Hormones Throughout a Female Lifespan

Hormones don't just affect reproduction — they shape nearly every system in your body across your entire lifetime. In this episode, Rick and Greg continue their conversation with women's hormone specialist Caitlin, covering the full hormonal timeline of a woman's life: what estrogen is actually doing from your twenties through perimenopause, how to recognize when symptoms cross from "normal fluctuation" into "something's off," and why the same habits that kept you healthy in your thirties suddenly stop working in your forties.

They also discuss the May 2026 renaming of PCOS to Polyendocrine Metabolic Ovarian Syndrome — and why that shift in language matters for how the condition gets treated. Plus: why sleep is usually the first place to start, how cortisol quietly undermines everything, and the stepwise approach Caitlin uses to restore hormonal balance without overwhelming the system all at once.

Nothing in this episode is medical advice. Please consult your healthcare provider before starting any hormone, medication, or treatment protocol.

Transcript

SPEAKER_01 0:24

And we're back. Hey. This is Healthier Ever After. We are continuing our conversation with Caitlin. Bring her on here. Hello, Caitlin.

unknown 0:34

Hi.

SPEAKER_01 0:35

Welcome back. Here we go again. Perfect. Excuse me. Just uh as a as a reminder, we talked last time about kind of the landscape about how we got to where we are with female hormone replacement and and kind of what went wrong for a couple of decades after the women's health initiative. So tonight we're going to talk a little bit about kind of just what what happens, what what uh maybe an individual woman might experience, you know, in general over the course of her lifetime and and and why this is an issue that we even care about when we're talking about health and wellness, right? Um and so again, very important that you uh discuss this and any uh medication, hormone replacement, exercise program, uh weight loss medication, whatever it may be, that you discuss that with your medical provider. Um and uh anyway, let's jump in. So so I I I just as we were talking about um starting this, I uh I uh I just within the last I don't know week uh I heard about this. Um the uh you know you hear people come in and they this they say I have I have uh uh PCOS, poly cystic ovarian syndrome. And and I think that there's been something happened like just recently on May 12th, 2026. And I always wanted to read a little statement about that because um something happened that I think illustrates a lot of what we're talking about here uh uh tonight, especially is is um anyway, just it's there's a coalition of 56 patient and professional organizations on May 2012, 2026, after um years of advocacy and uh research, um, talking to over 22,000 patients and clinicians. Um this includes the endocrine society as one of those 56 organizations. Uh, they formally renamed polycystic ovarian syndrome or PCOS to a new name of polyendocrine metabolic ovarian syndrome. Uh and so PMOS. Uh for three years, both of those terms are going to be used, but uh so you'll you'll hear that. But uh but I think this is an important uh you know it's it's just a little name change, but I think it's an important distinction um that that talks about how this is not a primarily a condition of cysts on your ovaries. This is a complex multi-system hormonal and metabolic disorder. Um, and and so the name change I think reflects that. And I think that kind of leads us into uh what we're talking about today with with women's health. I mean that because uh it changes over the course of a lifetime. And so let's let's talk about that a little bit.

SPEAKER_00 3:19

So yeah, Caitlin, I my question about that for you would be um with PCOS now renamed, what do you think they're trying to get out there? Like what's the the the idea behind that, uh especially as someone that deals with this so often in practice? And and um so what what's the reasoning you think that they're trying to aim in order to like change the name, uh in order to move forward and uh and maybe address this differently?

SPEAKER_03 3:44

I think there's a couple of reasons. I think they're not telling us health providers who take care of women primarily, they're not telling us anything new. The way I would describe back when I had a patient that would come in with PCOS, I would say this is a metabolic disorder that sometimes affects ovaries. I it was a rather than the other way around. Right. It's not the ovaries that affect the rest of your body. And so, so you know, because there's some women that come in that have every marker, high insulin levels, all these things, but they've never been diagnosed with the chain of pearls ovary on ultrasound, which is a diagnostic criteria. So it's like, so they're frustrated because they don't fit in any box and they feel like they're miserable, they have all these symptoms, right? So that's how I would explain it to women. It's still tricky, but I think one of the biggest things we're gonna get out of the name change is that we're finally gonna have the backing of endocrinologists. We're gonna have it's not just an OBGYN, you know, reproductive health problem. It's not just a, oh, you can't get pregnant, because that's traditionally what we've already always cared about with women. We don't really care more about quality of life and optimization. We only care if they can have babies. Well, one of the biggest reasons for infertility is PCOS or this, you know, what we've named it now.

SPEAKER_01 5:01

So having the word metabolic in there, just we're gonna get a lot more piece of information that this is not just this isn't about just ovaries.

