The MiDOViA Menopause Podcast: Real Talk on Hormones, Work, and Wellness for Midlife

Episode 047: The Truth About Hormones: How Your Body Really Works

• April Haberman and Kim Hart • Season 1 • Episode 47

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What happens when you outlive your ovaries? Dr. Kelly Casperson, board-certified urologist and award-winning author, joins us to unpack the truth about menopause and hormones in her characteristically honest, evidence-based approach.

Kelly challenges the outdated narrative that hormones are dangerous, walking us through why the 2002 Women's Health Initiative study has been widely misinterpreted. "The paper is free online," she explains, "and it says breast cancer does not reach statistical significance." Yet two decades later, this misunderstanding continues to prevent women from accessing treatments that could significantly improve their quality of life.

We dive deep into the timing hypothesis—why starting hormone therapy early provides the best preventative benefits against conditions like heart disease and dementia—and why baby boomers should be "pissed" about being denied hormones when they needed them most. Kelly doesn't hold back when debunking the patronizing "grandmother hypothesis" or addressing vaginal health with her trademark blend of medical expertise and humor.

Perhaps most valuable is her balanced approach to menopause management. While advocating for hormone therapy when appropriate, she emphasizes that slapping on an estrogen patch won't help much "if you're drinking and not sleeping and not exercising and your mood about getting older is shitty." The real power comes from combining hormone knowledge with lifestyle changes and a positive mindset.

Whether you're approaching perimenopause, deep in the menopause transition, or supporting someone who is, this episode delivers the straightforward education women deserve. As Kelly reminds us, "Nobody is more in charge of your body and your knowledge about it than you."

Be sure to order her new book, "The Menopause Moment," available at all your favorite bookstores. 

Dr. Kelly Casperson is a board-certified urologist, best-selling author, and top-ranked international podcaster empowering women to take charge of their health, hormones, and sexuality. Known for blending science with storytelling, she turns complex medical topics into relatable, actionable insights that help women live fully, especially in midlife.

With her signature candor and clarity, Dr. Casperson dismantles myths around sex, menopause, and desire. Her acclaimed podcast, You Are Not Broken, is a trusted resource for hundreds of thousands of women seeking real answers about their bodies and brains. Her work fuses urology, neuroscience, and mindset coaching to spark lasting change in intimacy, confidence, and well-being.

As a speaker and educator, Dr. Casperson challenges outdated norms in medicine while offering bold, science-backed solutions. Whether on stage, in clinic, or behind the mic, she is leading a health revolution through smart, honest conversations.

Website: https://kellycaspersonmd.com

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Email Us: info@midovia.com

MiDOViA is dedicated to changing the narrative about menopause by educating, raising awareness & supporting women in this stage of life, both at home and in the workplace. Visit midovia.com to learn more.

The information, including but not limited to, text, graphics, images & other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. 


April Haberman:

Welcome to the MiDOViA Menopause Podcast, your trusted source for information about menopause and midlife. Join us each episode as we have great conversations with great people. Tune in and enjoy the show. Hi everyone. Did you know? MiDOViA has the first and only menopause-friendly accreditation program in the U? S. Our program is the benchmark of excellence, backed by five years of experience, working with hundreds of employers around the globe, with our worldwide partners. You can join now with a 20% discount off your first year's membership in honor of perimenopause and world menopause months. Joined before October 31st to receive your discount by visiting menopause months. Join before October 31st to receive your discount by visiting menopausefriendlyuscom.

Kim Hart:

Hey, welcome back everybody. We have our favorite doctor, kelly Kasperson, on board today. She's a board certified urologist, author, speaker and the host of the top ranking podcast. You Are Not Broken, and before we hit record today, we were talking about all the great things she's doing with that podcast, but you probably know her through her best-selling and award-winning book, right?

Dr. Kelly Casperson:

You Are Not Broken. I'm now an award-winning author.

Kim Hart:

I know, of course you are. It's a good week. It is a good week. Stop shooting over yourself. And her courses and her podcast, dr Kasperson equips women with practical tools and evidence-based education to reclaim pleasure and confidence at every stage of life. She also makes you laugh, and welcome to the podcast, welcome back to the podcast.

Dr. Kelly Casperson:

Thanks for having me. I was on like two years ago maybe.

Kim Hart:

Yeah, yeah, you were one of our first guests. We were all important Look at you still podcasting?

Dr. Kelly Casperson:

I know Right.

April Haberman:

It's fun. It's one of our favorite things to do.

