocols to the test. That's why I like test, don't guess, and every protocol I put my clients on is customized based on their test so I know exactly what they need when they need it. We're like, okay, your methylation's slow and your gut needs some love and let's kill off these parasites and infections and Let's clean everything up. And in 6 months, they have, like, their road map for life. It's great.

Ali Shapiro [01:13:33]:
I love that. Well, I'm sure everyone is Gonna get so much out of today. So where can people find you if they Okay. Because you know what you're talking about. I mean, they're

Esther Blum [01:13:42]:
I do. Most of the time, Ally. Most of the time.

Ali Shapiro [01:13:47]:
Those are the only people I trust who aren't like, yeah, all the time.

Esther Blum [01:13:50]:
They know

Ali Shapiro [01:13:51]:
what I'm talking about.

Esther Blum [01:13:52]:
No. I never anyone who promises you a 100% result is selling snake oil and not fish oil, so let's be clear on that. I would much rather under promise than over deliver, so come hang with me in 2 places. 1 is on Instagram at gorgeous Esther, And the other is my website estherblum.com. I send out weekly newsletters that are really informative, really gonna help you make menopause your bitch, And then I love that tagline. Thank you. And then I'm gonna be starting a group coaching program, probably q 2 to just, again, give more women access to everything I'm doing for my 1 to 1 clients, so we're really excited about that.

Ali Shapiro [01:14:36]:
Amazing. Esther, thank you so much for your time, your work in the world, your passion, your fire. We really as you're Gen x too. Right? It's like Coats.

Esther Blum [01:14:45]:
Yeah. 3. Yeah.

Ali Shapiro [01:14:47]:
45. Total different breed, so I appreciate you blazing the trail. Thanks.

Esther Blum [01:14:52]:
Thanks, Ali. This was awesome.