SPEAKER_03 5:10

Right. It's a it's a metabolic condition that you sometimes see issues with the ovaries. And so that's how I just described it to my patients. And I think that we're gonna get a lot more specialties weighing in and saying, hey, wow, I never thought of it this way. This is really affecting every cell in the body, how it metabolizes all sorts of things, including sugar and uses our insulin and things like that. And also, yeah, we do sometimes see higher testosterone levels, which causes acne and facial hair growth and things like that. And those are there's those are life issues for women with PCOS. It's really hard to battle those kinds of things. So I think that like hopefully we're gonna get a lot more specialties that start weighing in and saying, okay, this is an us problem. This isn't a them problem. We're we all have to work on this together because it affects such a large population. And you know, when we first found PCOS, some of the first ways we realized it was metabolic was there were these women with type 2 diabetes who were fairly young. They put them through a trial. When we finally had to start using women in trials, put them on metformin to see if that would help with type 2 diabetes, and a bunch of them turned up pregnant. That's how we found out this was a metabolic disorder. Like talk about backwards, but you know, that's how we understood wow, the ovaries are actually working better because they've been insulin resistant. We had to, they worked backwards on that one. So it's just one of those things that, you know, when women's health isn't a priority and not just, you know, I love increasing maternal and fetal, you know, infant birth rates and survival rates. I love that. That is not my fight at all. But just that last half of your life from 40 on till 84 is the current women's health life expectancy in southern Utah. You know, that's a long time to be disregarded. So I feel like it's a huge win for women's health. We're finally saying thank you. You're looking at our specific women's health issues a lot closer, and you're finally getting other specialties involved, and we're gonna finally find some root causes and have better treatments. There's very few treatments for PCOS and you know, this condition now, even right now. So it's gonna be a good uh okay.

SPEAKER_01 7:27

So so let's talk about um kind of the life span of a woman.

SPEAKER_02 7:34

Okay.

SPEAKER_01 7:37

Like we talk an embryo, let's start with, you know, in the 20s and 30s, those are referred to as the reproductive years, right? Because you can have babies. Um and and so estrogen, um, you know, it it's it's not we call it a sex hormone, right? It's not just the girl hormone. It what is it doing across the body? Like it does so many more things than than regulated menstrual cycle. This is what kind of how people normally think about that. But you're we're talking about it, it um it supports your metabolic health, it it uh improves insulin sensitivity. You talked about that just a little bit. It uh it helps maintain lean muscle mass, it distributes body fat towards the hips rather than the abdomen, it protects bone density. I mean, there's a lot of things that are happening during those years uh with estrogen. Maybe just talk about that a little bit, like why Yeah.

SPEAKER_03 8:28

Well, it sets us up for the rest of the life. But I mean, at the basic level, biologic, human level, estrogen, what it does is at the beginning of your cycle it peaks and it's growing the endometrial layer or the lane layer of the uterus to build the nest for the baby if the egg gets you know gets fertilized and and so it can have a place to implant. That's an important distinction because it's growing, it's it's real, it's it's building a nurturing like blood-rich environment for this fetus eventually, right? If that were to occur, if that's what we choose to have occur, right? So not only is it like nurturing this layer in the uterus eventually, you know, and then estrogen dips and progesterone takes off, but like all across the body. I I explain this to women a lot. Um, if you picture a cell, even just soccer ball looking thing, and you picture these little spikes all over it, and this is a very basic concept, but you've got receptors all over these cells, and sometimes they're for insulin and sugar, and sometimes they're for different hormones. There's there's so many things that the cells need. It's kind of like picturing a receptor as a lock and the hormone as like a skeleton key. And when the skeleton key is walking around and it finds the right lock, it unlocks it and I'll and it tells the cell what to do. So there's so many hormones. I mean, thyroid hormones, obviously, there's a lot going on in the cell, but these cells don't know what to do, they don't know homeostasis, they don't know the calm, normal functioning unless there are receptors on all kinds of cells throughout your body for estrogen.

SPEAKER_01 10:01

I guess I think that's all over. That's a huge thing.