Dr. Kelly Casperson:

Really, it is the most fun.

Kim Hart:

Okay, before we start talking about this new book, which I am mesmerized by, I want to swing back to your award-winning book. You Are Not Broken. I was at dinner with a few girlfriends a couple nights ago and your name came up. I don't know why it came up I mean because everybody's a fan but they said they said something like Kelly says that you can have five orgasms in a row.

Dr. Kelly Casperson:

And we were all like, like Kelly says that you can have five orgasms in a row, and we were all like I never said that.

Kim Hart:

No, but but what?

Dr. Kelly Casperson:

I went back to Instagram and it was a title that someone suggested. Someone said you should call your book how to have five orgasms in a row. But I don't tell people how to have five orgasms in the book, it's just the knowledge you gain from that book could cause five orgasms in a row. We were like, oh I don't know.

Kim Hart:

We're like what. Yeah, is that funny?

Dr. Kelly Casperson:

I was like I had to do a reel on that because I'm like that's a pretty good recommendation well, it was, and it was clearly a topic of conversation.

Kim Hart:

Yeah, so yeah okay, I just thought that was such a funny story, cause I was like, oh my gosh, okay, I'm talking to her this week and I have to bring this up, cause we were like.

Dr. Kelly Casperson:

I don't remember the instruction manual.

April Haberman:

I didn't put it. We missed that part.

Dr. Kelly Casperson:

Yeah, yeah, I didn't specifically put that in there.

Kim Hart:

Okay, well, you've been super busy. I don't even know how you keep up with your own life. You were on the FDA panel and talked about you're talking about vaginal estrogen. You have a new clinic, you were hot on testosterone and now you have this new book. I mean, testifying on an FDA panel is a huge deal, and then all these things are happening too at the same time. Why did you feel that the menopause moment was a book that needed to be written right now?

Dr. Kelly Casperson:

Oh, because there's 80 million women over the age of 40 in the United States alone and everybody, first of all, nobody knows what menopause is. And the definition of menopause is the natural cessation of periods, which is actually meaningless, right? So, like the. What's actually happening is we're outliving our ovaries and nobody knows that, right? It'd be a lot easier if there were like testicles and we could just watch them shrivel up.

Dr. Kelly Casperson:

But so you know, the publishers reached out with the you Are Not Broken, came out and they're like will you write another book about sex? And I said, yeah, sure, but I would really like to write a book about menopause. And they're like will you write another book about sex? And I said, yeah, sure, but I would really like to write a book about menopause. And they said, great, write that. And that's why I told people like my life's not normal, because I just told the publisher what I wanted to write a book about. And they're like, yeah, so I'm eternally grateful that I don't know anything else about like book publishing. I'm just like, how, about a menopause book? They're like, yeah, and I'm like, great, let's do that. I think my book's really a.

Dr. Kelly Casperson:

It's very interesting because when I started writing this book two plus years ago, I was like I'm going to come out with the gloves on and basically say, listen, hormones are great for you, you need to know that. And I really wanted to have a book that supported women in their decision, because even women who are on hormones they get this backlash from like friends or doctors or whatever. Like I. Just I needed to be stronger than that. So I'm like listen, I'm going to give you all the data on what hormones do and it gets you to understand that these are molecules in our bodies that make our cells and our mitochondria function.

Dr. Kelly Casperson:

Like you have to understand what a hormone is and what happens when you choose to live without hormones. And so I was like, oh, that might be kind of an aggressive stance at the time, two and a half years ago, and that's how, that's how fast this is all moving. Because now, like I mean you've read it, like I don't think it's actually coming across that Not that it was aggressive, but like time, I'm like I'm not here to tell you what to do. I don't care, I don't have your body, I don't have your life goals. Like I don't care what you do, but I care greatly that you have the knowledge and the education and the tools to advocate and communicate.

April Haberman:

Yeah, you're clearly about choice, but be informed so that you can make healthy choices for your overall well-being right. So we have to educate ourselves so that we can make healthy choices. Otherwise, what are the?

Dr. Kelly Casperson:

choices we're not empowering. And I think what's much more common is women thinking they can't be on hormones, when actually the truth is that they can. And for people to understand, everything has risks, right, medications have risks. Not being on hormones has risks like. Just understand that instead of thinking that this is like an easy black and white yes or no. You know, the other big myth is age is a cutoff, right. So there's just so many myths out there and I really think my book is like the 2.0. To like ask your doctor if it's right for you, it's like no, no, you get to. You know, we're not all doctors, but we can understand basic physiology, right. We understand dental care, we understand periods right, we can understand basic physiology.

Kim Hart:

You do a great job of how to talk to your doctor in this book. Thank you, yeah, because we talk. We talk all the time in the workplace about how to talk to your doctor. I'm going to be reading that section over and over again. It's a really good one, but you are unapologetically pro-hormone.

Dr. Kelly Casperson:

Yeah, I mean, I'm pro-functioning bodies.

April Haberman:

Yeah Right, You're like.

Dr. Kelly Casperson:

I still stutter on that because haters will take it and they'll be like you just want everybody to be on testosterone and I'm like no, I have never said I want. Side note possibly vaginal estrogen is probably. We're probably at the point of preventative health for everybody with vaginal estrogen. But as far as hormones go, like I'm pro you understanding if this is a good decision for you or not. And I think the other thing, the layer under that, is like this paternalistic like only if you're suffering enough, which is a completely non-objective, subjective marker of like if you're worthy of hormones or not. And it's like hormones don't care if you're worthy or not or if you've suffered enough. Hormones make your cells and mitochondria function. Yeah, yeah, they're nonjudgmental. It's the humans who are judging.

April Haberman:

Yes, yeah, absolutely. But can I? I don't. It seems like every time we have a conversation about hormones, we come back to the fallout of the WHI study in 2002. But I do want to come back to that for just a moment, because yeah, I think you have to, I think we have to too, I think we have to. It's part of the cultural narrative. At this point it's still here.

Dr. Kelly Casperson:

Yeah, it's still here, yeah, and I think, like why women are afraid of the zeitgeist or the ether, even if they, even if women can't say I'm afraid because of the WHI, like they can't say where it comes from, and so I think the education goes a long way of like this is why you're afraid. Because there was some big shit went down in 2002 before social media, before doctors could communicate on a grand scale, when the big legacy media had all the power to influence movement in this country. Right, there was some big, big wind that blew that year and it was basically saying that hormones caused breast cancer, which, yeah, I mean. The other fascinating thing about the WHI is you know that paper is free online right now? Oh, it wasn't before.

Kim Hart:

It always has been 22 years.

Dr. Kelly Casperson:

It's always been free online.

April Haberman:

But your point being is that we don't understand it yet. It's free and it's accessible for everyone, so go read it.

Dr. Kelly Casperson:

You can go read it and it says it doesn't reach breast cancer, does not reach statistical significance and in the medical world we're still living around this fear and the outdated perception that it causes cancer. Yeah. And how do you get rid of fear? You can't tell people not to be afraid, right, that's not how it works.

Dr. Kelly Casperson:

That's not how brains work. And how do you get rid of fear? You can't tell people not to be afraid, Right? That's not how it works. That's not how brains work. The only way to get rid of fear is to say here's all the knowledge, read it if you want Right, right.

Dr. Kelly Casperson:

But telling people like you know it's like cognitive dissonance we see it in politics all the time right now of like if you tell somebody, no, that's not right, they will double down Right. And then they'll tell you about their cousin who was on hormones and had breast cancer, which correlation doesn't equal causation. Right, but brains don't know that. So how do you get rid of fear? Education. I don't know a better way.

April Haberman:

Yeah, which is is what you're doing, um, in so many ways and we're so appreciative. But you talk about the timing hypothesis and I want to break that down a little bit. I want you to break that down a little bit for listeners and talk about why you think baby boomers should be pissed.

Dr. Kelly Casperson:

Yeah. So the timing hypothesis is the theory and it was first developed in monkeys and then extrapolated to humans and done some research. And the theory is that our bodies age and things happen with aging and if you start hormones before your body starts to significantly age, hormones do a better job at preventing disease. Hormones don't do a good job at treating disease. Hormones don't do a good job at treating disease. So the timing hypothesis is at age 50, when your hormones go away, you start aging at a rate that you didn't age before hormones.

Dr. Kelly Casperson:

There's plenty of data on that. 50 is this huge physiologic age point, roughly 50, but different for everybody. And so by age 60, there's been some physiologic changes because you've lived longer than your hormone production that you can't reverse just by starting hormones again, right? So the timing hypothesis basically says that the best time to prevent heart disease, prevent dementia, is early menopause. Now we're pushing it, we're saying probably perimenopause, because remember, nothing magical about your last period, zero magic about the last period. The hormone changes really do start perimenopause. So that's your best bet. And you know, I tell people like on that horrible Tuesday when you or your loved one is 73 years old and they get diagnosed with dementia on that, really really bad day.