SPEAKER_03 10:05

Exactly. And there's a now that we're seeing, hey, wait, statistics are saying frozen shoulder, for example, in females, or frozen shoulder in general, the condition of frozen shoulder, so shoulder soreness, pain, inability to move it, it's really restricted, even without injury. So that's typically it's a diagnosis of exclusion. So we're making sure there's nothing else wrong. But even frozen shoulder, they kind of say, hey, most of the women with frozen shoulder are like over 65. Why is it women over 65? What's going on in their life? And they're like, oh, wait a minute, they don't have any estrogen. So they're starting to find all these using statistics and good extrapolation data, but they're finally starting to figure out there's a lot of conditions that are primarily female that tend to happen during hormone imbalance or withdrawal of hormones. And so now we're understanding when they went in and started biopsying, biopsying the cells in a shoulder, they go, Oh, they have a ton of estrogen receptors. Uh why would you have a ton of estrogen receptors in your shoulders and in your knees? I don't know. I guess just lubricating and moving shoulders and joints or whatever. But it's not just, you know, the lady parts, those need a lot of estrogen. There's a lot of blood flow that needs to move around down there. It's, you know, urethra, it's vaginal tissue, it's all of that because, like, that's that's a huge part of reproductive needs, right? But there's also women who say, My teeth are loose in menopause. My teeth are moving. I need braces at 50 years old, or my eyes are all of a sudden going weird in my 40s. That's a main thing, too. But that's also a very female thing because our tissues and everything's not tightening and moving.

SPEAKER_01 11:50

So even though we call this the reproductive years, I mean, not all women are able to, not all women choose to have babies, but but this doesn't this doesn't that doesn't decrease the importance of uh properly regulating or making sure you have good levels of hormones, and understanding that all your cells need estrogen.

SPEAKER_03 12:11

This isn't just about, you know, do my lady parts, are they sore? This is not just that. It's it's really about every cell in your body needs estrogen. So getting the most women who are safe enough to use it, systemic estrogen at appropriate doses and appropriate monitoring is essential because it's gonna help all the cells. It's gonna retain muscle, which is your metabolism. Literally, part of your what's eating and using calories in your day is just maintaining muscle. It's gonna help retain bone, it's gonna help with muscles, everything, all sorts of things, even though cardiovascular systems, huge. Oh yeah, we're gonna prevent cholesterol and like insulin resistance. So it literally is a systemic problem. We can use topical local stuff, but really the most women get the most benefit from systemic estrogen, and there's very safe methods and all the things for that.

SPEAKER_00 13:03

Caitlin, I'm gonna put you on this on the spot a little here. So for someone in these reproductive years, um, and I'll ask this, you know, maybe into the more into the perimenopausal time frame as well. Like if someone's earlier on, like in those more reproductive years, typically when we don't really think about women and hormone having hormone issues or problems, what are some of the things you're looking for as a provider? Like ver like, you know, just like I'm just having menstrual cycles and I feel a little bit off when I'm, you know, PMSing or things like that, versus actually I have a hormone problem. Like, what's the things that you're like, hey, these are the things I'm seeing? Like, I don't know, weight gain or or mood or normal normal fluctuations versus something going a little bit. Yeah, what are the outliers that you're like, hey, they you have a problem you need to look into versus just the regular stuff?

SPEAKER_03 13:54

I call those vague symptoms versus smoking gun symptoms. And that's how I present it to my patients. There's vague symptoms like I'm gaining weight. Well, that could be some thyroid issues, which is a hormone problem, but not necessarily sex hormones. Um, you know, it could be stress levels, it could be poor eating, could be poor diet. You know what I mean? It could be a lot of things, right? So there's, and then, you know, there's other symptoms like, man, I'm just kind of sleeping bad. We can get into that later. There's different things, but then there's smoking problems, smoking gun problems like I'm growing facial hair for a woman. That's a smoking gun testosterone problem.

SPEAKER_02 14:32

Yeah, you're like this is I am this is obvious.

SPEAKER_03 14:35

Nope, that's a big one. That's smoking gun. And then, like, I'm having insomnia problems. And I say, tell me about it. And I can almost finish their sentence. I can say, Are you going falling asleep dead at 9 p.m.? And you're waking up at 2 a.m., 3 a.m., 4 a.m., wide awake for no reason. Like, not like something woke me up, like just out there, just out. And they're like, How did you know it's been every night?

SPEAKER_02 14:57

You're just describing me.

SPEAKER_03 14:59

No, that's progesterone, that's smoking gun progesterone. So there's all these things that in my mind I'm listening. So it's a really good taking of good history with my patients, just sitting and talking. My my visits take an hour on these horns at least because a lot of it's just talking and listening. It's easy for going on with the yeah, because and you got to understand, most women have kind of gaslit themselves into this for a few years. They're like, Well, it's probably because of this. Oh, it's probably just well, how long are they told?

SPEAKER_01 15:28

Well, this is normal. This is just you're just you're just hormonal.

unknown 15:32

Yeah.

SPEAKER_03 15:32

Or they get their labs drawn by their primary, which bless their hearts. Thank you for checking them. But they get their labs drawn by the primary, and the primary says they're normal. Well, they're normal on the lab slip within typical ranges, but we now know those are not optimal. And then when you can look at them in ratios and you can say you can tease it out. And I mean, Greg, I he probably remembers, but there's one day he was telling me about a patient we both work on, and I was like, What is going on with her cycles? It's weird. And he's like, What? They were all normal. I'm like, nope, she hasn't had a period in months. And sure enough, I go, but they were normal in the labs. And I go in there and I talk to her, and she's like, How did you know? It's been like seven months since I got a period, and I'm not even 35 or whatever. So, really, you can look at labs if you're practiced enough at it, and you can say, No, something's not, these aren't making sense. Something's not right in the body, and that can, and I've had women cry and just thank me for saying, like, wow, thank you for not just telling me all these labs that I spent all this money to get drawn are normal because I'm not normal. I feel terrible and I'm not myself. So I think that there's smoking gun symptoms that I definitely watch for, and that you know, it's definitely like, and then there's some big ones that I can say, well, it could be a hormone thing, but it could be all these other things when there's women coming in in their 30s and I say, Have you had a hysterectomy? Because that typically puts you into perimenopause five years earlier on average than any woman with a uterus that has a root uterus already, it's still, I mean, and so there's all these questions. What did your mother's periods look like? When did she go into, you know, because there's a lot of family history genetics involved as well. You know, if they've got a history of endometrial cysts and things like that, there's there's lots of things to it. But when somebody comes in in their 30s and we go through symptoms, and I say, Hun, I think it might be this, this, this, this. We could check some labs, but I have a strong suspicion this is XYZ. Then there's some women I'm like, oh, honey, we can check some labs, we could treat off symptoms. I personally like a little baseline labs. I like that to be able to say, okay, we've locked in now. Let's treat you, let's get you treated. So it kind of is different for everybody. It's but those are my things.

SPEAKER_01 17:46

A question to the questions I will never know the answer to. What were your mother's periods like? Yep.

SPEAKER_00 17:53

I know someone asked me that. It's gonna be uh I don't know. Well, I was born at some point. She had those.

SPEAKER_02 17:59

She had those.

SPEAKER_00 18:02

I don't want to know. My mom's my mom doesn't have periods, she's my mom, right?

SPEAKER_03 18:07

Well, most women of your parents' age range and a little bit of mine didn't even talk about periods. Most women did not find out how to use a tampon or use a maxi cab from their own mothers in my generation and my culture.

SPEAKER_01 18:20

Because because just understanding, like we we kind of say that in jest a little bit, but just understanding the this this hormonal cycle that is that is normal, you know, these variations on a monthly cycle uh within you, but but there are more effects. It's not just a mood thing, right? That like it can increase, you know, when we're talking about when we talk a lot about weight loss, right, and and general health, and those those fluctuations can affect your appetite and your fatigue, and it can increase your cravings and reduce motivation to exercise. And so just just understanding that I think is helpful um to know that that some of those those feelings that are real are not just you being lazy or you know, it's it's it's it's actual things that are happening with your body.

SPEAKER_03 19:08

Right. Well, the number one symptom I get, the first symptom I usually get from women is I just don't feel like myself. The number two symptom is I sleep like crap. Can I say that on here? Where would you?

SPEAKER_02 19:21

Yeah, this is crap. Yeah, yeah, usually there.

SPEAKER_03 19:23

I think that literally when their most pervasive symptom, one of their most specs specific symptoms that they can walk into is I'm falling asleep at nine o'clock, but I'm waking up at two, three, four, and nothing's wrong. I it's I don't got a pee. It's not, I don't know, and I'm wide awake and it's demoralizing. When you just look at just the symptom of sleep, statistically, we're going to be eating more carbs the next day. We're going to be dragging, we're less likely to do exercise, physical act, physical activity, our mood's going to shift because we're dragging. Biologically, we are built to eat when we're sleepy. You know, it's just, it's how it works. So just that one symptom can break down so many different ways. And a lot of women are like, if I improve my sleep, you know, and I never promise anything, but if if we work on this sleep, maybe we can just get you feeling a little bit better, make you have a little more motivation to move through the day. And you're just like, wow, my body makes a little more sense. And what as we're working through a lot of things, so that's usually the first place to start. Yeah.

SPEAKER_01 20:24

Like, you know, makes it a little bit easier to not overeat or or you know, whatever.