Dr. Kelly Casperson:

That dementia started 20 years ago, right, and when is that? That's the average age of menopause for women. And so, tying back to why are the boomers pissed? The boomers should be pissed because they were told they can't have hormones, yeah, and now they're being told it's too late for hormones, which is a very interesting discussion. I just did a lecture on it last week that like filled up my Zoom to its limit.

Dr. Kelly Casperson:

Because the boomers are pissed and the boomers aren't doing okay in like, oh, don't worry, the hot flashes end. Yeah, these people are. They have mood issues, they have sleep issues, they have joint aches and pains, they have untreated menopause symptoms yeah, and they're completely voiceless, they're completely blown off. They're asked if they're suffering enough and, by and large, they're doing everything right they're eating healthy, they're exercising, they're trying to manage their stress, they're staying a healthy weight, they're lifting weights right, like they're doing everything they can, and they continue to suffer and they likely will not get the preventative benefits of if you started when you were 50, but if they choose hormones, they will get the hormone benefits of bone protection less joint aches and pains.

Dr. Kelly Casperson:

Better sleep, less hot flashes a lot of these ones. They're still having hot flashes, yeah yeah, we hear that it's this grand paradox and there is.

Dr. Kelly Casperson:

You know. People say, oh, my doctor says it's too late, and I'm like there's no guideline that says it's too late. North menopause society guidelines 2022 says best benefit is early, right. They do not say and then, as you get older and you get more comorbidities, it's a risk benefit discussion. So to behave as if it's black and white is hurting a lot of women. I'd say about a third of my ago, and she woke up in the middle of the night with night sweats and had to change everything.

Kim Hart:

See, she would benefit. They're suffering, yeah, she's suffering. Bank time.

April Haberman:

For years and years and years. By the way, yeah, yeah, she didn't just wake up in her 70s having hot flashes, the only boomers that aren't pissed are the ones who don't like.

Dr. Kelly Casperson:

They've never heard that this is an option. Once they get educated, they're like what about me? Yeah.

Kim Hart:

Yeah, well, and so, speaking of my mom, who's a grandmother, I read over and over the section on your point of view around the grandmother hypothesis, because yours was the first one that was like how'd I do Well, no, you did great and I totally understood it, but it was different than anything. Your point of view is different than anything I've ever read on the grandmother hypothesis. Can you talk about that and how to debunk?

April Haberman:

that myth? What is it for the listeners that don't know what that is? And then, what's your?

Dr. Kelly Casperson:

point the grandmother hypothesis is this it's been used as a patronizing way of saying we were meant to go through menopause because we needed to stop having babies so we could have more resources devoted towards our children's children. So it's basically a justification, which is so. I basically debunk it and say F the grandmother hypothesis, because average age of menstruation, let's say 15, just because it's unpleasant to think about a 12-year-old getting pregnant, but you can get pregnant. I would say average age of marriage in Abraham Lincoln's time was 17. Okay, so you're having a kid in your teens in the natural world?

Dr. Kelly Casperson:

Uh-huh, all right. That means you're a grandma by 40. Yeah, right, right, okay, right, all right. You could be a great grandma, maybe by 48, if the math's right, right. And then average life expectancy, excluding infant mortality, maybe 60. Right, right. But if you're a grandma at 30, because you had a kid when you were 15, and then that kid had a kid at 15, which is completely possible and it's how our bodies work, there's nothing about oh, thank God, my period stopped so I could be a grandma, right. So what the patronizing grandmother hypothesis did? It says in modern times we don't tend to have babies until we're 30. Right, but that's not how nature works. That's called birth control and like controlled family planning.

April Haberman:

Exactly.

Kim Hart:

Not our bodies.

Dr. Kelly Casperson:

So to say, oh, menopause is natural, because people will take it and they'll be like menopause is natural. Therefore you shouldn't treat it because you're supposed to be a grandma and you're not supposed to have kids so you can take care of it Like that's how kind of dark the grandmother hypothesis has gotten. And even so I put in the book that even the guy who like kind of coined the grandmother hypothesis was like I'm not so sure about this. I mean, the other big thing is like what I wanted to name this book, aging in Captivity, because I think my audience gets that. My publishers did not get that.

Dr. Kelly Casperson:

But I got it because I'm like if you take any animal, except for orca whales, who do really, really shitty in captivity because we keep them in small pools. But if you take any animal and you give them clean food and water. You eliminate natural predators, you give them great health care. They live longer in captivity than in nature. Right, there's a harbor seal in Oregon that's like 49 years old right now. In nature they live to be 18, right.

Dr. Kelly Casperson:

And so, like we are aging in captivity, we've got clean water. Antibiotics alone has increased life expectancy by 16 years on average per person. Like it's insane, right? We're really good at trauma. We're really good at treating cancer. We're really good at keeping us alive. Yeah, our average life expectancy now is 40 years with no hormones, and that has consequences. I would also like to argue that erectile dysfunction and enlarged prostate are natural occurrences and nobody goes around telling men that that's natural and we shouldn't treat it Very true.

Dr. Kelly Casperson:

Really, the book is just challenging the dogma that I truly believe is built to keep women quiet in their place and resulting exhausted dropping out of their workforce.

April Haberman:

Yeah, 100% right, yeah, 100% Right. And, by the way, I we often say that we need to change language, that menopause is a natural process, right? It's not natural. For someone that is experiencing menopause, that's going through surgical or medical menopause, it feels anything but natural. So it's a normal process, but it's not a natural process for everyone. So just want to throw that in there for our listeners.

Dr. Kelly Casperson:

Yeah, and we know I mean to speak to like the, not that we want to compete on who's having their menopause managed most poorly, but the award probably goes to the early menopause women because we have very clear data, very clear data of increased risk of dementia, increased risk of death by heart disease if your hormones end before the for lack of a better word natural age of menopause of 50. Like that's standard data. And we know that Louise Newsome did this study in the UK and we don't think it's better in America that surgical oophorectomy is treated with hormones 5% of the time.

April Haberman:

I can't believe that 5% of the time. It's a disgrace.

Dr. Kelly Casperson:

I'm a urologist, I will remove testicles for tumors and other reasons. It is a never event to remove testicles and not replace with testosterone Never event.

April Haberman:

Unbelievable.

Dr. Kelly Casperson:

Unbelievable If a urologist did that they would be reported to the medical board and probably would lose their license.

April Haberman:

Oh yeah, that ticks me off it should. Okay, I want to talk a little bit more about things that frustrate us, because why not, while we're on that subject, myths, misconceptions, that that frustrate us, because why not?

Dr. Kelly Casperson:

uh, while we're on that subject, myths, misconceptions, misconceptions that still frustrate you uh, you can't be on systemic hormones and vaginal hormones at the same time. That hormone replacement therapy only means estrogen. That you have to stop hormones at a certain age because I said so. Because now you're too old. You can't start hormones at a certain age because I said so, or you're too old. What else? That sex, that painful sex is normal. That it's really awkward to talk about sex, so we shouldn't talk about sex. That your doctor knows best about hormones.

Kim Hart:

Just a few.

Dr. Kelly Casperson:

Just a few yeah.

Kim Hart:

Okay, let's talk about sex, because you let's talk, you're the best one to talk about this with of anybody.

April Haberman:

Mainly take that as a compliment well at any age too, by the way, because um our daughters love your last book and um, they do and and you know what? They're giving your book to their friends and they're in their 20s. Yeah, yes, way, I think it's fabulous, and that conversation is happening at a younger age, so bravo. Yeah, thanks for breaking it down in such.

Dr. Kelly Casperson:

Go young.

April Haberman:

Go young, yeah Kim go the senile vagina.

Kim Hart:

What is it?

Dr. Kelly Casperson:

Senile vagina is a medical term in the 1980s to describe a what we now call genital urinary syndrome of menopause. So thinning of the tissues, decreased lubrication, dryness, tearing pain with with penetration and so what do I mean?

Kim Hart:

do we get it? How do we not get it? Like what, what? How do we keep it? We all yeah.

Dr. Kelly Casperson:

Hopefully nobody gets senile vagina anymore, because it's an antiquated term and we try not to use it, but I use it in my talks a lot because it makes people laugh and makes them mad, also Mad laughter. That's really what I'm going for 50 to 90% of women post menopause and again the problem is women don't know what's actually going on. You've outlived your ovaries. Ovaries make hormones that make your body function well. Right, Like that's what they don't understand. Or I'll be like you know this is because of menopause, and they're like my last period was eight years ago. You're like, oh, you thought this was just the end of periods.