SPEAKER_03 20:28

Get out and get your physical activity. Because you know, a lot of women, that's usually the number three or three thing I hear is I'm just gaining weight. And I've always I've always been able to like just work, exercise, I and just eat my stuff. I've never gained weight my whole life, except for maybe when I had babies, normal weight gain, you know. But they're like, I've always been able to lose it in these last years or so, and they're frustrated. And some women are going to into dangerous calorie restrictions because they are type A girls who know how to get stuff done. The math is always math for them, and they can't make the math work. So they're getting a little dangerous. And I have to say, hey, hang on, there's other variables we can work on it. We got to get you back into homeostasis. Let's see if we can work on some stuff. So it's it's really, it's it's pretty, it's a big conversation for women. And I tell them, hey, you know, like it's not just one quick fix-all, but if we can get to going back into it. And I think that's why it's so important to treat when someone's perimetopausal, because when somebody comes in and says, My sleep is garbage, all of a sudden, hey, it's a lot easier to fix one symptom and work on that through hormone replacement instead of hitting them with all these heavy sleep aids and all these things. But if we can restore that a little bit, then you know, a year later when they're like, okay, I've got another symptom that's maybe more estrogen. I'm like, oh, we got it. We can we can add things in slowly instead of this woman who's ready to give up, you know, in full blown menopause, who's miserable and every life is shutting down. That's a lot of things to work on because there's all these hormones and different places.

SPEAKER_01 21:55

So you mentioned so this paramenopause appears. So we, you know, we talked a little about reproductive years, and then we move into. Perimenopause. And that that's usually a a a state, I guess, or or a yeah.

SPEAKER_03 22:07

Collection of symptoms.

SPEAKER_01 22:08

It kind of starts in the mid-40s, usually. Um, you mentioned if you've had a hysterectomy, that's that could be five years earlier than that.

SPEAKER_03 22:15

On average, yeah.

SPEAKER_01 22:16

About mid-40s, you get into what's called perimenopause. And that's that can last a few years, it can last more than a decade.

SPEAKER_03 22:23

Seven, seven to ten on average.

SPEAKER_01 22:25

Yeah, so so we don't we we often, you know, we say like the way we at least I was growing up, menopause was like an event that that happened. You you're a you're female, you can have babies, and then you go you have menopause, and then you don't have no period, right? So we talk about it like an event, but this is a event, like a party. I like that perimenopause is really how we talk about that because it is it is yeah, it is a yeah, seven to ten year process, yeah. And it's oh it's not it's not just a a gradual decline over that time of your estrogen, it's craziness, like it's up, and it's up and it can really change and affect like all kinds of symptoms.

SPEAKER_03 23:02

That it's really pretty crazy. Like I always tell my patients, you know, and this is why, you know, dragging a woman in at 25 and saying, What are your hormones? You're the best of your life, and what are all your hormones looking like? Because it changes throughout the month, right? Well, then you take a perimenopausal woman, and we would never do this, but if we did, we would if we drew their blood and Hertz blood and checked her all her sex hormones every day for 30 days and graft it, it would be very chaotic. It would be like up, up, down, up, all around. And then the next month we think, oh, it's probably going to show the same pattern. Nope, all different. So it's really chaotic throughout the every month. Is different. One, some women might be like, Oh, my period length was 22, you know, my cycle length was 22 days, and next month is 29 days, and the next month I, you know what I mean? It's all over the place. And so I really try to get women away from this idea of like, we can lock it in. No, we can just bring your threshold up, your symptom threshold up, we can kind of gently decrease that so that when you're hitting these chaotic lows, we're not dipping down into that threshold of symptoms.

SPEAKER_01 24:10

That's kind of where you would be symptomatic, right?

SPEAKER_03 24:13

And so we can, if we can with hormone replacement, if your symptom threshold is here and you're dipping down and like, oh, hot flashes all night, oh, sweats, oh, you know, migraines. If we're if we're dipping down below those thresholds chronically, and we bring your hot, you give you, we give you hormone replacement, we bring your levels up just like this, you might not hit these thresholds so much. And you might just have a lot more stable outlook throughout all your hormones for the month. So it's it's we're not fixing this. It's like your ovaries in your brain are like, I got you, girl. No, I don't. Okay, I got you, okay. Let's have a period. Okay, we can't. And it's just it's they're fighting because these ovaries are trying to keep up like they were 25 and they're not, they're 40 something or even pushing 50.

SPEAKER_01 24:56

And so thinking about that, like like um testosterone don't be like that.