Dr. Kelly Casperson:

Periods is just a symptom of what happens because of low hormones, right? So I mean even the whole conversation about menopause and a lot of thought leaders now are like we need to stop actually talking about menopause because it's not clear of what's actually happening. But there's no female word for castration, which is very interesting because words matter. But so, yeah, GSM can happen years after your last period. It can happen in perimetopause, it can happen with breastfeeding, it can happen with cancer treatment, Like there's lots of things will affect the tissues. The gold standard is hormone therapy, because that's why it's happening. Right, and this is local vaginal hormone therapy, most commonly an estradiol product. The DHEA product is also lovely, but it's expensive in America and it works wonderful. And people use moisturizers and lubricants for comfort. Nothing wrong with that. They help hold in moisture, but it doesn't solve the underlying pathophysiology of why it's happening in the first place underlying pathophysiology of why it's happening in the first place.

April Haberman:

Well, and you mentioned earlier that we're getting closer to vaginal estrogen being a preventative medicine as well, Because I think, typically what happens correct me if I'm wrong but we end up in the doctor's office because our vaginas are so dry, because the sex is so painful that we want you to suffer first.

April Haberman:

Yeah we've reached a point where we're like I am freaking miserable and what is happening to my body? Right, I don't understand, because nobody told me that this was coming Horrible place to be. So can you speak to that a little bit and maybe even sprinkle in there your conversation on the FDA panel? What's happening with that black box warning?

Dr. Kelly Casperson:

Because of the WHI, which we now know, nearly everything's been walked back on the risks of that. The FDA put on what we call a boxed warning on all estrogen products. What I mean is synthetic estrogen, oral estrogen, synthetic oral estrogen, transdermal estrogen, vaginal estrogen. Anything remotely that wasn't even studied in a WHI, they just went. That would be like putting a label on a statin and then applying it to a blood pressure medication and being like, well, they're both on the heart, so we should call it all the same. Like. Synthetic estrogen that you swallow is very different than a vaginal bioidentical estrogen product. I don't expect everybody to know that, but I'm trying to explain the madness of putting a warning label on things that are not the same thing Right Stroke, heart attack, liver disease, probable dementia, which is a stronger term than possible dementia on a vaginal estradiol product, which is just skin care, it's just skin care.

Dr. Kelly Casperson:

If I measured your blood after you going on a vaginal estrogen product, it would still be postmenopausal. It's not getting into your bloodstream. And the reason why? Because people don't know this, they're like why doesn't it get into your bloodstream? Dosing, dosing, why? Because people don't know this, they're like why doesn't it get into your bloodstream, dosing, dosing. So it's a skincare product, skincare for down there, which is already trademarked, not by me oh shoot, because I attribute it to you all the time. No, I just say it but it's not just.

Dr. Kelly Casperson:

I can't sell it.

April Haberman:

So you can say it but can't sell it I can say it, but I can't sell it.

Dr. Kelly Casperson:

Twice a week is the maintenance dose. And here's the proof of it. It's preventative medicine. So a woman comes in with recurrent UTIs or bad bladder, urgency frequency getting up at night. We put her on a vaginal estrogen product and it gets better. Do we tell her to stop it? No, no, tell her to stay on it. So we're already using vaginal estrogen products for preventative health.

Dr. Kelly Casperson:

I don't want you to get another UTI. I don't want you to get up five times a night to pee. I don't want you to start having pain with sex again, right, so we're already using that product as preventative health, and I think the needle is, you know, the biggest thing for the lay population is when they're like you mean, my labia minora goes away and my clitoris shrinks with hormone changes. We're like, yes, they became adult via hormones and now you're outliving your hormones, so they go away and so they want to go on the products just to preserve function, and there's nothing wrong with that. Now, from a doctor's point of view, we're like that's not the worst thing that can happen, but from their point of view, it is the worst thing that can happen, of course.

April Haberman:

Yeah, it's shocking Right?

Dr. Kelly Casperson:

So to me I'm like there's a little disconnect in, like we think this is the biggest problem. The doctors are like but you're not having recurrent UTIs, it's not indicated.

April Haberman:

Right.

Dr. Kelly Casperson:

So I think it's worth it. Like shrink, They'd want to do something about that. So I think it's very fair. In America it's still a prescription product, but we are getting closer. Universal agreement that this warning shouldn't be on vaginal estrogen products. Universal agreement by the experts.

Dr. Kelly Casperson:

There's studies on over 55,000 women, including breast cancer survivors, including people on aromatase inhibitors. So it's near universal that vaginal estrogen is safe. Then begs the question why isn't it over the counter Right exactly? It is limiting access that you actually have to see a doctor and hope your doctor's trained to give you-.