SPEAKER_00 25:02

No, testosterone. I that's what I was actually thinking about as you're talking about this, is like it's so much easier. Yeah, testosterone is this just gradual decline, and it's interesting because actually the symptoms of low testosterone are very similar. Similar, yeah. The difference being is that it doesn't seem like it's it's it fluctuates so much, meaning that you know, we have this gradual decline as you get into your, you know, it kind of depends on the person, just like with women, uh, you know, sometimes in your 30s, sometimes in your 40s. I also want to point out that I I feel like uh genetic definitely just seems like genetics, at least anecdotally in clinic, where I hear guys are like, hey, look, dad and uh uncle and grandpa all-dad's testosterone like so well. Some guys will casually like mention that they're just like on that, you know, their son on oh, you feel like garbage? Like I'm on testosterone and it made me feel better. You should maybe go get it checked out. And yeah, and guys do the same thing that women do, right? They gaslight themselves into I'm fine. I'm just getting all I'm fine, I'm just it's just it's just it's just feeling crappy, is just how I should. But the the thing that I get from the guys' end, Caitlin, and and it's something that we haven't actually brought up symptom-wise, at least you might have mentioned it, but I I I'm not remembering it, is from the guys' perspective, because they're going through their changes, oftentimes they'll start talking about their partner in many cases. And the biggest one, of course, that gets brought up with them is libido. And so I'm like, we uh I think this is something that uh we're kind of conditioned to believe that this is just how it should be, that women should just stop wanting to have sex. And of course, we know there's a lot of psychological factors there, what's their relationship like, things like that. But if in another word, that otherwise good relationship where sex was was uh common and good and everyone was happy with it, and then all of a sudden a woman starts changing, and uh but what the man brings up to me, they're not talking about the woman's sleep, they're not talking about the hot flash, right? The men bring up to me like, hey, all of a sudden my wife doesn't want to sleep with me anymore.

SPEAKER_03 27:05

And libido stink, and that's a big deal all that.

SPEAKER_00 27:08

What is your perspective on that? How does that all play in?

SPEAKER_03 27:11

I think there's a lot of variables, obviously. Like if if a woman comes into me and she's like, I've got this going on, and my mother just passed away, and my I'm sweating all night, I don't feel attractive, I'm gaining weight, and all these things. And if they tell me the last thing I, you know, because I'll ask, I'll be like libido, motivation, muscle, you know, there's all these kind of testosterone-ish questions. And they're like, you know, and we we have a conversation, I say, What was it before? And they'll say, Oh, it was pretty good. And I said, How are you feeling about it now? And they say, I don't know that it's my priority. And I said, That's okay. Because if you don't feel great about where you're at, body, mind, emotional state. I don't particularly know any dude that wants some woman that's just laying there. I don't like it the part of a relationship is the connection. And you know, and my hope and what I communicate to my patients is, hey, let's see if we can get you feeling better about your body, feeling like it's yourself again. Well, you gotta remember a woman starts out as a teenager, she has a period at what, 12, 13, 14, her body's not her own all of a sudden. Nothing makes sense, right? She gets used to it. Then she's in her 20s and 30s, having babies up and down, up and down, weight gain and all that, her body's not her own. She hits her 40s and she thinks, heck yeah, I'm done having babies. I finally get to have my own body and have hobbies, and maybe life's gonna settle out, and then you hit free comparisonopause. And then you're like, my what life's not my own. Can I just win? Can I just win one minute? When you look at a woman's life across their lifespan, like mental health and hormone-wise, it's really frustrating because you finally thought, like, yeah, I'm gonna go do humanitarian projects, I'm gonna serve people, I'm gonna have hobbies, I'm gonna finally done taking care of little, little kids that need me all the time. I get to do me. And then you got nothing. So when there's another human that's coming in and saying, like, hey, I need you, you're kind of like, I bet I don't even need, I don't even got me. You know, so it's it's hard. And so usually when I talk to women about about libido and I say, how does how is that for you? Are you worried about it? And some of them are like, Yeah, I actually kind of missed that that was enjoyable. I miss, I miss that connection. I have a really great relationship. I feel bad for my husband, but I just got to get some stuff sorted and get back to that mentally. And I'm like, I love it. If it sounds like a purely testosterone issue, like to where they're like, Yeah, I don't get it. This is not me at all. And there's not these other variables we can isolate, we check a level and we can replace it. And that's that's the easiest part of my job.

SPEAKER_00 29:42

But a lot of times it's that's the men's side of it, right? Right. Like ours is ours is pretty straightforward. And I so I think what I hear you saying is you're like, hey, it doesn't matter even if a woman, like even if a woman like libido is probably like almost in some cases, like a secondary, it's like they feel so crummy about kind of all these other factors that of course, like of course their libido is not great. So we fix those things, and do usually at least we would expect that it would return to baseline given everything else is fine.

SPEAKER_03 30:14

Yeah. And and my stepwise approach is we start with a little progesterone, get them sleeping better. If they're not exhausted, hey, that might help with libido all by itself. If we're not like eating out of control the next day because we're miserable, exhausted, and drinking a ton of caffeine, right? We work on estrogen next. So that's the next visit or two. We optimize that. And then we work on testosterone. It's hard to work on libido fatigue and motivation when it could be progesterone and estrogen. And those are our two big, big wheels on the on the trike. You know what I mean? Those are the big ones. So I kind of have to do them all in a stepwise approach because if I hit them all with all these hormones all at once and something doesn't agree with them, we don't know which one to take away. And so that's why it is hard for a go-getter that wants to just come in, see me one time. And I'm like, listen, it's really challenging to do it that way. But I think most women, when they're just being listened to, you know, I can tell that they're safe, they got a safe, good relationship, they're valued, they're respected. We just got to get them feeling a little bit more like themselves, get them feeling rested, get their bodies feeling like they're their own self again. It usually resolves itself. And then, you know, if we got to do a little testosterone at the end, great. Do it all the time. I get it, girl. Like I'm happy with that. That's easy.