April Haberman:

Well, and I think that's a key point there, I'll share the story. My mom is in her 70s. She had recurring UTIs for years and years and years, antibiotic resistant, like it was getting scary, right. I asked her the question not too long ago hey, mom, are you on vaginal estrogen? She said and she doesn't mind if I share this she said I don't need that. You know. I didn't ask what that meant, but I don't need that. And I said yes, you do Talk to your doctor and here's what you need to ask for. And she talked to her doctor and doctor was like oh, are you sure? And she said yeah. I said be adamant, Tell her you want it, Write the prescription, don't take no for an answer. She did. She hasn't had another UTI.

April Haberman:

I mean, come on, Right, but this is what we're facing, right. We need more education. We need to education for healthcare practitioners. We need more education for the general public so that they understand what's happening, so that they make those healthy choices that we talked about in the beginning of the podcast. Absolutely, but just just to recap, we can take vaginal estrogen combined with our transdermal estrogen or systemic estrogen. We can start vaginal estrogen even in perimenopause. Yes, Yep, Yep, and you can with your vaginal estrogen. Okay, I'm going to get a little bit more in detail here for listeners, but it comes in a tablet, it comes in a cream. It varies forms, but you also want to apply the cream on the outside as well as the inside to keep it healthy.

Dr. Kelly Casperson:

If you care about your genitals. Yes, yeah, okay, yeah, I mean I mean that's, some people like the tabs because it's less messy, right Right. But the tabs are actually pretty low dose and they're contained in the vagina. So it can be great for a non-sexually active person who has recurrent UTIs and you just need a little bit of estrogen in there. But if you're sexually active, especially if you started noticing decrease in sensation, tightness, pain, decreased lubrication, all of those things that's not in your head. Those are hormone issues. I like the cream. People are like, oh, it's a little messy, and I'm like, do you remember your 18-year-old vagina? That is messy.

Dr. Kelly Casperson:

Want it back? Yeah, that's lubrication.

Kim Hart:

Yeah, absolutely.

Dr. Kelly Casperson:

And so I joke around about it a little bit. But I truly, if you put it like finger, index finger, fingertip to first knuckle that amount in the vagina and then fingertip to first knuckle are in the external genitalia and rub it in, like I always say, it's like you're in Texas in August with sunscreen. With sunscreen and you don't want to get burned Like, rub it in, that's great. Get it in the tissue, don't just like slap it on and put on your underwear and have it go on your underwear.

April Haberman:

Yeah, and then it's on your underwear. It's not going to help, right?

Dr. Kelly Casperson:

And then here's the next question, which is telling. But sweet People are like what if it gets on my partner's penis and I'm like they have? They have estrogen in their body. Number one, number two it's it's skincare, right, like it's not gonna hurt them. Don't use, don't use estrogen cream as a sexual lubricant. That's not what it's designed to do. But if you happen to put on your vaginal estrogen that night and the mood strikes, it's not a reason to say no, you're not going to hurt anybody. They've actually done study on this, that's good.

April Haberman:

Yeah, that's actually a good point. Kelly, we have about five minutes left on our podcast and I have so many questions for you, but I really want to come back to your book, and there's so much information contained in that book. I hope everybody goes and purchases that book. But what haven't we talked about? That's in your book that is close to your heart, that you want our listeners to know.

Dr. Kelly Casperson:

Oh, I really don't think everybody knows how bad alcohol is for your brain oh yeah, it's going to bring that up and how, how beneficial exercise and lifting weights is for dementia prevention and breast cancer prevention. And I think we we lose those in when we talk about hormones, because hormones are hot and you know, everybody kind of wants them to be the Holy Grail. But it's like I can't. I can't slap on an estrogen patch and expect it to do much if you're drinking and you're not sleeping and you're not exercising and your mood about getting older is shitty.

Dr. Kelly Casperson:

So I talk about mindset and really that you know, so many people are like, ah, growing older, bah. And I'm like my grandma said there's only one alternative and she's right, she made it to 96. And there's actually data on your mindset about growing older actually affects your health. So I have a chapter in there on mindset, because estrogen patch won't do that all for you and there's so much we can do. That isn't hormones, because, again, all hormones are our messengers that help our cells function. That's all. They are right. We still have to do all these other amazing things that feel good and help us thrive, and not just age, but age with health.

April Haberman:

Mm-hmm. I really appreciated that balanced approach because you are pro-hormone, but you emphasize lifestyle and mindset and have that balanced approach in the book and it's extremely important. Kim and I both believe in that. We're health coaches for yoga instructors. I mean it's, it's the full meal deal, as we call it, it's not just one solution. All right, Kelly, we're gonna ask you this question again, and because I can't remember what your answer was the first time that you were on the podcast, and it's probably different now, but we ask everyone the same question at the end of our podcast what the best piece of advice you've ever received or given has been. So what would your answer be today?

Dr. Kelly Casperson:

I think this might be the same answer. Okay, I was a medical student doing my general surgery rotation. I remember where I was standing. I remember that I was a medical student doing my general surgery rotation, Like I remember where I was standing. I remember that I was halfway up a flight of stairs turning around looking down Like I was profound statement and it was a general surgery chief resident and he said nobody is more in charge of your education than you. And I think that ties into like why I'm reading, writing these books and why I want women to have the knowledge, because nobody is more in charge of your body and your knowledge about it than you.

April Haberman:

Such a good reminder.

Kim Hart:

That's huge. And your book does such a good job of informing you about your body. I mean I like, for example, you talk about men having estrogen. I didn't know that for a year. I mean, I didn't know that until I started getting into the menopause business, that this was. There's so many things like that that you just need to know, and this book does such a good job of describing all the things that are happening to your body and what your options are, and I can't, I can't tell you enough your body and what your options are, and I can't, I can't tell you enough it just it has, as I said in my LinkedIn post, it has your sense of humor and also great knowledge and just really really appreciate. Appreciate it Cause it's it is different for our listeners. You know, it is different than the other books that that have come out on this topic, because it's so it's so informative.

Dr. Kelly Casperson:

Yeah, I think, and I think it's really approachable and friendly and I really want to narrow the gap between medical knowledge and you. Like, I want to narrow the gap between, like this unobtainable stuff is like no, no, no, we can. We can all understand this and it's a true compliment because I'm like I was worried you are not broken, is so loved, right, and it's so it's so me and my personality it's an it's award-winning what can I say?

Dr. Kelly Casperson:

at this point, but really worrying that, like did the science overwhelm the personality to the detriment of the menopause moment, and so far I'm hearing that it hasn't no, I mean you f-bomb throughout the book you like.

Kim Hart:

are you kidding me?

April Haberman:

You're real. You're persecuting me. Thank you, Kelly I texted a friend.

Dr. Kelly Casperson:

I was like pages before the F word comes out in this book like 63. It's okay.

April Haberman:

Kelly, where can our listeners get your book? Where can they get?

Dr. Kelly Casperson:

it Wherever they want.

April Haberman:

So it's on Amazon.

Dr. Kelly Casperson:

Barnes Noble. If people want to do mom and pop, local bookstores, great, I know a lot of them are carrying them and on my website under books, I actually have a whole list for mom and pop. If they want to do a retailer, that isn't that local chain started in Seattle.

Kim Hart:

Fantastic, and you're traveling the and you're traveling I mean the world, essentially, so people could look up on your website.

Dr. Kelly Casperson:

yeah, I just got an event long like long overdue. Uh, just got an events page on the website, because now I think we're up to eight cities. We just like added connecticut Love it. Love it, so it's hard to keep track of, and we'll see you guys in Seattle and Bellingham. Yeah, we'll see you on the 29th of October.

Kim Hart:

So if you're in the Seattle area, come join us October in.

April Haberman:

Seattle. Yeah, and if you'd like to see Dr Kelly, you have your own clinic as well up in Bellingham, washington, so you can look her up on the website there as well, but I see my poor math like.

Dr. Kelly Casperson:

These are percentages, but it's about a third perimenopause, a third boomers who are pissed 70 plus, and then a third regular menopause people and then probably about 5% men Love it. I love seeing partners, so we have a good time, we get lunch, we take care of everybody. It's really fun.

April Haberman:

I love that Great reminder too, that you see men as well, and couples. Kelly, it's been a joy, it's been a pleasure. We could talk all day long, but we thank you for your time and listeners. Until we meet again. Go find joy in the journey, thanks everyone.

April Haberman:

Thank you for listening to the Medovia menopause podcast. If you enjoyed today's show, please give it a thumbs up. Subscribe for future episodes, leave a review and share this episode with a friend. There are more than 50 million women in the US who are navigating the menopause transition. The situation is compounded by the presence of stigma, shame and secrecy surrounding menopause, posing significant challenges and disruptions in women's personal and professional spheres. Medovia is out to change the narrative. Learn more at medoviacom. That's M-I-D-O-V-I-A dot com.

People on this episode

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April Haberman

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Kim Hart

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