SPEAKER_01 31:32

So I think we're gonna get into a little more specifics on on how to fix the the problem, I think. Um, I wanted to just talk about another thing that I think, you know, we've I mean we started this really because of the weight loss issue, and and we've been talking about that for for months now. Um and and and healthy lifestyle changes, and and that's been kind of our mantra. I I just wanted to maybe touch on that for a second, like as part of this experience uh during during a women's life span and in these hormonal changes that we're talking about with the reproductive years and the perimenopause, one of the things I think that gets um, I don't know, maybe gaslit or just forgotten about or isn't part of the conversation is is that uh one of the things I think that women are will experience, and and I I guarantee there's people that are gonna hear this and be like, yeah, that's exactly what I thought is is that like the same thing that worked, the same exercise program, the same dietary restrictions that have worked for my life uh don't anymore. Like it just doesn't work anymore. I can't the same old thing, it doesn't, it's not working. I'm getting I'm getting heavier and I'm doing the same stuff and it's not helping me anymore.

SPEAKER_00 32:42

Like yeah, I I think the way that I hear that is um, and and I think that me and you have talked about this before, Caitlin, is that I haven't changed anything, but my body's changing. Yeah.

SPEAKER_03 32:52

Right. Yeah. And and and it's super frustrating for women because that's one of the biggest ways they know their body. What for good or bad, our society has women tracking their weight pretty close. There's a few women out there that are like, I don't know, I don't worry about it. I just care about how I feel, which is amazing. And I love that. But a lot of times that's, you know, I like I said, like the third complaint I have, you know, the third most common one I have. And then when I can say, hey, you know, if you're doing everything you've been doing, and you know, you're going and you're working out every day, or you're even walking every day and you're eating pretty good, and you're like, yeah, I understand. And there's variables, there's just so many more variables. And these hormones, you know, when we can get cells more at a balanced homeostasis, like the teeter-totters balanced a little bit better, those cells know what to do better. And if we give them the right instructions, we give them instruction again with these hormones, so to speak. They know how to move insulin differently, they know how to build muscle and retain it.

SPEAKER_01 33:52

That insulin uh sensitivity and the efficiency that your body stores fat are affected by these by these estrogen fluctuations.

SPEAKER_00 34:01

Well, and I think the third, the third key to add in there is um, which I know we're gonna talk about a little bit, is um you add in that third leg, which is cortisol, which me and Rick have talked about in previous episodes as being you know such a huge factor in in driving some of this stuff. Yeah, fast stories.

SPEAKER_03 34:19

I I actually have handouts that I give to some of my patients, um, but it's basically it sounds really hokey and it's kind of a funky handout. But when I got into researching a lot of this, you know, when we're in our 40s, technically, right, most of us women have teenagers. Sometimes we've got older parents that we're now taking care of, or there's lots of some bigger problems. It was almost easier when they were in diapers because we could control a lot more. Once they're older, it's a little difficult. We've got a lot more life stressors that are have huge impacts. And so I talk to women a lot about like balancing overall wellness. It's not just like, hey, we'll throw some hormones at it, you'll be good as new. It's definitely not that. And I literally have a goal sheet that says, this is what I do now, this is what I want to do, this is the ways to improve it. And I and I have some women actually take this home. I know it sounds hokey, but write down a few goals, see what you can do. If you've always wanted to take a painting class, now's the time to do it. It's not gonna be later. It's not, you know, like we need to start taking care of ourselves and reducing cortisol because that drives insulin resistance. Yeah, it it's a huge variable, and a lot of a lot of more standard providers are like, oh, I'm not gonna check it at cortisol level. And I don't necessarily check it because I say all the time, but I say to women, I say, Hey, guess what? I'm gonna tell you if your cortisol is high, yeah, diet and lifestyle, it doesn't relax.

SPEAKER_00 35:42

It doesn't change. I I could not agree with that more. I I get that question all the time. Yeah, and then uh men even ask me all the time. Women ask me a lot too, uh, when I see them in clinic, and they want to they want their cortisol level checked. And I'm like, I I just are you stressed? Like if you're stressed, I can argue, especially if chronically stressed, I can tell you your cortisol is up uh now, or if if it's not later and you're still chronically stressed, it's probably because now you're an adrenal burnout. And the answer for that is going to be the same things. We can talk about supplements to support that, but ultimately the the actually the fixing the problem, no matter what we find, is gonna be the same thing. It's sometimes, and I hate to say it like this, but sometimes when you look at someone's throat that has strep throat and you know it's strep throat, yeah, you're like, uh, we can do a rampant strep 20% of the time anyway. But I'm probably gonna start you on antibiotics.

SPEAKER_03 36:38

Yeah. And so yeah, it's a challenge, and a lot of women, and I've had a few really cute patients who I'll look them in the eye and I'll say, Listen, I can tell you you are the best mom and you are the best wife, and you are the best daughter, and you are the best relief society president, and you're the best at everything, and you're amazing. But you need to start saying no. You cannot, you're in grief overload. You can't recover from one high cortisol event like a death in the family and then a car accident and all these things. You're not having time to recover and get your cortisol levels back to normal before you got another bump. And we can't have we can't control those things, obviously. But I tell women, what you say yes to means you're saying no to your family. It means you're saying no to your health to some extent. And I'm not saying say no to everything, you know what I mean? I'm not saying, you know, you got to turn down every calling and every opportunity and everything, but I say you got to start being more selective. You got to look your husband in the face and say, honey, I need help with this. I need this to be your job from now on. I need, you know, mom, I need, I need this, or maybe sister can help you with this or something. You got to start delegating because if you don't start retaining some of yourself and recovering from some of this and breaking it just down to the basics and getting your wellness back, you're not gonna be around for the grandkids or for other major events. You're not gonna be feeling great and optimized for that. And so, and I don't say that to everybody, but man, when I can look them in the eyes and I'm like, you are crumbling under the weight of all this. It's okay to say no to some things. If you keep telling everybody yes, that means you're saying no to important things that are gonna get you wellness later on. And so, and usually they tear up and they're like, You're right. And I said, girl, there's 24 hours in a day. You deserve an hour. Go to a yoga class, go to a painting class, go read your book and tell everybody, put your phone on mute. You get to do those things. You're at that time of life. And so it's really hard. I call it cortisol rehab. And I and I usually tell these women, when you come back in a month, I want to hear how you're taking care of you and how you're just desensitizing, you're calming your cortisol, you're retraining your body into a slower pace because some of these poor women are just barely hanging and they're crashing by 2 p.m., falling asleep, standing up, basically, because they're they're so burned out. And there are medications for that. Nobody wants them, nobody wants to go there, and they're for extreme cases.

SPEAKER_01 39:04

So let's let's um we're gonna keep you on uh for next time and let's talk. We went 40 minutes. We did, yeah. We've been going. I told you, I told you we could talk about this. I'm talking too late, Cloud. I did not realize we'd come. Let's let's we'll move into next time. Uh a little more specifics on what to do about this, what to you know, and it's gonna be a lot of reiterating some of the things we've talked about uh again and again.

SPEAKER_02 39:30

Yeah.

SPEAKER_01 39:30

Um, but so so just kind of in summary, the understanding this this hormonal timeline of a of a woman's kind of life uh or lifetime, um, it changes the conversation from like you know, why can't I just try harder, maybe, to what does my body need right now? And and that's not always gonna be the same thing, but but there are things that can be done that are both healthy right now and will protect your aging years and make them much more livable, enjoyable, healthy, um, less risky.

SPEAKER_00 40:05

Yeah, and I think that really goes to speak of when we're talking about this, and you can see we can't even cover it in you know what's gonna be three episodes. You know, how do you expect a primary care provider to figure all this out and treat it uh effectively and get to the the pro you know, get to the real problem in five minutes? And that's why a lot of people don't go they're not really aware of why it matters who you go to to seek help for this. I mean, geez, if I'm a woman, Caitlin, just listen to the you talk, I'm ready to book right now. Give me an hour. Give me an hour.

unknown 40:38

Come on.

SPEAKER_00 40:39

So I think it's really important to point out that a lot of people don't really understand that this is not a, it's a little bit of an art um and and science, kind of all mixed in and understanding all of that. And and uh, and that's why Rick and myself are so adamant that you find a healthcare provider um that can you can talk to that's gonna dive into this and and help you with this. And that's why we always are pushing that you find someone that will will do this with you. It's very difficult to do this on your own. Um so yeah, right.

SPEAKER_01 41:12

Awesome.

SPEAKER_03 41:12

No, I agree.

SPEAKER_01 41:14

Well, we'll end it there, and then we will be back to talk about some more specific things on what to do about this. Thanks a lot, and we hope you all are healthier ever after.